November 1, 2022

ADHD and Relationships Part 6: Self Trust with Dr. Russell Ramsay

We end our relationships series by circling back to the most important relationship: the one we have with ourselves. Dr. Russell Ramsay is here with us to chat about why self trust is especially difficult for adults with ADHD, and what we can do to build it.

Dr. Russell Ramsay is co-founder and co-director of the University of Pennsylvania’s Adult ADHD Treatment and Research Program and a professor of clinical psychology in the department of psychiatry in the Perelman School of Medicine at the University of Pennsylvania. He’s authored several books on ADHD including one that that I reference often called Rethinking Adult ADHD: Helping Clients Turn Intentions into Actions

Learn more about Dr. Russell Ramsay here!



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Kristen Carder 0:05
Welcome to the I have ADHD podcast, where it’s all about education, encouragement and coaching for adults with ADHD. I’m your host, Kristen Carter and I have ADHD. Let’s chat about the frustrations, humor and challenges of adulting relationships working and achieving with this neurodevelopmental disorder. I’ll help you understand your unique brain. Unlock your potential and move from point A to point B. Cable what’s up this is Kristen Carter and you’re listening to the I have ADHD podcast episode number 182. I am medicated I am caffeinated and I am ready to roll.

Today we have a very special returning guest Dr. Russell Ramsey. Dr. Ramsey is the co founder and co director of the University of Pennsylvania’s adult ADHD treatment and research program and a Professor of Clinical Psychology in the Department of Psychiatry in the Perelman School of Medicine at the University of Pennsylvania. He’s authored several books on ADHD, including one that I reference often called rethinking adult ADHD, helping clients turn intentions into actions. Dr. Ramsey was here this previously to discuss cognitive behavioral therapy for adults with ADHD. And if you’re interested in listening to that conversation, it’s a good one, you can check out episode 143 of this podcast to go listen to that combo. But today we’re talking about self trust. And this is something that adults with ADHD struggle with massively. I’ve seen it in myself, and many if not all of my clients. And so as we continue our relationship series here on the I have ADHD podcast, Dr. Ramsay and I are going to dive into the concept of self trust. And I know this is kind of annoying, I’ve said it before. But the relationship that we have with ourselves is going to be the foundation for all of our other relationships. And so improving our self trust is huge part of improving our relationships. On today’s episode, we’ll chat about what self trust is, why ADHD, or struggle with it and the specific steps we can take to improve it. So please join me in welcoming Dr. Russell Ramsey. Dr. Ramsey, thank you for being here.

Dr. Russell Ramsay 2:24
Kirsten, thanks for having me back. I appreciate it.

Kristen Carder 2:27
So good to chat with you. And first and most important topic of the day as per our custom. The Philadelphia Eagles are looking real good. You think they’re looking good?

Dr. Russell Ramsay 2:37
I think they are looking great. Yes.

Kristen Carder 2:40
They’re looking so good. Do you think? I mean, we’re foreign? Oh, right now at the recording of this podcast, I believe Correct. For now, correct? Yes. Okay. So what does this mean for our future? Should we get our hopes up? Or should we look at the history of Philly sports and say, You know what, it might not be quite time to get the hopes up.

Dr. Russell Ramsay 3:01
They look like they have a great team, a great format. But I think it’s only half a coincidence that cognitive therapy developed in Philadelphia to deal with some of the frustrations we’ve had as diehard Philly sports fan. So but I’m but I’m disposition Lee and athletically hopeful this year.

Kristen Carder 3:20
Yes. Yes. Agreed. And yeah,

Dr. Russell Ramsay 3:23
the Phillies, the Phillies just made the postseason last night. No,

Kristen Carder 3:27
I’m not sure how that happened. That’s great. It’s amazing.

Dr. Russell Ramsay 3:30
They made it as a wildcard.

Kristen Carder 3:32
We’ll take it, we’ll take it. It’s so good. I love how you say there’s a reason why cognitive behavioral therapy originated in Philly. Like we needed it, we really didn’t need it. Okay, so let’s chat for a minute, or actually for several minutes about self trust. Now, when you are here. And we were talking about cognitive behavioral therapy, our conversation wandered into the area of self trust. And I remember kind of putting a pin in that and saying, I think I need to have you come back on so we can have an entire conversation about this because ADHD years struggle with this on a major, major level. And I’m just wondering what your thoughts are. Do you also see this in your practice? How it each dears struggle with self trust?

Dr. Russell Ramsay 4:21
Oh, yeah. And that was actually the main motivator for the whole rethinking adult ADHD book. I was asked a question at the end of one of our and are being myself and Tony Rothstein, the co founder, and really the Zuckerberg in the adult ADHD program at Penn coming to be and he just asked me to come along on the ride. But it was a very well meaning and insightful question at the end of one of our first presentations on the model. Somebody asked, what is the cognitive theme in the thoughts of adults with ADHD? So for people with depression, the cognitive distortions that are well known for Cognitive behavioral therapy like all or nothing thinking, mind reading, catastrophizing, they’re all common, but there are different themes. So in depression, a common theme is that of loss, loss of opportunity, loss of potential in the future loss of a relationship with anxiety, it might be the perception of threat or risk, and really what we’re understanding it to be as the intolerance of uncertainty, which is directly relevant for ADHD that we might get back into. And I didn’t have a good answer, nor did I don’t think any colleagues in the field doing CBT at that time, because we’re just sort of fumbling around just trying to show whether CBT worked, but it stayed with me over the years. And then, you know, part of that with the Rethinking adult ADHD book, I had noticed some people talking about trust or lack of trust, I don’t trust myself to do something. If I don’t write it down. I know I can do it. But I don’t trust I will do it when I plan to do it or when I have to do it. And I was meandering around, well, you know, what’s going on here? And what are we talking about with his self mistrust? And I thought, Well, this sounds like self efficacy theory, like Albert Bandura, do I believe I can do something now, but that was also similar that is compromised, say in depression, anxiety, other things? Is it personal agency, the belief and ability to make changes in our life to our betterment again, depression, anxiety. But in reading one of banderas books, I ran across this concept within efficacy theory that I’d never heard before, called self regulatory efficacy. And what it was, is virtually a rewording of the executive functions. And it’s a precondition for efficacy. And it’s the belief in our ability to do the little boring, tedious tasks that go into getting the class completing all the assignments, household chores, and those are taken to be intact with depression. And depression just weakens the belief. But like I said, in reading the text, and I present slides on this, when I talk on this, it’s a reworking of the executive function. So that led me to start thinking, that’s the level of self mistrust. I may be a good writer, but I’m not sure if I’m going to be able to get myself to write in time to meet the deadline for the class, or we could fill in the blank with other things. So with that, I made the contention in the book. Now this is based on my clinical experience, there’s no empirical data for it yet. That self distrust D I S, T. R. U. S. T, is the main theme of the automatic thoughts and self mistrust is the main theme in the deeper beliefs. The only difference being when I looked up the words, distrust seems more local and immediate, and mistrust seems more global. And that seemed to fit with the automatic thoughts versus the core beliefs. So that’s where it came from. But like many things, learning by doing, just hearing people literally say, I don’t trust myself. I know I can do it, but I don’t trust myself to do it. The the idea of ADHD is a performance problem, not knowledge, or necessarily a talent problem.

