Overcoming Shame in Adult ADHD: The Power of Schema Therapy

Credit: iStock Image Source

Source: Credit: iStock Image Source

Carlos*, a 35-year-old married man working in the healthcare field, has been grappling with symptoms of attention-deficit hyperactivity disorder (ADHD) for most of his life without a formal diagnosis. Despite his intelligence and potential, he consistently falls short of his expectations in both his career and personal life. However, there's something deeper at play than just these challenges—shame.

Feeling discouraged, overwhelmed, and stressed, Carlos sought help at the encouragement of his wife. While he had never been diagnosed with ADHD, his wife suspected that his struggles extended beyond mere anxiety or depression, possibly involving focus and organizational issues.

After a comprehensive psychiatric assessment, which included a review of his lifelong symptoms and current struggles, I diagnosed Carlos with ADHD. My recommendation was to initiate medication for ADHD and to commence therapy to address his underlying shame.

Understanding Shame in Adult ADHD

Shame is a frequently overlooked aspect of adult ADHD. It arises from a lifetime of perceived failures, missed opportunities, and a persistent sense of not measuring up to societal or personal standards. For Carlos, this shame takes the form of a belief in his inherent defectiveness—a core schema deeply ingrained in his psyche.

Traditional talk therapies often fail to effectively address the underlying schemas that fuel shame in adults with ADHD. This is where schema therapy, developed by Jeffrey Young, comes into play. Schema therapy targets maladaptive schemas that are deeply entrenched emotional patterns developed in childhood that continue to influence thoughts, feelings, and behaviors into adulthood.

Addressing Shame Through Schema Therapy

1. Early Phase: Understanding the Shame Schema. In the initial stages of treatment, Carlos and I delve into the origins of his shame. We explore how his childhood experiences, combined with the challenges of ADHD, have shaped his beliefs about himself. By identifying triggers and core beliefs, we establish a foundation for healing.

2. Middle Phase: Challenging and Restructuring. Here, we actively challenge Carlos' shame-based beliefs. Using techniques such as cognitive restructuring and experiential exercises, including imagery, chair work, and role play, Carlos learns to recognize the distortions in his thinking and replace them with healthier, more adaptive alternatives. This phase is pivotal in breaking the cycle of shame and self-blame.

3. Later Phase: Healing and Integration. As Carlos progresses, we focus on cultivating self-compassion and acceptance. Through mindfulness practices and imagery rescripting, Carlos learns to nurture his wounded inner child and develop a more balanced view of himself. He begins to see his ADHD not as a defect but as a unique aspect of who he is.

The Journey

Through a combination of ADHD medication management and schema therapy for shame, Carlos experiences significant changes in his life. As his shame diminishes, he rediscovers his sense of self-worth and agency. This newfound confidence permeates every aspect of his life.

Carlos' journey exemplifies the power of addressing shame in adults with ADHD. As his shame recedes, so do the barriers holding him back. His self-esteem improves, paving the way for personal growth and fulfillment. Professionally, he has become more assertive and decisive, enhancing his productivity and earning the respect of his colleagues. Most importantly, his marriage flourishes as he learns to communicate openly and authentically with his wife.

Carlos' journey underscores the importance of not only addressing ADHD with medication but also seeking effective treatment to confront shame and embrace one's true potential.

To find a therapist, visit the Psychology Today Therapy Directory.

* Details of cases have been altered to protect the confidentiality of any and all individuals.