How My Late Diagnosis with ADHD & OCD Changed My Work With Clients

A late diagnosis has a way of rewriting the story you thought you knew about yourself. For me, it also rewrote how I work as a therapist. Here is what discovering my own ADHD and OCD later in life taught me, and why so many adults wait far too long for answers.

The ADHD Diagnosis

I was 37 years old when I was diagnosed with ADHD, and six months later was diagnosed with OCD. I had been a therapist for 11 years, with a thriving private practice for six years. ADHD and OCD had been on my “rainy day” list for therapy. Meaning, if I ran out of pressing things to talk about in therapy, I wanted to explore them.

Eventually life transitions settled, and I brought these topics up to my therapist. The idea of me having ADHD wasn’t new, and we already referenced my likely ADHD symptoms. I was very familiar with ADHD, and had accidentally begun to specialize in ADHD and autism by working with lots of trans and queer folks who also happened to be neurodivergent. Seeing and understanding my clients so clearly led to me recognizing some of my own experiences. (Isn’t that always the way?)

I decided to pursue a thorough assessment for ADHD, in part because I was curious. A multiple page report detailing the specific ways my brain works? Fun. Before the meeting, I completed the standard assessments, and then typed up some supplementary notes. The document was five pages long, and I titled it: “All The Ways I Know I Have ADHD that Aren’t in the DSM.” (I like to joke that the psychologist I met with could have just given me the diagnosis then and there.)

For me, the ADHD diagnosis wasn’t monumental. I was already pretty sure it applied to me, I had already accepted my quirks and behaviors, and I was able to self-accommodate. I had been working hard, for a long time, to find systems that would work for me, and had been able to do this well enough, for long enough, that my ADHD had flown under the radar. 

A late ADHD diagnosis in adults very often happens exactly this way. Strong coping systems quietly mask the signs for years, which is part of why ADHD in women and 2SLGBTQIA+ people is still missed so frequently.

The diagnosis was confirmation, and validation. Through the lens of ADHD, I have continued to understand my past and current experiences in different ways. I got access to medication, and have continued to develop strategies and skills to work with my own particular brain. I didn’t have to wonder anymore if the reason the hard things were so hard was because of ADHD.

My OCD Diagnosis, After Years of Hidden Symptoms

As we continued to check rainy day topics off the list, I told my therapist why I thought I might have OCD. I had been a therapist for over a decade, but I didn’t have any training in OCD and felt pretty out of my depth. My strongest point of reference was the movie As Good As It Gets. I didn’t wash my hands compulsively, but I wondered if checking and counting, fueled by discomfort and sometimes leading to a sense of paralysis, might be similar.

Unlike ADHD, I hadn’t talked about these experiences a lot – not in therapy, and not to friends. But like ADHD, I had worked to manage it, even while not knowing what I was managing. My symptoms occurred most often when I was alone, so they weren’t observable to even my closest loved ones, and didn’t show up in my own therapy sessions in obvious ways.

My therapist was kind and supportive as I shared specific examples and said things like, “But I know that is not going to happen,” and “I am not actually scared of that,” and “I don’t know why, I just feel like I have to.” She consulted with a colleague in her practice who specialized in OCD, and we came up with a plan. I started adjunct therapy with that therapist, and continued to meet with my longer term therapist on a monthly basis. This isn’t always how OCD treatment goes, but it worked for me. 

I met with the new therapist and completed a long assessment about obsessions (anxious thoughts) and compulsions (behaviors meant to relieve or prevent the anxiety). I began to learn about mental compulsions (you can’t see them!) and less-stereotypical presentations of OCD. I cried through so many of those early sessions. It felt vulnerable and overwhelming to be talking about things I’d experienced for so long but had never been able to make sense of. It was an intense experience to realize how much OCD had impacted my life. 

ERP, or Exposure and Response Prevention, is the evidence based gold standard treatment for OCD. It works by gently facing the thoughts that trigger anxiety while resisting the compulsions normally used to relieve it, so the brain learns the distress will pass on its own.

