ADHD and Child Psychotherapy 2/2: The Relational Experience

My previous blog described some of the therapeutic activities that can support a child with an ADHD diagnosis. Here, I explore in more depth how therapy of this kind can have a positive impact on the child’s relationships with peers and teachers.

The key to therapy is not so much what the therapist and child do, but rather how they are together. It is the quality of the relational experience that has the most impact on the child. For example, a child with ADHD may find school a struggle. The classroom can be a fraught place as the child struggles to concentrate, or to manage without frequent adult response and interaction, and to keep still while concentrating. This makes life challenging for the child, the teacher and their peers. They may struggle to make enduring friendships and may also often be on the ‘wrong side’ of the teacher. Being seated separately from the rest of class as a classroom management strategy can lead the child to feel that are not liked, or troublesome. 

Feeling that you are wanted, enjoyed and liked is a key component of good self-esteem, and of the resilience that supports any person in managing the ups and downs of life. Too many negative relational experiences can increase a child’s emotional fragility.

It is the therapist’s primary task to build a positive therapeutic alliance with the child. They can do a range of things to make this possible – apparently ordinary comments such as, “I’ve been really looking forward to playing that game again today,” or, “That was really fun – you made up a great game there,” when authentically expressed, are all positive reinforcement reducing the child’s internalised sense that they are a source of difficulty. Additionally, if the child has fun, then endorphins such as serotonin and dopamine are released. These feel good and also aid optimal brain function, so may lead to the child having more constructive learning experiences. Direct experiences of reciprocal, pleasurable play can be transferred to the playground with peers. Therapy provides a chance to practice getting along with others in play. 

Therapy can also be a valuable space to let off steam, to not have to repress feelings in the interests of a settled classroom, and give vent to feelings of frustration, anger or injustice at being misunderstood. From such expressions, a child with ADHD can develop a deeper emotional vocabulary and also learn to link their bodily sensations with a particular emotion. This can help them manage their impulses in class, and also communicate to others who are trying to support them.   

One child said, “I can feel the frustration bubbling up in my tummy.”
“What would the bubbles say if they could talk?” I asked.
“I can’t do it!” the child replied, with anger in her voice, which I mirrored and reflected back. 

An experience of being ‘witnessed’, understood and empathised with can provide relief of emotional tension, which can carry over to the classroom. Internalising a sense that there is someone in the school who ‘gets them’, can in itself be very containing for the child.

Whilst confidentiality boundaries must be respected to preserve the privacy of the therapy, a therapist can also be an advocate for the child when there are discussions about support needs – expressing, in reports and feedback, some of what the child themselves may be feeling and experiencing.

Therapy cannot be a ‘cure’ for ADHD but it can be a part of altering the narrative that the child feels themselves to be a bad fit with school. It can help the child to enjoy company and, in turn, to be enjoyed.

Tamsin Cottis’ recent book, How it Feels to be You: Objects, Play and Child Psychotherapy, is published by Karnac.