Latest / State Of Mind Mental Health Podcast / #119 - Masking, Missed Diagnoses, ADHD in Relationships and Tools that Work with Dr. Bryan Gastelle

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#119 - Masking, Missed Diagnoses, ADHD in Relationships and Tools that Work with Dr. Bryan Gastelle · State Of Mind Mental Health Podcast

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one of the things that can show up is misattribution or misunderstanding
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of why someone's behaving the way they are.
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if you have a neurotypical partner or even a partner with ADHD that maybe doesn't
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know they have it or has a different group of symptoms.
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then the other partner with ADHD,
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let's say inattention. So someone might forget,
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a major engagement or, know, to text back or a birthday or something like that
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the person who is interpreting in that way might see that as like,
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they don't care,
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That can be a huge issue. I think some of the executive functioning can show
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up as well. So ability to complete repetitive tasks,
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like even something as simple as loading a dishwasher or folding laundry
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can show up in relationships as frustration,
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stress. And it can even show up with two parties with ADHD where it starts to...
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the workload starts to pile up and there's not a lot of ability to cope.
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And so that stress comes into the relationship.
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Hello, everybody. Welcome to the State of Mind Podcast.
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Tools, Stories, and Truth on Being Human.
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My name is Mike Stroh, and this is a podcast for living with courage,
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clarity, and compassion.
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On today's episode, I am speaking with clinical psychologist Brian Gastel.
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hello, Brian. Thank you so much for being here and for sharing your wisdom
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and expertise with us. Can you please introduce yourself and tell us
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a little bit about how you got to this point in your life and the work that you're
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currently doing?
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Hi, and thanks for having me. So my name is Brian Gestell.
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I'm a clinical psychologist and also the founder of Empower Psychotherapy,
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which is a telehealth company that provides outpatient therapy.
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And how oftentimes people in your position,
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myself included, have personal interests or sometimes experience
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or whatever with this type of work.
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Can you tell us sort of how your life brought you here and kind of what
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got you into this work?
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Of yeah, I've always really had a passion for psychology and helping people.
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And I ran into that when I actually took my first psychology class.
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And really, it was history from there.
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12th grade, I knew what I wanted to do.
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since then, I've just been pursuing it.
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Amazing. So what did you, how did you go from,
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guess your undergrad university years into clinical psychology?
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Like what was the pathway there?
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So undergrad, went to Salisbury University as a psychology major,
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of course. Then I went on to Philadelphia College of Osteopathic Medicine.
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I trained there for my master's in clinical and counseling health psychology.
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And then I went on to the doctorate also at PCOM,
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Philadelphia College of Osteopathic Medicine and got my doctorate in clinical psych.
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And what are your areas of interest or kind of what is most interesting
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to you about the work?
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I do a lot of work with neurodivergence,
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so ADHD and autism. I do some work with couples and I do treat other issues
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like depression, anxiety, trauma.
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But yeah, I'd say that those are where my interests are centered.
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Yeah. Can you help explain?
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I guess describing sort of autism and I know it's a range,
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but how do people usually come into being assessed for it and what are some
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of the pathways that people tend to go down to help themselves?
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Yeah, autism is an interesting one for what brings people in.
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It can actually be almost anything.
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Some people will come in maybe because their parents recognized it early on.
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You know, some people will come in because they've just felt different their entire
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lives and don't know why. So it really does run the gamut.
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But I think they come together with an interest in,
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you know,
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fitting, well, I don't want to say fitting in,
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but living in a world that is really built by and for neurotypical people
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and they're trying to live in that.
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Can you sort of explain, I interviewed a gentleman who was diagnosed with autism
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in his mid thirties. Can you explain a little bit about.
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the quote unquote obvious cases.
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So sometimes when kids, the pediatrician,
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whatever might notice a couple of things or the parents notice things.
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And so some cases I guess are clear or obvious so to speak.
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And then the cases that are not so obvious,
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how do you kind of, like how do people navigate that and how does that stuff get,
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get seen or found out?
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So yeah, some cases are very pronounced.
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The symptoms reach into every aspect of life.
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Not to say that even in the high functioning cases,
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they don't, but they're very pronounced.
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They're hard to miss. And usually there's either a pediatrician or a parent that
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has some kind of background in it and recognizes it early.
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Sometimes, you know,
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the parents will take the child in or the adolescent in to a doctor
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and the doctor will diagnose it.
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And then in the cases where it flies under the radar,
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sometimes it just has to do with the social circle of the individual.
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So if the parents and the support group around that person are not as aware of it,
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then sometimes it can go under the radar that way.
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Sometimes the symptoms can be masked so well that it takes until later life
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to even recognize them.
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That was, I'll pick up on the gentleman,
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Chris, his name was, would say how good he was at masking and pretending
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and kind of whether he knew he had autism specifically,
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just knowing kind of the way his brain worked.