Kristen Carder 8:20
Right? Exactly. There are so many talented people who don’t trust themselves to follow through and so are not taking, maybe not taking a promotion or not taking that, you know, that book deal, or whatever the case may be, because it’s like, well, I know I have the talent for it. I know that I’m gifted in this area, but am I going to wake up at the right time and start working at the right time and work for long enough? And will I have the stamina? And can I follow through on it? We just don’t trust that we can. And we’ve gathered a lot of evidence that we’re right.

Dr. Russell Ramsay 8:55
We’ve got salutely. So well, that guy. And that’s what I was saying before about the uncertainty theme with anxiety now anxiety, both in diagnostics and in some sort of anxiety diagnosis most, most recently, in a study looking at Generalized Anxiety being over represented in adults with ADHD, at least in one sample. But I would say even if it’s not diagnostic level, just even task oriented anxiety, and it’s from the uncertainty. I don’t know if I’m going to be able to get myself to do it today. I think that factors in for all the reasons that you mentioned before, the past history of that consistent inconsistency, and how that punctuates and disrupts otherwise reasonable endeavors. Now, sometimes I’ve seen and heard about adults with ADHD, who might have some unrealistic expectations, but generally it’s about how much somebody’s going to be able to do in a shortened timeframe, but maybe not the actual skill or topic or subject or whatever the case may be. So that’s where the thoughts and the emotions and behaviors are like this braided cord of experience, but we sort of disentangle them. So that way, it gives us a fair chance to try to modify it and CBT and probably the other helping approaches for adults with ADHD.

Kristen Carder 10:14
Why do you think that self distrust? How did you put it? It’s mistrust and distrust, but how did you?

Dr. Russell Ramsay 10:23
Let’s see, as I put it as distrust for the immediate thought, like, I distrust myself, that I’m going to be able to run all the errands I have to do today. But that’s part of my overarching self mistrust. And that that the schema are very emotionally loaded. And this could be sort of like, you know what, I’m not even going to bother enrolling in the course this semester. I’ll do it later. I’ll do it some other time. But I’m not sure if I’m going to be able to do it now. So it can like almost like head off, you know, some things at the outset before we have a chance to, quote unquote, fail at them. It’s failing

Kristen Carder 10:55
ahead of time, I’ll fail by not engaging so that I don’t have to fail in the in the moment. It’s a

Dr. Russell Ramsay 11:03
preemptive strike. That was a phrase I was thinking about, are you going to fire me because I quit type of thing? Yes, totally, totally. Okay. Which is exactly what procrastination is. I’ll wait till later when I’m in the mood to do it. Because feeling like, Okay, I don’t trust myself now. But later on, I’ll be in the mood to do it, but probably not. Because there’s gonna be some discomfort with, you know, facing one of these tasks, because they’re of that uncertainty. Now, most people might know, nobody’s in the mood to do homework. So most people feel a little bit of that what we call the hug feeling. So part of the emotional side and how we think about emotions, which is I think we talked about maybe last time front end perfectionism. Yes, everything has to be right, I have to be in the mood to do it. Well, that won’t happen. But it’s how can we tolerate that? That’s where the emotional tolerance and the thoughts about our emotion, I have to be anxiety or stress free is a precondition for doing it? Well, I don’t think you were I would have gotten up this morning. And Had that been the case that there are preconditions. So I mean, kidding aside, I mean, we use humor about this, but this is the stuff that gets in the way of like you said, applying to the program showing up for class, catching up on that SEO there through two thirds of the way through the semester, but then that paper and maybe not asking for the extension, because of the interpersonal shame, that undermines what has already maybe been some good effort, but then that punctuation, of efforts and incompleteness in life,

Kristen Carder 12:34
do you think that this is just a hallmark trait of ADHD? Because it is just part of the disorder? Or do you think that this is something that we weren’t necessarily born with, but was developed over time maybe by like, people pointing out our flaws and telling us like, you’re so inconsistent if you could just be more consistent? Or, you know, just being raised in families that were not super nurturing? Or like, where do you think that self mistrust overall comes from?

