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with Cynthia Martin
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ADHD Therapy in San Francisco (Psychodynamic & Relational, IFS-Informed)
ADHD as Biology, Ecology, and Mystery
ADHD is often framed as a biological condition. And it is—with a defined pattern in the brain, a clinical diagnosis, and treatments that help many people. But it’s also more than that. It’s also influenced by the environment you live in. From a transpersonal perspective, ADHD might also reflect a deep sensitivity to the unseen—subtle energies, nonlinear time, intuitive knowing—that doesn’t always fit within conventional systems. In this post, we’ll look at ADHD through multiple lenses—biological, psychological, systemic, and transpersonal.
DSM-5: what gets diagnosed, how, and why it helps (but doesn’t explain everything)
What the DSM-5 is. It’s the clinician’s handbook—the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Think classification, not character. It gives shared language for research, treatment, and insurance; it does not tell your full story. ADHD is defined as: a persistent pattern of difficulty with attention and/or impulse–activity regulation that begins in childhood, shows up in more than one setting, and causes real interference with life. The manual groups symptoms into two clusters. Inattention includes things like losing the thread, missing details, disorganization, time-blindness, and forgetfulness. Hyperactivity/impulsivity includes inner restlessness, moving or speaking faster than the moment can hold, interrupting, acting quickly without enough pause, and trouble waiting. You can meet criteria mainly in one cluster, mainly in the other, or in both.
What must be true for a diagnosis. Several symptoms were present before age 12. The pattern shows up in at least two places—home and work/school, or relationships and daily tasks—not just in one narrow context. There’s clear evidence of impact: missed goals relative to ability, conflict, strain, or underperformance. And other explanations—sleep disorders, anxiety or depression, trauma responses, substance effects, medical conditions, learning differences—have been reasonably considered and ruled out.
How it looks in adults. The “hyperactive” piece often moves inward with age. Instead of climbing on furniture, you feel driven by a motor, overbook, talk fast, or live in constant mental pacing. The inattentive side can present as quiet overwhelm: decision gridlock, perfectionism as a shield against “careless” errors, or people-pleasing that hides missed details. Many adults mask so well that impairment only becomes obvious at transitions—college, parenthood, promotions, remote work—when scaffolds fall away and load increases.
How diagnosis happens. A careful evaluation gathers history from childhood to now, asks about school and work, checks sleep and medical factors, screens for mood and trauma, and usually includes rating scales from you and someone who knows you well. Neuropsychological testing can help but isn’t always necessary. Good evaluations also notice strengths, not just deficits.
A note on girls and AFAB folks getting overlooked. Across childhood and adolescence, those socialized as girls are less likely to be referred or diagnosed—even when impairment is real. Why? Their presentation often skews inattentive (daydreamy, perfectionistic, “good student”) rather than overtly hyperactive; masking and people-pleasing can hide struggle; teachers and families may interpret effortful compensation as “fine.” Add fawn responses, internalized anxiety, and cultural expectations to be agreeable and self-managing, and the pattern is easy to miss until life ramps up. Many finally get recognized in late high school, college, early career, or parenthood—moments when the load exceeds their camouflage.
Why getting the name can help. Diagnosis can unlock accommodations, legitimize medication trials, create shared language with loved ones and workplaces, and end years of moralizing self-talk. It gives you access to supports designed for the pattern you actually have.
What the DSM can’t do. It doesn’t weigh culture or context very well; it doesn’t describe how shame, safety, or meaning change your day; it won’t tell you why your attention blazes for art but dies for spreadsheets. The DSM is a map of symptoms. You are a landscape—shaped by wiring, yes, and also by systems, relationships, identity, and purpose. We’ll hold both truths as we move forward.
