I am a psychologist with over 35 years of clinical experience. I’ve worked a great deal with individuals with various forms of disordered eating, but my focus in the last twenty years has shifted to individuals with overeating and obesity. While having a considerable depth of past experience, I also try to greet every new client with an open sense of discovery. Instead of jumping to conclusions and making quick diagnostic categorizations, I listen to each client with an open mind and a fresh perspective. I am a perennial student; I am constantly open to new findings and alternative ways of understanding the process of overcoming human suffering.
For more than 20 years I have had a special interest in the assessment and treatment of adult ADHD. Instead of issuing a battery of psychological tests, I assess my patients clinically, looking at the degree to which ADHD symptoms may have impacted their life. This is also done with a careful attention to other conditions which may be mimicking the symptoms of ADHD as well as looking carefully at the many co-occurring disorders which often need to be addressed and treated along with the foundational neurological predisposition of ADHD.
The kind of counseling I offer varies rather considerably depending upon the specific needs and challenges of a given individual. Counseling begins with a thorough understanding of a person’s history and their struggles and successes. It also involves understanding what an individual’s basic beliefs and values are so that the guiding principle becomes orienting them toward living a valued life. My treatment orientation interweaves the three major frameworks I have studied during the course of my professional career. I began as a psychoanalytically-oriented therapist reflecting the training I received as a postdoctoral fellow at the University of Chicago and its associated hospitals. After a few years of practice, my orientation began to reflect more of a cognitive behavioural approach. With greater involvement in dealing with ADHD, my approach also included a variety of behavioural interventions aimed at improving my clients’ repertoire of coping skills. Over the past decade my work has progressively become more informed by mindfulness-based cognitive therapy. In the end, my clinical work is informed by all of these different approaches and I believe is all the richer as a result.
Treatment is a collaborative process beginning with a firm understanding of the person and the life they are currently leading. While not particularly focused on the past, it is clearly important to understand a person’s history since it plays a very large role in the self-limiting thoughts and understandings by which they guide their current life. Focusing on the present also involves acknowledging the impact of the past. Very few people had any clear guidance as they grew up and learned to navigate the world. For example, most people grew up with the mistaken idea that a good life was one that avoided any type of emotional discomfort. This routinely turns into a life dedicated to the process of minimizing emotional distress which in turn tends to be defined by the effort to control emotion. Rather than providing a comfortable and fulfilling existence, this is most typically a formula for unhappiness.
Therapy isn’t just about insight; it’s about identifying self-limiting behaviours, thoughts and practices and creating alternative ways of engaging with world. A person should be able to see changes in their life that makes it not only less distressing but also more fulfilling. There are no easy answers but rather finding ways that more productively engage the person in living the life they want to live.
Every few years I have offered a course in teaching mindfulness skills for individuals with ADHD. While this might seem an almost ridiculous proposition, the majority of participants have found the program useful in achieving both a better understanding of ADHD as well as a set of tools to improve their ability to cope. This course is designed to help people with ADHD live more comfortably with ADHD while at the same time engaging more fully in life. It gives people an opportunity to explore this neurological condition inside a group of peers who have struggled with many of the same issues. We use mindfulness as a framework to understand ADHD as well as a set of skills for coping more effectively.
Mindfulness does not require any particular belief system but instead is an empirically-based set of skills that has been repeatedly demonstrated to improve people’s ability to face the inevitable challenges of life. For over 30 years research has consistently demonstrated that these skills impact not only well-being and stress resilience but also alters brain structure and even such things as immune function.
While meditation practice certainly looks different in an ADHD mind than it does in the so-called average mind, meditation is something that does not require emptying the mind in order to become successful. Mindfulness is about bringing a specific kind of attention to whatever shows up in the mind. In one sense, the very nature of a restless mind provides incredible opportunity to practice the underlying skills of mindfulness.
Since around 2000 I have been interested in the relationship between obesity and ADHD. In a series of studies codirected by myself and my colleague Dr. Lance Levy we have investigated the incidence of ADHD in a series of individuals with BMIs over 40 referred for treatment to a specialist. In very brief summary, we found a significant correlation between obesity and ADHD. In some we found approximately 30% of individuals referred for the treatment of severe obesity to also suffer from largely undiagnosed ADHD. In a follow-up study we also looked at the effect of treatment for ADHD on the subjects’ obesity. Here we found that those successfully treated with medication for ADHD proved to have approximately a 12% reduction in weight over the course of an approximate year long follow-up.