Dr. Russell Ramsay 13:05
I think like, like are your other other thought and emotional patterns? When you’re sitting with somebody and asking where it comes from, or what came up in a situation? It makes perfect sense. I mean, it doesn’t mean that it’s necessarily helpful to have in that situation if you want to follow through on it, but it’s usually self protective in terms of emotionally self esteem. And I think one, it comes from the feedback loops growing up and dealing with school and frustrations in school. Everybody tells me I’m smart, or but somehow I don’t seem to get everything done. I probably cite this almost every time I write or talk about this, but one of the early books on adult ADHD, you mean I’m not lazy, stupid or crazy? Because those are the attributions. Those are some of the other belief themes that developed. So it can be from one’s own experience of their performance in these situations. Why do I always wait till the last minute? It can be from feedback, you must not want to do it because you don’t seem to try. Right? It could be both from maybe families that were not very supportive. It could be from well meaning families who didn’t understand ADHD, and trying to do the best they can. But it just wasn’t the poor fit because they didn’t know and I’ve heard many adult parents after the fact like almost in tears as much as their adult child who is now tearful about the diagnosis like had we only known Yeah, we could have done it, but we didn’t know what to do different or we were following the advice that we had at the time. So yeah, it can come from a lot of avenues and all have them together at the same time. There can be those interactions with the coach or the music teacher that helps somebody foster a wonderful skill that they have or a capability. It can would come from the teacher who got it and would spend extra time or allow the student to retake the test. Who somebody who didn’t do well with the multiple choice tests, they would say, hey, just tell me, right? Tell me why the Declaration of Independence came to be or something. And then they could just riff on it. Who found workarounds, impromptu workarounds? There are other positive examples of this, including the helping professionals or later even the relationships with people who go, or the partner who says, oh, yeah, now I understand ADHD. And they can be more more responsive to it. And hopefully, I’ve seen like what your podcast does for people to spreading accurate information out there about what can be done.

Kristen Carder 15:43
So how do you define self trust? We’ve talked about mistrust and distrust. But how do you define trust? Is it believing that we’re always going to get it right?

Dr. Russell Ramsay 15:54
No, I would say it is the ability to tolerate that. We know we won’t always get it right. And, and you know, the relapse rate for all of us on procrastination is 100%. So it will happen. But it’s, it’s having some confidence, more than self esteem, self esteem is sort of a positive regard. And, you know, it’s been shown that, you know, sometimes it was thought that bullies don’t have good self esteem. No, their self esteem is too good. Because they have the self esteem from their bullying behavior. Now, it’s not the best behavior, but that’s where it comes from. Yeah, so we want to have other so we do want to have some self esteem, but I view it more as self efficacy. And the belief that even when a day gets away from us, that we’ll have a plan that more often than not, we’ll be able to put into place and carry out and get to some at least good enough outcome. But along the way, maybe doing better than that, or, you know, let’s just say getting close to our average. And hopefully, our average is pretty good, even if we don’t see it right away. So it is sort of that not just hopefulness. But it is that trust in our past abilities. And even if we don’t do as well, the ability to tolerate that, learn from it, and maybe get back to average, whatever, whatever that is.

Kristen Carder 17:20
Yeah, and I love that definition. And I would add to that, like, I will be kind to myself in the process. Right. So that is something that a lot of times I see clients not taking risks, or taking steps, or even just showing up for their lives, because they’re afraid that when they inevitably mess up, because we are human, and not just human, but humans with ADHD, when I inevitably mess up, I experienced the embarrassment and shame from the outside, but also the inner dialogue and the inner shame of just like, I can’t believe you did this again, here we go again, you’re never going to change this is just the same old, same old, that inner self judgment is so harsh, that we don’t even want to set ourselves up for that. So we avoid showing up for our own lives,

Dr. Russell Ramsay 18:10
right. And I like how you defined it. Because I totally agree with your definition of self compassion. It is our relationship with our self. And that is a good reframe, because even some of the things that you’re doing, and I remember a client who she was going on about herself talk and really berating herself for a mistake. And I commented, you know, what, if you talk to somebody else on the street, or they talk to you, and that way they would be arrested for assault? Yes, what it was, how hard somebody was being. And one more thing I’ll add to what you said, because you’re using the use statement. Now, this hasn’t been studied specific for ADHD, but his name is Ethan cross with a K. He’s a neuroscientist at the University of Michigan, he talks about distanced self talk, talking to yourself by name or as you as we would to somebody else. And that form of talking has been found to be helpful, again, non clinical samples, but for dealing with problematic emotions, like somebody after a breakup rather than I can’t believe they left me, I’m never going to find somebody, it’s, you know, you’re gonna feel bad for a while, you don’t know why they broke up with you, you’ll eventually get through it. So the I statements, which are called immersive self talk, and tend to be ruminative and keeping us stuck in it, whereas you we can talk to ourselves as though we were talking to somebody else. And it’s also to do it aloud. I know you can’t do that on the train or something. But I think it makes us put it through the language system. So it is processing the emotions as we would in journaling. And we’re also hearing ourselves say it and I think it also draws on the compassion that we usually have for somebody else. So that has been found to be helpful both for emotional management and for task initiation. You know what Russ, you just need to sit down open the document reread the last paragraph you wrote, see if you can add another sentence And that’s where I became familiar with his work and the direct applicability for adults with ADHD and dealing with procrastination. And I found that to be very helpful.

Kristen Carder 20:11
This is making me think about our executive functioning skills and how we really are deficient in having the inner dialogue. I believe it’s nonverbal working memory, is that what it’s called? Am I

Dr. Russell Ramsay 20:24
it’s the verbal working memory, working memory. Okay. Yes, nonverbal is the imagery, but that is also considered cognition on many fronts, because it’s another way of making sense. Okay, perfect. Yeah.

Kristen Carder 20:35
Yep. So our verbal working memory, being, you know, of course, it’s on like a spectrum. Everybody struggles at different levels. But for many of us that being deficient, that self talk is something that we really have to learn how to develop, it’s not something that comes very naturally, that you know, like, Hey, you’re gonna be okay, let’s get through it. What do you need, right, that inner dialogue? I, that was something that I learned to do in my 30s. Like, I never, I didn’t do that as a kid or an adolescent. And it was something that I like, intentionally incorporated into my life. So I just I wonder if that’s another reason why establishing self trust can be so difficult is because like, even that skill is impaired.