My new therapist guided me through ERP, or Exposure & Response Prevention therapy. This approach uses intentional exposure to anxiety-provoking stimuli, while removing compulsive behaviors. (I know, I know. Sounds like a horror show.) Her approach was so compassionate, collaborative, and creative, and it is the approach that I use with clients now. Through ERP, I learned to practice new ways of existing with my distress – specifically with the distress that would arise if I didn’t engage in a compulsion. For so long, I knew the behaviors didn’t make sense, but the discomfort was consuming enough that it was easier to just engage. 

ERP was hard, and it worked. Through practicing exposures, I learned that the distress would, eventually, pass. I stopped having an undercurrent of anxiety that just wouldn’t go away. I was able to resist compulsions more, and sometimes I didn’t even have to resist, because it was just… easier. I started to get a break from looping thought patterns, and my brain got quieter. 

Things that I had spent years trying to cope with – using all my skills, all my rationalizing, all my self-comfort, all my intellectualizing, and a few different wonderful therapists – suddenly, I was able to feel less impacted by.

After seven months of structured treatment, I graduated from OCD therapy. This time the crying was because of deep, deep gratitude.

How My Late Diagnosis Reshaped My Practice

Okay, so my late diagnosis of ADHD did not actually significantly change my work with clients, because I was already in my element. But my OCD diagnosis and treatment? Gamechanger.

Different studies have been done about the gap in time between when people first start to experience OCD symptoms, and when they are diagnosed or begin to receive OCD treatment. One of those statistics reports that it can take up to 17 years for a person to receive diagnosis and effective treatment. For me, it had been more than seventeen years between the time that I first started experiencing symptoms of OCD, and when I was diagnosed. There are many reasons for this, but a lack of comprehensive training about OCD and OCD treatment is one of them. Without specific training, therapists can misunderstand client’s symptoms, and miss them all together. 

As I learned more about OCD, I began to conceptualize my own clients’ experiences differently. I took trainings and sought consultation from therapists who had years of experience providing OCD treatment. I thought about current and past clients who never seemed to experience sustained relief from their anxiety. Clients who worked hard in therapy, who were receptive and engaged, and clients to whom I had offered everything I knew how to offer as a therapist.

OCD doesn’t always look like the stereotypes you see in movies. Before my diagnosis, I thought that I would be able to recognize OCD symptoms if they were there, and then I could refer to someone who specialized in working with OCD. Instead, I didn’t have enough information, and I missed those symptoms in my clients, the same way my own symptoms had been missed. I also didn’t know that standard talk therapy can make OCD worse. I didn’t know that smart, thoughtful, and attuned therapists with good skills could be reinforcing OCD by accidentally engaging in a client’s compulsions. 

After receiving training and consultation, I gently approached OCD with some of my clients. I shared that I did not have training in this area before, and now I did. I asked if they’d be interested in exploring it, and explained why. I disclosed my own diagnosis to some of my clients. I offered deep compassion to those who had spent years suffering while their OCD was missed. With their consent, we tried something new.

ERP can feel counterintuitive as a therapist. It is pretty standard to provide validation, information, and reassurance to your clients. But in OCD, reassurance-seeking and information-seeking can be compulsions of their own. No reassurance or comfort is enough, because the compulsion doesn’t actually work. Helping clients to understand how OCD works and impacts them is an important part of treatment.

My clients don’t always believe me when I first tell them that they can experience relief from this kind of anxiety. But with trust and time, and using a treatment approach for OCD that actually works, I have seen those shifts and changes.

Some of those clients, who were stuck for so many years? They get to experience relief. There is less anxiety, less disruptive compulsions, and less self-doubt.

The wonderful thing about the skills used to manage OCD is that they are transferrable, and can be applied to new situations. You don’t have to start over when you realize that OCD is showing up in your life in a new way. When the ability to manage OCD symptoms becomes integrated into your daily life, life just becomes easier. OCD is no longer in control.

Untangling the Intersections of ADHD, OCD, Autism and Trauma

I sometimes tell clients that therapy is like doing qualitative research inside their own brain. 

For many years, I have been helping my clients explore what is underneath an experience or behaviour, working with them to identify and understand all the nuanced contributing factors. Now, I often find myself helping clients to untangle OCD from ADHD (and autism, and trauma, and…).