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What are some of the ways that it shows up in those more subtle cases
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or how do people
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walk that line of, it seems like I don't get certain things or
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I struggle with certain things.
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And then I'll just keep it to myself and kind of carry on.
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So common ones are social interaction.
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So there's cues and scripts that we all follow without really thinking about it.
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And that social intuition for neurotypical people is instinctual,
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typically. So ~ we just intuit our way through it.
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And then for folks that are on the spectrum,
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there's varying degrees of difficulty with that.
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So they might be able to intuit certain things,
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but miss other cues. And so the masking comes from observing others doing something.
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And to someone on the spectrum,
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they might think, ~ that person is doing this behavior in a social situation.
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Let me copy that. And so that's where masking usually begins.
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So they observe the social dynamic and see it as,
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I guess, effective or something like that.
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And then compute for lack of a better word that I,
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it's probably a good idea for me to emulate that behavior.
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And as opposed to understanding the decisions behind the behavior,
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or is it really just like the intuition thing that you were describing
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for normal folk, if whatever that means.
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Yeah.
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Yeah, so it is a big difference in the way it's processed.
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So for someone on the spectrum,
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it's typically processed through an intellectual route,
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right? So if we think it's just a fact that when somebody,
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you know, says something to you that you reply,
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right? So for someone who is neurotypical,
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that is something that just comes instinctually,
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typically.
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versus if someone on the spectrum might have to,
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in some cases, learn that. I chose that one because it's kind
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of a low-hanging fruit, and it depends on the severity,
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but it just depends on the path,
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I guess, if that makes sense, like where they learn it.
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Is it intellectual or instinctual?
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have heard autism be,
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sometimes the testing is, and I don't know if this language is right.
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testing people on their ability to practice theory of mind for someone else,
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right? Or putting maybe it's cognitive empathy or emotional empathy into someone
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else's experience. Is that, is that true first of all?
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And how does, how does that get measured and assessed?
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cognitive versus emotional empathy,
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it's sometimes as difficult to determine the origin of the empathy
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~ unless you directly question the person about,
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know, where are they getting this behavior?
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And so sometimes that's where it can be masked as,
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and that actually empathy is a decent example.
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So in some cases it may be learned intellectually,
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like, okay, I see somebody else behaving in this specific way.
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I'm starting to intellectually pick up on that pattern.
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Let me copy that versus someone who is higher in empathy,
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which actually doesn't rule out people on the spectrum,
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interestingly, but someone who is higher in empathy might instinctually behave that
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way, like an empathic way.
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And so people on the spectrum aren't necessarily lacking in empathy.
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Is it sort of just a case by case thing or can you just describe that a bit more?
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It's,
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Yeah.
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yeah, it's interesting. Empathy can be influenced in both directions
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for people on the spectrum. Some are actually extremely high in empathy.
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Some experience it in a different way.
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Some are not as high in empathy.
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And so it really does depend on the case in that circumstance.
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Right. Can you, describe,
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I want to ask you questions of where it overlaps with ADHD.
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Maybe first, first, how do people with autism?
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And again, I know it's a spectrum and every case is different.
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How do people generally, or in a therapeutic way,
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how would you help somebody? And maybe you can just give
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sort of specific examples, because again,
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I know it's generalized and people,
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everyone is different, but can you give a couple of examples of
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how someone with autism might help themselves with certain things they struggle
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with?
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Yeah, so maybe someone will say a case is maybe
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on the higher functioning side where it goes under unseen for a long time.
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They might realize it later in life.
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And maybe one of the deficits is,
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or one of the challenges is social intuition.
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So.
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One of the things that therapy can provide is education on social intuition and why,
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the why behind it, as you mentioned earlier,
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which can help bring these concepts together for them so that they see it
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in a more universal way. And another is just simple training.
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like teaching the ins and outs of social interaction can be another
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way that they can help themselves.
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There's actually lots of things they can do,
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but it does depend on the symptoms.
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For folks with sensory overload,
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processing overload, weighted blankets have been incredibly helpful for
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a lot of folks like that. Sensory toys,
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things like that.
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Can you give an example of the,
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like a very specific social intuition examples,
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something along the lines of, yeah,
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I don't want to maybe, yeah, can you give an example of like what that looks like
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in sort of playing out the scene?
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Of course.
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Yeah.
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So a social intuition, if we're having a small talk with
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a coworker and the coworker shares a minor amount of information like,
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I went to the movies this weekend,
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the instinct to match them in the level of information is an example
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of social intuition. So you wouldn't say,
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oh, I struggled with my
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paying my taxes on time, you know what I mean?
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Like you wouldn't over disclose.
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Yep, yep, yep, yep.
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~
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You would just say something simple like,
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yeah, so did I. Right. And so that's social intuition.
