Tips for Remaining Present in Sessions When You Struggle with ADHD
By Shannon Heers
As a therapist and clinical supervisor with ADHD, I know firsthand how challenging it can be to stay fully present during therapy sessions. Our brains are often moving faster than our surroundings, at least that is my experience. While this can make us creative, intuitive, and empathetic clinicians, it also means that maintaining focus, especially over the course of a long day, can be tough.
You’re not alone if you’ve found yourself suddenly realizing your mind wandered in the middle of a client’s story. Or if you’ve panicked during telehealth because you forgot what the client just said. These experiences can feel frustrating, shame-inducing, and even isolating.
But here’s the good news: with the right strategies, tools, and self-compassion, it is absolutely possible to remain grounded, present, and effective in your sessions, even when your ADHD flares.
Let’s talk about some practical tips that have helped me and the clinicians I supervise stay connected and present in client work, both in-person and virtually.
Tip 1: Use Rituals to Transition Into and Out of Sessions
One of the biggest challenges for ADHD brains is transitioning between tasks, and doing this in the allotted time frame. Your attention may be pulled in several different directions between notes, email, personal life, and administrative tasks. Having a grounding ritual signals your brain that it’s time to shift gears.
Example – In-Person:
Before each session, I stand up, take three deep breaths, stretch my arms and legs, and, if needed, review the client’s last session note. This helps center my energy and focus on that particular client.
Example – Virtual:
When I’m doing a virtual telehealth session, I close all other tabs, turn off my phone or any notifications I have active on my computer, take a sip of water, and say a quiet affirmation like, “Be here now”. Then I open the virtual room at least one minute before the session to feel calm before the session begins.
A consistent transition ritual, even if it’s 60 seconds, can train your brain to “arrive” mentally as much as physically, and can help limit external distractions.
Tip 2: Use a Fidget or Movement Tool (Yes, Even as a Therapist)
This one can be controversial in our profession—but I promise it’s a game-changer. Many therapists with ADHD focus better when your hands or bodies are engaged in gentle movement.
Helpful Tools:
- A quiet fidget stone, cube, or putty under your desk or in your lap
- A rocking desk chair
- A small foot pedal or balance board
Example – Virtual:
I keep a smooth palm-sized worry stone in my lap during Zoom calls. Touching it and smoothing it grounds me without distracting from eye contact or my listening skills.
Example – In-Person:
When meeting with clients in person, I will change positions in my chair as often as I can without being distracting to the client. This helps keep me anchored and alert without affecting the therapeutic space.
Tip 3: Take Brief Notes During the Session
Contrary to what some might think, writing short notes while your client talks can help keep you engaged, not pull you away. For ADHD brains, this serves as a memory aid and attentional anchor. While you don’t want to be writing the entire session, or even a lot while clients are talking, a few words or shorthand can be appropriate.
Try this structure:
- 1-2 word feeling or theme
- Any shifts or patterns
- Questions to follow up on
Example – Any Setting:
During a session, I might write on a sticky note: “anger rising → shutdown → Dad mention – follow-up.” It takes 3 seconds but helps me track the process and stay in the flow.
Bonus: These quick notes make your clinical documentation faster and easier. Just ensure that anything you write down by hand is HIPAA compliant without any identifying client information on it!
Tip 4: Ask Yourself Anchor Questions
If you catch your attention drifting, or even if you’re just zoning out because the topic is repetitive or emotionally activating, use a quick mental anchor to bring yourself back.
Anchor questions:
- “What’s the emotional tone right now?”
- “What’s the client really needing from me in this moment?”
- “What’s my body doing right now?”
These self-check-ins take 1-2 seconds and gently nudge your mind back without judgment.
Tip 5: Let Your Body Support Your Focus
Your brain isn’t the only tool you have. Your body can cue focus, safety, and presence. Set up your workspace intentionally so it works for you and is not distracting during your sessions.
Virtual Sessions:
- Use a standing desk to switch posture
- Sit on an exercise ball or balance stool
- Keep feet flat and hips supported
- Blue-light filters or anti-glare glasses can reduce screen fatigue
In-Person Sessions:
- Make sure your chair isn’t too cozy (or nap-inducing!)
- Maintain open body posture to promote attention
- Use natural light or a soft lamp to reduce overstimulation
When your body is supported, your brain doesn’t have to work as hard to regulate sensory input. I never turn on the fluorescent lights in my office, and I alternate between sitting and standing for my virtual sessions.
Tip 6: Embrace Brief Silence (Don’t Panic)
Sometimes, your brain hits a blank. You forgot what your client just said. You have no follow-up question ready. You’re overstimulated or under-interested. And then panic kicks in.
Here’s the reframe: Silence is not failure. It’s often therapeutic.