I support ADHDers with executive function challenges like time-blindness, task initiation, working-memory slips, and the fun combo of sensory overwhelm and perfectionistic shutdown. We treat ADHD as a difference, not a defect. My approach is neurodiversity-affirming and strengths-based, blending psychodynamic therapy with IFS-informed parts work and gentle somatic regulation. Sessions are practical and collaborative: we externalize memory, build friction-reducing systems, experiment with body-doubling and practical supports, while designing environments that fit your actual brain. We also address the deeper stuff—rejection sensitivity, masking, shame—and grow self-trust so follow-through doesn’t require self-punishment. Pacing is flexible and humane; we iterate, not “try harder.” I’m queer-affirming and trauma-informed, and I coordinate with prescribers when medication is part of care. The goal is sustainable rhythms and creative focus, so life runs on your settings instead of against them. I offer virtual-only therapy for clients across California.
ADHD as Biology, Ecology, and Mystery
ADHD is often framed as a biological condition. And it is—with a defined pattern in the brain, a clinical diagnosis, and treatments that help many people. But it’s also more than that. It’s also influenced by the environment you live in. From a transpersonal perspective, ADHD might also reflect a deep sensitivity to the unseen—subtle energies, nonlinear time, intuitive knowing—that doesn’t always fit within conventional systems. In this post, we’ll look at ADHD through multiple lenses—biological, psychological, systemic, and transpersonal.
DSM-5: what gets diagnosed, how, and why it helps (but doesn’t explain everything)
What the DSM-5 is. It’s the clinician’s handbook—the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Think classification, not character. It gives shared language for research, treatment, and insurance; it does not tell your full story. ADHD is defined as: a persistent pattern of difficulty with attention and/or impulse–activity regulation that begins in childhood, shows up in more than one setting, and causes real interference with life. The manual groups symptoms into two clusters. Inattention includes things like losing the thread, missing details, disorganization, time-blindness, and forgetfulness. Hyperactivity/impulsivity includes inner restlessness, moving or speaking faster than the moment can hold, interrupting, acting quickly without enough pause, and trouble waiting. You can meet criteria mainly in one cluster, mainly in the other, or in both.
What must be true for a diagnosis. Several symptoms were present before age 12. The pattern shows up in at least two places—home and work/school, or relationships and daily tasks—not just in one narrow context. There’s clear evidence of impact: missed goals relative to ability, conflict, strain, or underperformance. And other explanations—sleep disorders, anxiety or depression, trauma responses, substance effects, medical conditions, learning differences—have been reasonably considered and ruled out.
How it looks in adults. The “hyperactive” piece often moves inward with age. Instead of climbing on furniture, you feel driven by a motor, overbook, talk fast, or live in constant mental pacing. The inattentive side can present as quiet overwhelm: decision gridlock, perfectionism as a shield against “careless” errors, or people-pleasing that hides missed details. Many adults mask so well that impairment only becomes obvious at transitions—college, parenthood, promotions, remote work—when scaffolds fall away and load increases.
How diagnosis happens. A careful evaluation gathers history from childhood to now, asks about school and work, checks sleep and medical factors, screens for mood and trauma, and usually includes rating scales from you and someone who knows you well. Neuropsychological testing can help but isn’t always necessary. Good evaluations also notice strengths, not just deficits.
A note on girls and AFAB folks getting overlooked. Across childhood and adolescence, those socialized as girls are less likely to be referred or diagnosed—even when impairment is real. Why? Their presentation often skews inattentive (daydreamy, perfectionistic, “good student”) rather than overtly hyperactive; masking and people-pleasing can hide struggle; teachers and families may interpret effortful compensation as “fine.” Add fawn responses, internalized anxiety, and cultural expectations to be agreeable and self-managing, and the pattern is easy to miss until life ramps up. Many finally get recognized in late high school, college, early career, or parenthood—moments when the load exceeds their camouflage.
Why getting the name can help. Diagnosis can unlock accommodations, legitimize medication trials, create shared language with loved ones and workplaces, and end years of moralizing self-talk. It gives you access to supports designed for the pattern you actually have.
What the DSM can’t do. It doesn’t weigh culture or context very well; it doesn’t describe how shame, safety, or meaning change your day; it won’t tell you why your attention blazes for art but dies for spreadsheets. The DSM is a map of symptoms. You are a landscape—shaped by wiring, yes, and also by systems, relationships, identity, and purpose. We’ll hold both truths as we move forward.