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That's an example.
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that's a great example. And so,
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so in that case, people would learn to say,
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what movie did you see? Or did you like the movie or like that type of thing?
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Exactly.
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Yeah. Okay, great. And is that,
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is that role modeled in the therapy room basically?
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Like as if, yeah. Yeah.
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Yeah, sometimes
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we'll use role modeling. Sometimes we'll just explain it as a concept,
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you know, as an answer to a question they may have or a situation that felt
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a little bit off. It all depends on how they're going to best absorb.
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Yeah, yeah. And I think I forgot the other example.
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So you give the example of the,
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the sensory overload. So.
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Hmm.
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What's an example of somebody who struggles with that?
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is it sort of would, I don't know.
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I think you're, are you in Nevada?
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Arizona. Okay.
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Arizona, Tucson.
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I, yeah, I don't know what the public transit is like down there.
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I know in the U S it's not great,
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Hehehehehe
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but in most
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places, but, ~ so is something,
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so I live in Toronto and one.
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what's the affectionate term for Toronto Transit Commission,
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TTC is totally, totally crappy.
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so, I know some people may struggle in that environment.
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Is that a good example of like public transit or large events where a
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lot of people are around or even in one's home or in a school?
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Can you kind of describe the sensory overload idea and how it shows up for people?
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Absolutely. ~ Sensory overload,
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can just, it just can be simply the five senses.
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So a crowded bus would absolutely count as something that would overload someone
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potentially. Other things that are maybe less known would be eye contact can do it.
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It draws a lot of, it takes a lot of energy for our mind to do that
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and that can create overload.
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And then usually it's something of that nature,
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very social, very crowded, lots of noise.
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But then it can be something as simple as like a specific texture or even
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a specific noise as well.
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And so how do people learn to...
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deal with that is it, yeah, how do people navigate that?
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So for sensory overload, a lot of times we'll figure out what's doing it first.
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And so if it's eye contact, then there's strategies of looking at
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the forehead or looking at the bridge of the nose.
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If it's virtual, you can actually look at a different part of the screen
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and just position the camera differently.
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If there's maybe noise and it's more of that nature.
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than sunglasses, earplugs,
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things like that to limit it. Also taking breaks.
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I had a client who had some of those earphone things that he would sort
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of walk around with that he found helpful.
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Okay. Thank you for that. where,
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where can you explain the, the bridge?
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Oftentimes people with autism have ADHD as well,
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not necessarily, but that is common and also vice versa.
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Can you explain a little bit about that crossover and just kind of how,
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how those things are maybe understood and assessed?
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There is a lot of crossover there and ~ the jury is still kind of out
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on the origins of ADHD and autism,
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but there's definitely, there can be crossover,
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especially around executive functioning.
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So executive functioning is a skill set that largely relies on
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our ability to inhibit our behavior.
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you know, decision-making
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when
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the long-term decision outweighs the short-term decision or planning,
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impulse control, things like that.
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That can be something that can actually overlap between ADHD and autism,
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which sometimes adds to the difficulty in recognizing it.
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cut out there for a second. Yeah,
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dear I...
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maybe it was me. I don't know.
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Sorry. So you said the overlap.
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So you were explaining executive functioning,
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long term planning, those kind of things.
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Yeah.
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Yeah, absolutely.
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So it's just a set of skills that kind of draw from the same well,
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if you will, where we're inhibiting our behavior somehow,
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or we're manipulating our mental resources.
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And so that can be more challenging for folks with ADHD and autism.
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And that can be a big source of that overlap that you mentioned.
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I have ADHD and I often think I know it's,
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it's subtle. do notice sometimes,
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definitely sensory overload, definitely difficult times,
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difficulty in
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slowing it down to respond effectively in certain situations.
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And I wonder, I smoked. So the way I coped as a young person was to get high
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on weed nonstop and that quieted a lot of the noise.
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And then as I sobered up and went on,
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I started to recognize that actually how much,
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not necessarily crowds,
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but sensory overload. It's hard for me to pinpoint.
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think it's more almost like a visual thing for me.
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but where I would notice a lot of discomfort with sensory overload.
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then I start to realize,
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oh, I know how I dealt with this before.
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I was high all the time. So it just kind of
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you
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numbed it all out. Wow.
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Yeah.
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guess, yeah, and where do,
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I don't think I'm on the spectrum,
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although as for many of us, I heard a.
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neuroscientists explain the spectrum goes from really intense autism to psychosis,
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sort of the spectrum of psychology.
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And I know we're all on that to some degree.
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With the, just to dig into the ADHD,
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autism overlap or whatever. I guess,
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yeah, can you just share more anecdotes or more ways that it shows up for people?
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Yeah, there's actually a relatively new term to my understanding.
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It's a UDHD, A-U-D-H-D.
