I apprehensively open my prescription bottle and peer in. I pour its contents into my hand, double and triple checking my count of its contents. Dread washes over me; it’s time to get a medication refill.
The ADHD medication shortage that started in late 2022 – and still with no end in sight – has deeply and profoundly worn me down. I am exhausted. I am frustrated. I struggle immensely due to the extra time and effort I now have to invest to get the medication I need to function. Even though millions of us are affected by this shortage, I’ve felt isolated and hopelessly alone in navigating this overwhelming system that has failed us.
An Executive Function Gauntlet: The Outrageous Absurdity of Refills
I take both a long-acting and short-acting version of my ADHD medication, and have been doing so for a decade. Prior to the shortage, the process I followed to obtain medication was imperfect, but more doable than our current nightmare. I had grown accustomed to the task of getting a new prescription for each of my medications to bring to my pharmacy every month. I knew when I had to make an appointment with my doctor to request the prescriptions, and I diligently showed up to my pharmacy within the three-day refill window, as allowed by law, and was ready to wait the usual 45 minutes for both of my medications to be filled.
With the ongoing medication shortage, I only have about 10 blissful days a month where I’m not dealing with some aspect of refilling my medications. Now it’s not only a question of being within my three-day refill window but also relying on my medication to be in stock.
At every turn, obtaining the medication I need requires executive functioning – the very area that is impaired in ADHD, and for which medication, along with employing strategies and learning skills, improves. My prescriptions have gone from being filled on the same day to being filled on different days and then weeks apart. This means shifting things around to make room for more trips to the pharmacy, more phone calls to disgruntled staff, more things to complicate my day-to-day life, all while undermedicated. (As it turns out, living with impaired executive functioning sure takes a lot of executive functioning.)
More than once, I’ve been scolded by pharmacy staff for making the mistake of calling to request my prescription release one day too early. (As many ADHDers know, staying on top of dates is no easy task.) I was acridly reminded that this is a scheduled drug and that my refill is not due yet. Each time it’s happened, I say, “My apologies, thank you for your help,” silently chastising myself for messing up the dates, loathing that I have to start this process all again the next day.
I also started rationing my medication, skipping doses on weekends to make sure I could at least have medication to do my job. After a few months of this, my frustration gave way to panic when my pharmacy said it had no idea when the next shipment would arrive.
I once contacted 15 different pharmacies over three days, trying to find a location that not only had medication in stock, but that would be willing to take my prescription. Pharmacy after pharmacy told me that their location was no longer accepting new ADHD patients. One pharmacy even had the audacity to laugh at my provider when they tried to call my prescription in. This system, designed to prevent drug abuse, was now forcing me into the role of a literal drug seeker despite being on my exact same dosages for ten years – the irony of which was not lost on me.
One pharmacy was willing to take my prescriptions, but getting there and back would easily take me an hour, and they could only put me on the wait list. Another pharmacy was closer, and while they didn’t have my exact dosage in stock, they told me that they’d be able to fill my prescription if my doctor split my dose between two lower-dose pills. I hesitated, anxious to make the request because my doctor had already submitted and cancelled two sets of my prescriptions that month. I worried that the back-and-forth would flag me as a troublesome patient. Thankfully my doctor was willing to accommodate. Still, I thought to myself that this cannot be the price we pay to function.
Then there’s the work of verbally calling to release my prescriptions, which can take anywhere from three minutes to a very literal two hours on hold, only to be hung up on. I can’t just leave a voicemail to release my prescription – there is no way to confirm they received it without calling in again.
At my doctor’s appointments, on the phone with the pharmacy, and at the pick-up window, I started venting my frustrations in the form of humor. I joked that this system is an executive function gauntlet for people with ADHD – it certainly wasn’t designed with us in mind! Yet these jokes only got an occasional weary smile. Meanwhile, I simmered, knowing this “joke” was my real life.
Trapped in a Solitary, Multi-Year Riptide
I have educated myself on the shortage, reading endless articles about it. I have observed how the different agencies, producers, and regulators involved shift the blame. Yes, it is a complex system, but that does not diminish any one participant’s part in making it better or making it worse. I have written to Congress. I have listened to countless stories of the strife everyday folk endure to get their prescriptions.
Every story I hear makes me feel like each individual with ADHD is on their own little island. We’re able to send along messages in a bottle, but we’re unable to collectively make those in power recognize our stories and our pain. I am sick of feeling trapped in this riptide all by myself, subject to forces that I cannot control, powerless to take care of my own physical and mental health. I am saddened that there doesn’t seem to be a way for the 8.7 million of us with adult ADHD (and parents of children with ADHD) to collectively advocate or have a say in this process. We deserve a seat at the table.
A Seat at the Table: How We Can Make Our Voices Heard
The ADHD medication shortage cannot go on. It has caused far too much damage and pain for those of us who simply want to live and work and achieve what we are capable of by limiting the burden of this neurodevelopmental disorder.
I have done all that I can on my part – following all of the expert advice during this shortage – to independently manage my health. I am working toward medical school, and I have thought long and hard about what I’d do if I could magically fix this system. Perhaps new monthly prescriptions should only be required in the first year that a newly diagnosed patient is trying different ADHD medications and dosages. From there, documentation attesting to ADHD and the continued need for medication can be submitted to the DEA, insurance companies, and any relevant regulatory board in order for a patient to be granted the privilege to have their medication treated like any other normal, regularly prescribed medication.
Pharmacies would be able to better predict their orders of stimulant medication instead of having to turn people away with valid prescriptions because they’re already overwhelmed with managing this shortage. I do not deny that stimulant medication has potential for abuse, and a regulatory system is appropriate for this class of medications. But the bottom line is this: There must be a way for diagnosed ADHD patients who have a history of established care to be able to reliably obtain their medications.
But work must be done on all fronts. Individually, we are isolated. Yet we have power in our multitudes and in our stories. It’s time to start to #ADDUsUp. We can all be #ADHDvocatesForChange.
Share your stories of and frustrations with navigating the ongoing shortage, plus ideas for how to make the world better for neurodivergent individuals on social media using the above hashtags.
As you share your story, tag celebrities with ADHD and ADHD organizations/platforms and demand that they unabashedly call out the shortages and seek not just answers, but change.
Write to your U.S. representatives, the DEA, and the FDA, who must understand the real-life consequences of drug shortages and current policies for the millions of us who live with ADHD. Untreated or poorly treated ADHD wrecks lives, and medication is an important tool upon which we rely for our health and wellbeing. Highlight how policy at the governmental, regulatory, and healthcare system-level (including procedures at insurance companies and manufacturers/distributors of medications) directly impacts the care and wellbeing of ADHD patients.
Together we can elevate our voices, share our experiences, and demand more of our institutions and those in power. If we, a bunch of executive functioning-challenged ADHDers can get organized and start a movement, then those with power have no excuse for ignoring breaks in this system. It’s time for them to do their part, too.
ADHD Medication Shortage: Next Steps
Elizabeth (Elle) Sharrard is an aspiring medical student and a proud #ADHDvocate who hopes to empower people to use their voices to improve the world for all. Elle’s blog post inspired the creation of ADDitude’s call-to-action scripts for contacting representatives about the ongoing ADHD drug shortage.
SUPPORT ADDITUDE Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.
NEW YORK — Emily Hollenbeck lived with a deep, recurring depression she likened to a black hole, where gravity felt so strong and her limbs so heavy she could barely move. She knew the illness could kill her. Both of her parents had taken their lives.
She was willing to try something extreme: Having electrodes implanted in her brain as part of an experimental therapy.
Researchers say the treatment —- called deep brain stimulation, or DBS — could eventually help many of the nearly 3 million Americans like her with depression that resists other treatments. It’s approved for conditions such as Parkinson’s disease and epilepsy, and many doctors and patients hope it will become more widely available for depression soon.
The treatment gives patients targeted electrical impulses, much like a pacemaker for the brain. A growing body of recent research is promising, with more underway — although two large studies that showed no advantage to using DBS for depression temporarily halted progress, and some scientists continue to raise concerns.
Meanwhile, the Food and Drug Administration has agreed to speed up its review of Abbott Laboratories’ request to use its DBS devices for treatment-resistant depression.
“At first I was blown away because the concept of it seems so intense. Like, it’s brain surgery. You have wires embedded in your brain,” said Hollenbeck, who is part of ongoing research at Mount Sinai West. “But I also felt like at that point I tried everything, and I was desperate for an answer.”
Hollenbeck suffered from depression symptoms as a child growing up in poverty and occasional homelessness. But her first major bout happened in college, after her father’s suicide in 2009. Another hit during a Teach for America stint, leaving her almost immobilized and worried she’d lose her classroom job and sink into poverty again. She landed in the hospital.
“I ended up having sort of an on-and-off pattern,” she said. After responding to medication for a while, she’d relapse.
She managed to earn a doctorate in psychology, even after losing her mom in her last year of grad school. But the black hole always returned to pull her in. At times, she said, she thought about ending her life.
She said she’d exhausted all options, including electroconvulsive therapy, when a doctor told her about DBS three years ago.
“Nothing else was working,” she said.
She became one of only a few hundred treated with DBS for depression.
Hollenbeck had the brain surgery while sedated but awake. Dr. Brian Kopell, who directs Mount Sinai’s Center for Neuromodulation, placed thin metal electrodes in a region of her brain called the subcallosal cingulate cortex, which regulates emotional behavior and is involved in feelings of sadness.
The electrodes are connected by an internal wire to a device placed under the skin in her chest, which controls the amount of electrical stimulation and delivers constant low-voltage pulses. Hollenbeck calls it “continous Prozac.”
Doctors say the stimulation helps because electricity speaks the brain’s language. Neurons communicate using electrical and chemical signals.
In normal brains, Kopell said, electrical activity reverberates unimpeded in all areas, in a sort of dance. In depression, the dancers get stuck within the brain’s emotional circuitry. DBS seems to “unstick the circuit,” he said, allowing the brain to do what it normally would.
Hollenbeck said the effect was almost immediate.
“The first day after surgery, she started feeling a lifting of that negative mood, of the heaviness,” said her psychiatrist, Dr. Martijn Figee. “I remember her telling me that she was able to enjoy Vietnamese takeout for the first time in years and really taste the food. She started to decorate her home, which had been completely empty since she moved to New York.”