Maybe someone has been told their whole life that they talk too much. There are some go-to questions that I ask. Like, according to who? Is it actually disruptive? How? Through lots of conversation, curiosity, and clarifying questions, we gain more information about their specific experiences.

Is the chatty talkativeness because of ADHD? Are there tangents because of distraction or a hyperconnective brain? Is it excitement, a love of detail, a desire to share, or a special interest? Is there a struggle to recognize or understand others’ social cues? 

Is there a compulsive need to share every detail? Is there a connection to trauma? What happens if you cannot say everything you want to say? How disruptive is it? 

Is all of the talking because you feel like if you just get it out, if you say it again and again, if you use the right words, then they will understand, you will be known, it will be released, you will feel better? Do two or three hours pass and you are still just as caught in the storm, still feeling like none of the words were enough?

This complexity can feel mind-boggling for some clients, and for some therapists. Always, the goal is to help a person understand their own brain better, so they can work with and not against it. Sometimes we can untangle the origin and function of the behavior, and sometimes we can’t. Sometimes accepting that we cannot know something with absolute certainty is an exposure of its own.

When we understand a client’s (or our own) unique experience, it becomes easier to know what to do about it. And sometimes there is nothing to do. Sometimes the work is self-acceptance, knowing that there are many different ways that brains work and many ways to exist. Learning that it is okay to be verbose, and detail-oriented, and excited to share. 

Yet it is true, too, that for some people, the way that their brain works feels annoying, distressing, or disabling. There is grief in living in a society that is built to function best for certain kinds of people, with certain kinds of identities, and certain kinds of brains.

So, along with the psychoeducation and self-acceptance, I help clients to identify and meet their needs, and support them in advocating for themselves. I teach skills and work with clients to brainstorm the strategies that will work for their specific lives and experiences. 

Our brains are special and strange and capable of so much. What if you could hand someone the ball of tangled yarn, and they could gently, thoughtfully, start to pull the threads and untangle the knots? 

If you’re looking for guidance as a client or a clinician, I would love to support you.

In addition to providing individual therapy, I offer adjunct ERP for clients who are already established with primary therapists, and extended sessions for individuals who would like to specifically explore OCD symptoms. I also offer professional consultation for therapists. 

Work With ADHD, OCD and Neurodivergence at Blueprint Counselling

If any of this feels familiar, whether you are exploring a possible late ADHD or OCD diagnosis, navigating both, or you are a therapist who wants to better recognize OCD in your own clients, support is available.

At Blueprint Counselling, Heather Butt offers individual therapy, adjunct ERP for clients already established with a primary therapist, extended sessions focused on exploring OCD symptoms and ADHD counselling for late-diagnosed adults. Sessions with Heather are available virtually across Ontario.

Book a consultation today, or learn more about ADHD Counselling and OCD and ERP Therapy at Blueprint Counselling.

Frequently Asked Questions About Late ADHD and OCD Diagnosis

Can you have both ADHD and OCD?

Yes. ADHD and OCD can occur together, and many adults discover both later in life. They can look similar on the surface, which is one reason a careful, informed assessment matters so much.

Why are so many adults diagnosed with ADHD later in life?

Many late-diagnosed adults built strong coping systems that hid their symptoms for years. Late ADHD diagnosis is especially common among women and 2SLGBTQIA+ people, whose presentations have historically been overlooked.

How long does it take to get diagnosed with OCD?

For many people it takes years. Research suggests the gap between first symptoms and effective OCD treatment can reach up to 17 years, partly because OCD rarely looks like the stereotypes shown in film and media.

What is ERP therapy?

ERP, or Exposure and Response Prevention, is an evidence based therapy for OCD. It involves gradually facing anxiety triggers while resisting the compulsions normally used to relieve that anxiety, so the brain learns the distress eases on its own.

Can talk therapy make OCD worse?

Sometimes, yes. When a therapist offers repeated reassurance, they can unintentionally feed the reassurance-seeking that keeps OCD going. Approaches built specifically for OCD, like ERP, work differently and tend to be far more effective.

A few of my favorite resources:

Blog post about supporting a loved one who has OCD: https://iocounseling.com/blog/supporting-a-loved-one-with-ocd

Free OCD trainings (for therapists): https://www.nocdacademy.com/