I treat ADHD in children and adults using cognitive behavioral interventions and by creating good old-fashioned routines at home such as using a calendar or having a centralized location for keys and eye glasses.  But what does a person do at work if their ADHD symptoms are getting in the way of the work? This article by M. Tartakovsky offers several tips that may be used in the office.

ADHD and Work: 9 Tips for Thriving at the Office 
​By Margarita Tartakovsky, M.S.

Adults with ADHD are all-too aware of their shortcomings at work and regularly bash themselves for their inconsistent productivity and sinking motivation. But there are many things you can do to thrive at the office.
For starters, it’s important to recognize that all workers struggle.
“It would be a mistake to assume that non-ADHD or neurotypical workers do not struggle with some of the very same ebbs and flows of productivity, focus, and prioritization difficulties,” said Aaron D. Smith, MS, LMSW, ACC, a certified ADHD coach who helps individuals with ADHD and executive functioning challenges to bridge the gap between their current performance and their potential.
“The difference for ADHDers is that these issues pose a more significant challenge due to the degree of severity in which the symptoms manifest.”
It’s also important to recognize that workplaces are responsible, too. Ironically, many workplaces aren’t optimized for working. As Smith noted, many are noisy and commotion-filled, and have insufficient training and internal processes.
So what can you do?
The key is to focus on your strengths and to mitigate your challenges, said Smith, founder of Potential Within Reach.
You can start by finding the right job for you (if possible). “A lot of challenges can be avoided if the job is right for how your brain works,” said Linda Swanson, MA, PCC, PCAC, an ADHD coach who specializes in working with adults and college students with ADHD.
To help you figure that out, Swanson suggested considering these questions: “What type of work will hold my interest longest? Do I need a lot of variety and action or something on which I can hyper-focus for extended periods of time? Do I work best in a calm, peaceful, minimalist environment, or do I need an environment that is busy and stimulating to my senses? How connected do I need to be to the end product of my work or my employer? What kind of supervisor do I find most helpful?”
It also can be tremendously helpful to get input from a coach or an observant, nonjudgmental friend, since self-awareness can be difficult for individuals with ADHD, Swanson said.
Whether or not you’re able to find the best job for you, below are nine tips to help you capitalize on your strengths and minimize the challenges.
Create structure. “When there are no externally provided anchor points in time or space, someone with ADHD is likely to get lost,” Swanson said. “Since the ADHD brain often does not readily create structure, structure has to be created externally.”
You can establish structure in how you schedule your day and arrange your workspace. For example, a 10-minute walk every two hours can become an anchor point, which reminds you where you are in the day, and helps you to pause and make sure you’re working on what you need to, Swanson said.
An anchor point in your workspace can be a whiteboard to jot down your schedule, ideas, and reminders (something that works great for one of Swanson’s clients). “It’s important that the arrangement work with your brain, and not the brain of your office manager, or you’ll start losing things.”
Know your priorities. “Don’t let the stream of emails, phone calls, and random chatter from co-workers get you distracted from your big-ticket items,” said Smith. How do you know what those are? Smith suggested asking this question: “At the end of the day when I look myself in the mirror, what tasks do I have to complete today to feel satisfied and productive?” These might not be easy or enjoyable, but they are important.
Plan backwards. Swanson shared this suggestion from Marydee Sklar’s course “Seeing My Time”: Ask yourself, “What is the last thing I need to do before this?” until you get to the first step of your project. (For example: “What is the last thing I needed to do before I give my presentation?”) Write each step or task on a sticky note, and put all of them “on your paper calendar so you can see your project laid out before you,” Swanson said.
Get clarity on projects. Smith stressed the importance of making sure you understand the aim and specifics of a project before you start. He suggested taking good notes, and following up by email to confirm the details. “It’s much better to get feedback early on than to realize that you misheard or misunderstood the project midstream.”
For example, one of Smith’s clients was working on a project for weeks before realizing that the objective wasn’t what he thought it was. He ended up being “late with the work and [investing] a significant amount of time on something that he ultimately needed to scrap.”

Match tasks to your energy levels. That is, if your focus is sharpest in the mornings (and your energy levels dip in the afternoons), block out time to work on an important report in the a.m., Smith said. “[I[f you can anticipate these fluctuations in energy, then you can respond in ways that mitigate their impact.”
Decompress before tasks. This is especially helpful if you’re feeling angry or overwhelmed. Smith suggested taking a few minutes to breathe and re-center yourself. “Don’t overly identify with the emotional state of mind. Just observe it, breathe through it, and then let it pass.” And refocus on the present moment.
Stay curious. Smith suggested being curious and asking questions about work procedures and practices. “If a process does not make sense and there is a better way to do it, be professional, but assert your ideas.” This provides “an opportunity to contribute on a deeper level and helps keep our ADHD brains engaged for the long haul.” (Of course, some workplaces will be more receptive to this than others.)
Don’t go it alone. Create a support system of people who understand you, don’t judge you and offer support and encouragement, Swanson said. She also noted the importance of having an accountability partner, such as a friend, family member or colleague. “Perhaps you decide to send an email to let your buddy know that you have done your daily planning, and you send that by a certain time each morning.”
Advocate for yourself. Disclosing your ADHD is a complicated issue with advantages and disadvantages. On the one hand, it can spark stigma. On the other hand, you can request accommodations—and your employer can’t fire you for actions related to your ADHD, Smith said.
Whether you disclose or not, you can still be an assertive advocate for yourself by framing your requests in this way, he said: “I work best under these conditions.”
I work best in a quieter environment, so I’d like to move to a different office.(Which is what one of Smith’s clients did.) I work best with noise-canceling headphones. I work best when I’m not frequently interrupted, so I’d like to tape a “Do Not Disturb” sign to my door. I work best when I can record meetings.
(Smith mentioned a product called “the Live Scribe Pen, which makes a digital copy of your handwritten notes, and records the audio. This way you can go back to a part of the meeting where your attention drifted off, tap on the page and bring up that audio.)
ADHD can make certain aspects of your job challenging. But by knowing yourself, harnessing your strengths, and being your own best advocate, you can shrink those challenges, and absolutely thrive.
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Merry Christmas to you and yours from me and mine! 