In these cases, you can say something like:
“Let’s pause for a moment—I’m taking that in.”
Or:
“Give me a second to sit with what you just said.”
This not only buys you time to regroup, it models reflective presence for your client.
Tip 7: Prepare Visual or Written Anchors
Having a visual aid near your desk can keep you from spiraling into ADHD overwhelm.
Try:
- A sticky note with client goals or themes
- A session structure reminder (e.g., “Check-in > Deep dive > Closing intention”)
- A photo, quote, or image that reminds you why you do this work
Example:
I keep a nice candle on my desk, and even unlit, it helps remind me to stay calm and focus on the present moment.
Tip 8: Build in Buffer Time Between Sessions
Back-to-back sessions are an ADHD nightmare. They don’t leave space for processing, movement, or bio breaks. If you can, space your sessions 10–15 minutes apart. If that isn’t possible, ensure that you end your sessions on time as scheduled so you have at least a 5 minute break in between clients (see more below on time-blindness challenges that are oh-so-real for ADHD therapists).
Use that time for:
- Movement (even a few stretches)
- Rehydrating and resetting
- Processing what just happened
- Meeting your physical needs (bathroom, snack, movement)
- Grounding before the next session
This helps prevent the “mental traffic jam” that can happen when your brain doesn’t have time to switch gears.
Tip 9: Plan Your Session Closures (So They Don’t Surprise You)
For many therapists with ADHD, time blindness is real. You’re 47 minutes into a 50-minute session and only just realized it. Make sure you have clear access to a clock or timer during the session, so you always know where you’re at during the session. You can put a clock on a side table next to your client so it’s easy to glance at during in-person sessions, or set a timer on a watch that only vibrates when it goes off.
Start closing sessions with a gentle time check at the 5-10 minute mark.
Say: “We have about 5-10 minutes left—where would you like to go from here?”
This helps you stay oriented while giving your client agency. Plus, it decreases that panicked feeling of rushing through the end of the session.
Tip 10: Be Kind to Your ADHD Brain
You are not a bad therapist for having ADHD! In fact, your neurodivergent brain likely gives you strengths that neurotypical therapists may not have, such as pattern recognition, nonlinear thinking, creative problem-solving, and the ability to be fully focused in the here-and-now.
But like any clinician, you also have areas that require attention and support.
If you find yourself zoning out more often than you’d like, beating yourself up won’t help. Try instead:
- Journaling, tracking, or video recording yourself about patterns (time of day, client topics, overstimulation)
- Checking in with a trusted colleague or supervisor about your secondary emotions related to being distracted in sessions
- Adjusting your schedule or caseload if needed
You are allowed to design your work in a way that supports your brain, your energy, and your integrity.
Real Talk: You're Doing Better Than You Think
I’ve worked with many therapists in private practice who have ADHD, and most of them carry a secret shame: “If I can’t stay perfectly present, I must be failing my clients.”
But perfect presence doesn’t exist.
What matters more is your ability to:
- Notice when you drift
- Gently bring yourself back
- Stay connected to your values
- Create systems that support your strengths
Therapists with ADHD are often some of the most attuned, passionate, and compassionate clinicians out there. We just need to be thoughtful about how we work—with our brains, not against them.
A Quick Recap: Tools to Stay Present with ADHD in Session
Here’s a summary of what you can try:
- Create rituals to enter and exit sessions
- Use fidgets or body movement discreetly
- Take brief notes to anchor your focus
- Ask yourself grounding questions when you notice drifting
- Support your body to reduce distraction
- Embrace silence when needed
- Keep visual cues nearby
- Build in buffer time between clients
- Signal time closure with intention
- Practice radical self-compassion and adjust systems when needed
You don’t need to change who you are. You just need tools and support that honor how your brain works best.
You Are Not Alone
If you’ve ever felt ashamed of your wandering attention, or worried that ADHD makes you a “less than” therapist, I want you to hear this:
You are not broken.
You are not alone.
You are doing deeply meaningful work in a brain that may just need a different kind of support. And that’s okay. In fact—it’s something to be proud of.
From one neurodivergent clinician to another: you’ve got this.
How We Can Help
If you’re a therapist with ADHD navigating the challenges of staying present we offer clinical consultation and supervision that honors your neurodivergence, supports your growth, and helps you build systems that work with your brain, not against it. Schedule a free 20-minute consultation to connect with a supervisor who truly gets it because we’ve been there, too.
Author Bio
Shannon Heers is a psychotherapist, approved clinical supervisor, guest blogger, and the owner of a group psychotherapy practice in the Denver area. Shannon helps adults in professional careers manage anxiety, depression, work-life balance, and grief and loss. Follow Firelight Supervision on Instagram and Facebook.