Neurobiology (plain English, with lived-life examples)
Think of attention as a job your brain performs. That job has three moves that trade places all day: hold the plan and carry it through (executive function), decide what matters right now (salience), and drift inward to remember/imagine/plan (default mode). Everyone uses all three. The difference isn’t which moves you have—it’s how smoothly you can pass the baton between them and what it takes to get the system to “ignite.”
Morning scene: inbox → meeting → notes.
A neurotypical handoff looks like this: you open an email, the plan-holding part keeps the thread (“reply to Sam, attach the PDF”), the salience system briefly flags a calendar alert for your 10 a.m. meeting, you finish the email, then shift to the meeting. During the meeting, a good idea pops up from that inward, imaginal space; you jot it down and return to listening. Each system steps forward, does its job, and steps back.
An ADHD handoff often feels like this: you open the email to reply to Sam and, before the task clicks in, the wall of unreads yanks your eyes; a calendar ping pops; a Slack bubble flares. The salience system promotes each signal in quick succession. The plan-holding part loosens its grip; the imaginal part whispers, “Maybe just clear the whole inbox right now.” By the time the meeting starts, your inbox is still full and the reply sits half-written. Your boss asks a question and you miss it—busy beating yourself up for not getting back to Sam. It isn’t that you don’t care; the ignition didn’t catch, and the baton kept bouncing between systems.
Dopamine & norepinephrine — fuel and the spotlight
Think of dopamine as motivation fuel and norepinephrine as the spotlight that helps you lock onto one thing at a time.
Dopamine (fuel).
In ADHD, the issue isn’t “you have no fuel.” It’s that fuel shows up unevenly. When a task is meaningful, new, urgent, or connected to someone you care about, dopamine arrives and the plan-holding part of your brain can grab the task and keep it. When the task is boring with a payoff far away, dopamine often doesn’t arrive on cue. That’s why starting feels like a wall even when you care. It’s fuel delivery, not effort or morals.
Norepinephrine (spotlight).
This signal sets how bright the salience system’s spotlight is—the part that decides “what matters right now.” If the spotlight is too dim, nothing catches; everything feels far away. If it’s too bright, it flickers like a strobe and everything looks urgent (email, ping, thought, crumb), so the baton keeps dropping between noticing and doing. In the just-right zone, one target stays lit long enough for the plan-holder to work, while the imaginal/default part waits its turn.
Put together in plain English: fuel (dopamine) helps you engage and stay engaged; spotlight (norepinephrine) helps you choose and keep one thing in view. ADHD means fuel is interest-dependent and the spotlight can be wobbly. That’s why a looming deadline or a co-working buddy can suddenly make starting easy (fuel arrives), and why a noisy room or a tidal wave of notifications can blow up your focus (spotlight flickers).
The nervous system (somatic) — the stage the show plays on
We just talked about the three “actors” of attention—plan-holder, salience-decider, and imaginal drifter—and the two cues that help them perform: dopamine as fuel and norepinephrine as the spotlight. Now zoom out one level. Every performance happens on a stage, and the stage changes what the actors can do even if the script is the same.
On a steady stage, the floor feels solid, the lights are warm, the sound is clear. In your body, that reads as safe enough: breath that actually moves, a jaw that isn’t braced, a chest that isn’t armored. In that climate, the spotlight finds one target and stays there; the plan-holder speaks their lines; the imaginal one waits in the wings until it’s invited. The fuel lands and turns into action instead of static.
When the stage tilts toward fight/flight, it’s like someone has cranked the lights to a strobe and turned the speakers up too loud. Your salience system keeps flagging everything; the spotlight skitters from cue to cue; the plan-holder trips over their own lines. You feel charged without direction—ready to do anything except the thing in front of you. Fuel may be present, but it burns hot and scattered, and the baton between actors keeps slipping.