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And it's more of a, I suppose,
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a nickname that you might use to describe someone who has both,
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right? And that those symptoms do overlap.
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So sometimes you'll see that where,
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you know, there's a little bit of both.
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Maybe it's high functioning autism combined with ADHD.
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Then you have folks with
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ADHD that has executive functioning issues and starts
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to step into that territory where it's potentially observable as autism
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and vice versa. So it can absolutely overlap and then there can be both.
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So it does take,
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I think, a professional to really get to the root of that and differentiate.
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Yeah.
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And is that that's just through different assessments and perhaps interviews with
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the people around the person and the account.
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does, how does one get to the root of those things?
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So there is like the formal assessment with the report write up,
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which is probably the more traditional way to do it.
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Someone might have just a multitude of testing on ~ both diagnoses
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and have a full report written up.
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And that's probably the most involved way that it's done.
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I think in other cases, sometimes it's just recognized by the provider,
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the person's on a journey of self discovery and they're not interested in like.
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a formal label. so, you know,
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Mm-hmm. Mm-hmm.
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sometimes it's just at advisement,
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you know, from a professional to a client.
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But it can it can take many forms.
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There's different levels of testing,
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too. It just depends on, you know,
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your goals for it.
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Okay, can we maybe move over into the ADHD side of things or,
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and I think it's a question maybe for both.
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The increase in diagnoses,
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I think it's gone up for autism and it seems to have gone up for ADHD as well.
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Can you, yeah, what are your thoughts on that?
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What do you sort of think about that increase over the past generation or decades?
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I think it's difficult to isolate the true cause.
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However, a plausible explanation I've heard is that the recognition is greater.
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So the stigma has dropped around mental health at large in a number of areas,
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including ADHD and autism. And there are just simply,
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you know, the field has advanced over time.
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And so the ability to recognize it is greater.
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And I think that accounts for some of the increase,
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certainly.
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And do you think maybe let's go into the ADHD.
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Can you explain the difference between how it's assessed
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and even spotted and let's stay sort of with maybe preteen kind of kids?
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Like, can you just talk a bit,
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a little bit about that, the difference between boys and girls,
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how it shows up, the difficulty in assessing it properly?
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Yeah, so the difference in boys and girls is actually pretty significant with ADHD.
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The way that the neurology behind it is different from boys and girls.
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The girls have more connectivity between the left and right hemispheres.
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And so sometimes boys, also there's just cultural differences and expectations.
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So boys might present as inattentive,
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which can overlap. And then there's hyperactive,
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which may be in some cases for a girl might not show up as much because
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of that social expectation. The inattention can sometimes be masked
23:04
by that increased connectivity.
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So there's lots of ways that it can show up differently.
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And it has been a whole
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field of study to recognize the difference between the boys and girls.
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There's actually lots of ways that can show
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And so in that sense, is that partly why,
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as far as I understand, younger boys are much more likely to get
23:31
a diagnosis of ADHD?
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Absolutely. It's harder to recognize in girls a lot of times for those reasons.
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so, you know, ~ and this is broad strokes,
23:42
but for a boy, maybe there's a little bit more emphasis on rough play,
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a little bit less inhibition culturally,
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right. And so the boy is behaving in a way that is culturally allowed,
23:57
so to speak.
23:58
~ And so that becomes very obvious when that gets out of hand
24:02
or seems different than their peers.
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And then for girls, there's just more pressure to,
24:08
you know, behave in specific ways,
24:10
especially when they're younger.
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And so it may not show up. And also the connectivity thing,
24:16
it can get them through, so to speak,
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grade school, which it's, that's another big point of recognition is.
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difference in their performance despite their ability.
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And do you think, I guess, what are your thoughts on the?
24:32
the differences of opinion culturally,
24:35
perhaps with North Americans, Europeans,
24:38
other places on ADHD actually being a thing,
24:43
so to speak, and the over, under diagnosis and treatment of.
24:48
So yeah, there is lots of differences there and that's been a heavily debated topic.
24:54
For me, I'm on the side that it is definitely a thing as
24:59
you could probably imagine.
25:00
Yeah.
25:03
I think that I use the brain scan studies as something
25:09
to point to, but there are folks that feel that it is not.
25:14
I think the counter argument is that,
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and the interesting thing with ADHD is that a lot of the symptoms are things that
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do happen to neurotypical people,
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but they just happen less. So forgetfulness,
25:27
impulsivity, things like that.
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And so most of the executive functioning ~ errors do happen.
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And so that's why there is this tendency to say,
25:38
well, just control it better. Just try harder.
25:40
And so, yeah.
25:41
Right. Yes.
25:43
How do you see the reduction of
25:47
play and physical activity in,
25:50
in our primary schools over the last couple of decades,
25:54
playing a part in all this. Or do you,
25:55
do you think it that relates to the increase in diagnosis or just kind of generally,
26:01
what do you, how do you see that affecting our kids?
