The gaps between ADHD coaching and therapy

Let's not beat around the bush: therapy is expensive. Insurance is expensive. Not everyone can access it, and we need change at a systemic level. Availability and waitlists also make it tricky to find a provider who meets your needs rather than just settling for anything. And I'm a big believer that sometimes no therapy is better than "bad therapy" or therapy that isn't a fit. So when I bring up coaching to folks, I'm reasonably met with the response "You want me to add another thing?" often. I offer the caveat that you don't need both to meet all of your goals. And everyone's needs are different, so I can't make a blanket statement about what you, dear reader, need. However, I can confidently express my opinion that for a period of time, those who are struggling with both executive functioning and deeper-rooted emotions and stressors can strongly benefit from integrating both a therapist and a coach into their care. My rationale goes further than just "the more, the merrier" - hear me out.

What ADHD coaching offers

I will use ADHD coaching and executive functioning coaching here interchangeably because that's how coaches talk about their services, but please know that executive functioning goals and challenges can be on anyone's radar, regardless of neurotype, and there are some pieces of ADHD coaching that are unrelated to executive functioning.

Now that we have the language cleared up, let's define what this kind of coaching typically entails. It's focused on practical strategies, accountability, and skill-building. It tends to be present-oriented. In other words, "How do we help you do the thing now?" Many of my therapy clients lament that my role is to help them access internal wisdom rather than to simply tell them what to do. That's usually when I bring up coaching. Just because I can't tell you the what and the how doesn't mean someone can't. And to be fair, it's just "telling you what to do" in the way a bully on the playground might boss a kid around but rather giving concrete, tangible action steps toward what might've previously been a vague and frustrating vision (e.g. "Be happy, feel better").

Executive functioning coaches often help with things like structuring your workday; learning a new system for reminders and planning how you're actually going to implement that system around your typical barriers, like memory or low motivation; or breaking down a big task into micro-steps. Some coaches work by demonstrating a skill that you observe and then turning the tables so that you try it while they observe, and finally have you teach it back to them.

The pitfalls of coaching without therapy

Remember, this is not a blanket warning. If you can only access coaching or you need to prioritize the concrete right now, go for it. My hope is to shed some light on some flags to look for so that you can be aware of what needs troubleshooting.

• Unaddressed emotional patterns: Shame, perfectionism, trauma responses, and old narratives that sabotage follow-through may not (and in some cases, ethically speaking, should not) be a part of what coaching offers, leaving useful insight on the table that might invoke the behavior change you're looking for and, without it, cause frustration with stuckness.

• Strategies that don't stick because the root cause is emotional, not logistical

• Feeling "broken" when tools that work for others don't work for you

• Risk of burnout if you're forcing execution without addressing mental health load

What therapy offers

In contrast to coaching, therapy focuses on emotional processing, self-understanding, and relational patterns, often digging into the "why" behind struggles. For example, we might tackle the root causes of rejection sensitivity, understand how masking has been protective as well as disruptive to identity formation, or process grief around past difficulties. What differentiates a therapist from a coach (besides degree and licensure requirements and board regulation, and there's a whole rabbit hole I won't go down about gatekeeping and academic elitism with that) is that therapists can treat mental health conditions. The confusing thing here is that sometimes the most or even only impairing part of a mental health condition a person identifies can be tackled by coaching (like motivation and executive functioning interruptions), and in that case, it's up to personal preference about approach!

The pitfalls of therapy without coaching

• Insight without action: understanding why you do something but still being stuck can be extra frustrating (though not uncommon - information alone doesn't ignite change)

• Therapy sessions may become a revolving door of "I didn't do the thing again," which, even when held with grace and compassion by a therapist, can equate to stagnancy

  • Sometimes we just need a change of pace/scenery/interaction!

• Missing real-time experimentation with systems that fit your cognitive style

• Feeling good about self-awareness but frustrated about daily-life chaos

How do ADHD coaching and therapy complement each other, then?

Coaching can translate therapeutic insight into tangible action steps. Therapy helps coaching strategies stick by addressing emotional blocks. For example, your therapist might help you process childhood experiences that activate fear of asking for help, they check in with your coach to let them know that theme came up, and your coach encourages you and supports you in drafting and sending the actual email asking for help.

If you only have access to coaching, consider flagging emotional roadblocks and journaling them for self-reflection or future therapy. Look for coaches with trauma-informed training (and think through what "trauma-informed" means to you so that you can ask in a consultation whether your definitions match). If you only have therapy and behavior change is a goal that is high-priority, ask your therapist to incorporate behavior experiments and practical accountability. For example, sometimes my clients intentionally pair our session time with taking their medication so that they don't forget. Therapists are equipped to shift our structure to meet your needs if you ask. Even though I'm not a "worksheet therapist" and I don't adhere to rigid modalities, I can work in more concrete task-oriented ideas and skills. We just have to collaboratively decide what, when, and where. You can also use peer accountability or low-cost and free virtual ADHD groups for strategy building and body doubling. If you do have access to both coaching and therapy, think about allowing your providers to share notes and update each other on important insights, challenges, and setbacks (and feel free to ask for clarification about what this would sound like if you're uneasy about it). Use therapy to process why strategies felt hard and coaching to adjust how you'll try again.

In an ideal world, therapy and coaching would work together like our minds' emotional and logistical support teams. In reality, though, we often have to work with what we've got, and understanding the limits of each can help you fill in the gaps in other ways.