For Hollenbeck, the most profound change was finding pleasure in music again.
“When I was depressed, I couldn’t listen to music. It sounded and felt like I was listening to radio static,” she said. “Then on a sunny day in the summer, I was walking down the street listening to a song. I just felt this buoyancy, this, ‘Oh, I want to walk more, I want to go and do things!’ And I realized I’m getting better.”
She only wishes the therapy had been there for her parents.
The road to this treatment stretches back two decades, when neurologist Dr. Helen Mayberg led promising early research.
But setbacks followed. Large studies launched more than a dozen years ago showed no significant difference in response rates for treated and untreated groups. Dr. Katherine Scangos, a psychiatrist at the University of California, San Francisco, also researching DBS and depression, cited a couple of reasons: The treatment wasn’t personalized, and researchers looked at outcomes over a matter of weeks.
Some later research showed depression patients had stable, long-term relief from DBS when observed over years. Overall, across different brain targets, DBS for depression is associated with average response rates of 60%, one 2022 study said.
Treatments being tested by various teams are much more tailored to individuals today. Mount Sinai’s team is one of the most prominent researching DBS for depression in the U.S. There, a neuroimaging expert uses brain images to locate the exact spot for Kopell to place electrodes.
“We have a template, a blueprint of exactly where we’re going to go,” said Mayberg, a pioneer in DBS research and founding director of The Nash Family Center for Advanced Circuit Therapeutics at Mount Sinai. “Everybody’s brain is a little different, just like people’s eyes are a little further apart or a nose is a little bigger or smaller.”
Other research teams also tailor treatment to patients, although their methods are slightly different. Scangos and her colleagues are studying various targets in the brain and delivering stimulation only when needed for severe symptoms. She said the best therapy may end up being a combination of approaches.
As teams keep working, Abbott is launching a big clinical trial this year, ahead of a potential FDA decision.
“The field is advancing quite quickly,” Scangos said. “I’m hoping we will have approval within a short time.”
But some doctors are skeptical, pointing to potential complications such as bleeding, stroke or infection after surgery.
Dr. Stanley Caroff, an emeritus professor of psychiatry at the University of Pennsylvania, said scientists still don’t know the exact pathways or mechanisms in the brain that produce depression, which is why it’s hard to pick a site to stimulate. It’s also tough to select the right patients for DBS, he said, and approved, successful treatments for depression are available.
“I believe from a psychiatric point of view, the science is not there,” he said of DBS for depression.
Hollenbeck acknowledges DBS hasn’t been a cure-all; she still takes medicines for depression and needs ongoing care.
She recently visited Mayberg in her office and discussed recovery. “It’s not about being happy all the time,” the doctor told her. “It’s about making progress.”
That’s what researchers are studying now — how to track progress.
Recent research by Mayberg and others in the journal Nature showed it’s possible to provide a “readout” of how someone is doing at any given time. Analyzing the brain activity of DBS patients, researchers found a unique pattern that reflects the recovery process. This gives them an objective way to observe how people get better and distinguish between impending depression and typical mood fluctuations.
Scientists are confirming those findings using newer DBS devices in a group of patients that includes Hollenbeck.
She and other participants do their part largely at home. She gives researchers regular brain recordings by logging onto a tablet, putting a remote above the pacemaker-like device in her chest and sending the data. She answers questions that pop up about how she feels. Then she records a video that will be analyzed for things such as facial expression and speech.
Occasionally, she goes into Mount Sinai’s “Q-Lab,” an immersive environment where scientists do quantitative research collecting all sorts of data, including how she moves in a virtual forest or makes circles in the air with her arms. Like many other patients, she moves her arms faster now that she’s doing better.
Data from recordings and visits are combined with other information, such as life events, to chart how she’s doing. This helps guide doctors’ decisions, such as whether to increase her dose of electricity – which they did once.
On a recent morning, Hollenbeck moved her collar and brushed her hair aside to reveal scars on her chest and head from her DBS surgery. To her, they’re signs of how far she’s come.
She makes her way around the city, taking walks in the park and going to libraries, which were a refuge in childhood. She no longer worries that normal life challenges will trigger a crushing depression.
“The stress is pretty extreme at times, but I’m able to see and remember, even on a bodily level, that I’m going to be OK,” she said.
“If I hadn’t had DBS, I’m pretty sure I would not be alive today.”
___
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
Twelve years ago, I embarked on a transformative psychedelics journey that opened my eyes to my true self. I did not know then that this trip into my subconscious would completely change my perception of the world, make my then-undiagnosed ADHD more manageable, and lead me to help others experience similar life-changing revelations.
On that fateful day, my psychedelic guide gave me magic mushrooms and said, “Look at the forest one last time; you will never see it the same way again.”
To say he was right would be an understatement.
I arrived with a simple intention: to get to know myself better. What emerged were aspects of myself that I never knew existed. The psychedelic experience revealed the roots of my depression and provided insight about how to regulate my emotions — a godsend for me as I struggled with intense mood swings and disorders. Whereas therapy had failed, this journey transformed me entirely.
To be clear, it was not a magical solution that solved all my problems overnight. But my psychedelic journey gave me a vision of the destination to drive toward. It filled me with an intrinsic motivation to change the patterns that were keeping me stuck.
Fast-forward 12 years, following numerous psychedelic experiences combined with therapy: I have achieved a state of emotional stability. Severe mood swings and depression are a distant memory.
I was diagnosed with ADHD last year, and I consider this revelation the last missing piece of my puzzle. Today, I find it easy to love myself for who I am. I have developed new ways to live and embrace my ADHD brain without using medication.
Helping Others Follow the White Rabbit
In 2016, I decided that I wanted to help others by becoming a psychedelic-assisted therapy facilitator. At the time, psychedelic facilitator training programs didn’t exist, so I pursued extensive training in various modalities. I trained in inner child work and trauma integration therapy. I attended workshops and seminars conducted by experts in the field of psychedelic-assisted therapy.
Since then, I have co-founded a psychedelic-assisted therapy company and guided hundreds of people through psilocybin journeys in the Netherlands, where this work is legal. The changes I have witnessed in people, especially those with ADHD and neurodiversity, have been nothing short of astounding.
Most of the people undergoing this form of therapy experience significant changes in their lives, overcome addictions and depression, transform their self-doubt, and reduce their rejection sensitivity.
It is important to say that this therapy is not for everyone, nor is it a one-size-fits-all solution. Individuals who are prone to psychosis, diagnosed with schizophrenia or bipolar disorder, or who have a family history of these conditions should abstain from this therapy.
That said, it helped me to redefine my life, and I hope it can benefit others like me.
Psychedelic Assisted Therapy: Next Steps
Alice Smeets is a neurodivergent psilocybin-assisted therapy facilitator and co-founder of A Whole New High, which offers guided, private psilocybin therapy sessions and group retreats in the Netherlands.
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This worksheet mentions several mental tools and relaxation techniques that are essential for making the most of your anxiety hierarchy. Here are links to learn more about each one.
White rice, white bread, ground beef, chicken fingers, French fries, and pepperoni pizza — for most of my life — and with very few exceptions — these were the only foods I ate.
From a young age, trying any food outside of this short list was a struggle like no other. I’d chew the food and try to pass it, but my throat would close, and I would gag and choke. No matter how hard I tried to swallow, I just couldn’t.
Of course, everyone thought that I was simply a picky eater. My mom learned early on that there was nothing she could do to get me to eat different foods. Unlike other parents with picky eaters, she couldn’t bribe me, give me trouble, or make me sit there until I was done with my plate. None of it worked on me, so she eventually came to terms with my limited diet, where most of the foods I ate were of the same flavor and color.
Over time, a few other foods did make it into my diet, so long as those foods were of the right brand and prepared a certain way. Fruits and vegetables definitely did not make the cut. And another thing: If foods on my plate touched, I considered my meal ruined.
If I did muster the courage to try a new food and manage to swallow it, I usually ended up getting sick. Eventually, trying new foods was no longer an option.
I struggled with my health growing up, whether it was stomach problems or a cold that would stick around for months and require trips to the emergency room. But my doctor’s visits often ended with me being told that I was a “medical mystery” because all my numbers, even my weight, were good. Though I ate few foods, the fact that my diet comprised mostly calorie-dense carbs meant that I never had any difficulties with putting on weight. If anything, I was always on the heavier side. No one could figure out what was wrong with me, and never did we think that my eating had caused all of these issues. The doctor never asked, and we never brought it up.
It wasn’t until I started Googling “how to fix my picky eating” that I learned about avoidant restrictive food intake disorder (ARFID). The more I learned, the more my eating habits and entire life made sense.
Finally! I knew this went beyond picky eating. Now all I needed to do now was learn how to manage it, right? Or so I thought. Knowing a reason, unfortunately, didn’t make it any more possible for me to try foods.
ARFID in Adults: Diagnosis and Recovery
Years after I learned about ARFID, and now in my late 20s, I checked myself into an eating disorder clinic, where I finally received a professional diagnosis. For the first time, a doctor fully examined me and determined that I’ve been severely malnourished my entire life, no matter what “the numbers” might have said. It made complete sense. I mean, I went over 25 years without consuming a vegetable.
Thus began my ARFID recovery, a journey that gave me the opportunity to travel to England to receive treatment and, later, film a documentary to create awareness around this poorly understood eating disorder, especially in adults.
In my ongoing recovery and research, I learned about a therapist who specializes in ARFID. Given his phenomenal success rate with his clients, I figured that if anyone could help me, it would be him.
Before my session, I went to the grocery store to look at a handful of foods I’d never even think of trying. It was hard, and it was scary. I had a panic attack after picking up a kiwi because the thought of consuming it was so unsettling.
A few short hours later, it was time to head to the clinic.
After I settled into a big, comfy chair and wrapped myself up in a blanket, the therapist and I started talking. To this day, I can’t fully explain or understand what he did. It felt like he spoke to my inner child who had been grasping onto a massive ball of anxiety all this time. He somehow convinced that part of me to let go.
After our talk, I walked over to a table full of foods that I’ve never tried before, or that I had eliminated from my diet, knowing that the next step was to try them. It was different this time. The table full of unknown foods no longer filled me with anxiety. In the next 24 hours, I tried more food than I had in the preceding 28 years.