26:06
I would imagine that would have some effects on the frequency
26:11
of diagnosis because if you don't have a physical outlet,
26:14
then you're more likely to just carry out that energy in class,
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let's say. you know, I think also it probably I would frankly
26:24
a bigger factor I would imagine is the ability for a professional to catch
26:28
it and the knowledge that, you know,
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teachers have at this point and certainly professionals have at this point.
26:36
Yep. Do you, how do you see, exercise and physical activity being part
26:42
of the treatment or whatever you want to call it for people with ADHD.
26:48
Exercise and physical activity can actually be incredibly beneficial
26:52
for people with ADHD. There's a lot of different avenues that it helps on.
26:58
So one thing is that it puts out a cocktail of neurotransmitters that folks with
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ADHD are generally not producing as much of.
27:08
And so that definitely by itself accounts for some of it.
27:13
research that suggests that oxygen delivery could be a factor to the last,
27:20
if you have my knowledge. So I imagine that oxygen delivery with exercise would
27:25
change as well. And also I think just that outlet.
27:29
So, you know, if we're doing unstructured activity for a while,
27:35
then that allows the brain some time to rest.
27:38
And so it can kind of compose itself,
27:40
organize itself for when it is time to focus.
27:44
Do you see exercise as being?
27:49
I don't know if it's left out of the treatment plans or whatnot,
27:53
or how have you sort of seen that clinically speaking in terms of helping people?
27:58
Cause it's not a direct, you know,
28:01
go exercise and you'll focus better,
28:01
No.
28:03
so to speak on your math test or whatever.
28:05
Yeah.
28:06
Can you, can you see it show up in treatment plans or lack thereof and,
28:11
and any sort of insights on how to integrate it into those things?
28:16
Well, I've been, I haven't seen a lack thereof,
28:22
but I think part of that is that as a professional,
28:25
I don't always see the work of other professionals,
28:28
so I can't really speak to what they're doing.
28:30
But
28:30
Right, right.
28:32
personally, I definitely emphasize it as an ingredient to a larger success plan.
28:37
So.
28:38
I'll talk a lot about strategies with folks just to manage some
28:43
of the ADHD symptoms. There's simple things you can do like external reminders,
28:48
know, like visual reminders, could do smart goals to name a few.
28:55
And then in tandem with those strategies is more of a comprehensive ~ package.
29:00
say like exercise can mitigate some of this,
29:03
but it's not
29:04
not the key, it doesn't do everything.
29:07
Yep.
29:07
and what do you think about, meditation for ADHD?
29:11
Personally, it's been by far the most helpful thing,
29:14
I think. And it's hard to, what do you say?
29:17
pinpoint what I do many things to try to help myself.
29:20
I guess you often hear the whole thing of,
29:22
can't meditate. My mind just bounces all over the place,
29:25
cetera.
29:26
Yeah, I guess do you see that as helpful for people with ADHD
29:30
and what's your experience with that?
29:32
Absolutely. It does seem counterintuitive sometimes.
29:37
I think hence the resistance that,
29:39
you know, folks will say like,
29:41
I can't do that, or it's impossible.
29:43
And it's hard, I will say, you know,
29:45
especially at first. ~
29:45
Yeah, yeah, yeah.
29:48
But I would think I would encourage folks to think of it like a muscle,
29:51
right. And so at the beginning,
29:53
it's very weak. But that muscle is instead of,
29:57
you know,
29:58
conventional way we think of a muscle,
30:00
it is in charge of attention control.
30:03
So the more you exercise that quote unquote muscle,
30:07
the better you're going to get at it.
30:09
And so for folks whose symptoms are grouped around attention,
30:12
that's definitely going to help.
30:15
Yeah.
30:16
How about ADHD in relationships?
30:19
So you said you do a little bit of relationships.
30:21
Can
30:22
Mm-hmm.
30:22
you maybe share your insights with that,
30:26
how it shows up in relationship and how people tend to navigate it more effectively?
30:32
Yeah, it can definitely show up in relationships and often does.
30:36
There's, you know, and I do deal with that a lot actually directly.
30:40
So one of the things that can show up is misattribution
30:45
or misunderstanding of why someone's behaving the way they are.
30:49
if you have a neurotypical partner or even a partner with ADHD that maybe doesn't
30:53
know they have it or has a different group of symptoms.
30:57
~ then the other partner with ADHD,
31:00
you know, and maybe let's say inattention.
31:03
So someone might forget,
31:06
a major engagement or, know, to text back or a birthday or something like that even.
31:12
And so the, the neurotypical person or,
31:16
~ you know, the person who is interpreting in that way might see that as like,
31:22
they don't care, you know? And so.
