How the Mental Health Field Falls Short in Helping Us at a Deeper Level – 096Mar 03, 2022
If you’ve ever been disappointed or frustrated with the information or care you’ve received for your mental health and well-being, stay tuned.
Carl Jung said, “I feel it is the duty of one who goes his own way to inform society of what he finds on his voyage of discovery.”
Jung’s quote inspired this episode. I feel it is both my duty and moral obligation to share with you what I’ve found out that I trust will benefit you and help you create a better quality of life. So, here’s some hard truths here in the USA:
In this episode Dr B talks about:
- DSM-5 for diagnoses
- ICD-11 for insurance billing and diagnoses
- Lack of appropriate training in mental health field
- Learn about 13 Signs Weak Executive Functioning Is Holding You Back
- Find out what you can do about your weak executive function skills even without a diagnosis
Developing your Executive Function Skills and shifting your limiting beliefs is the fastest and most effective way to overcome ADHD limitations, find focus, gain confidence, and a newfound freedom in your life!
My mission is to put an end to the worldwide needless suffering of adults with ADHD and those with under-developed Executive Function Skills - whether from ADHD, chronic depression or anxiety, trauma, addictions, or chronic illnesses. And, you don't need a formal diagnosis to know you need help developing these executive function skills in order to greatly reduce your suffering.
Full Episode Transcript How the Mental Health Field Falls Short in Helping Us at a Deeper Level — 096
If you've ever been disappointed or frustrated with the information or care you've received for your mental health and well-being, stay tuned
. Carl Jung said, “I feel it is the dyty of one who goes his own way to inform society of what he finds on his own discovery.” Jung's quote inspired this episode. I feel it is both my duty and moral obligation to share with you what I've found out that I trust will benefit you and help you create a better quality of life.
So, here's some hard truths here in the USA:
1. The DSM-5 is the manual that clinicians use to diagnose mental health conditions.
a. Adult ADHD is the only diagnosis that includes executive function skill challenges and that makes up about 80% of the ADHD diagnosis.
b. Chronic depression, anxiety, trauma, addictions, illnesses and more often times result in under-developed executive function skills, yet the list of symptoms indicating these under-developed skills is not part of the diagnostic criteria for any of these conditions.
c. There is no diagnosis of “executive function disorder or dysfunction or under-development” or anything like that in the DSM-5 (2013).
d. It appears that the only way to get to your executive function skill issues is by way of a diagnosis of adult ADHD. And there are adults who don't have ADHD and yet they do have under-developed EF skills.
2. The ICD is a coding manual that is used for medical condition diagnoses, as well as insurance billing for medical and psychological conditions. a. The ICD-11 (2022) just added ADHD to its list of diagnoses. b. There is now a billing code for “impaired executive functioning.”
3. There is no academic requirement for any training pre-license nor post- license about adult ADHD. a. This means that the thousands of mental health professionals licensed to practice won't know how to identify, diagnose, or treat adults with ADHD unless they seek training outside of their mainstream education (as I did).
b. Many adults spend years working with a therapist, who doesn't bring up ADHD because they lack the training. Instead, it could be you who asks them if they think you have adult ADHD. Perhaps they agree with you but not because of any formal training (if they don't have it).
c. If a mental health professional is seeing couples where one or both have adult ADHD, and don't have any specialized training in adult ADHD, they are working with them as if the ADHD doesn't exist, and giving meaning to situations that isn't necessarily correct.
4. I haven't explored all the international licensing boards; only those in the USA and what I've shared is what I found.
For other diagnoses and treatment where executive function skills are under- developed, such as depression, anxiety, trauma, addictions, traumatic brain injury, and chronic illnesses:
1. The development of executive function skills is derailed in other diagnoses, just as it is with adult ADHD.
2. None of these other diagnoses include the same list of executive function skills that adult ADHD does.
3. If you've been diagnosed with any of the conditions, I mentioned earlier other than ADHD, mental health professionals wouldn't typically be focused on your executive function skills; they would be focused on the “symptoms” of your depression or anxiety and their elimination. Yet your chronic depression or anxiety could be due in part to your under- developed executive function skills.
More to consider in case you want to get diagnosed with impaired executive functioning:
1. Mental health professionals in the USA primarily use the DSM-5 for diagnosing, but reply on the ICD-11 codes for insurance billing purposes. This can cause confusion and conflict when a disorder is classified different (or not at all) from one manual to the other.
2. In the case of EFD, there is no code in the DSM-5 and so no diagnosis can be made using that Manual.
3. With no code in the DSM-5 for EFD and the billing code for it buried in the ICD-11 and called "impaired executive functioning" — it's no wonder that no one is getting diagnosed with EFD along with their other diagnoses.