One Bite at a Time
It’s been nearly four years since I’ve been in active ARFID recovery, an experience that has been harder than I imagined. By now, I expected to be eating plates full of colorful foods and enjoying a wider variety of foods, but I’m not.
It’s hard to think about where I thought I would be by now and realize that I am not even close. But when I feel discouraged, I think back to where I started. My foods can touch, I’ve added multiple foods to my diet, and I am able to swallow when trying something new. As long as I keep trying new foods, I’m better — and moving forward.
ARFID in Adults: Next Steps
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For a good chunk of my life, I suffered greatly in the friendship department. The feeling of being hopelessly abnormal started in elementary school, where, as a child with ADHD, I struggled to sit still like the other kids, feared getting called on by my teachers, nervously solved math problems on the board while everyone watched and teased, and stumbled through sports whose rules I could never quite grasp. I truly felt like I was beyond the reaches of friendship. At an early age, I was intimately familiar with intense loneliness.
I found comfort in my cherished books. If I had no one to play with, I could always lock myself away with a good book and hyperfocus on a different life through its pages. But stories, though wonderful, are no substitute for friendship.
As a parent, I struggled to fit in with other mothers. I joined local mom groups, but quickly left once I realized that I was a different kind of person than the rest. Given all of my experiences, I had no difficulty discerning by then that we wouldn’t be friends.
What Makes a Good Friend? A Dash of Neurodivergence
Lest you pity me too much, I haven’t been devoid of friendships completely. I’ve been lucky enough to make friends whom I love deeply, and who love me. Most of these friends happen to have neurodivergent traits. Some have received a diagnosis, some have not. Either way, the way we think, converse, and go about life is the same.
At this point in my life, I can often tell right away if a person is neurodivergent, and most of the time these are the people with whom I have an instant connection. Their friendship is a joyous relief. I am free to stop masking, let my guard down, and be myself. I can be as weird as I want, and they are weird right back, and we celebrate our mutual weirdness. It is wonderful.
We have great, intense conversations about our latest hyperfixations and discoveries – my favorite type of conversations. I love sharing my new knowledge and interests with my friends just as much as the next person with ADHD.
These are friends who understand my oft-messy house, forgetfulness, or sudden need to bail when I am overstimulated and need to decompress. When I’ve missed an important appointment or misplaced my child’s birthday gift, it is so comforting to vent to people who have been there, and who understand. They tell me that it is not my fault, and that I am not the only one struggling with these things.
How do I describe the pure bliss of finally meeting people who will sing along to the song playing in the grocery store, make up funny lyrics for it, and dance in the checkout line because it’s the only way to pass the time? It’s like finally being able to say, “Yes, I’m different – and that’s okay!”
I am approaching my 40s, and I’m not sure I have a single friend who is neurotypical. It’s not an intentional omission. It just so happens that most of the people I click with are neurodivergent. How lucky for me.
True Friendship: Next Steps
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In the intricate maze of human emotions, the pervasive question of one’s lovability can cast a profound shadow on personal well-being. The contemplation “Am I unlovable?” echoes through the hearts of many, reflecting a complex interplay of internal struggles and external influences.
This article delves into the depths of this emotional labyrinth, exploring nine common reasons behind the haunting sensation of being unlovable. From the intricacies of self-esteem and past traumas to the impact of societal expectations and mental health, each facet contributes to the intricate mosaic of our self-perception. By unraveling these threads, we aim to illuminate the pathways toward self-discovery and healing, fostering a compassionate understanding of the factors that may cloud our sense of worthiness in the realm of love and connection.
According to Harley Therapy, feeling unlovable might ‘sound’ like it’s not a big deal. But it is a very serious matter. It can be a contributing cause for many other psychological conditions and is sadly a leading cause of suicide.
We asked our expert counselor Nandita Rambhia (M.Sc. in Psychology) to help us understand why some people have the fear of being unlovable and how to cope with being unloved. Read on to find out what she has to say about the matter and join us on a journey of introspection, as we navigate the nuanced landscape of human emotions and unravel the mystery behind the question, “Why am I unlovable?”
For more expert-backed insights, subscribe to our YouTube channel
Why Do You Feel Unloved? 9 Reasons
You might ask yourself, “What makes a person unlovable?” Well, absolutely nothing. Everyone is lovable, and feeling like you aren’t can be a result of some deeper issue. Is it possible to be unlovable? Nandita says, “I don’t think it is possible for any person to be unlovable. It is about your own perspective.” And yet, you can’t shake off the thought, “I feel unloved and unwanted by everyone.” It’s time to delve deeper and investigate where this “I feel unloved” feeling is stemming from.
Feeling unlovable can stem from various factors, and it’s important to recognize that these feelings are complex and subjective. But why is feeling loved even important? Feeling loved is an essential element of the human experience, influencing our mental, emotional, and physical well-being. Embracing love provides a deep sense of emotional safety and support, acting as a powerful antidote to the stresses and challenges of life.
A study demonstrated that a sense of love and security “calms jittery neurons.” In the study, female subjects were scanned through an MRI scanner while being administered a slight shock to their ankles. The females left alone in the scanner felt the shock and the pain. On the other hand, the females holding the hand of the lab technician felt the shock but much less pain. Likewise, the females holding the hands of their loving husbands felt the shock but no pain.
Due to a number of reasons, some people might develop certain mental schemas (patterns of thought) that lead them to believe that they are unlovable and that no one will ever want them, or that they aren’t enough, resulting in the “I feel unloved and unwanted by everyone” feeling. We are here to tell you why this happens and how to cope with this feeling. Below are some causes a person might be feeling unlovable in a relationship or in their day-to-day lives.
1. Low self-esteem
“Low self-esteem can be a potent catalyst for feeling unlovable, and one of the most common causes for someone feeling unlovable, creating pervasive personal beliefs that one is inherently unworthy of affection,” says Nandita. When individuals harbor a negative perception of themselves, it distorts their perception of how others perceive them and they begin to see signs of feeling unwanted in a relationship.
Morris Rosenberg and Timothy Owens, in their book Low Self-Esteem People: A Collective Portrait, say that people with low self-esteem tend to be hypersensitive. They have a fragile sense of self that can easily be wounded by others. Furthermore, people with low self-esteem are “hypervigilant and hyper-alert to signs of rejection, inadequacy, and rebuff.” Here’s how people with low self-esteem tend to feel unlovable:
They may struggle to accept love or convince themselves that they don’t deserve love
Their self-doubt can lead to a pattern of self-sabotage in relationships, as they may find it challenging to believe in their own worthiness of love and acceptance
They have trouble loving themselves and tend to discount the positives. This means that they only focus on the negatives in their lives and disregard the positive experiences
Breaking this cycle often involves addressing and rebuilding self-esteem through self-reflection, positive affirmations, and supportive connections
Unrealistic expectations create unattainable standards for oneself and others. When people set excessively high expectations in relationships or for themselves, they set themselves up for failure. Any perceived failure to meet these unrealistic standards can lead to self-criticism and a belief that one is fundamentally flawed or unlovable. As a result, a person may start questioning, “Am I loved?”, which further dents their sense of self-esteem.
The gap between reality and such lofty expectations becomes a breeding ground for feelings of inadequacy and unworthiness, undermining one’s confidence. This makes it difficult for people to feel accepted or believe that others could genuinely value them. They perceive even the slightest departure from their expectations as signs of feeling unwanted in a relationship. Addressing this often involves reevaluating expectations and adjusting them to be more realistic and of achievable levels, fostering self-compassion, and embracing the imperfections that make each person uniquely lovable.
3. Past experiences
Negative past experiences, such as rejection, abandonment, or traumatic events, can contribute to feelings of being unlovable. These experiences can create emotional scars that affect one’s perception of themselves and their ability to be loved, leading a person to believe that the “I feel unloved and unwanted by everyone” feeling they are struggling with is a fact. Here are some examples that might help you understand this better.
After numerous job rejections, my neighbor Mark began questioning his competence, feeling unlovable as he struggled to separate professional setbacks from his personal worth
A friend of mine, Emily, has a similar situation. Her parents divorced when she was young. This left her with a lingering sense of abandonment that fueled insecurities and made forming deep connections challenging for her. This fostered feelings of being unlovable
My friend, Sarah, who experienced a painful breakup marked by betrayal, developed trust issues, and found it difficult to open up in subsequent relationships, attributing the trauma to her sense of being fundamentally unlovable
Linda Graham, a licensed marriage and family therapist, explains in her blog how past experiences can make us feel unlovable. She says that repeated experiences of reaching out and encountering pain can lead the amygdala, our fear and emotional center, to encode a memory linking yearning with anticipation of hurt, time and again, creating an unconscious loop, reinforcing a neural pattern. The brain, accustomed to this repetition, establishes a rigid neural connection, akin to a self-reinforcing loop or neural cement.
Constantly comparing oneself to others, especially in terms of physical appearance, achievements, or relationships, can lead to feelings of inadequacy and unlovability. The habit of comparing yourself to others often stems from societal standards and unrealistic ideals.
Comparing your life with the lives you see online can cause an intense feeling of internalized unlovability.
As individuals internalize these comparisons, they may start to believe that their unique qualities are insufficient, breeding a deep-seated conviction of being unlovable. Breaking free from this cycle involves practicing self-compassion, recognizing individual strengths, and embracing a more authentic and self-affirming perspective, independent of external comparisons.
5. Lack of positive reinforcement
A lack of positive reinforcement can profoundly impact an individual’s sense of self-worth and contribute to feelings of being unlovable. Here’s how positive reinforcement works:
Positive reinforcement, which includes affirmations, encouragement, and expressions of love, plays a crucial role in shaping a person’s self-perception
Without these affirming experiences, individuals may struggle to internalize a positive self-image
The absence of positive reinforcement, especially during the formative years, can lead to childhood trauma and persistent core beliefs that one is unworthy of love and acceptance
Distant parents who constantly criticize and rarely praise can lead the child to develop deeply ingrained belief that they are unworthy of love. Such people can go through their entire adult life wondering, “Am I loved?”