Dr. Russell Ramsay 21:22
Yes. And that’s why being able to, I mean, we use labels judiciously, but they are having containers for experience is what helps us understand it and make sense of it. And and all these things, like, yes, the language of cognitive behavioral therapy can be clumsy with maladaptive this and distorted that. But on the other side, there are always adaptive versions of this. And like I said, even the quote unquote, maladaptive ones, when you hear the explanation, it makes perfect sense. Yeah. Why would I want to start a writing assignment when it’s going to be hours and hours? And I’m not good at it? And I still don’t know if I’ll finish it by the deadline, and even an extension? Oh, great. I get to work on writing for yet another week. Do I really want that? So and sometimes getting that explicit? People say, Yeah, I can hear it. As I’m saying it, it doesn’t make sense. But internally, it does, because it’s self protective. But these things can be marshaled to recognize, alright, what am I saying to myself about myself about the task about my future, and then we have some space to open up for what are alternatives. Now a lot of this will deal with coping, the coping skills for ADHD, the executive functioning workarounds, whatever we want to call them, to try to do things differently. But there may be things that like the student in school, who says, You know what, I really liked my summer job working as a car mechanic, I think I’m really good at that. I don’t maybe I don’t need school, maybe I’m forcing myself for something I don’t need to. And at least I know, I rely on my mechanics a lot. And I think I’m funding them pretty well, because I’m not a handy guy. So no, it’s a more than noble profession. And some mechanics I had before I would put them on par with like, psychologists or surgeons who are able to conceptualize and diagnose things they were able to do, like, you know, problem solving. But in a format that works for them, you put him in my position and mine and there’s we’re both, you know, all of us are we’re living very frustrated lives. You find that niche, and that’s very personalized. And sometimes people can have, I’ve heard people talking about like, Well, my family, what I’m good at wasn’t considered a good job or, you know, things like that, or I’m the I’m the the outlier in the family who, but that that’s, and sometimes it wasn’t even things the family was saying the family was saying all the right stuff, but the individual said, Yeah, but I just see the difference. One of these things is not like the other ones. And so it’s more self generated, but you know, societal standards with you, if you will. So we really want to find like, Goodness of Fit is a nice phrase that comes up a lot of ways, but what is the good fit for your skills where you can feel that trust and, you know, build up, we are not what we do. We’re not defined by our grades or jobs or tasks or things like that, but the endeavors that we take on and I always have to say, pardon, the double negative, they’re not nothing, because we wanted to try this, and we think it’s a good fit. Now we at least want to give it a try to see, see how it works out. We have some skin in the game,

Kristen Carder 24:24
for sure. And it’s an expression of who we are and the type of person that I’m showing up as and at least in my work, I feel like I’m not my work and yet I put so much of myself into my work. And so when something doesn’t go right, which of course happens it’s very hard for me to separate you know, this is my job over here and this is me and my self worth over here. It does feel very connected.

Dr. Russell Ramsay 24:51
Right, right. No, but I think the right of self determination not that we can do everything but to find out and yeah with that, like the self expression And, you know, some of the some of the therapy and I know coaching probably does this to the girl falls into the purview of trying to find those right fits. And also, I think it’s important to point out incremental progress and pointing out the strengths that we’re seeing authentically. And not just oh, you’re awesome, you, you can do anything you put your head to, but it’s sort of like, you know, what, you’ve demonstrated this, I’ve heard you say this, and you can be very compassionate. And even if it’s not like an employable or not immediate, you can immediately put it into an employment box. But it is some of these these skills that may be relevant for certain pursuits.

Kristen Carder 25:38
Love that. So we’re defining self trust, as I trust that even though this process might be bumpy, and I might not do it perfectly, I will at least be able to move forward. Is that like, a concise way to say it? And maybe so yeah. Okay.

Dr. Russell Ramsay 25:56
And, and see and see something through to completion? And even if we find out No, I don’t want to do that anymore, or it wasn’t what I thought it was going to be, to be okay. And to be able to let it go then and move on.

Kristen Carder 26:07
Yes, the being okay, I think is so crucial, because I, one of the things that I’ve changed about myself in the last five to 10 years is, you know, when something doesn’t work out, or when I changed my mind, just the way that I treat myself on the inside, I’ve drawn a lot of boundaries, which I think is part of deciding to trust yourself is like, I’m actually going to be nice to myself. And I’m not going to accept, like you said, the assault of raiding or judging or beating yourself up. It’s just like, Okay, this didn’t work out. How do I want to handle it? You know, I’m going to be sad for a little while. I might feel shame or judgment, and that’s fine. I can feel that, but I’m not gonna pile it on, from myself to myself. And now, a word from our sponsor. Hey, Kristen here, I’m the host of this podcast, an ADHD expert and a certified life coach, who’s helped hundreds of adults with ADHD understand their unique brains and make real changes in their lives. If you’re not sure what a life coaches, let me tell you, a life coach is someone who helps you achieve your goals like a personal trainer for your life. A life coach is a guide who holds your hand along the way as you take baby step after baby. Step two, accomplish the things that you want to accomplish. A good life coach is a trained expert, who knows how to look at situations or situations with non judgmental neutrality, and offer you solutions that you’ve probably never even considered before. If you’re being treated for your ADHD, and maybe even you’ve done some work in therapy, and you want to add to your scaffolding of support, you’ve got to join my group coaching, program focused, focused is where functional adults with ADHD surround each other with encouragement and support. And I lead the way with innovative and creative solutions to help you fully accept yourself, understand your ADHD, and create the life that you’ve always wanted to create, even with ADHD. Go to I have adhd.com/focused to join. And I hope to see you in our community today.

So how do you see that self trust or self mistrust shows up in our interpersonal relationships in our families and our like, partnerships and our friendships? Like it’s a whole thing? In my opinion? What’s your experience with that?

