Podcast Summary: The Leading Edge in Emotionally Focused Therapy

Episode 80: When ADHD Has a Role in the Bond
Host: Dr. James Hawkins
Guest: Alexine Thompson-de Benoit, Marriage & Family Therapist and EFT Trainer (Switzerland)
Date: April 2, 2024

Overview

This episode delves into how Emotionally Focused Therapy (EFT) needs to adapt when working with couples where one or both partners have ADHD. Guest expert Alexine Thompson-de Benoit draws on clinical experiences and personal insights to share nuanced strategies for holding neurodiversity—particularly ADHD—within attachment-focused couple work. The conversation explores psychoeducation, therapeutic pacing, empathic attunement, and the relational implications of ADHD within partnerships.

Key Discussion Points & Insights

1. Understanding Neurodivergence within EFT

• EFT as Foundation, with Adjustments:
  EFT remains applicable, but clinicians must adjust their approach for neurodivergent clients, especially those with ADHD. Alexine primarily focuses on ADHD but affirms that similar principles can extend to autism and other neurodivergent presentations.

  "EFT doesn't look so much different, but you do have to take certain things into account... Just like when you work with trauma and you have to slow down and slice it thinner." (Alexine, 02:19)

• Importance of Therapist Education:
  Misunderstanding or ignoring the diagnosis may inadvertently harm the therapeutic process.

  "If you ignore the diagnosis and you don't take that into account, you can do more damage by taking them deeper and then allowing them to fall from really high." (Alexine, 03:36)

2. Adapting Session Structure and Pacing

• Managing Attention and Engagement:
  ADHD symptoms can impact focus during sessions, so therapists must scaffold the process, checking in and segmenting enactments.

  "Sometimes I need to interrupt and, or pause... to make sure your partner can take that in. I might do an enactment in several bits to make sure that there's somebody in front of them." (Alexine, 05:18)

• Checking in with ADHD Partners:
  Techniques include periodic checks on engagement and explicitly inviting attention before key relational moments.

  "You might pause and check in... like, hey, are you still with us?... I'm about to have them turn and share about that sadness with you. Do you think you can be with us for about the next five minutes?" (James, 06:51)

3. The Relational Cycle: Triggers and Misunderstandings

• Common Triggers:
  Non-ADHD partners may misinterpret symptoms (forgetfulness, disorganization, impulsivity) as indicators of disregard or lack of care.

  "They come back from the store with three items instead of five... They never remember. They always interrupt me... We often say people with ADHD are like a Ferrari with bicycle brakes." (Alexine, 07:54)

• Meaning-Making and Injured Bonds:
  These misinterpretations reinforce negative relational cycles—one feels ignored, the other misperceived.

  "If you forget everything I say to you, I'm going to start feeling unimportant... what you'll see is a partner that goes crazy and gets really, really mad... and add someone who is really not doing it on purpose." (Alexine, 10:00)

4. Role of Psychoeducation and Empathic Reframes

• Weaving Neuropsychological Insights into Empathic Reflections:
  Both partners benefit from understanding the ADHD brain's functioning, but this must be conveyed relationally, not just as dry information.

  "We try to do it the EFT way... I like to weave that into my reflections... this is what your brain is struggling with." (Alexine, 12:58) "I've just talked about a symptom, but I've put it in a reflection... the ADHD brain does... They need more stimulation to feel the dopamine." (Alexine, 14:23)

• Empathizing with Both Partners:
  The therapist must validate neurotypical frustration and neurodivergent struggle, often “channeling” empathy until the couple can hold it themselves.

  "It's mind boggling, isn't it?... And I get how hurtful and how angry making that is." (Alexine, 16:40) "Can you help your partner understand what it's like in your mind? ...Can we take a walk in your brain right now?" (Alexine, 17:00)

5. Balancing Shame, Pain, and Safety

• Risks of Shame in ADHD Partners:
  The therapist must avoid plunging the neurodivergent partner into shame while inviting neurotypical pain forward. Frequent titration and pacing are essential.

  "Anxiety and shame are almost always there in your divergent but at least ADHD partner... We titrate right back and forth between the two and we slowly go deeper and deeper, but not like deep plunges." (Alexine, 20:14)

6. Responsibility, Ownership, and Treatment

• Addressing ADHD Openly:
  Compassion is critical, but so is personal responsibility—both partners must work on their respective contributions to the cycle.

  "If somebody has ADHD and they're refusing to address that, it's tricky. It's going to be difficult... the person taking charge of their ADHD sends a clear message of you matter enough to me that I'm going to do all I can..." (Alexine, 25:14) "The non ADHD partner also has a responsibility to own their anger and the way they respond to the symptoms." (Alexine, 26:11)

7. Grieving and Celebrating Neurodiversity

• Integrating Loss & Acceptance:
  Partnership with neurodivergence entails grieving what cannot be changed, but also discovering unique strengths and “superpowers.”

  "Grieving is also something that needs to be a part of the process. Right. Because you can't change that brain… and grieving and celebrating... ADHD comes with a lot of gifts." (Alexine, 27:49)

• EFT Treatment Map: James summarizes how these insights fit into the classic EFT stages:
  • Short, back-and-forth regulation and empathy (Stage 1)
  • Deeper work with grief and care (Stage 2)
  • Reaching new awareness and celebration of strengths (Stage 3)

  "It feels like you just walked us through the whole EFT treatment map." (James, 30:03)

Notable Quotes & Memorable Moments

• "EFT doesn't look so much different, but you do have to take certain things into account... you have to sort of adjust the model just like when you work with trauma."
  — Alexine, 02:19

• "You might pause and check in... just want to get your attention back for a moment... can you be with us for about the next five minutes?"
  — James, 06:51

• "People with ADHD are like a Ferrari with bicycle brakes."
  — Alexine, 07:54

• "I've just talked about a symptom, but I've put it in a reflection... the ADHD brain does this because they need more stimulation to feel the dopamine."
  — Alexine, 14:23

• "Can you help your partner understand what it's like in your mind? Can we take a walk in your brain right now?"
  — Alexine, 17:00

• "Anxiety and shame are almost always there in your divergent but at least ADHD partner... we titrate right back and forth."
  — Alexine, 20:14

• "If somebody has ADHD and they're refusing to address that, it's tricky... the person taking charge of their ADHD sends a clear message of 'You matter enough to me that I'm going to do all I can.'”
  — Alexine, 25:14

Timestamps for Important Segments

• 00:44 — Why ADHD & neurodivergence matter in couples work
• 02:02 — How EFT shifts with neurodivergent clients
• 04:25 — Adapting session pacing for ADHD attention needs
• 07:44 — Typical relational complaints & triggers for neurodiverse/typical couples
• 12:22 — Weaving psychoeducation into emotional reflections
• 16:40 — Validating both partners' pain and opening the "walk in your brain" invitation
• 20:14 — Preventing shame in ADHD partners, titrating vulnerability
• 23:51 — The essential role of responsibility and treatment "pillars"
• 27:49 — Grieving and celebrating within neurodiverse relationships
• 30:03 — Mapping these concepts onto the classic EFT treatment stages

Final Takeaways

The episode underscores the importance of specialized, empathic adaptation when using EFT with neurodivergent couples. Success involves psychoeducation, sensitivity to symptoms, balanced validation of both partners, and pacing that accommodates attention differences. Therapists should support responsibility, attune to shame, and foster both grief and celebration around neurodiversity.

Contact for Training & Consultation:
Alexine Thompson-de Benoit: atomson.mftmail.com | EFT Switzerland website (training in Oct 2024, online & in English)