Nandita says, “If an authority figure (parent, teacher, guardian, relative) has constantly been critical of a person, especially during their early childhood, or gaslit them into feeling inferior to others, it would most definitely lead to low morale.” Over time, this deficiency in positive external validation and emotional abuse may contribute to low self-esteem, making it challenging for individuals to believe in their lovability. They may start believing that they don’t deserve positive relationships.
Addressing these feelings often involves building self-esteem through positive affirmations, seeking supportive connections, and opting for professional counseling. Growing up in an environment where love and positive reinforcement have been scarce can impact a person’s self-worth and their belief in their own lovability.
Mental health issues contribute to feelings of unlovability by distorting self-perception, fostering negative thoughts, and influencing social interactions. Here’s how:
Someone who is mentally unwell or suffers from conditions such as depression and anxiety can start believing in inherent flaws or unworthiness
Social withdrawal, fear of rejection, and difficulties in emotional regulation or emotional abuse further add to the struggle, limiting positive interpersonal experiences
The impact of mental illness on relationships, coupled with low energy and motivation, can reinforce a sense of isolation (loneliness) and unlovability
The interplay between mental health and feelings of unlovability often involves a cyclical pattern. Breaking this cycle requires a holistic approach, including therapy, medication, and self-care practices, aimed at cultivating self-compassion, building a support network, and fostering healthier connections. Recognizing that mental health struggles do not define one’s capacity for love and connection is a crucial step in the journey toward healing and a more positive self-perception.
7. Fear of vulnerability
Sometimes the fear of being unlovable or feeling unloved in a relationship stems from the fear of being vulnerable and opening up to the possibility of rejection. This fear can lead to a self-fulfilling prophecy where people isolate themselves emotionally. Fear of vulnerability in a relationship can lead a person towards loneliness, because of self-isolation. A study shows:
Loneliness can lead to personality disorders (such as borderline personality disorder, narcissistic personality disorder, etc.) and psychoses, suicide, impaired cognitive performance and cognitive decline over time, increased risk of Alzheimer’s Disease, diminished executive control, and depressive symptoms
Loneliness also increases perceived stress, fear of negative evaluation, anxiety, and anger, while it diminishes optimism and self-esteem
The study thus suggests that a perceived sense of social connectedness serves as a scaffold for the self. Damage the scaffold and the rest of the self begins to crumble.
8. Unhealthy attachment styles
Unhealthy attachment styles can contribute to a profound sense of unlovability through various mechanisms. Here’s how:
Those with anxious attachment may fear abandonment, seeking constant reassurance and forming emotional dependencies that reinforce the personal belief that they are unlovable without continual external validation
Conversely, individuals with avoidant attachment styles may struggle with intimacy, fostering emotional distance and a perception of being incapable of sustaining meaningful connections
Disorganized attachment patterns, marked by inconsistent behavior, can create confusion and emotional turmoil, making a person feel unworthy. But what causes these unhealthy patterns? “When a person’s first attachment experience is being unloved, this can create difficulty in closeness and intimacy, creating continuous feelings of anxiety and avoidance of creating deep meaningful relationships as an adult,” says Nancy Paloma Collins, LMFT.
Unhealthy attachments often lead to self-fulfilling prophecies and heighten attachment issues, which a person may interpret as signs of feeling unwanted in a relationship. Behaviors driven by insecurities can strain relationships, reinforcing the belief of being unlovable. Therapy plays a crucial role in addressing and transforming these patterns, fostering self-awareness, establishing secure attachments, and cultivating a more positive self-perception.
9. Cultural and societal influences
Cultural and societal influences can significantly contribute to feelings of unlovability by imposing unrealistic standards and expectations. Dominant cultural narratives often dictate norms related to beauty, success, and interpersonal relationships, creating a framework that may be unattainable for some individuals.
Those who deviate from these prescribed ideals may internalize a sense of inadequacy, believing that they fall short of societal benchmarks for love and acceptance. Discrimination, stereotyping, or exclusion based on cultural differences or gender can worsen these feelings, fostering a belief that one is unlovable due to societal biases.
A study shows that self-esteem can be best gained from identities that fulfill the values of the surrounding culture. For example:
Participants in cultural contexts where people emphasized values such as self-direction and having a stimulating life (e.g., the UK, Western Europe, and some parts of South America) were more likely to derive self-esteem from controlling their own lives
Those in cultures where there was relatively more emphasis on values such as conformity, tradition, and security (e.g., parts of the Middle East, Africa, and Asia) were relatively more likely to derive self-esteem from doing their duty
Overcoming these challenges involves challenging societal norms, embracing diversity, and fostering a sense of self-worth independent of external cultural expectations. Seeking support from communities that promote inclusivity and understanding can also be crucial in combating the impact of cultural or societal influences on feelings of unlovability.
It is important to note that these reasons are interconnected, and an individual may experience a combination of these factors. Nandita suggests that a person should choose to love themselves. “It is about your perception of yourself, rather than society’s outlook on you,” she says.
The causes of feeling unlovable — or feeling unloved in a relationship — are multifaceted, intertwining psychological, emotional, and societal elements. Exploring these factors in therapy, practicing self-compassion, and challenging negative perceptions are essential steps toward breaking the cycle and fostering a healthier, more positive perception of oneself in the context of love and acceptance. In the next section, we will look at a few ways to cope with feeling unlovable.
How To Cope With Feeling Unloved?
If you find yourself asking questions like “Why do I not feel worthy of love?” or “What makes a person unlovable?” or Why do I keep feeling unloved in a relationship?”, it could be due to some of the reasons listed above. But what about dealing with such a situation? Now, there are a lot of ways to cope with feeling unloved or unlovable. Navigating the intricate landscape of feeling unlovable requires a compassionate and intentional approach to self-discovery and healing. Acknowledging these emotions is the first step in a journey toward self-acceptance and resilience.
There are various ways you can learn to cope with feeling unlovable.
A Quora user said, “The way you cope with being unlovable is the way Hellen Keller coped with being born deaf, dumb and blind. You find your purpose.” Another user suggested, “Start with thinking ‘you matter’. When you love, respect, and care for yourself, you can love and care for others too. Whenever you want to give something to someone, first start with yourself. You want to love, first love yourself, make yourself happy. It will flow from you like blood flows in your vein then.” Here are some ways you can cope with feeling unloved.
Practice self-compassion by treating yourself with the same kindness and understanding that you would offer to a friend facing similar struggles. Give yourself unconditional love, be patient with yourself, and acknowledge that everyone has insecurities. Tara Brach, in her best-selling book Radical Acceptance: Living Your Life with the Heart of a Buddha says, “Acceptance and love are what heal the ‘trance of unworthiness’. And they are the only things that heal feeling unlovable.”
2. Challenge your negative thoughts
Nandita suggests, “Figure out why you’re feeling unlovable. Is it a self-inflicted feeling? Is it due to a partner who is being distant, or gaslighting you in the relationship, or ill-treating you emotionally? Is it because of some past experience? Once we find out the ‘why’, it becomes easier to go further into treating it.” Here’s how you can do that:
Identify and challenge negative thought patterns contributing to feelings of unlovability
Replace these thoughts and negative self-talk with more balanced and positive affirmations to reshape your self-perception
3. Seek professional help
Consider therapy or counseling to explore the root causes of these feelings. Therapists can provide valuable insights and tools to navigate and overcome feeling unlovable and other challenges that come with it. But in the end, the only person who can help you is you.
According to Nandita, one should seek professional help from a licensed clinical psychologist to rule out any mental disorders that are associated with feeling unworthy and unlovable. And if a mental disorder is diagnosed, the professional will be able to help you find the best treatment plan. Should you need it, skilled and experienced counselors on Bonobology’s panel are here for you. A licensed clinical psychologist will be able to offer treatments such as cognitive-behavioral therapy, dynamic interpersonal therapy, and commitment therapy.
4. Build healthy relationships
Nandita says that having a strong support system and a good social connect is important. But even more important is trust. So confide in the people you trust, and keep your friends and family members close. If you’re feeling unlovable in a relationship, it might be time to assess if it would be better to leave that relationship. Here’s how healthy relationships help:
Building healthy relationships serves as a powerful antidote to feelings of unlovability by providing positive social reinforcement and support
Engaging with individuals who understand, accept, and appreciate you contributes to a sense of belonging and worthiness
These relationships foster an environment where you can challenge negative self-perceptions, receive genuine affection, and gradually rebuild a positive sense of self in the context of love and connection
Setting realistic expectations is a crucial coping strategy for combating feelings of unlovability, as it involves acknowledging that perfection is unattainable. By reassessing and adjusting expectations, you allow room for self-acceptance and embrace the reality of being human, with strengths and imperfections.
This shift in mindset fosters a more compassionate view of yourself, contributing to a positive sense of self-worth and an increase in self-confidence. “You should remember that it is all majorly psychological, so it is imperative to retrain your mind and thoughts to be kind to you and look at the positive qualities more,” says Nandita.
6. Engage in self-care and focus on personal growth
Prioritize self-care and wellbeing activities that bring you joy and relaxation. Taking care of your physical and emotional wellbeing can positively impact your self-esteem and overall outlook. Identify areas for personal growth and set realistic goals. Accomplishments, no matter how small, can boost self-esteem and contribute to a more positive self-image. Let go of your self-sabotaging behaviors.
7. Try affirmations, journaling, mindfulness, and meditation
Focus on positive activities to know yourself better, stay aware of your feelings, and learn to sieve out positivity through a mess of maladaptive thoughts. Here’s what’s required:
Create and repeat positive affirmations that reinforce feelings of self-worth and lovability. Affirmations can be a powerful tool to counteract negative self-talk and promote a more positive mindset
Finding ways to express your feelings and thoughts through journaling can be a therapeutic way to gain clarity and insight into the root causes of feeling unlovable. It also provides a record of your progress over time
Practice mindfulness and meditation to cultivate self-awareness and reduce anxiety. These practices can help you stay grounded in the present moment and develop a more balanced perspective
Embracing personal strengths, understanding the root causes, and gradually rebuilding a positive self-perception are crucial aspects of this transformative process. Through self-reflection and intentional steps, individuals can cultivate a more authentic and loving relationship with themselves, ultimately breaking free from the grip of unlovability and fostering a sense of worthiness in love and connection. So remove questions like ‘Is it possible to be unlovable?’ and ‘Why do I not feel worthy of love?’ from your mind and try a few things mentioned above to help you cope with feeling unlovable.
