Radical Acceptance Meets Executive Function

My approach to helping women with ADHD and other brain-based challenges is different than many others—it combines the concept of radical acceptance with a minority mental model of counseling.

After more than 30 years of counseling women with chronic and severe executive function and organizational challenges, I want to help other mental health professionals understand the importance of shifting from a pathological or medical lens to a person-centered point of view. This approach measures the success of these woman’s lives not by the decrease in their symptoms (which is helpful) but instead by how they can continue to lead fulfilling authentic lives; the goal is not just getting over their struggles but developing a healthy relationship to them.

Women with the executive function challenges of ADHD are the primary group that often are seen through a narrow lens when experiencing chronic and severe organizational, memory, and attention difficulties and differences that disrupt their lives and functioning. There is, however, an increasing need for professionals to also understand and apply an expanded frame to women who are aging and experiencing new memory challenges as well as women who are actually becoming diagnosed with some form of cognitive impairment or dementia.

I consider these changes and challenges other manifestations of neurodiversity. This conception can help us help these women move toward a new level of “radical acceptance,” where women move toward accepting what is true in their lives. I believe that professionals who see these women as continuing to be themselves; whole women with challenges that affect some areas of their functioning, can help them move toward living well even with these real difficulties, without letting the difficulties define who they are.

The goal then becomes to help these women, whether their executive function challenges are chronic or new, to see themselves with their full array of enduring characteristics and help them accept of all of who they are instead of disparaging, disowning, and disavowing large parts of themselves.

Accomplishing this requires that we acknowledge the influence of culture on one’s self-image that results in internalized stigma and shame. A framework of minority mental health takes into account the larger culture’s negative view of differences and difficulties. This view considers the toxic messages these women absorb through a process I have coined, neuro-bigotry, in which women with organizational and attention difficulties are judged by outer appearances and then internalize a distorted lens through which to view themselves. The professional helping this woman can counter these messages by identifying these messages and allowing for and embracing differences while at the same time helping to find a way to provide support for her difficulties. When this is the goal, a woman’s strengths and other important enduring traits that are often overlooked, are kept intact regardless of the challenges.

I have found in my thirty years of counseling these women, when the internalized negative view remains unchallenged, a woman frequently hides her need for help and withdraws, thereby depriving herself of the very support that could help her continue to make a contribution and lead a fulfilling life with connection and meaning. These women tend to be painted by their family, friends, and/ or colleagues with a broad brush, often overlooked and disregarded. The process I encourage for women with these challenges involves “untangling” their brain challenges from their core sense of self.

Below are seven ways to begin thinking about how to help your women clients with brain-based challenges, whether chronic from ADHD or new from aging or cognitive impairments.

1. Help them identify or develop people around them who can support them and provide assistance with tasks that present severe challenges. Instead of encouraging a person to just get “organized," help family and client to understand which tasks need to be delegated due to overwhelming executive functioning difficulties in particular areas.
2. Validate and help them process feelings of loss or shame or resistance from family as a result of their severe disorganization.
3. Focus on helping these women maintain or develop what is strong and emblematic of who they are, i.e. their core selves that transcend these brain-based challenges.
4. Encourage a whole self-view, where neither their challenges nor their strengths are discounted or minimized.
5. Develop goals for the woman you are working with to develop more of her authentic self even though and even while she is experiencing memory or organizational deficits. Reinforce the idea that while these are difficult to live with, they are not who she is and don’t need to define her.
6. Help devise and implement plans to modify her environment, not for the sake of organization alone, but also to increase ways for her to express herself—her talents, interests, connections in new ways.
7. Move away from an over-focus on symptom elimination as the most important measure of successful treatment or focus of treatment. Instead, help her move toward increased connection, vitality, and an ability to contribute to the world in a way she finds meaningful without the excessive stress of executive function challenges that overwhelm her resources and fill her with shame.

Above all, I have found after so many years of working with these women that we focus on healing—which is different than curing. Healing means to restore to wholeness. That is the goal to remember for the woman with brain-based challenges—for her to be able to see and hold the truth of all she is, even though and even when she is experiencing difficulties with memory, attention, and organizing.

Finally, remember and reinforce the idea that the disowning of oneself is far more destructive for women than living with the chronic disorganization and executive function difficulties that result from aging, ADHD, or other brain-based challenges.