Freeze (low power). You’re mid-line and you spot your ex—the one who ended things—in the front row. In a heartbeat the stage tilts. The house lights drop, the mic feels far away. Inside, the salience system swings the spotlight to one target: them. Fuel drains. The plan-holder tries to keep the next line, but it comes out as a whisper. The imaginal/default side drifts forward—replaying old scenes, predicting new ones—because picturing costs less than doing. From the outside it looks like you “lost your train of thought.” From the inside it’s low battery and social threat taking the stage. Time goes gauzy at the edges; the scene stops holding.
Fawn (please-and-appease, same room). Same ex, same front row—but instead of freezing, you start playing to them. The audience gets louder than your script. The salience system prioritizes their face, their reactions, their imagined judgments. From the balcony it reads as “inattention.” On the stage it’s a survival role outranking the task: stay connected, stay safe.
This is why chemistry and mechanics never land on a blank slate. Fuel and spotlight hit a living stage—steady, overamped, or dimmed by what (and who) is in the room. When the stage steadies, the plan returns, the spotlight widens beyond one face, and your lines come back.
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Attachment
A child doesn’t learn regulation from a worksheet. She learns it from someone’s nervous system meeting hers—over and over—until her body knows what “settled enough” feels like from the inside.
In the first years, the “planning and brakes” part of the brain (prefrontal cortex) is still wiring up. The left-brain skills we lean on later—language, sequencing, rules—are growing but not yet in charge.
So the early teacher is relationship: a calm, attuned caregiver who can notice the child’s internal weather and answer it accurately. Psych folks call this co-regulation and serve-and-return. In plain English: the child serves a signal (a cry, a wiggle, a bright burst of joy), and the caregiver returns with presence that matches the moment—soothing when there’s distress, delight when there’s discovery, boundaries when there’s overwhelm. The caregiver’s body becomes a borrowed prefrontal cortex, lending pacing, breath, and meaning until the child can carry more of that inside.
For a child with ADHD traits, this matters even more. Her attention is interest-based and her arousal swings a little wider. She may rocket toward what’s exciting and slip off tasks with thin meaning. In that landscape, an attuned adult is not a traffic cop; she’s a weather reader. She names what’s happening (“big energy,” “lost the thread,” “your brain wants novelty right now”) and holds the tone that says you’re safe enough for this moment. Over time, the child’s body learns the feeling of coming back from too much or too little. That felt sense—not a lecture—is what later becomes self-regulation.
You can feel the difference in two tiny scenes:
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The child knocks over a glass while chattering about her drawing. One caregiver snaps, “Be careful! Pay attention!” Her body freezes; shame spikes; the salience system now orients to danger, not the drawing.
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Another caregiver breathes, meets her eyes, and says, “Oops—big ideas and fast hands. Let’s get a towel.” The nervous system reads connection first. The plan-holder can re-enter. The lesson lands as a body memory: I can come back from a spill.
Neither moment “cures” ADHD. That’s not the job. The job is building implicit regulation—the quiet, wordless expectation that feelings and impulses can be noticed, named, and held without anyone losing relationship. That expectation is what later lets an ADHD nervous system work with its own weather: noticing the gusts, steering with them when possible, easing off when the wind is wrong.
When attunement is missing or inconsistent—chronic criticism, misreading, or a home that’s too loud to track subtle cues—the body often learns different lessons: perform to belong, hide the mess, move faster, don’t need anything. Those lessons look like “inattention” from the outside (fawn, freeze, hypervigilance), but underneath they’re loyalty to survival rules. Raise attunement and steadiness later—through therapy, healthier relationships, gentler rooms—and you can watch the stage change. The spotlight widens beyond threat, the plan-holder finds its line, and the imaginal part returns to its proper place: a source of creativity, not an escape hatch.
So attachment isn’t a side note in ADHD. It’s the context that teaches a developing brain what to do with its sparks: how to aim them, how to pause without shame, how to begin again. With a steady other—early in life or later in repair—the child (and the adult she becomes) learns to read her own sky and sail by it, not against it.
State-changes (timing & thresholds)
Think of your day as a play with scene changes. Attachment teaches you that you won’t be dropped between scenes; state-changes teach your body how to change scenes at all.