Key Pointers
Feelings of unlovability can be very dangerous for a person, sometimes even leading to suicide. So, it is very important to find out what is causing these feelings and how to cope with them
Some common causes of feeling unlovable are low self-esteem, past trauma or experiences, mental health issues, unrealistic expectations, and societal influences
Coping strategies involve fostering self-compassion, challenging negative thought patterns, and seeking support from trusted individuals or professionals
In the intricate exploration of the haunting questions “Am I unlovable?” and “Why am I unlovable?,” it becomes evident that the journey to self-discovery and the healing process are both personal and transformative. Acknowledging and challenging negative thought patterns, fostering self-compassion, and seeking support are foundational steps toward dismantling the roots of unlovability.
It is within the deliberate steps of self-reflection, intentional growth, and cultivating meaningful connections that individuals can transcend the shadows of unlovability, ultimately discovering a profound and enduring love and acceptance within themselves. The journey toward self-love is not linear, but through patience, self-compassion, and commitment, one can emerge from the depths of doubt into a brighter and more affirming understanding of one’s inherent lovability.
I’ve never been one to shy away from the spotlight. As a child, I was known to “sermonize” from the pulpit in church, and I’d always volunteer to read out loud in class. I relished every opportunity to say something funny or personally meaningful in front of a crowd. In high school, my outgoing nature, ease in front of large crowds, and quick thinking under pressure helped me become captain of my school’s debate team. I even got to present arguments to my state’s school board.
Once I left my tiny hometown and moved to the city, I found myself gravitating toward comedy clubs. I very quickly began performing, oftentimes impromptu style, and, less than a year later, I was signed on to a local, all-female comedy show.
I’ve never considered my ADHD brain to be a hindrance in the comedy world. If anything, it’s more like a secret weapon that gives me the upper hand on stage, that magical place where bouncing, bubbling, free-thinking maniacs like us take charge and absolutely shine.
How to Do Stand-Up Comedy with ADHD: Quick Thinking to the Test
The pressure of performing to hundreds of scrutinizing ears under bright lights is not for the faint of heart. Anything can happen. Yes, anything, like forgetting your own jokes, scrambling up lines, dealing with hecklers, doing some crowd work, and stumbling onto topics that weren’t part of the set at all, which often happens for me.
While a large part of stand-up comedy is rehearsing – practicing a set over and over until you’re well-versed enough to deliver your lines, completely memorized (but not showing it) and at just the right timing – rolling with the punches is where your mastery in this craft comes through. Because, as a performer, there are no second chances; you must always be ready to roll with the punches of a one-time-take during a live set.
Somehow, every time I’m on stage, I manage to fool the audience into thinking that I have my crap together. (Joke’s on them!) How do I do it? With the help of a bulleted list that I keep on stage and occasionally glance at while performing. If I’ve forgotten a joke or scrambled up my lines, potentially disrupting the flow and organization of my set, I look at the next bullet point and find a way, on the spot, to connect the random topic I’ve stumbled upon to the next joke. The list also helps me smoothly skip to the next bit in my set if a joke doesn’t seem to land with the crowd.
It’s in these moments that my ADHD brain actually works best. When I allow myself to shift around freely and think quickly on my feet, my sets tend to feel more authentic, lucid, fluid, and complete.
It’s a big reason I enjoy crowd work. There’s a new crowd to weave through every time, meaning endless possibilities for teasing. Shall I focus on the size of an audience member’s shoes? On the choice of words they used to answer my question? On their unfortunate choice to wear a scarf during the summer or shorts during the winter? Or should I jump through all these choices?
And how about those hecklers? I try my hardest not to “punch-down” as a comedian, but, hey, no one’s perfect! The best thing to do in this scenario is to keep the show light and quickly find a distraction that will satiate the heckler until security can escort them out. No problem for me!
Perhaps another reason I gravitate toward a live audience is because performing offers the opportunity to express who I really am and to be truly seen. Sometimes I even feel more like myself when I am presenting or performing on the stage. Because it’s where my brain, funny enough, is free to behave in a way that isn’t always appreciated away from the spotlight.
Stand-Up Comedy and ADHD: Next Steps
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Waveland, Mississippi — Following his retirement and the death of his wife, 76-year-old Danny Chauvin of Waveland, Mississippi, said he had way too much time on his hands.
Chauvin served in the Army during the Vietnam War and has been treated for depression and post-traumatic stress disorder. It’s when he’s alone with his thoughts that he’s the most vulnerable.
“That’s when stuff comes back to you,” Chauvin told CBS News.
But to keep his sanity, he knew he also had to keep busy. But how?
That’s when Chauvin realized one of the things he missed most about his wife was all the little handyman jobs he used to do for her. So, a few months ago, he posted a note on Facebook that read: “If there’s any honey-do jobs that you can’t handle, I’m willing to help.”
“And it spread,” Chauvin said. “It spread like wildfire.”
So now, on a daily basis, and sometimes four times a day, Chauvin fixes the hole in his heart by fixing just about everything else, like putting up a shower, hanging up a porch swing and fixing a closet door.
The price for his services? Nothing. It’s free.
“He showed much kindness to people,” one of his customers told CBS News.
Most of those Chauvin helps are women, many of whom are single or widowed. They call him the “Honey-Do Dude,” and say he is just about the only person they know willing to help with these small jobs. And, obviously, no one is going to match his price point.
In fact, when the work is done, the only thing he takes is a picture with his customers as a reminder that he is not alone in his struggle.
He also revealed his PTSD has improved since he started offering free handyman work.
The one and only Elmo of Sesame Street” asked people how they were doing earlier this week on “X.”
Elmo got a flood of responses, many of them from people who are struggling.
Even celebrities confided in Elmo.
Actress Rachel Zegler said she’s: “resisting the urge to tell Elmo that I am kinda sad.”
The Detroit Free Press is still dealing with the Lions’ loss in the NFC Championship and said, “We’ve been better, Elmo.”
Dionne Warwick just responded with this gif:
Elmo even caught the attention of the White House.
President Biden posted:
“Our friend Elmo is right: we have to be there for each other, offer our help to a neighbor in need, and above all else, ask for help when we need it. Even though it’s hard, you’re never alone.”
Elmo followed up with a post that he was glad he asked and promised to check on everyone again soon.
As a chatty kid, I saw myself (I’m embarrassed to say) in Donkey, the talkative motor-mouth and sometimes annoying character from Shrek who could not and would not shut up. I suppose the rest of my family and friends, to my chagrin, also saw the uncanny similarities between myself and that hyperactive little sidekick.
“Donkey, You Have the Right to Remain Silent. What You Lack Is the Capacity.”
Though I excelled in classes that relied heavily on participation and creative thinking, my enthusiasm – in the form of constant hand-raising and oversharing – wasn’t always appreciated. I still remember being absolutely mortified when a teacher I loved politely shushed me in front of the class and said, “Alright, too many side comments.”
Some of my classmates thought I talked and talked for attention. What they didn’t understand was that my oversharing and chattiness – symptoms of an overactive ADHD brain – felt compulsive more than anything. How else was I to release the overwhelming tsunami of thoughts that flooded my mind? I was brimming with ideas, stories, rants, and opinions about everything.
I did have one fan, my mom, who listened patiently and enthusiastically to whatever came out of my mouth. Or at least she tried to listen to it all. (At some point, she did need a bit of me-time.) She had the brilliant idea of buying me a tape recorder into which I could pour my stories, rants, and thoughts. Before I knew it, I had completely filled six tapes with audio. It was a gift that changed the course of my life.
An Outlet for Never-Ending Thoughts
Talking into a recorder absolutely served as a healthy outlet for my active mind, as my mom intended, but it became much more than that for me. It led to my next creative avenue: writing.
Recording my thoughts helped me organize, remember, and build upon them enough to put them down on paper. Those thoughts racing through my head became first place prizes in school writing competitions and, today, an average of 300 pages a year of journaling (no kidding!), published short stories, poems, articles, and even skits and scripts for stand-up comedy.
Turns out that there was nothing wrong with having a wild sea of thoughts raging inside of me. I wasn’t doomed to be annoying or overbearing, as I had feared. Through the right lens and care, I could make like an alchemist and turn each drop of the raging ocean into gold.
When my boyfriend recently asked me, “Where do you get all your ideas? Aren’t you worried that you’re going to run out?” I shrugged. “No, actually, I’m not worried about running out of thoughts,” I said, borrowing a line from Shrek. “It’s getting ‘em to shut up that’s the trick!”
Excessive Talking in Children with ADHD: Next Steps
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Death is terrifying, in part, because it’s impossible to imagine ‘nothing.’ Instinctually, our brains and bodies actively reject the unknown. I suspect this is why so many cultures and religions have formed beliefs and stories about the afterlife — to give death some boundaries, some purpose, and some meaning. Still, death is arguably the only thing in life you can’t reject, escape, or deny. You can only try and avoid it for now.
Still, I ride a motorbike every day, knowing that the only laws that I cannot defy are physics and fate. One mistake and I’m injured — or worse. It may be a dark and uneasy truth, but it’s also quite liberating.
So why is a machine that I know may maim or kill me one day such a vital part of my life?
I think it has something to do with my ADHD. Riding gives me pure peace of mind, total focus, and a rush of adrenaline. There’s a single task and purpose: To get from Point A to Point B alive. It’s urgent for the sake of everything and nothing, making every journey and movement matter with an energy that defies fatigue. There simply is no room for error and no safety net beyond my reactions and skills as a rider.
I can feel the danger in the air pushing back on me as I choose to accelerate, a quiet demonstration of the immense power beyond my daring. Nothing else matters. No distractions, just me, a little music in my ears, and the ribbon of asphalt and the obstacles on it before me as I grip an explosive rocket nestled snugly against me. It puts me right there, right on the edge of oblivion. Every. Single. Time. (It makes grocery shopping rather dramatic, too.)