31:24
That can be a huge issue. I think some of the executive functioning can show
31:28
up as well. So ability to complete repetitive tasks,
31:33
like even something as simple as loading a dishwasher or folding laundry
31:38
can show up in relationships as frustration,
31:41
stress. And it can even show up with two parties with ADHD where it starts to...
31:48
the workload starts to pile up and there's not a lot of ability to cope.
31:52
And so that stress comes into the relationship.
31:55
How, okay, and so then how would,
31:58
so let's go with the texting things.
32:00
I certainly don't like responding to text messages.
32:03
And my
32:03
You
32:03
wife and I have found balance.
32:05
How do people, yeah, how do you help that communication or what are ways you've seen
32:10
people navigate that effectively?
32:12
So yeah, with the texting.
32:14
Yeah, I'll give you a specific strategy I use actually.
32:17
So there's reminder apps out there.
32:19
Personal favorite is Do, DUE, it's got a for iPhone and it's
32:25
got a persistent reminder. It'll go off every five minutes till
32:28
you acknowledge the task is done.
32:30
And it's also quicker. So anyways,
32:33
what I would suggest is someone download Do or a similar app and
32:37
put a reminder, let's say once a day or twice a day,
32:41
depending on the needs of the partner to reply to all texts.
32:45
That would be how I'd help them.
32:47
Okay. And for the person on the other side,
32:52
who's frustrated in judgment,
32:56
et cetera, how do you help them navigate that?
33:02
A lot of times it's a little bit of explanation and a little bit of compromise.
33:08
We don't want to take the responsibility entirely off of the person with ADHD.
33:12
There is some, you know, I think it's important in any relationship
33:16
to show up mutually. So the person with ADHD can try to work more towards
33:21
the goals of the, you know, let's say less symptomatic person.
33:26
So maybe if it's texting, then
33:28
trying to text back once a day or something twice a day.
33:32
And then for the other person,
33:35
the person who's less symptomatic,
33:37
would just ~ cultivate some understanding,
33:40
normalize it a little bit and explain why it's happening.
33:43
Yeah, nice. think that's, that's basically how my wife and I have navigated
33:47
it over time. Yeah.
33:47
Nice.
33:49
Yeah, definitely. think just to maybe be explicit,
33:51
certain examples around cleaning up the dishes or a certain area
33:58
of the house, a compromise we have is if she wants to clean up the thing,
34:04
then she can go ahead and do that.
34:07
as long as she doesn't carry around the resentment and the,
34:11
the blame for her choosing to have cleaned it up.
34:15
Cause that
34:16
there.
34:16
often happens, right? I, I'm always cleaning up after you.
34:19
That's so annoying. Blah, blah,
34:20
blah, blah, blah. Without the
34:21
Mm-hmm.
34:22
recognition that while you're cleaning up because it bothers you
34:24
and you're choosing to clean it up.
34:26
Mm-hmm. Yeah. Yeah,
34:27
Yeah.
34:29
I would, I think that could, to an extent,
34:34
be a decent solution. I think I'd also say the other thing you can
34:38
do is reinforce that circuit a little bit.
34:41
So if the person doesn't pick up their plate at the end of dinner or something,
34:45
rather than doing it for them,
34:47
which reinforces the problem behavior,
34:50
you say, can you go pick that up?
34:50
Yep. Yep.
34:51
Which reinforces
34:53
the opposite.
34:54
Yeah. Yeah. That's a great point.
34:55
And to your earlier thing,
34:59
you said we, and I'm, think I'm pretty good at this.
35:03
It's never an excuse, right? So,
35:05
I didn't put the dishes away or clean up that thing because of my ADHD.
35:10
And you just have to kind of deal with that,
35:12
right? That's not going to go over very well either.
35:15
No.
35:15
And I think
35:17
I see a lot of people get sort of stuck in that excuse making and finger pointing.
35:22
And obviously that doesn't ever help.
35:24
and I think it is on all of us to take responsibility for our part
35:28
in the situation and to work towards reducing the,
35:32
the tension. the,
35:36
I'm curious, one thing I find helpful and I've heard clients say is helpful too is,
35:40
is the
35:41
The second you think of the thing,
35:43
just try to do it that second,
35:45
because then the thought disappears and off it goes to wherever it goes.
35:49
do you, you,
35:50
Absolutely.
35:51
yeah. Do you see that or maybe you can explain neuroscientifically
35:56
or whatever the working memory or the thought action struggle.
36:02
Can you talk a bit about that?
36:05
Yeah, that's absolutely a strategy I will often lead with when working with folks
36:10
with ADHD is if you think of it and it's a short task,
36:15
just do it right away. If it's a longer task,
36:17
you'd probably want to build a SMART goal so that's not overwhelming and then
36:22
put it in a reminder app. And so either way,
36:25
we're offloading it. We're not relying on that working memory because that's
36:29
a form of executive functioning that essentially takes fuel
36:34
from the larger will, if you will.