Dr. Russell Ramsay 28:47
No, and I’m glad you brought it up now, because sort of the scenario that you’re just giving, you know, sort of spoke to that like setting limits with other people. So how it came up for me, and I’ve, I’ve used the analogy of our relationships being like accounts, financial accounts with other people. Yeah, we sort of have like a shared account, and we make deposits and withdrawals, and there might be different expectations for what we contribute. So like a parent and a child, the parent takes on the bulk of it, and the child maybe has some chores they do but it’s you know, they’re you know, it’s not equal but generally in adulthood, there may be different roles, say at work or school, where that relationship has a certain account, but also the relationships our friends family, that network from which we get a sense of belonging. Maybe there’s more expectation of reciprocity and quid pro quo. So going back to the self trust how this became apparent, is a lot of times adults with ADHD seem like they’re always operating or they are they’re assume they assume they’re operating in the debt of other people. Well, I’m always late or I’m unreliable or even one joke one person I was working with talked about even getting to know somebody knew they start to anticipate, okay, how am I going to let this person down? So it’s almost like, you know, reducing their account already. And so some areas where they I noticed this coming up would be about assertiveness slash self advocacy. And these are some of these qualities or these behaviors that we say we all want to have those and do them. But what do they actually mean? So we talked about self advocacy, like for college students with ADHD, you have to advocate for yourself, well, what does that mean? It’s a degree of assertiveness. And, yeah, without going into the weeds, I sort of had this model where I broken down assertiveness into like actionable terms like what is my role in this situation? So maybe, well, I’m a student, I want to ask for an extension, and I have to make the professor, I have to get the accommodation without the professor being angry at me. Well, you can’t control what the professor’s reaction. What is your role, you’re a student in the class and you’re falling behind, you want to ask for it. The professor’s role is to field your request. And they don’t know that you want to ask it yet you have to introduce this. Their role is to hear it so they could be frustrated. But what else could it be? And that could be their first reaction and how you frame it probably goes a long way. If you go and say, Hey, Doc, I need a I need an extension. Now. I can guess yeah, we can reasonably guess. But if you go in and say, Hey, I know this is on me, and it’s something I’m working on. But could I have an extension till Monday? Still could be no. Right? And then that’s then you deal with it. But you could get the you could get the Yes. So how do you fulfill your role? And that would be an assertive statement. So assertiveness can be done nicely and collaboratively. And sometimes it is restating facts as we see them. Excuse me, I think I ordered french fries with my sandwich, not potato chips. Oh, yes. You know, a parent advocating for their child like with ADHD, who struggles with homework. You know what our daughter has been staying up, and we’ve been helping her but it’s still taking us till nine o’clock, and she’s really sacrificing sleep and we think it’s affecting her schoolwork. Yep. Now a snarky teacher could say, I don’t hear a question there. Now, it may be well, what can I do it? No, I don’t think he would get that. But I just use that to illustrate that, you know, be ready that they might go. Yeah. Well, I’m sorry to hear that. You know, what can we do? Well, when we were thinking, Can we like only have our daughter do the odd numbered math? Math question. So don’t be all 20. But it will be 10. But we’ll get a representative sampling. So there are ways to do assertiveness and self advocate, including and especially saying no, because, or to know, to unreasonable requests. Were very often this comes from that lowered self social capital of, okay, I can make it up with my friend. If I promised to do these things, or with my boss, I’ll promise to do this. In fact, I’ll see you and raise you. I’ll have it to you tomorrow morning, by eight o’clock. Until later on, we go, oh, my gosh, how am I going to do it? And then it becomes this self defeating cycle of now I have to ask for another extension. Or it wasn’t realistic. I wanted to it’s almost like pushing all your chips into the table. So I mean, so part of the assertiveness is being able to say, or at least learn to let me think about it and get back to you. Yes, and maybe make a counter proposal, you know, I won’t be able to do it this weekend. But if we could do it two weeks from now, or if I could have two weeks for it rather than one week. Yeah. And if we can’t get to it, it’s okay. But that’s another way that social capital comes up feeling. I can’t say no, because I owe somebody so much. And I am all for, hey, you drove me to the airport one and picked me up one time when I needed it. I want to I want to repay in kind, right? Or you did a big solid for me, I want to repay you or for family, we put ourselves out sometimes, but at least making informed decisions. So I think where that self mistrust comes up, is the public facing element of ADHD. Yes, how it can affect relationships, or at least for the person with ADHD may assume that maybe showing up late for lunch repeatedly annoys a friend. Now it may be something that you go even if my friend is fine saying no, no, I use it to catch up on my emails and things like that. It’s fine. But the individual may say I still want to get better at that. And there may be times where a boss says you know what, you’re late too often we’re going to have to, you won’t get your bonus if you keep up. So there can be actual things to work on where it does affect some of these relationships. But that automatically assuming a one down position, and I have to I have to build it up and I can’t look out for my needs. That’s where the assertiveness and self advocacy seems like it comes in as a very useful but underutilized skill.

Kristen Carder 34:50
I just love every single word that you just said because I do see this cycle in so many of my clients where we’re assuming a Deaf Sit right off the bat. But then what we increase that deficit by heaping on the things that we either take on we say yes to we agree to we assume that we have to do. And then by nature of that, like we’re signing up for too much. And of course, we can’t complete it. And so it’s a self fulfilling prophecy of like, okay, I knew I wouldn’t be able to show up for this person, I knew I wouldn’t be able to do this. And it’s like, well, yeah, but because you took too much on not because you’re a terrible person, or you don’t know can’t follow the steps.