Something about me changed after I got on my first bike at age 14. I truly loved that feeling, the rollercoaster with no end. I needed it. I obsessed about bikes for seven years until I finally persuaded my parents to let me get one. They were beautiful and dangerous, like diving eagles. I’ve since ridden bikes through tropical storms and down hellish, tattered roads — never once wishing I’d bought a car.
When my last bike was stolen and destroyed, my heart shattered. I mourned her like a lost love. I felt naked somehow like the thieves had taken more than just a vehicle, but a part of me — a part that gives me license to feel really and truly free.
Risky Behaviors Help ADHD Brains Thrive
We live in a sensible society that can feel very restrictive for people with ADHD. Our society relies on rules and a degree of moderation to function. Everything is controlled, predictable, economically prosperous, safe, and in good order. I don’t have a big problem with rules; most make a lot of sense. However, this isn’t how our ADHD brains thrive. Rules discourage the risky behaviors that are like catnip for our dopamine-starved brains.
Every Sunday, I teach one-on-one swim lessons for children with autism and ADHD. In the two years I’ve been doing it, I’ve noticed that most of my neurodivergent students quickly outstrip their neurotypical peers once they’re allowed to skip ahead and face deep water directly. I’ve been tutoring a five-year-old girl with autism who now swims 25-meter lengths. She thrives because nothing I was trained to do in standard lessons worked, so I jumped in the water with her to keep her safe. With her mother’s consent, we bypassed the centre’s depth limit (The pool manager names his headaches after me!), and I gave her tasks to do while I followed her around the deep end. She instinctively adapts to mitigate the danger. She’s perfectly capable and happy, but if I teach her at the shallow end, it’s a completely different experience, and she won’t engage.
Another time, I needed to teach a student with ADHD how to tread water to ensure he could survive out of his depth. After a few lessons together, I jumped into the deep end of the pool with a float and told him to fetch the rubber duck beside me. At first, he was a bit freaked out over the depth. Then he looked into the deep and said, “Give me a minute. I’ve not got Lord Duckington yet!” He got the duck, and he trod water for a full minute. Challenging him like that forced him to innovate, which he did successfully. He’s only eight years old, but what a man.
When the only real restrictions are the irrefutable, unforgiving, and yet totally fair and logical laws of nature, it puts everything else into perspective. The laws of nature are a beautiful thing for neurotypical minds. It’s literally sink or swim. Death, or the threat thereof, provides the ultimate boundary. In doing so, it simplifies things, making the often confusing (and sometimes trivial) reality of our broad social and economic structures so much easier to rationalize and understand.
Learn to ride a motorbike or swim (safely, with witnesses, please!) a little out of your depth (safely, or at least with witnesses, please!), and you’ll see what I mean.
Risky Behaviors and ADHD: Next Steps
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At the dawn of each new year, we set ambitious goals, buoyed by the feeling we can tackle anything — and now is the time to do it. Then the daily grind sets in, our initial enthusiasm wanes, and the novelty of new goals fades. Or we miss a goal, or a plan goes sideways, and we want to throw it out the window, along with any progress made.
This isn’t because of a lack of commitment or desire but a difference in how our brains work. Setting goals that work for ADHD brains requires understanding, self-acceptance, and reasonable expectations. Here are a few tips on extending that New Year momentum.
How to Set Goals and Achieve Them with ADHD
1. Set Goals Aligned with Your Values
Before diving head-first into goal setting, consider what’s important to you. By starting with what truly matters, you’ll select more meaningful goals, increasing the likelihood of following through with them even when your momentum wanes. Reflect on your values through journaling or explore lists of common ones, like Brené Brown’s Dare to Lead List of Values.
2. Reflect on Feelings or Themes You Want to Experience
Instead of focusing on specific tangible goals, determine the desired emotions or themes you want to feel, such as ‘rested,’ ‘inspired, ‘creative,’ or ‘balanced.’
3. Swap Outcome-Oriented Goals for Process-Oriented Goals
We can feel frustrated and discouraged when we set — but don’t achieve — goals (even if it is due to factors out of our control). For example, if you set a goal to lose 20 pounds and only lose 10 pounds, yet you show up to the gym consistently and eat healthy, you still end up ‘failing.’ Instead, set goals around improving a skill or engaging in an activity regularly rather than a specific outcome.
Year-long goals can quickly sputter and stall for adults with ADHD who crave immediate rewards. Setting seasonal or quarterly goals keeps the end in sight, allowing you the flexibility to change your goals as priorities shift throughout the year. It also forces you to reflect on your progress more frequently.
5. Visualize and Keep Goals Visible
If you’re anything like me, you forget your goals pretty quickly. Creating a visual or auditory reminder can be a powerful motivator to keep goals fresh in your mind. I like to make a digital vision board with images, quotes, and items representing my values and goals for the year. Place these visuals around your room, in your wallet, or as your phone’s background. Here are some of my favorite vision board templates from Canva.
6. Create a Resiliency Plan
Take some time to jot down ideas on potential obstacles that may pop up and strategies for getting back on track. Coming up with a plan when you’re calm and in a good headspace is far easier than when chaos or stress ensues.
7. Include the ‘Baby Steps’
Nobody runs without learning to walk, and nobody walks without crawling first. For each goal you set, write down an alternative ‘baby step.’ For example, if your goal is 30 minutes on the treadmill daily, the ‘baby step’ could be putting on your workout clothes each day or going to the gym. This approach ensures you keep moving forward, even in small ways.
Incorporate accountability into your goal-setting plan from the start. Find a check-in buddy or a partner for activities like going to the gym and regularly get in touch with them.
9. Challenge Your ADHD Brain
We know that ADHD brains get bored quickly. Set mini-goals or try new activities to keep your interest piqued and cater to your need for novelty. For example, learn to do a handstand, hike every two-mile path in your city, or teach yourself how to Samba.
10. Stay Flexible and Kind
Above all, remember that the goal is to live your best life, not to achieve maximum productivity. Be gentle with yourself and allow for flexibility in your plans.
Understanding and working with our unique brains is key to maintaining the New Year momentum. We can make consistent progress toward our goals by focusing on our values, embracing flexibility, and celebrating small victories. Remember, it’s not about perfection; it’s about progress, self-acceptance, and finding joy in the journey. Here’s to a year of growth, self-discovery, and sustained motivation!
How to Set Goals: Next Steps
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We all have bad days. Sometimes our day starts on a sour note when we wake up late and have to rush to school or work. From there, daily obligations only seem to push the day tumbling downhill. Mix in stress with ADHD emotional dysregulation, and you have irritability and grumpiness that seem impossible to shake. A bad mood, especially if prolonged, can lead to regretful choices that perpetuate problems and sustain a bad mood.
Some parts of your day are simply out of your control. What is in your control is easing yourself out of a bad mood to make your day go better. Use my “SMILE” method to decrease stress and help you move into a calmer state.
Sincere gratitude. Remind yourself of the positive in your life. Think of a person, place, thing, or experience that you truly appreciate. Remember what really matters to you. Consider making visual cues (photos, videos, drawings) to remind you of the things for which you are grateful. When you think of the good that surrounds you (and even get a “smile” out of it), you’ll see that your bad mood is not a constant.
Mindfulness. Give yourself a mental break from a bad mood by practicing mindfulness. Focus on your breathing; notice how the air fills your lungs and how it feels to fully exhale. Notice what your senses are detecting in the moment and name what you hear, see, smell, taste, and touch. Visualize a calm and safe place where you feel happy and content. Taking a minute to slow down and be present can help interrupt negative thought cycles.
Investigate your thoughts. Explore what is really going on that is contributing to your bad mood. What happened? How are you framing the situation? Are your thoughts actually helping or making you feel worse? What could be a more useful approach right now? What do you really need (not want) to help you right now? Answering these questions can help you redirect your thoughts to more effectively work through the bad mood.
Listen to your favorite music. Cue up the songs that lighten your mood. Hum the melody, sing along, and tap your foot to the music. Focus your attention on the rhythm and lyrics that make you feel good. What does the song remind you of? What are positive times that you associate with the music? Let the sounds surround you and lift your spirits.
Exercise. Release some of that bad mood through movement. Get the blood flowing with stretches or calisthenics. Take a walk or go for a jog outside to get fresh air. Try dancing or skipping to lighten your mood in a playful way. Do a laborious chore that requires lots of movement. Exercise can help both your mind and your body get to a better place.
Get Out of a Bad Mood: Next Steps
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Every day, I find myself staring at a giant mountain of things I need to do. Oddly, only some of what’s on the so-called mountain is real, important, and valuable. Most of it is a lot of airy nothing, the result of funky thinking on my part.
Before I start my climb up the mountain, I stand at the base and squint up to the tippy top. If I can just make it up there by the end of the day, I’ll win. I say this every day, but I’ve almost never gotten to the top of that mountain. I’ve rarely won.
Why? Is it because I’m an amateur mountain climber? Are we talking El Capitan here? What’s the deal?
The deal is that my to-do lists — whether for today, this year, or my life — don’t always reflect what I can do or what I want to do. I would need five of me to clear off my typical daily to-do list. My to-do list for life reads more like what five different versions of me want for my life, not just the single living, breathing me.
Why My To-Do Lists Go Awry
Sometimes, I lack clarity on what I truly need or want to do — the world, after all, is a big mountain of endless options. Other times, I’m cognitively inflexible and can’t switch gears when life asks me to, so I miss out on the optimal trail. I’m left with a lengthier trek and a bigger mountain. Still other times it’s perfectionism that comes through, enabling my mountain to grow. Finally, my old friend Time Blindness comes for a visit (actually, she lives with me permanently, because that’s ADHD) and suddenly my current task stretches like the Appalachian Mountain range.
Just kidding. It’s cold on my mountain, and lonely, especially when the trek involves fretting, scrambling, forgetting, rushing, and rarely arriving at satisfaction.
How to Shrink To-Do Mountains
So, what are my options? Am I destined to be stuck climbing interminable mountains forever?
I am not. I have the option to be a curator of my time, effort, and intentions.
Trust me, I get you. But I’ve found that noticing what’s going on in me in the moment is the first step to whittling down my mountain to the approachable, achievable, well-suited hill that makes my life happier and calmer.
Each day, when I wake up to face what appears to be Mt. Behemoth, I kick it with my toe to see if it’s real. I ask myself, “Steph, how much of what you insist you need to do today genuinely needs to be done?”