36:36
And so we don't wanna waste energy on something that our phone can remember
36:41
or that we can immediately do.
36:43
when you talk, when I hear smart goals,
36:46
think how, it's, doesn't have to be complicated.
36:48
there, although it can be incredibly thorough.
36:51
Are there, are there, I don't know what you would call it sort of simpler,
36:57
like what's a condensed version of a smart goal or something like that,
37:01
that can help people in, in, ~ you know,
37:05
in this way.
37:06
Yeah, so I'll give a common example.
37:09
So a vague goal that's going to create a lot of overwhelm might be get a job,
37:14
right? Super vague, no direction.
37:14
Right, Yep.
37:17
A smart goal might be surf indeed for 10 minutes on Monday at 6 PM,
37:22
right? And we set a reminder to back it up.
37:25
So the second one is not nearly as overwhelming,
37:29
very specific, and it accomplishes the task.
37:33
And so that's the purpose of a smart goal is to take a larger vague goal
37:37
and turn it into a smaller executable goal.
37:40
Yeah. Nice. Are you familiar with,
37:43
Solanto? she wrote the cognitive.
37:45
was like cognitive
37:47
yeah.
37:47
behavioral for adult ADHD. Do you know that work?
37:50
Mm-hmm. Yeah, I do.
37:50
Yeah.
37:51
She has a wonderful play on words,
37:53
the commandments of planner use.
37:56
then sort of following from that is the time estimation sort of log or whatnot.
38:02
Can you?
38:04
How do you see people resist that idea?
38:08
Right? So the commandments of planner use is basically like,
38:11
need a planner and a calendar,
38:13
whatever it is, it doesn't matter,
38:14
but you need one and you must adhere to it.
38:17
And, and what's the sort of pushback to that and how do you help people come
38:23
to terms with that reality?
38:26
It's interesting in a lot of my work,
38:28
people approach me at a point where they're not really resistant to that idea
38:33
OK. OK,
38:33
so much as they're resistant to the idea of executing it and the challenges.
38:38
OK, yeah, yeah.
38:40
So selling the idea frankly is a little easier for me,
38:44
but doing it is harder because a lot of times there's a pattern
38:49
of difficulty around it. So.
38:52
maybe we have a notebook but we forget we have it or we don't check
38:55
the dates or it's disorganized or something like that.
38:58
So a lot of the work I do is to bridge that gap and make sure that none
39:04
of those executive functioning issues are not gonna interfere with it.
39:07
So, like the example I gave of the SMART goal and programming that into the phone,
39:13
that is probably the least likely to be dismissed versus,
39:20
taking loose notes in a notebook with no date on it or something,
39:24
much more likely to be forgotten.
39:26
can you talk about, I can't believe I haven't asked you about this yet.
39:29
one thing I, I definitely experienced myself and also I see with people
39:36
and I haven't, you I haven't read all the literature and treatment manuals for ADHD,
39:41
whatever, although I don't see it often really focused on in any of that stuff
39:46
is the
39:47
guess Freudian defense mechanisms versus shame and guilt and that sort
39:53
of sense of self loathing or frustration with the all this accumulated over time.
40:00
the world is constantly reminding you that you have this shortcoming with being
40:06
on time, remembering things, staying organized,
40:08
et cetera. And we build these defense mechanisms against that.
40:12
And often
40:12
Mm-hmm.
40:12
those are blaming everyone else or intense shame and all that kind of stuff.
40:18
Can you talk a bit about that and how,
40:21
how you see people heal from that or just address that?
40:27
Yeah, and you see it a lot really.
40:30
And so the world does have a way of punishing executive functioning difficulties
40:37
and creating a negative atmosphere around them.
40:40
A lot of times there's misguided blame.
40:42
People will say, I guess you don't care about it,
40:46
like I mentioned before, ~
40:48
Yeah, yeah.
40:49
or just attribute it to a character flaw.
40:52
And so the first thing I will do is explain that that is not a character flaw,
40:56
right? And that takes some of it away.
40:59
And then the intensive work that we'll do,
41:02
I'm a CBT practitioner, cognitive behavioral therapy.
41:06
So part of the work I do is around thoughts and the way people see the world.
41:10
And so we'll look at like those little micro points where someone might've decided
41:15
like, I'm, you know, lazy, for example,
41:17
have a larger view of themselves as lazy.
41:20
~ and we'll just dismantle it piece by piece and give them strategies
41:25
to replace that.
41:27
yeah, where do you balance the.
41:29
Yeah, the self loathing, the self blame,
41:32
the sort of labels we give ourselves with.
41:35
Yes, I do. So I'll speak for myself.
41:38
I do maybe not as much anymore.
