Psychodynamic Psychotherapy for Time Distortion in Attention Deficit Hyperactivity Disorder

Abstract

Psychodynamic psychotherapy does not feature in current treatment guidelines for attention-deficit hyperactivity disorder (ADHD) in the United Kingdom. However, there is some psychoanalytic understanding of the disorder, which is corroborated in current neuroscientific theory, and supports clinicians in thinking beyond the behaviourally biased diagnosis and treatment models. One of the core features of ADHD is distortions in chronoception. This clinical paper therefore explores the psychoanalytic and neuroscientific theories of time perception as a way of exploring a discrete element of the complex idea of executive functioning more generally. It supports therapists approaching such executive dysfunction and to reconsider the treatment guidelines. A case example is used to explore how a transference-, affect- and relationally-focussed therapy can effect lasting change for people with ADHD in a way that behavioural and medication approaches do not. It is argued that such an intervention can improve oscillatory attention between subjective- and objective-time and increase the capacity to self-contain emotions. This brings patients into alignment with reality and restarts their psychic development towards themselves, others, the parental couple and grieving, which stalled in infancy. The internalised schema of the 50-minute therapy session also provides a frame of reference for future tasks.