4. In case you want to read about this code for 'impaired executive functioning” is can be found via online search as ICD-11 MB21.7. The description reads: Impairment in higher-level cognitive abilities, such as planning, sequencing, concept formation, abstracting, and decision-making. Does this sound like what you've been experiencing?
5. And what is called the "parent code" can be found as ICD-11 MB21. The signs, symptoms, or clinical findings involve cognition (which is thinking) and are indicative of a disturbance in mental abilities and processes related to attention, memory, judgment, reasoning, problem solving, decision making or comprehension, or the integration of these functions.
6. This description plus the other represents so many of the adults I work with who don't have a diagnosis of EFD. Do you understand now why it's not your fault and yet it is your responsibility to take care of this if you don't want to continue to have these limitations and challenges for the rest of your life.
7. And do you understand how it's not the mental health practitioners’ fault either, since they aren't made aware of the gaps in their education, so they can fill in the gaps. However, it is their responsibility to do no harm to those they are attempting to help. And not having training in adult ADHD and especially EF skill development is a huge missing piece.
So, it's not important to wait for a diagnosis to help yourself with your EF skill development.
There are no skills in pills, so waiting for medication won't help the development of these skills. And, if you see someone who doesn't know about the diagnostic code for what you are challenged with, you will most likely come out with another diagnosis, such as depression, anxiety and perhaps ADHD, but not EFD. And, in most all cases, won't be given a recommendation to get EF skill training to remediate the problems.
This condition is real. It has a diagnostic code. And, it is impacting millions of adults around the world — and perhaps you are one of the million. It isn't being identified and addressed properly, and leads to so many other problems as a result of the lack of awareness of the diagnosis and the proper training to develop EF skills. It's easy to see from this perspective how things have gotten so difficult for so many of you. And, you are not powerless to change the course of your life. If did, and so can you.
Let me go a little deeper with what Executive Function actually is, what a disorder of EF is, and what you can do to course-correct this situation for yourself.
Executive Function is defined as a set of skills that regulate and control your ability to accomplish tasks and get things done. Well-developed executive function skills enable people to plan and organize information, and then to act on that information. An Executive Function Disorder (EFD) interferes with your ability to organize your thoughts, remember important facts and events, complete tasks, and so much more. You can learn more about the signs of under-developed EF skills by getting my free resource: 13 Signs Weak Executive Functioning Is Holding You Back. The link is in the show notes.
The impact of Executive Function Disorder can be overwhelming to you as an adult. No matter how hard you try, your under-developed EF skills render you unable to complete the simplest tasks at times. You might find yourself in a state of panic when you can't find your car keys to get to work or the work assignment you spent days on and its due today. You couldn't even figure out how to start it let alone finish it up. Your desk is such a mess that you can't find the important bills you need to pay and you know they are already past due. You may slip into a state of mild or deeper depression because you are missing out on opportunities and time is slipping away, day-by-day. You know that living with a structure and schedule would be great for you and you can't seem to manage to create one that lasts longer than half a day. Those around you who also have under-developed EF skills understand you; the rest of the people in your life just don't. You may be losing friends, jobs, marriages and any sense of self-worth because you don't see yourself improving; your life is only getting more difficult to manage.
Again, not blaming anyone, just pointing out the many losses. Is your marriage suffering? Are you in debt or going bankrupt? Was it easier to manage your life when you were single, and before you had kids, and now that you are responsible for more than yourself, you just aren't able to successfully juggle it all?
The typical steps that are suggested to take to help with executive function disorder are appendages or band-aids. To-do lists require you to actually do what's on the list. Seriously! If you could, you would. And even if you do here and there, you lack the consistency that adult living requires. And, verbal prompts from others may no longer be possible because they are tired of that responsibility. Or, they feel like you are just another kid they need to monitor, which is horrible for a marriage.
So, what's the answer? It's simple, from my perspective: develop your under- developed EF skills in such a way that they replace your current, poorly developed skills, and that they become internalized so they are as automatic as your current ineffective skills. Most of the ways we have all found to get through our days and survive with the way things are isn't sustainable. It leads to burnout and worse. To me, trading in under-developed EF skills for well-developed skills is a journey worth taking. Otherwise, the idea of having to consciously remember what you need to do to be able to do your life on your terms is exhausting. I trust you understand what I am saying.
ADDventures In Achievement Foundational Skills program or AIA-FS for short, was developed to address and transform the under-developed EF skills that more and more adults are surfacing with. These are core capabilities such as working memory, initiating, inhibiting, conscious focusing, emotional control, task monitoring and more. Additionally, AIA-FS addresses the pre-skills needed to be more successful with the core skills, as well as your limiting beliefs and negative sense of self or identity. When all of these ingredients come together, as they do in AIA-FS, it is a recipe for success. The link is in the show notes for more information.