Dr. Russell Ramsay 35:37
You over promised but then under deliver. And what we want to do is switch that around under promise and over deliver, yeah, meeting asked for, I don’t know, if it’s reasonable, but let’s just say ask for the five days to work on something. But then if you get it done in two or three, great, thanks perfectly, give yourself the buffer that you know, you might need. Yeah, you know, and going back to something else. And I think you used it when you were using an example of yourself how hard you can be on yourself, shame and guilt come up as emotions a lot. And these are two of the social emotions. And they it is good that we have this capacity. Now guilt is an emotion associated with the perception which can be accurate, that we have made a mistake or done or wrong. Yeah, we forgot an anniversary dates. We promised to pick somebody up and forgot we didn’t pay the bill or overspent or something like that. And it in reasonable doses. It is helpful. Oh, you know, I’m sorry. Let me pick you up tomorrow. I haven’t my calendar or what I said, I realize, I realize you’re a Cowboys fan. And so I’m really sorry that it might be yell. I’m sorry, I was bragging about our foreign Oh, start. Sorry, sorry. But so in reasonable doses can be helpful. But a lot of times we’ll miss perceive, or we think we’ve committed a felony. And actually we did jaywalking, right? And not even a ticket just the officer saying, hey, next time wait for the walk sign, right. But what we think we’ve done a capital crime and shame is that we have violated community or our personal values, which we are humans doing human things, people have extramarital affairs, things like that. But we’ve somehow lost face. And that’s why a lot of people say I can’t look people in the eyes for what I did. But that’s now there can be things like, folks with ADHD just like everybody else can have, you know, whatever. Yeah. And in terms of making amends, that is helpful to energize that, but very often, we’re talking about things that way out of proportion, either. No, you should not shouldn’t. But there’s no need for you to feel shame or guilt that that wasn’t like really a mistake you have to apply. Not just folks with ADHD, but I’ll hear it sometimes people who will reflexively say, oh, sorry. It’s like, you know, you don’t you don’t have to feel guilty for that. Oh, I’m sorry. I felt guilty. It’s like, No, you don’t have to Yeah, and some and sometimes it is a practice, like, just observe how many times you say sorry for something that isn’t you’re doing? Oh, coming in, you know, let’s just say somebody’s coming in for a meeting. And like, oh, it’s all it’s all wet. It’s raining outside? Oh, yeah. Sorry. It’s like, you’re not you don’t control the weather. But it you know, but it is it is funny, but people catch it and say, you know, I do do that a lot. Yes. And so it is interesting to catch it. And an even I heard a twist on this on some social media forum. Rather than coming into a meeting you’re late for say Sorry, I’m late say. Thanks for waiting. Yes, almost like giving a credit. And it’s sort of like, Hey, thank you for your patience. And that it’s just a different energy. Now it’s a reframe, and we’re still late and stuff like that, but just different ways to think about how we handle ourselves and handle situations. But I think the like setting boundaries is a big one for adults who and and being able to ask for and as crucially accept help. When Yeah,

Kristen Carder 39:13
okay, let’s just chat about the boundaries, just very quickly, because this has been a theme of my life recently. And one of the ways that self trust shows up for me personally, is, I trust myself to say no, when I need to, I trust myself to set a boundary when I need to. And that hasn’t always been the case. And I’m starting that process of like, if something is too much, I’m going to trust myself to say no, rather than what it used to be was like, I’m just going to say yes to everything because I have FOMO and I also feel like I’m working from a deficit and I just, I really like people and I want to help everybody. And so I’m just gonna say yes, yes, yes, yes. And then I don’t trust myself to like no, my own limits. And I think that that’s one of the most beautiful ways that we can develop self trust is, we can start to notice where our limits are, and trust ourselves to show up and say, like, no, that doesn’t really work for me, or I’m sorry, I’m not gonna be able to do that. Or, actually, when you talk to me like that, I feel really terrible. And I’d like it, if you can do it differently, right? It’s just like, trusting yourself to set limits.

Dr. Russell Ramsay 40:23
And what you did nicely there is framing it and behavioral terms when you talk to me like that. As opposed to, you know, I mean, there’s a you in there, or you can say when I’m spoken to like that, but you know, this is the therapists cliche, because like defensiveness is our factory setting as humans. As soon as we hear you need to, we go, oh, really, as you can see me, I’m crossing. I’m crossing my arms in defiance right now. And even if it’s like, hey, you need to be nice to yourself. We’re eventually going, Oh, what do I need to do? Tell me more, right. But you’re like, something like that. Even like a relationship partner, you know, when you call me that, that really hurts my feelings. And hopefully, it’s in a relationship where you go, you know, I’m wrong. And that was my bad. And the other thing was setting limits. We’re also a lot, we’re trusting the other person and allowing them the time and space. Because will will say, I want to set limits. I want to be assertive that but I don’t want people to be upset with me. Now, the first reaction for that person might be disappointment. Oh, we really wanted you to do it. And now I gotta go find somebody else. So that’ll be maybe their first reaction, maybe even a little anger. It’s like, oh, well, who are you to say no. But then a few seconds later, very often, people go, well, she’s really busy. And okay. And other people said no to me, and allowing them the time and space to work through what they need to. And even though the first reaction might be a little snarky, or like, frustrated, Oh, I gotta find somebody else. That’s not their last or most representative reaction. Just like if we ask somebody for a favor, and they say, Yeah, I can drive you to the airport. Oh, nevermind, I just wanted to see if you’d say yes, no, we’re great. But if they say no, it’s like, all right, I got to think of something else. And allowing them to solve it on their own and work it through just like we would on the other hand, if somebody said no to us, yeah. Our first reaction might be a little frustration. But then later on, we go, well, that’s reasonable. And I respect that. They said, No, and maybe they just can’t do it. Okay, I’m fine with that. And we move on.

Kristen Carder 42:24
So doesn’t that circle back to like, self agency and self efficacy, where it’s just like, oh, yeah, you’re a human. And I’m a human, and we’re not the same. It’s like, right, right, remembering that we’re not all enmeshed beings, but like, we’re actually separate. Humans. And I, for some reason, I think that adults with ADHD really struggle with this on a more profound level, where it’s just like, we feel the need to take care of everybody and make sure that they, and maybe it’s rejection sensitivity, like, you know, if you are upset with me about me setting a boundary, then I don’t feel good about me anymore, rather than just remembering like, oh, yeah, you’re a human, you get to be upset. This is an inconvenience. And a boundary usually is an inconvenience to the other person. And just like that,