@gabriellefreiretherapy  #mindfulness  #stressfree

You may know someone who is taking an opioid to manage pain they could be at risk for misusing this their medication. The Center for Disease Control and Prevention (the CDC) recommends that you talk about the opioid and the medication, gather information about your loved one's pain level and monitor them for misuse.  For more information, contact www.hhs.gov/opioids or call 1-800-662-HELP. 

​I work with a lot of individual and couples who are working on themselves and their relationships.  I've noticed  that being in a relationship can bring about a lot of underlying feelings, some of those feelings are of  inferiority and may be connected to your self-esteem.  Low self-esteem often results in stress or anxiety, loneliness and an increase likelihood of depression, it can cause problems in friendships and relationships, it can impair your work or job performance and it can lead to an increased chance of using drugs or alcohol.  To address your low self-esteem try to quiet that inner critic voice, try a new hobby and you can always "fake it until you make it." For more ideas on how to raise your self esteem, read an article that I contributed to:  upjourney.com/how-to-deal-with-low-self-esteem-in-a-relationship
​#gabriellefreiretherapy

In a world where everyone wants to be someone.....be yourself. Simple advice, not always as easy to execute.  
If you don't know how to be yourself, I  recommend self-reflection, meditation and a discussion about what you want with a trusted individual. Hold true to your values and remember, no one else knows your journey.  
When working with an individual or a couple, I explore a person or couples strengths and we talk about how to build on them. I also explore the underlining wants and needs that will assist you to be yourself.  #gabriellefreiretherapy 

Are you searching for a therapist for yourself or a loved one? Do you feel confused about how to find the right therapist? Read this article where I explain how I use engagement skills and encouragement to build the therapeutic relationship with my clients.  #gabriellefreiretherapy #therapy #mft

Using engagement and encouragement as a therapy technique: A licensed marriage and family therapist walks you through her therapeutic processby Gabrielle Freire | Sep 21, 2018 | Counseling News, Counseling Techniques, Mental Health | 0 comments
Counseling Feelings Mental Health Therapy Wellbeing

• It’s important the client feels engaged right away, in that the client feels welcomed and receives dedicated care from the get-go.
• Once the client and counselor have decided they’re a good match, the counselor can help them feel more comfortable by explaining everything they’ll need to know about the first session: no surprises makes for less anxiety.
• Open ended questions also help to create a comfortable therapy space, in addition to assisting the therapeutic process and helping the client to share their feelings.
• It’s also important that therapists assess each case individually and then cater to that client: for example, one may take different approaches with an anxious client and a depressed client.
• Also, active listening is an effective counseling technique, where the therapist reflects what the client has just communicated to them.
• Finally, it’s beneficial for counselors to close a session by asking if the client has any questions or would like to share any final thoughts or feelings.

*Gabrielle Freire is a licensed marriage and family therapist and has been for 14 years. She has worked in the mental health field since 2004, providing individual, group, and family counseling.*
Engagement is a primary focus of the initial portion of treatment. (There are typically 4 phases of treatment: the engagement phase, intake phase, implementation phase and the transition or discharge stage). I start engaging with someone when they first call me and ask me questions about therapy. I ask open ended questions to get the potential client talking about their symptoms and behaviors, that helps me get an idea if I will be able to help him or her (by this I mean to see if I have the experience and training to meet their clinical needs).
If I can help them, I move on to schedule the appointment, I ask their availability versus telling them a date/time that works for me. To also aid with the comfort levels, I tell them info about the first visit including parking suggestions and tell them to wait in the waiting room. That allows the client to not have to worry about when I will get them out of the waiting room. It also helps them plan their trip if they know where to park. Someone who is anxious may worry about finding parking, someone who is depressed may not have the energy to look for parking and give up rather than look for a parking spot.
I ask open ended questions to help them talk about their feelings. The open ended questions helps the potential client understand that I’m interested in them (which I believe builds the relationship). When we have that first phone call, I have an idea if they are depressed, anxious, if they had trauma, ADHD, impulsivity problems etc. That helps me prepare my office/myself for when they come in.
I will act differently with someone who has depression versus someone who is anxious. For example, for an anxious person, I may talk in a calm voice and try to let them talk more than say a depressed person who may not have as much energy to formulate questions. I put myself in their shoes and talk about things that I think they may want to know (not that I’m all knowing but I do know that coming in to a therapy office may be overwhelming and they may forget to ask questions). Someone who had trauma may need me to move a little slower and not make any quick body movements which they might interpret as jarring.
Other ways I help a client feel comfortable is by using active listening skills; reflecting back what they said to me, not interrupting, nodding my head when they speak. Those are all great ways to connect with the client. I ask them, “how did that make you feel” versus “you were feeling sad.” Also, matching body language is another way; it works on the subconscious mind, so if the client’s legs are crossed, I may also cross my legs. I don’t cross my arms even if they have their arms crossed because arm crossing is more noticeable and I wouldn’t want the client to feel that I was disconnected from them or I disapproved of what they were saying. I will even slightly nod my head when they are talking so they can see me validating what they are saying.
Additionally, I almost always end a session asking if they had any questions. That allows for clarification and also demonstrates that I value their input in their treatment. I also write treatment plan goals with their input and never reject an idea for treatment. I don’t laugh at them if they share something out of the ordinary and don’t laugh at them if they make a mistake.