Our self-confidence is a direct result of our self-competence. And if we aren't competent, we can't really be confident. We can fake it; but that is exhausting and not a sustainable way to live. Plus, we know we are faking it and fear we will be found out and then what? That's a horrible way to live. I know; I lived that way for years and was able to hide my short-comings and look like I had it all together until I didn't. I trust you can relate.
How much time do we have? Not much. So, let's get to it.
ADHD coaching has its place, just as therapy does, however, they both fall short in helping you at a deeper level. In therapy you might get to the core issues and talk about them, but not receive strategies or skill building techniques. You might talk a lot about what you need to do but not how you can actually do it. It's not the same. With coaching, you are taught, skills and methods for your situation, however, if you don't have the basic EF foundational skills to enable you to learn the skills of your sport or life, you will end up frustrated and possibly quit.
If I am an athlete in training with a coach to help me up my game and compete in the Olympics, that coach is observing me first and then teaching me to modify what I am currently doing so that I do what will get me to the Olympics. All of that is external. Like a golf swing or baseball swing that is off in timing or angle, the coach sees that error and calls it to my attention and then coaches me on what to do instead to get the hit. Again, all of that is external. They may address mindset or other internal things and make note of them, however, if they aren't teaching me how to transform what's holding me back, no matter what it is, then I will still be held back and not achieve the success I seek.
What if the reason that I am missing the ball when up to bat or unable to sink the ball when on the putting green is mental or emotional and not behavioral? What if the cause of the misses are my limiting beliefs and poor self-identity? Does the coach understand who I need to BE first, so that I can DO what s/he wants me to do to make the hit? Can the coach help me with those aspects? Perhaps. It all depends on their training and approach.
I stopped thinking of myself as an ADHD coach and started thinking of myself as a transformative coach because it's the transformation that matters to you and to me, and without addressing what is needed for that transformation to happen, it just won't happen. I am uniquely qualified to guide you through your transformational journey, and I'll be sharing about that in a future episode, so keep listening.
As a world composed of many societies, cultures, beliefs and qualities of life — the one thing I know is that we are disabling those who inhabit our planet, with labels and disorders for all. It is true that many of us have challenges with our thinking, behaviors, feelings and more — however, these challenges are behaviors, not identities; yet the labels would have us feel that they are who we are. It is not. We are precious children of this universe and our value is a given because we were born. We are pure potential and were filled with wonder, awe, curiosity, silliness, and more — before it was bred out of us. We have learned to look to others for permission to be who we came here to be, rather than turning inward to ourselves for that permission. I was this way years ago and no more for me.
There is a hollowness in the walking dead. That's what I used to call adults when I was a kid. There was no spark or passion or excitement in their eyes. It made me sad to think that was going to be me years down the road. There was no way I wanted to join the ranks of the walking dead. I knew I would get older and have adult responsibilities to be accountable for. However, I decided that I could and would find a way to BE that responsible adult while retaining the childlike wonder that I promised would go with me for my entire lifetime journey. I look at the achievement of this as one of my greatest wins. I love my childlike nature, even at 70. I remember my mother in her 80s. I remember when she and I went to the beach one day and she was so quick to take off her shoes and socks and hop into the water. There was that childlike wonder. She wasn't one of the walking dead. She had kept her precious childlike wonder alive throughout her lifetime. I was grateful to have recognized it in her, and to have preserved it within myself as well.
For over 30 years, I have worked with adults who came to me because of their ADHD, anxiety, depression, trauma and more, and underneath each of those presenting issues, we uncovered the deeper and more significant issues.
The solutions that were offered to me when I sought healing for myself weren't helpful, for the most part. They were band-aids and temporary fixes to a much deeper wound. Over my lifetime, I have sought the deeper solutions; seeking the causes and the possible solutions for healing. Over the years I have created many games for myself to keep life fun and engaging. I have taught myself and others to see the humor in human existence. We are human beings having a spiritual experience and spiritual beings having a human experience. And, we are all doing the best we can with what we have in any given moment; there is nothing more that we can do until we can.
And...when we develop our EF skills, and eliminate our limiting beliefs and create a new identity to move into and it all comes together, life is amazing.
I don't do superficial. I didn't learn how and I am not interested in learning how. Living full out is about depth not superficiality. After a lifetime of being beaten down and shamed, ridiculed, bullied, and outright abused, you need a safe space with the right ingredients to heal and continue to grow. To focus on the solutions rather than the problems. I designed the AIA-FS program to be exactly that.
