Despite ever-mounting evidence of the profound and pervasive influence of attentional disorders in a range of public spheres, from depression to substance abuse, from the educational system to the penal system, these conditions remain poorly understood, inaccurately diagnosed, and ineffectively treated. This is due, in large part I believe, to the complicated relationships between ADD and procrastination, dissociation, and trauma. Although this is a complex topic indeed, I will do my best to be brief.
Several key points:
1. People with ADD can often pay attention quite well, especially to things that matter to them.
2. Not all adults with ADD procrastinate, and those who do are quite uneven about it, so often it looks simply willful.
3. Stimulant medication does not routinely resolve issues of procrastination and disorganization. Medicine may help you to focus, but it will not choose for you what to focus on, nor will it automatically compensate for years spent phobically avoiding organizational issues.
4. Each and every individual faces the maturational task of integrating the primary right brain experiential aspects of themselves with the secondary left brain (verbal, judging, and planning) aspects of themselves. When this integration is successful we are both planful and spontaneous, goal-directed and process-oriented at the same time, and we can be both effective and authentic. When it is not successful, logic and emotion are at odds, and distractibility is king.
5. Trauma interferes with the natural process of merging our planners and doers, a deficit which interferes mightily with the development of sound and reliable executive functioning.
Growing up with attentional issues is inherently traumatic. Socialization is often difficult, and chronically high levels of negative feedback can easily create a rift between the judging/planners and the feeling/doers. Procrastination is the inverse of effective executive functioning, and it is my contention that it is the nature of the relationship between these parts of the self that is the mediating factor in whether or not adults with ADD are stuck in this particular fashion.
Attentional deficits, dissociation, and impaired executive functioning feed on each other in a negative spiral because each is required to repair the others. It takes focus to reintegrate dissociation, it takes integration to enhance focus, and it takes focus and integration to remediate developmentally delayed executive functioning.
Although medicine may improve focus, it will not address dis-integration and dissociation, without which the elimination of procrastination is unlikely indeed.There are a number of therapies, largely developed by non-M.D. hypnotherapists, which effectively address dissociative illnesses. Dissociative disorders are a group of conditions that are characterized by a dysfunction in the way parts of the self communicate with each other and the way in which they move in and out of conscious awareness. They include various sorts of amnesia, multiple personality disorder (also called dissociative personality disorder), and post traumatic stress disorder (PTSD). Both ego state therapy and EMDR were developed to address profound dissociative conditions that result from truly horrible circumstances: rape, torture, sexual and physical abuse. I have found that these therapies, modified slightly, are also effective in resolving much milder, though chronic, traumas and the poor executive functioning that it brings in its wake. These techniques are not monstrously complicated, they make sense when explained well, and with a little imagination and creativity they can work extremely rapidly to reverse decades of dis-integrated, dissociative, procrastinational behavior. They mostly involve personifying and visualizing aspects of yourself, and then dickering with them as if you actually liked them and cared about them. It’s kind of fun, it can be amazingly moving at times, and once it is understood, it either starts to work in 3-5 sessions, or it doesn’t.
The problem for adults with ADD is that most prescribers are not interested in providing therapy themselves and unfamiliar with or skeptical about the directive, experiential, Neo-Ericksonian therapies like EMDR and Ego State Therapy. The trauma specialists, on the other hand, are not especially trained in diagnosis generally let alone in the nuances of the oh-so-slippery adult with ADD.
At the present moment, we here at Greenpoint Psych and theattentiondoctor.com are developing a unique, innovative, comprehensive approach to the treatment of adults with ADD, a mindfulness/hypnotherapy group experience that includes optimizing medication regimes and the use of intra-group coaching among members. This group treatment addresses the often subtle but very powerful role of dissociation in creating, maintaining, and exacerbating the procrastination and disorganization so commonly displayed in this huge population.
For further information on this and other subjects please see my book Getting Unstuck: Unraveling the Knot of Depression, Attention, and Trauma, or listen to one of the talks available here on the site. If you are interested in the unique innovative therapy program, groups are forming regularly. Get in touch.