Practices

Put something small at stake and you turn up more. Groups that charge a token amount get better attendance than free ones, and the same trick works on yourself.

It does not have to be money. Book the class you would have to cancel a day ahead, tell a friend you will meet them there, pay the small deposit. The…

If cognitive behavioural therapy is the approach you keep being offered for ADHD, part of the reason is that it is easy to measure. It has good evidence behind it, and being the most studied is not the same as being the only thing that helps.

Structured, session by session approaches produce tidy numbers, so they get trialled more often and written up more often. That leaves quieter…

The change mostly happens between the sessions rather than in them. Catching a thought where it actually turns up, at the kitchen table or in the car park, is what makes a new one stick.

Make it small enough to survive a bad week. One thought written down as it came, and one line underneath saying what else might be true. If you have…

You are allowed more than one feeling about the same thing. Relief and grief when someone dies. Love for a job you would walk out of today. Neither one cancels the other.

A lot of the distress is not the feelings themselves but the argument over which one is the real one. Try saying both plainly, out loud: I am…

If your only system for remembering things is your head, of course you are anxious. Nothing is safe in there and some part of you knows it.

Some people hold everything mentally because letting go of it feels like the thing will stop existing. The answer is not trying harder to remember.…

A reward that is far off has almost no weight in ADHD. Tying the task to something you actually care about gives you a reason that does not depend on the payoff arriving soon.

So instead of 'I should file these', try 'I want to be someone my family can rely on, and this is part of that'. The other half of this approach is…

When someone has gone flat, the question is not what they ought to be doing. It is what still has any life in it for them, however small or unimpressive, and then how to get more of that.

Activities handed out from the outside do not lift much. Someone who brightens talking about their car, or a cousin, or a game has just given you the…

If you run a group for people with ADHD, keep it to about five or six, or bring in a second facilitator. Past that you spend the session keeping order instead of doing the work.

The limit is not really about behaviour. It is about how many people one person can genuinely track while also holding the thread of the session.…

Sitting in a room with other people who lose their keys, cry at nothing and hate themselves for both does something no explanation can. You find out you were never the only one.

Groups also do encouragement better than a therapist can. When someone with the same trouble asks whether you managed the homework, it does not land…

When the words for feelings are not there, ask for a number instead. How much did the handwashing take over this week, one to ten, is a question someone can answer on a bad day.

A number asks far less of a person than a description, which matters when putting feelings into language is hard for them, and you still end up with…

Agree a short phrase to use at home. Saying I am having OCD worries tells a parent what is going on without handing them the worry to solve.

Once a parent hears the details they will nearly always try to help by answering, and answering is the thing that feeds it. A label gives them…

The thing your obsession keeps circling is usually something you care about a great deal. Contamination worry sits on top of wanting people safe, and harm worry sits on top of never wanting to hurt anyone.

This is worth saying out loud, because most people carry these themes as proof that something is rotten in them. Read the other way round, the theme…

What the thought is about matters far less than what happens next. Germs, illness, something too silly to say aloud: the machinery running underneath is the same in each case.

Chasing the content puts you in a game that cannot be won, because the moment one worry is settled the next turns up wearing different clothes. The…

Notice how when one worry is finally settled, another takes its place. That pattern is the thing you are actually dealing with, more than whichever worry is currently in the chair.

Most people work this out for themselves long before anyone names it. Naming it still helps, because it gives you something to watch that is bigger…

Some worries are perfectly reasonable, and settling them still will not settle you. Someone living where the storms come can build the kit, check the kit, and find the worry has quietly moved on to something else.

This one is worth testing on yourself, because it removes the argument that you would be fine if only the fear were irrational. The probability was…

Plenty of people quietly believe that thinking about something bad makes it more likely to happen. It has a name, it is a known part of this condition, and having the belief does not make you dangerous.

Hearing that it is a documented feature tends to do more than any argument about probability, because arguing about odds is a game the doubt plays…

It can help to give the parts of your brain jobs. The front of your head is the manager, the memory system is the librarian, and the alarm is a security guard who is good at his work and far too keen on it.

The point is not accuracy, it is having language you can reach for quickly. Saying the guard is overreacting again gets you further than trying to…

If stopping the ritual is out of reach for now, do it differently every time. Different order, different hand, different room, as long as it is never the same twice.

Compulsions take a lot of their grip from exactness, and disturbing the shape loosens that grip while you are still allowed to do the thing. It also…

Offer choices rather than instructions. With a problem that runs on control, being told what to do gives that control somewhere to dig in.

Two or three real options, the trade-offs said plainly, and then the pick is genuinely theirs. That holds for the big decisions too, like moving to a…

When obsessions start early and dig in deep, ask gently what anxiety looks like elsewhere in the family. Often there is an undiagnosed parent, and often that parent is helping in ways that keep the whole thing running.

None of this is about blame. A parent who checks the locks for their child, answers the same question fifteen times, or arranges the evening around a…