And let me be clear. This is not a class or a course. It is not superficial or a quick fix. It's a comprehensive 7-month transformational program that guides you to develop your EF skills and EF pre-skills as well as provides you with the scaffolding support and strategies you need to actually develop your EF skills and keep what you achieve. That's right — keep what you achieve. When I'm training, I offer the specifics of what to do and how to do it. When I'm coaching, I'm not telling you what to do. I'm asking you deeper questions and eliciting a level of awareness in you so that you can evolve past where you left off years ago. It's the opportunity of a lifetime, if now is your time.
So, this is a perfect transition to the celebration of your WINS. Please don't short- change yourself and check out here, or think that it's pointless or stupid to reward yourself for all the little things you're “supposed to do." There are important reasons to celebrate often and intentionally. Are you really going to make yourself wait for something HUGE to happen to celebrate? Does something HUGE happen every day? Probably not! But the kind of WINS I'm talking about can and often do. That means that you can increase your dopamine levels and motivation every day by celebrating your WINS; big and small!!
So, what's it going to be for you today? What are you going to celebrate? Maybe you decided to slow down so you could learn and integrate rather than just consume information; that's a fantastic win. Perhaps you made a decision to change one thing that isn't helping you live the life you want; that's a great win. Maybe you're coming to believe that real change is possible for you and you are ready for it; that's an awesome win. You get the point; celebrate all of them; big and small. And none of this “half-hearted celebrating”; you've got to mean it. Exaggerate your emotions. YES!!!! WOW!! AWESOME!! You want your acknowledgement and celebration to register in your neurology with the power to move you and shift your state. Many of us need a higher level of stimulation or intensity for things to register. So, if that's you, give that to yourself and exaggerate your celebration so you can actually feel it and benefit.
A Favorite Quote: Ralph Waldo Emerson said, “Do not follow where the path may lead. Go, instead, where there is no path and leave a trail."
This quote describes my life's journey. The paths I traveled didn't lead me to a deeper knowing or the quality of life I was seeking. Instead, I decided to go where no path existed and leave a trail for you; if that's of interest to you.
We are all 100% responsible, 100% of the time for the outcomes in our respective lives. I've learned to ask myself "how can I” whenever I come to a crossroads instead of creating defeat for myself. You can learn to think this way as well. It's a skill.
Whether you're learning from my podcast episodes, free resources, or working with me directly, you are in my world and I'm here to serve your needs. It's up to you to take action so things can change for the better for you. And they can only change for the better for you if you change. As Jim Rohn told us, he can't do our pushups for us; we have to do them to benefit.
So, here's the path today. Make it a priority to get your copy of 13 Signs Weak Executive Functioning Is Holding You Back. Next, get on the Waitlist for the AIA- FS program to learn how you can build your EF skills and strategies the Dr B way. Enrollment will be opening up sooner than you think, so get prepared now so you know if this is your time and your opportunity knocking. I hope it is and that we will be working together soon.
And, if you want a place to hangout with like-minded listeners to my show, you can ask to join the Living Beyond ADHD FB group. Be sure you are mindful when asking, so you answer the few questions we ask, so you can be approved into the group. Otherwise, it won't happen. And, once you are a member of the group, be sure to visit often and engage with us. Joining and never visiting doesn't help you at all. This is about follow through for you. The FB group isn't a training group, although there are great posts to learn from and a supportive community to surround yourself with. As a member of the Living Beyond ADHD FB group, you will hear about training opportunities sooner, unless you are also on the AIA-FS Waitlist. However, you do have to open and read your emails in order to know about the new opportunities. We won't flood your inbox with tons of emails, however, when we do send them, they have important information in them for you.
If you enjoyed today's episode, please share this podcast with others. I would also be grateful if you'd rate the show and write a positive or inspiring review on iTunes so I know I'm meeting your needs. That helps the ratings and more people like you will get to know about the show and be helped. That's you making a difference in others' lives and that means a lot to me.
Are you ready to stop your needless suffering? Have you had enough? Be sure to check out the show notes for the links and opportunities available to you. I have real solutions to the challenges you are experiencing. Time is our most precious asset, and none of us have time to waste on solutions that don't work. I would love to help you realize a new freedom, that is...if that's of interest to you. Thanks for listening... Until the next time... Bye for now…
Resources referred to in this episode:
• Free PDF - 13 Signs Weak Executive Functioning Is Holding You Back: https://www.drbarbaracohen.com/Executive-Function
• Executive Function Information List & AIA-FS Program Information: https://www.drbarbaracohen.com/AIA
• Living Beyond ADHD Facebook Group: https://www.facebook.com/groups/livingbeyondadhd
- First, get your copy of 13 Signs Weak Executive Functioning is Holding You Back:
Next, find out what you can do to change this for yourself & how AIA-FS can help:
There is no obligation to being informed about an amazing opportunity that changes lives!
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- Follow me on Dr B Facebook Page and enjoy live videos and more
- Follow me on Instagram and enjoy relevant resources
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