Let’s put timing back where most of us actually learned it: school. For twelve-plus years, the stage is run by bells. Subjects change on the half hour whether you care or not. You sit still, face forward, hold your questions. Attention gets graded as a posture—quiet, compliant—rather than a living process that runs on fuel and a steady spotlight.
For an interest-based system, those years teach endurance and masking more than they teach timing. Transitions are external: stand, move, sit, begin. If the lesson is dull, you grip the plan with white knuckles or drift inward while pretending to track. If a teacher’s approval equals safety, your salience system orients to faces, not ideas. The schedule works—sort of—but it isn’t yours. It’s borrowed time.
Then the bells stop. Graduation drops the curtain on external structure. No homeroom, no hall pass, no teacher handing you the next scene. For a lot of folks, that first wide-open year is freedom and hell at once. Freedom, because you can finally follow meaning. Hell, because nobody taught you how to build a stage when the institution stops doing it. Without a bell to yank the spotlight or a countdown to pump fuel, the baton pass between plan, salience, and imagination skids. Days stretch and snap in odd places—wired at midnight, flat at 10 a.m., bright in sudden pockets, foggy the moment a task needs to change shape.
In adulthood, thresholds are chosen—or they vanish. You’re asked to generate internal time: to feel when a scene ends, to mark it, to cross into the next scene without a shove. If nobody modeled that, the stage feels bare. Even work you care about can turn slippery, because fuel in ADHD is interest-dependent, and the spotlight gets wobbly without a shared script.
Mystery
ADHD Through a Transpersonal Lens
ADHD is often spoken of as a deficit, a lack of focus, a disorder to manage. But through a transpersonal lens, what looks like a struggle to hold attention can also be understood as a sensitivity to the vast field of life itself—an attention system tuned to more frequencies than most minds can comfortably carry. The challenge, then, isn’t just about focus—it’s about relationship with awareness itself.
In the language of the nervous system, ADHD describes a difficulty regulating arousal: the body’s rhythm outruns or undershoots the moment. In the language of the soul, it can describe a difficulty staying embodied in time. Some part of consciousness remains open to what’s not yet here, what’s just beyond the veil of the present task. That’s why the mundane can feel unbearable, and imagination feels like oxygen.
Transpersonal psychology invites us to see attention not merely as a cognitive skill but as a bridge between worlds—the material and the imaginal, the personal and the collective. The mind of someone with ADHD is often porous: intuition rushes in before logic arrives, insights flicker faster than language can hold them, and the body lags behind the storm of perception. From this view, the task is not to narrow awareness but to ground it—to learn how to live as an open system without burning out.
Grounding doesn’t mean shrinking. It means remembering the body as a channel that consciousness flows through, not away from. Breath, sound, movement, ritual—these bring attention back into form. In therapy, we might call this co-regulation or somatic anchoring. Spiritually, it’s incarnation practice. Each return to the body is a micro-meditation on being here now, again.
And the “hyperfocus”—it’s devotion in disguise. When the outer world finally syncs with the inner current, attention can rest, luminous and effortless. In that sense, ADHD isn’t just a neurobiological condition—it’s a rhythm of consciousness learning how to balance expansion with embodiment, cosmos with calendar.
When we stop seeing ADHD as brokenness, we start to see it as a unique initiation: an invitation to become fluent in energy management, to dance with awareness instead of disciplining it. Healing, then, is not about fixing the mind’s scatter but befriending its scope—trusting that the same system that forgets appointments may also glimpse truth others miss.
The Hidden Strengths of an Expansive Mind
When viewed through the narrow lens of productivity, ADHD can seem like chaos. But through the wider lens of consciousness, it reveals extraordinary capacities—just not the ones our culture is built to reward.
People with ADHD often track patterns beneath patterns. They sense undercurrents in conversations, spot emerging themes in groups, and intuit connections across disciplines that others might miss. This associative flow is not random—it’s the mind’s way of mapping the living web, seeing the world as a whole rather than a sequence of tasks.