This is when the mountain raises a suspicious eyebrow because it knows that this question could lead to its shrinking. It’s a big clue that I’m at the juncture of owning my decisions or giving that power away. We each hold our position, but only one of us can be in charge. Who will it be? Me, or this mountain of tasks, goals, and dreams that nobody, even in an alternate universe, could ever accomplish in a reasonable amount of time?
“Since I’m writing a story with a happy ending here, it’s going to be me. But, full disclosure, the mountain sometimes gets the best of me. However, I’ve gotten so much better over time at calling the shots.”
The first trick is to say, “This thing doesn’t need to get done today.” The second trick is to believe this deep to your core. When you reach advanced-level mountain shrinking, you’ll learn that some tasks can simply be chucked off the mountain.
This is because there are channels of prioritization. One channel is for things that need to get done — the when, where, and how. The other channel is for things that need to get punted from our self-expectation mountain. When these channels become murky, climbing our mountain is no walk in the park.
But what is a lovely walk in the park? It’s the serenity that comes when I narrow down my daily priorities to a list that my earlier self would have laughed at. “Are you kidding? That’s a tiny list!” she’d have said. Old me would have fretted through her day and sulked at only being able to cross off, say, three things. Present me, though, feels empowered for crossing off the same number of items.
What I’ve noticed about adjusting to tinier, more doable plans is that as I accomplish what I set out to do and rack up the wins, I’ve grown a palpable confidence that says, “You can realize your dreams.” It’s hill-sized goals that lead us to mountains of accomplishment and happiness.
To-Do Lists Overwhelm: Next Steps
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I recall attending a school 504 meeting, as a single parent of a child with inattentive ADHD, where a panel of teachers, counselors, and administrators all sat across from me. I had a sinking sense that I was being judged for my child’s behavior and struggles. I felt like I was on trial. At the same time, I felt the pressure of how important the meeting was for gathering information on my child’s progress and advocating for beneficial changes to their education.
It turns out I was not alone. As a mental health educator and psychoeducator today, I often hear from parents and caregivers about the distress they feel ahead of meeting with their child’s educational support team.
School meetings are critical because they allow us as parents to to gather needed information and promote beneficial changes to our child’s education. Yet, we can feel powerless at times. We may also vicariously experience the trauma and shame associated with disability during these meetings.
So, how can we best support ourselves during an IEP/504 meeting (or any advocacy meeting) so we can fully support our kids? Here are some tips I’ve gathered from families, professionals, and my own parenting experiences over the years:
1. You don’t have to do it alone. IEP and 504 meetings can feel even more daunting if you feel isolated. Remember that you can bring a trusted family member or healthcare advocate with you. Beyond being a calming presence, a relative or trusted friend can help by making sure that you express your key points, stay on track, and ask pointed questions. Your support person can also help you debrief after the meeting.
2. Write out your questions and concerns ahead of time. Whether you use a phone, laptop, notepad, or an old-school clipboard, jot down any questions that come to mind well before your meeting. Chances are that you have many concerns. Writing down your thoughts will help you to keep organized and to fit your important concerns into the limited time allotted. Also, take notes during the meeting if you want to remember details and worry that you won’t!
3. Go ahead and ask your questions. Just like you might have heard from your favorite teacher growing up: No question is a stupid question. Ask questions, seek clarification, and gather information without worrying about feeling self-conscious. It’s your right as a parent.
4. Remember that everyone on the IEP team is trying their best. Most educational professionals are spread thin, overworked, underpaid, and burnt out. Keeping this in mind should help you to communicate with kindness and compassion. If you’re concerned about nervousness giving your speech an unintended edge or otherwise hindering effective communication, try roleplaying with a supportive friend who will give you honest feedback.
5. Commit to following up. You can request a review of your child’s plan at any time. Make sure you collect the contact info of all those in attendance at the meeting so that you can reach out if a new issue arises. Don’t be afraid to express that the plan isn’t working and needs revamping if need be.
6. Remember, Rome wasn’t built in a day. Be a fierce advocate for your child, but also keep in mind that educational advocacy is a process that takes trial, error, and refinement over time.
Parenting a child with an atypical neurotype isn’t always easy. Advocacy isn’t, either. The silver lining? We grow through meeting challenges. We become stronger and develop more confidence as we become used to the role of advocate. In fighting for your child’s needs, you may find a voice you didn’t know you had.
IEP Meeting Anxiety: Next Steps
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Seasonal Affective Disorder is in full bloom with short days and long dark evenings and nights…here is what you need to know.
Season Affective Disorder (SAD) is a common winter ailment. Roughly 5% of adults in the U.S. experience SAD and it typically lasts about 40 percent of the year. More women than men are hit with this issue. SAD has been linked to a biochemical imbalance in the brain prompted by shorter daylight hours and less sunlight in winter. How do you know know if you have it, what to do and does where you live make a difference? Here are the states must likely to have SAD and can weed help?
Those who are suffering from any of these symptoms should refrain from self-diagnosis and seek professional assistance.
Photo by Andrew Neel via Unsplash
There are a number of ways to offset some of the sadness that comes with the changing of the seasons. or example. While there is more clinical research needed, is data suggesting that CBD could help to alleviate anxiety and support healthy sleep patterns. CBD has also been seen as instrumental in boosting dopamine levels.
Cannabis contains cannabinoids which can have a positive impact on mood, while potentially increasing serotonin levels. Marijuana is also a proven sleep aide. Sleep can help your body rebalance and directly help moods.
Once you have been diagnosed, make a plan and you will see gradually improvement. Travel to bright places can help.
You’re running late (again). As you rush to leave, you scan your mental checklist: “Okay, I have my keys. Now, where are my sunglasses? Oh, they’re on my head. Good. Wallet? Check. Hold on – is my ID in my wallet? Is the other ID I need in here? What time is it? Let me check my phone, which I’m sure I left around here…. Wait, my sunglasses aren’t on my head!”
Panic and frustration set in. Your inner critic starts up: Why can’t I be more organized? Why am I so forgetful? Why is this so hard? Why do I always do this?
This was me before I left my home to do practically anything. Keeping track of all the items I needed for various activities, no matter how many times I had done those activities, always felt overwhelming and stressful. For work, I need my ID card on a lanyard, my name badge, and an ethernet cable adapter. When I volunteer, I need to bring my name badge and a specific t-shirt that identifies me as a volunteer. For my personal training sessions, I need to pack an athletic top and shorts, my heart rate monitor, a water bottle, a sweatband, my gym membership card, and the right shoes. I struggled to remember these items in my rush out the door, and I couldn’t reliably keep them in one designated place.
Accepting that forgetfulness, disorganization, and time blindness are a part of my ADHD was a milestone toward self-forgiveness. But I knew that I had to find a way to limit the overwhelm and forgetfulness that plague “neurospicy” people like myself.
Go Bags for ADHD: The Ultimate Organizing Hack
While mulling it over, I noticed that my partner keeps her stationery in a zippered bag. Everything she needs related to stationery is in that single, portable bag – not scattered about in random spots. And there, in the simplest of organizing tools, was my solution.
Rather than waste time tracking down (often misplaced) individual items around my home for a particular activity (while racing against the clock), I created “go bags” for various activities. If I’m spending the day in the office, I toss my office go bag into my backpack and I don’t think twice about what’s in there, secure in knowing I won’t have to ask for anyone to badge me in. I also have go bags for my personal training sessions and for volunteering.
How to Create and Maintain Your Own Go Bags
I know this isn’t an earth-shaking organization tool, but I’m happy with my go bag strategy because it’s simple, effective, relatively low-maintenance, and endlessly adaptable. You don’t have to use a zippered bag – substitute a plastic container, a reusable shopping bag, a fanny pack, anything portable that can hold your items. Here are some sample go bags to get you started:
Dog walking: Treats, waste bags, light-up collar (for night walks)
Everyday health: Hand sanitizer, sunscreen, lip balm, ADHD medication, lotion
Gym: ID card, clothes, water bottle, fitness monitors, sweat band or microfiber cloth
International travel: Passport, travel adapter, credit card with no international fees
Studying: Pens, highlighters, sticky notes, flash cards, energy bar (preferably one that doesn’t expire anytime soon!)
Swimming: Swimsuit, towel, goggles, water bottle, sandals
I know what you’re thinking: How do I remember to bring my go bags? I’m not perfect, but I’ve found that setting an essential item, like my car keys, on top of the bag works well. After all, I can only go so far from home without my car keys.
What about maintaining go bags? Some go bags (like for the gym) require more maintenance than others. Make it a point to check your go bags once a week, once a month, and at any other frequency that works for you. You may find it helpful to make duplicate go bags, like a toiletry go bag, to keep in your car, office, bathroom, nightstand, and other areas. Go bags, especially duplicate go bags, may take more time to set up initially, but they’ll definitely save you time, energy, and frustration in the long run. Think of it as doing your future self multiple favors.
For those of us with ADHD, there’s no greater thrill than sharing the hack to end all hacks – the strategy that finally got us to do the thing. (Bonus points if the hack was right under our noses all along.) I find go bags necessary to alleviate the racing thoughts, confusion, and overwhelm that once was getting out the door to face everyday life.
Go Bag for ADHD Organization: Next Steps
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The day I finally pulled the trigger and wiped all my social media accounts was the same day I posted a photo of my husband and me in a hot air balloon gazing thoughtfully at the miniature orchards beneath us. It was the perfect way to announce our wedding anniversary. These are the things that speak to people, right?
Apparently not. “Only 27 likes?” my brain scoffed. My mother-in-law’s voice rang in my ears: “Your expectations are your worst enemy.” I hate it when she’s right.
The truth is that she’s going to be right as long as I have ADHD, which, unfortunately (but, also fortunately), will be always. Rejection sensitive dysphoria (RSD) exists, and learning about it for the first time as a clinical psychologist allowed me to better understand my patients and finally name one of the most perplexing aspects of my own ADHD. I understood why I couldn’t handle rejection in all forms, including the rejection that is baked into social media use.
I’ll admit that the time I spent off social media was incredible. The world looked and felt brighter and clearer when I finally put down the phone and took a look around. But after seven years, social media has called me back – a desire that has caused equal parts confusion and intrigue.