41:40
have this tendency to want to blame others,
41:44
to want to make up excuses to also in making up excuses,
41:51
excuse myself from the responsibility necessary to do the thing better.
41:56
So yes, it's not a character flaw per se,
42:00
although
42:01
I can have thought patterns, self associations that actually
42:06
are not healthy ways of thinking about life.
42:11
~ so,
42:12
Thank you.
42:13
yeah, is it a character flaw? Maybe actually,
42:16
but it doesn't mean I can't do anything about it.
42:19
And it's not, think I like how you said,
42:21
it doesn't mean that that defines me as like a whole.
42:25
That's yeah, and you're right that when I call it a,
42:28
you know, I use that example, it is a reduction of things so it
42:32
can develop into maybe not so healthy behavior.
42:36
And, you know, the avoidance of culpability probably came from
42:43
honest places that weren't necessarily,
42:47
you know, character flaw. And
42:49
Yeah, yeah.
42:51
but developed into an avoidance strategy that is not so good.
42:54
And so I will make that distinction with folks and we'll say like,
42:59
okay, you know, we don't want to offload this because then that takes away
43:03
any opportunity for growth. When you,
43:06
when you deny culpability, it's like,
43:08
I don't want to say culpability,
43:10
but when you deny that it's a thing at all,
43:11
Yeah. Yeah.
43:13
then
43:13
it slows you down.
43:15
and and
43:17
How do you, so when people are able to harmonize those two potential realities,
43:22
Mm-hmm.
43:22
how
43:23
do you see that showing up for them or helping them kind
43:26
of navigate more effectively?
43:29
Yeah, I first want to look at like,
43:32
okay, let me help this person understand why they do this,
43:36
where this came from. And then once you break it down into those pieces,
43:39
it's a little easier to break it down further and say like,
43:43
let's come up with strategies so that the origin of this behavior is addressed.
43:49
So if the origin of it is I struggle to remember things or execute things,
43:55
and so therefore I'm going to offload the blame.
43:58
Now I get that.
43:59
and I'm going to try to cope with that.
44:01
So we kind of got to go down,
44:04
top down and then bottom up if that makes sense.
44:06
Yeah, yeah, yeah, it does. does.
44:07
~
44:08
Yeah. So, so sort of to the core root negative beliefs or appraisals
44:14
or reason making into
44:16
Mm.
44:17
a healthier, more balanced sense of self or,
44:21
or ability to exist in the world kind of thing.
44:24
Yeah.
44:25
Absolutely. Yeah.
44:27
Any, any kind of other thoughts around ADHD?
44:31
It's sort of treatment or just what people struggle with and also what helps them
44:37
succeed that we haven't discussed.
44:41
I'd say just as a general advice,
44:44
I think that the stigma around treatment can be kind of strong.
44:49
And with the executive functioning,
44:51
actually securing a provider can be difficult as well.
44:55
so, you know, and so like,
44:59
I would encourage folks with ADHD to check it out.
45:03
It does take a little bit of work.
45:06
maybe use some of the strategies I even gave you today to try that.
45:11
And it really couldn't help you with a great deal to advance in those ways.
45:17
We don't know what we don't know.
45:18
And so we may think we're doing the best we possibly can,
45:22
but it never hurts to get another opinion and see how we can even sharpen that.
45:29
Awesome. Thank you. And so all your,
45:32
you know, for people to check out your work and if people are,
45:35
are there are listeners in the States,
45:37
I don't think I get state by state breakdown,
45:39
but anyhow,
45:40
people can
45:40
You
45:41
certainly check you out and go from there.
45:44
And yeah, any last words or pieces of,
45:48
things that you want to share before we say goodbye.
45:50
Yeah, I'll leave you all with a little bit of a pitch here that I think
45:54
can help anybody regardless of what state you're in is Empower actually
45:59
has coverage in multiple states at this point.
46:01
But even if we don't cover your state yet,
46:04
if you go to our website, www.empowermytherapy.com and click book
46:10
a free consultation, you can get 20 minutes with me.
46:14
I'll advise you on the best possible care even if we don't serve your particular
46:18
state.
46:19
And so feel free to reach out for that resource.
46:23
So thank you so much, Brian. Thanks for doing the work you do
46:26
and sharing your wisdom with us.
46:28
And I wish you all the best.
46:30
Thank you. Thanks for having me.
46:31
Thanks for listening to this episode of the State of Mind Podcast.
46:35
Before you go, pick one idea from today's episode and practice it this week.
46:40
Remember, live with courage,
46:43
clarity, and compassion.
46:46
Practice inner strength and develop within.
46:48
If you enjoyed this, please follow us,
46:52
subscribe to the podcast, and leave a quick five-star rating
46:58
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47:00
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47:04
We wish you all the very best.
47:05
Take it easy. Peace out.