Dr. Russell Ramsay 43:13
like I said, that’s why I use that example. Somebody asked me for a favor, you agree with you? And you say, oh, nevermind, I just wanted to see what you’d say. No, no, we’re thankful. And that’s the other thing is reinforcing. And that social capital, oh, you’re the best. Thank you so much. Yes, for a picket all your life saver, or you’re, you’re the perfect, you’d be the perfect, and even beforehand, you’re the perfect person to run the school fundraiser. We can’t think of a better person. Because that if we’re at a deficit of that, it feels great until we go, oh, my gosh, what did I sign on for? And I would even say, in that case, you know, assertiveness is going back to say, You know what, when I thought about it later, there’s no way I’m going to be able to do it, I’m going to be out of town or whatever. But then we hold back, oh, no, give backs, I can’t help. I can’t give it back. Well, we can, we can at least give it a try. Or say I’m going to need help, or somehow advocate for yourself. You know what I think, you know, some of the social capital plays a role. But also if we, if we’re good at self compassion, that can be a positive trait, that and if we do get some, like we’re in helping professions, so we, you know, part of part of that, if we want to put it in core belief terms, it’s called subjugation. Putting others needs first. And that’s what being a parent is all about. That’s what working in healthcare is about. So like when somebody’s sitting down to me, and it’s like, Hey, let me tell you about my day, man. No, it’s real for that time. It’s not about me, it’s a service that I provide. Now, again, there can always be too much because then some people will say, I’m giving and giving and giving I feel good. I’m glad to do it. And but when I don’t get my 20% met, then I get angry, because that’s not fair. But if we’re training other people, okay, they’re there all the time. And they don’t ask for everything part of this is retraining everybody, if they’re used to us saying yes, hey, we’re gonna sign you up to be a speaker at our conferences here. And sorry, we can’t give you a fee or pay for your travel. But we can’t wait to hear what you have to say. And if you go, sorry, I can’t do that this year. Yeah. Or hear it? Here’s my speaker fee or something like that. Yeah, that’s like, oh, that’s different. And it’s not it’s not Najee. It’s just a It’s just business.

Kristen Carder 45:29
Totally. I have been in a retraining process in the last couple of years, with people in my lives. And I will say like, it’s hard for everybody, it’s hard for me to step into that new kind of identity. It’s hard for the relationships in my life of like, Excuse me, like, this is changing. And I’m like, yeah, no, like,

Dr. Russell Ramsay 45:50
I am we don’t I am changes uncertain. That’s why I’m positive change. Even positive change is stressful.

Kristen Carder 45:57
Yes. Oh, my goodness, it’s wild. I love the concept of being assertive. And I know that’s not necessarily what the bulk of our combo is about. But how do we begin to take steps to be assertive? If we’re not people that trust ourselves? Do they have to go hand in hand, I guess, is what I’m asking.

Dr. Russell Ramsay 46:19
You know what? I don’t think so. I call it you know, just to have something to call it I call it the Define your role strategy. So really what it’s meant to be just like I do with specific tasks. Let’s shrink this down and define it behaviorally. What do you have to do? Oh, I have to I have to write a book, or I have to write an A essay. Well, let’s, let’s talk about what are you writing about? What’s the topic? Tell me about your ideas? And like, you know, just Can you write down that sentence, you just told me, that’s a sentence, that’s part that’s writing, or, you know, sitting down, so it’s really trying to shrink it down, rather than I have to be assertive, or I have to, what is your what is your role in this situation? You know, people, you might have people saying, I have me on your broadcast, and you say, Oh, this is awkward. And I’ve got something to share, or whatever. And it’s like, what is my role? Here’s my, my, is my podcast, like I’m like, yeah. And so my role is to seek out people if somebody has something interesting, but I have a responsibility to myself, and maybe too quickly to my listeners. So I’m going to say, sorry, I can’t offer you an invitation. We have we have another way we go through this. So it’s what is my role? I am the gatekeeper. So how do I fulfill that role? Sometimes I may have to tell somebody, no, and a definitive No, because they might come back. But I can say that in a nice way. Or recommend maybe maybe you would want to, you know, submit for a Chad session or an ad and add a TED talk or something like that. Give them other ideas, but to say no, my my no is final, and I will not be corresponding with you anymore on this topic or something. Yeah. But it’s like shrinking it down. And how do I perform my role and actionable? What do I sit? What words do I say? What email do I type. So there’s an action that we can go, I’m typing this hitting the send button, which will be in the investment of three seconds of flushed? Okay, I did it, and they may hate me. But then at four seconds, and after you go, I just saved myself a whole bunch of hassle and doing a podcast I really don’t want to do and having an excuse why we’re not airing it or whatever. Yeah. So that’s sort of like the thinking behind this strategy. It’s like shrinking it down into actionable terms, including saying no, or making a request, or whatever the case be, and coming up with scripting out. What will you say even if you have to write it down and read it, which is not cheating.

Kristen Carder 48:50
It’s not cheating. I love that. I love I love this so much. Because what is my role is such a simple question. And it’s something that we can use and apply over and over. And I think about this, like as my role as a mom. So I have three kids. And one of the things that I am really trying to do well for them, that wasn’t modeled for me is like, show up an advocate for them, and maybe be a buffer between them and a teacher or them and like a friend that they’re you know, and so I like the concept of just asking myself, like, what is my role here? Oh, my role is like, Owens mom. Okay, as Owens Mom, how do I want to show up? Oh, okay. I want to be an advocate for him. I want to, you know, make sure that he gets the services that he needs in school, or that he’s getting the help from a teacher. Oh, that just makes it so much more clear than like

Dr. Russell Ramsay 49:43
I did with that. Like I said, it can be done nicely. I think I ordered french fries and potato chips and servers probably going to be Oh, sorry about that. Let me take care of that for you to probably have that somebody in the back or they’ll say sorry, we’re out of we’re out of French fries today. That’s why I gave Oh, okay. No problem. Yeah. And that’s why Roll the deal with it. And things like that going into the teacher, I gave that one scenario about the daughter spending so much time on homework, you can start it off. We’re really hoping you can help us out and we can use your wisdom as a teacher. Here’s what we’re facing. So starting off with a joining, so it can be also collaborative, just like totally calling up. Yo tech support. Hey, I’m really hoping you can help me out with a problem. Yeah, yeah. Collaborative. Collaborative. Yes. I know. That’s partly my did because nobody likes conflict. That’s what they say about being assertive. Because we conflate assertiveness with aggressiveness. I’m going to go in there. I’m going to get what I want. And that may be part of it. We’d like to have this outcome. I want french fries must be close to lunch. But I’m kidding. Kidding. But yet the man fries, the fries and chips aside the chips with that, too. I don’t take the chips. I’ll take those. I’m sorry. No, no, no. But we can still go in there with an objective that we want to get. And and Yeah, and like I said, restating facts, as we see them is a nice way to frame what am I asking for? Yeah,

Kristen Carder 51:06
I love that. I love that. What are some of the ways that you work with clients to develop self trust?