I’m not back for the likes or validation. I returned because, as a psychologist who specializes in working with children, teens, and young adults, I have something to say to youth struggling with mental health challenges today. I want to be there for them, and I cannot be heard or reach youth, I fear, without using social media.
Since re-entering the social media sphere and navigating the sensory overload that is YouTube and TikTok (I’m @drgillykahn on both platforms) I’m taking note of the healthy social media habits that are keeping me balanced – habits that may help you use social media in a healthy way, too.
1. Ask yourself why you’re using social media. You’re more likely to have positive experiences with social media if you tie its uses to a concrete purpose or value – like staying in touch with people you care about. Notice how you feel as you visit platforms and consider if the benefits outweigh the costs. It may be time to limit your use or get off certain platforms completely if social media is encouraging compare and despair, keeping you up at night, and anxiously attaching you to your phone.
2. Stick it to The Man. Think of social media breaks as a way to stick it tor the corporate giants who use you as pawns for consumerism and data collection. That’s another reason to use social media with intention, not passively. In other words, use social media in the same way that it uses you. Joke’s on you, social media!
3. Don’t be afraid to create physical distance from your phone. I remember the good old days when we had a landline and had to sprint across the house to answer the phone. Nowadays, it’s like our phones are fused to our hands. Unless you have a valid reason for keeping your phone near you, keep it in your bag, in another room, or out of sight somehow. If you must, build up to keeping your device away in 30-minute increments. Take it a step further by disabling notifications.
4. Remind yourself that social media is not real life. If you catch yourself in an RSD or comparison spiral after spending time on social media, ride out the wave of your emotions and then remind yourself that a lot of what you see on these platforms is simply not representative of reality. There aren’t beauty filters to activate on the fly in real life, for one, and most people only post the good part of their days, not the boring or negative stuff. Also remember that the relative anonymity of the Internet often emboldens users to post mean comments; don’t let this skew your perception of how interactions actually work in the real world. Your emotional responses to negative experiences online are valid, but keep in mind that platforms are designed to raise the volume on entertainment and drama while often muting sensitivity to, well, rejection sensitivity.
5. Let RSD inspire your posts. Shake things up by showing the world that being vulnerable is acceptable and admirable. Our heightened sensitivities should be nothing to be ashamed of. Allow yourself to be yourself on social media and consider sharing your emotional experiences in the moment. Who knows, maybe you will help someone recognize RSD in themselves and encourage others to spread support and acceptance of big emotions as a pertinent and underrecognized aspect of ADHD.
Healthy Social Media Habits: Next Steps
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According to “common factors theory,” the essence of successful therapy lies in shared core elements, and the differences between therapeutic approaches are often less important than fulfilling these fundamental criteria.
One frequent question people ask themselves when they first decide to seek therapy is, “What type of therapy should I get?”
There are many different types of talk therapy to choose from. Often specific types of therapy are geared toward specific mental disorders. Cognitive-Behavioral Therapy is common for depression and anxiety disorders, Dialectic Behavioral Therapy is common for bipolar and mood disorders, and EMDR is common among those with PTSD.
How much do these therapies differ? How much does it matter?
One interesting idea in psychology is “common factors theory.” The basic premise is that effective therapy isn’t necessarily based on any specific type of therapeutic tool or technique, but rather there are underlying factors behind all therapies that make them successful.
Many therapeutic systems have been invented over the past century. Today, every popular therapist or coach has their own trademarked brand that’s sold as the absolute best approach to mental health.
The less glamorous truth is that most successful therapies aren’t special. There’s significant overlap between different approaches, with a couple extra bells and whistles. However, at the end of the day the biggest reason they are successful is because they all meet fundamental criteria.
Below you’ll learn more about these “common factors” behind successful therapy, including: collaboration, empathy, alliance, positive regard, genuineness, and individual differences.
6 Common Factors Behind All Successful Therapy
One interesting study identified 6 common factors behind all “evidence-based” therapy. They also calculated estimates on how much each factor contributed to the overall variability of therapeutic outcomes.
Here are the 6 common factors behind all successful therapy:
Goal consensus / collaboration (11.5%) – The most important factor is that both the therapist and client share the same goal and they’re willing to work together to achieve it. A goal can be anything from managing negative emotions, to stopping bad habits, to improving communication skills. If their goals mismatch (such as the client not wanting to change or the therapist wanting to go in a different direction), then it’ll be difficult if not impossible to make any progress. Both people need to be on the same page.
Empathy (9%) – The therapist must have a clear understanding of who their patient is and where they are coming from. This means being aware of their current thoughts and feelings, but also learning a comprehensive history of that patient’s past experiences and background. We build empathy by seeking knowledge and understanding about another person. Don’t try to guess, label, or project where someone is coming from. Ask questions and learn. A therapist must treat each person as their own individual case. A scientific study of n=1. Every person has a unique story and a therapist’s job is to learn each person’s story.
Alliance (7.5%) – Both therapist and client must see their relationship as a partnership where each puts in equal effort to realize their shared goal. For the therapist, this means providing advice, encouragement, compliments, and constructive feedback. For the client, this means putting in work outside of the therapy session (in everyday life) so they actually see changes and results. A healthy alliance requires three main components: 1) A shared bond between therapist and client, 2) Agreement about the goals of therapy, and 3) Agreement about the tasks to achieve it (practical advice, tips, suggestions, exercises, homework). Therapy has to be viewed as more than just talking once per week, but rather an impetus to work together, create a plan, and achieve real progress.
Positive regard / affirmation (7.3%) – It’s important that the therapist treats the patient with optimism, positivity, compliments, and encouragement. While a therapist sometimes needs to provide critical and constructive feedback, they should generally promote the patient’s self-esteem and core values. If a therapist tries to fundamentally change something about a person that they don’t want to, there’s naturally going to be conflict and difficulties. One idea known as unconditional positive regard was popularized by the humanistic psychologist Carl Rogers. He highlighted the importance of being agreeable and respectful toward the patient’s core beliefs, values, and goals (even if you disagree with them). Rogers saw therapy as a tool to encourage self-discovery and self-awareness, not tell a patient exactly how they should live their life.
Congruence / genuineness (5.7%) – Both the therapist and patient need to be open, genuine, and authentic. If the patient feels the therapist is just “putting on an act” or “pretending to be nice,” they are going to want to pullback and disengage from the process. A good therapist needs to be just as vulnerable as the patient. This means sharing relevant thoughts and feelings, being honest and matter-of-fact, and being willing to express emotions when appropriate. One telltale sign of incongruence is when there is a mismatch in body language (including posture, facial expressions, or tone of voice). If a therapist’s words don’t match their body language, the patient likely won’t develop any trust or rapport.
Therapist differences (5%) – The last important factor, which may be beyond our control, is personality differences between the therapist and client. Not everyone is designed to get along with everyone, and sometimes the therapist and patient are just too different when it comes to attitude, temperament, background, or lifestyle. Many therapy sessions don’t work out simply because the therapist/patient relationship doesn’t seem to mesh right. This is why it’s recommended that a person tries out multiple therapists when first starting out. Then they can find someone that fits with their personality and a therapist to commit to long-term.
These are the 6 most common factors behind successful therapy. They account for ~50% of the total variability in therapeutic outcomes, so there are still many other factors at play.
In truth, different types of therapies have their advantages and disadvantages, and certain approaches may work better for some and not at all for others.
Regardless of the system, successful therapy often needs to meet the basic requirements listed above. Without these common factors being met, no technique or approach is going to work.
A Warning on Overspecialized Therapy
A therapist needs to be flexible in their approach and try not to force fit everyone into their preferred model.
The more a person is trained and/or educated on a specific field in psychology, the more they seem to be “locked in” to only one way of observing the human condition. They don’t talk to people as human beings at face value, but instead think, “How does this person fit into my cognitive/behavioral/psychodynamic/evolutionary model?”
Expertise (and overspecialization) can narrow vision. A certain element of beginner’s mind is the best approach to therapy. Start with the basic questions, “Who is this person? What do they care about? What makes them tick? What do they want to change?”
Assume nothing and ask questions. Learn about the person from scratch. Connect to them human-to-human and see where it goes.
More concerning, certain therapies have become popularized and over-hyped in recent years. They’ve turned into commercial brands. “Cognitive-behavioral therapy” has become a buzzword in many circles because the average person associates it with the only “evidence-based” therapy.
Of course I’m not against specific therapies. I’ve learned a lot of helpful tools and techniques from various systems (including CBT) that I still practice today.
At the end of the day, I’m a pragmatist, so there’s almost no therapy, treatment, medication, or technique I’m 100% for or against. If it helps just one person, then it’s that much effective.
However, in general, a good therapist needs to have a comprehensive understanding of how humans work. Tools and techniques can be in your back-pocket, but first and foremost you need to approach people as individual human beings seeking growth.
Successful therapy can’t be reduced to a checklist.
The Gloria Tapes: 3 Therapeutic Approaches
This topic reminds me of an old series of videos known as the Gloria Tapes.
It was an educational film made in the 1960s to teach psychology students the differences between therapeutic approaches.
The series follows a single patient, Gloria, who receives therapy from three distinguished psychologists of the time: Carl Rogers, Fritz Perls, and Albert Ellis.
The therapy is limited since it’s only one session each, but you can get a good understanding of the radically different approaches by each therapist.
You can watch each of the sessions here:
Each of these videos reveals a different approach to therapy.
Albert Ellis is most aligned with modern cognitive and rational-based approaches. Carl Rogers has a more gentle and humanistic approach. Fritz Perls has a direct and provocative approach (almost to the point of bullying).
If I remember correctly, the patient Gloria felt the most comfortable with Rogers, but she actually went for a second session with Perls. I don’t know how to interpret that – it’s possible she felt “unfinished business” with Perls or she simply enjoyed arguing with him.
None of this says anything about “successful therapy.” Just one session isn’t adequate to measure “success” vs. “failure” when it comes to a long-term process like self-growth. However, these examples will give you a taste for the different types of therapies out there.
Ultimately, successful therapy depends on both therapist and patient. The most important factor is to have a healthy, working relationship and a “build together” attitude. Once you have that foundation, anything is possible.
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