Self- and Interactive Regulation: Treating a Patient with AD/HD

Attention Deficit/Hyperactivity Disorder (AD/HD), only recently diagnosed in adults, usually is treated by medication and coaching. This article presents a psychoanalytic treatment of an AD/HD patient, taking account of the development of self-regulation in terms of interactive social exchanges, as well as neurobiologically based factors. The patient's gains in cognition and affect management opened the way for development of empathic capacity after the therapist began integrating ideas and methods from the AD/HD theoretical literature with Beebe and Lachmann's (1994, 1998) model of self-and mutual regulation. The key idea from the AD/HD research (Barkley, 1997b) is that the disorder is at root a deficit in the capacity to inhibit response to internal and external stimuli long enough to allow time for reflection, affect management, planning, and other executive functions that neuroscience links with the prefrontal cortex and other areas of the brain.