Dr. Russell Ramsay 51:12
Well, I won. It is around both the you know, their treatment goals. And what’s usually somewhat for my money, some form of procrastination or disengage not disengagement, not pardon, a double negative, it’s not not caring. But that repeated, I can never I can’t stay on top of this thing I really want to have the outcome on, it’s helping with that. But also along the way, making sure it’s getting metabolize, you know what, you’re doing this better than you think you are, or the fact that you say, I had three good days than a lousy day I failed and say, No, that’s 75%. That’s above average. They’re not going to do it every day. And you’re also finding about maybe how you’re calibrated. Maybe you need a day away from this. Yep. Now that could be wrong. But let’s look at how, how you do it? Well, I’m a big believer in the concept of equi finality, there are different pathways to get to the same positive outcome. So what works for me, I might like if I have a writing session I can with properly caffeinated I, if I can probably go at least two, two and a half hours, probably three hours on a regular setting. And sometimes if I do three, that’s good. Somebody else might go? No, I 90 minutes. Yeah, that’s what I’m calibrated for. But I might have to do it more frequently, or separate times during the day. So yeah, that works, too. Are you right? Am I right? We’re both right. Totally. So you know, it’s finding what works for you. And, and like, I’ll tell people, even in the books, these are starting points. This is what seems like it’ll work for a wide array of people. But if you want to use colored pages in your planner, or you go to No, I’m not gonna break this down, I’m okay. I won’t do it the night before. But I’m gonna wait till two days before because I still get everything done. That’s fine, I may not be able to do it, or other people may fall apart when they do that. But if that works for you, maybe a phrase I go back to it’s making informed decisions, which is how I think another way we generate trust, both in how we’re doing something, and that this is going to work for us. So it is still tied in with the treatment goals. And very often managing these real world scenarios, including sometimes going, I don’t want to be in this scenario anymore. I’m not good at chess. And I found out by trying, I’m more passionate about this over here. So I want to give this a try.

Kristen Carder 53:44
I love that you point out people’s achievements, because one of the things that I find with my clients is they’ll say things like, I’m not going anywhere. Or I’m always so behind. And then if I if we can reframe it and say like, Oh, is that true? Like, have you not accomplished anything in your life? Oh, well, I mean, I do have a college degree. And I do have 10 years experience in this and like, they can list out all of these things that they they have accomplished they can trust themselves to do but what we do is we go into this black and white thinking of like, that doesn’t matter now. Because today what I’m seeing is doom and gloom.

Dr. Russell Ramsay 54:24
Absolutely. I had one client she was working on being on time and showed up like a couple minutes early. She said Yeah, but I was almost late. It was almost like that. Well, because and I think it is self protective because it’s okay, what happens next time, because another thing with adults with ADHD as they’re doing better, their expectations change and others expectations change. And there’s that little bit of worry like, and people will say and partners will say yeah, I’ve seen you do well for three or four weeks. always goes back. Right. And part of that part of this may be not just with ADHD. It could be things that we all do we eat healthy for a while. then after two months or after a holiday meal, it’s sort of like, Oh, we got all these how all this Halloween candy leftover or, or hopefully in February we’ll be having Super Bowl parties in Philadelphia and there’ll be a whole lot of soft pretzels or whatever. Here for Oh, no. Yeah, there you go. No, but they kick the kidding aside, it’s sort of like some of that might be cyclical. And it’s not necessarily a bad thing you work it when you work it into the expectations, okay, we need a refresher periodically. So and that’s a couple could arrange to say, Okay, let’s sit down. What do we need to get back on top of so it’s not necessarily a bad thing. It’s how you think about it.

Kristen Carder 55:36
And it’s like, I trust myself to get back on the horse. Right, right. Like, I know, I’m gonna fall off the horse because everyone does. But I trust myself to get back on right.

Dr. Russell Ramsay 55:46
Yeah, what is it success is getting up one more time than you fall off.

Kristen Carder 55:50
Yeah, I love that. Thank you so much for your time and all of your just wisdom in this area, because I’ve learned so much from you. And I know that my listeners are just thrilled to be able to hear from you again. I appreciate you being here with us.

Dr. Russell Ramsay 56:07
Well, Chris, and I appreciate what you do with your podcast and all the good work you’re doing for everybody out there.

Kristen Carder 56:12
And if people want to get in touch with you read your books, your website, can you tell us what your website is?

Dr. Russell Ramsay 56:20
www CBT number four adhd.com. Now sometimes people get really excited thinking I said CBD, but they’re really disappointed when they say I have nothing to do with the books are available on the website. We actually learned the toolkit has been translated into Spanish, French, Canadian, Korean, and it is in the process of being translated into German. We just got some interest in that now and it’s going to happen so

Kristen Carder 56:48
to hear that international listeners go to CBT for adhd.com to find Dr. Russell Ramsay’s books and many of them translated in other languages. I love it. Thank you so much. Appreciate your time. Have an amazing day. Thanks, doctor and see you too personal bye. Bye bye. If you’re being treated for your ADHD, but you still don’t feel like you’re reaching your potential, you’ve got to join focus. It’s my monthly coaching membership where I teach you how to tame your wild thoughts and create the life that you’ve always wanted. No matter what season of life you’re in, or where you are in the world focused is for you. All materials and call recordings are stored in the site for you to access at your convenience. Go to Ihaveadhd.com/focused for all the info

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