There’s also a kind of creative fearlessness woven in. Because the ADHD mind doesn’t cling tightly to a single line of logic, it can pivot quickly, improvise, and generate novelty in the gaps where others stall. What looks impulsive from the outside often arises from a deep trust in emergence—an instinct that life will catch you mid-leap.
Many carry a high emotional intelligence that’s been hidden under self-criticism. Their sensitivity to subtle cues—the energy in a room, the micro-shifts in tone—can make them gifted in empathy, humor, art, and leadership. When channeled rather than suppressed, that perceptual openness becomes a form of attunement to the collective field.
And at its best, the ADHD nervous system is built for wonder. It’s designed to stay porous to awe, to feel the pulse of aliveness in ordinary things. The very same attention that drifts in classrooms can drop, unguarded, into the sacredness of a single moment.
How Therapy Can Help You Work With It
Therapy doesn’t aim to erase the way your mind moves—it helps you build a kinder relationship with it. From a transpersonal and somatic approach, we explore ADHD not as a collection of deficits but as a rhythm of energy that wants to move through you differently.
In session, we slow down enough to notice what happens during distraction—what your body feels, what your inner world does when the mind slips away. We work with breath and grounding to help your nervous system recognize safety, while also honoring the parts of you that crave freedom and novelty.
Learning about your own neurobiology and your energetic patterns is a form of self-initiation—becoming an expert on what helps you thrive. Therapy becomes a lab for lifestyle design: exploring sleep, nourishment, movement, and rhythm through the same lens of self-compassion and curiosity.
Unlearning shame is central to this work. Many people with ADHD have spent years feeling out of sync with the world’s tempo, trying to perform on other people’s time. Therapy helps loosen those old contracts—so you can begin to honor your natural pace, your cycles of rest and inspiration, and your right to create in the ways only you can.
Over time, you learn not just how to access your creativity, but how to tend to the mundane maintenance of life without losing its magic. Healing becomes a kind of integration—where the spiritual and the practical finally meet, and your attention learns to belong to you.
Conclusion
When you start seeing ADHD through all these layers, something softens. It stops being a story about deficiency and becomes a study in design—how your body, mind, and spirit organize around the world you’ve lived in. Therapy can help you trace that design, tend to the nervous system that carries it, and discover how your attention wants to move when it’s not bound by shame or survival.
Healing isn’t about fixing your focus; it’s about learning to live in rhythm with it. To build a life that fits the shape of your awareness—where structure supports creativity, the mundane becomes a practice of presence, and the mind that once scattered becomes the same one that sees the whole field.
ADHD FAQ
What is ADHD, in plain language?
A neurodevelopmental difference affecting attention, initiation, working memory, and regulation. It’s not laziness. Brains with ADHD seek novelty, interest, or urgency to engage; we build systems that honor that.
How can therapy help ADHD if meds address symptoms?
Therapy handles the rest: shame, burnout, relationship patterns, and sustainable routines. We design supports for executive function and practice scripts for boundaries, delegation, and realistic planning.
How do I know if it’s ADHD and not anxiety, trauma, or burnout?
They can overlap. ADHD shows up early and across settings; anxiety and burnout can mimic it. We map history and context, screen thoughtfully, and I’ll coordinate with other providers if needed.
Do you do formal ADHD testing or give diagnoses?
I provide therapy and collaborative screening. I don’t do full neuropsych testing; if that’s needed, I can refer and coordinate while we keep working on daily function and support.
What does work look like week to week?
Short experiments, not perfection sprints: externalizing tools, routine scaffolds, micro-goals, and parts-informed coaching so “future you” isn’t abandoned by “right-now you.”
What about rejection sensitivity and shame?
We treat them as protectors. Psychodynamic and relational work helps repair old patterns while we build kinder internal dialogue and practical buffers for hard moments.
Is this virtual only?
Yes. I work online with clients anywhere in California.
Is your approach affirming for LGBTQ+ and other neurodivergent folks?
Yes. Tools, pacing, and language are adapted to your nervous system, identity, and access needs.
How often are sessions and how long does change take?
Weekly is best at first. Timing varies by support, co-occurring stressors, and how much we’re unlearning. We aim for steady, sustainable change.