The ADHD Struggle with Consistency—Even in Virtual Therapy

As someone with ADHD, a therapist, and now the CEO of Shift, you’d think I’d have consistency mastered. Nope. Not even close.

Consistency is one of my biggest struggles. It shows up everywhere. I forget to respond to texts, I leave friends hanging while waiting on me to confirm plans, and sometimes, I even forget I have therapy until five minutes after it is supposed to start.

That last one stings because I know therapy is important. But ADHD makes consistency brutal. It’s not about motivation, willpower, or a lack of trying. It’s about how my brain works.

If you’ve ever felt excited about starting therapy only to ghost your therapist a few weeks later, you’re not alone. Virtual therapy should be easier to attend—no commute, no awkward waiting rooms—but somehow, that also makes it easier to avoid.

But therapy only works if you stick with it. So, how do you stay engaged when consistency is your biggest challenge? Here are some ADHD-friendly strategies (and things you can ask your therapist to help with) so you don’t drop out before you even get started.

1. Set a Recurring Session and No "Let Me Check My Calendar"

ADHD brains love structure but hate decision-making. If you have to pick a therapy time every week, you’re setting yourself up for failure. Instead, make therapy a non-negotiable part of your schedule.

• Commit to the same time every week. No rescheduling unless it’s an emergency.
• Make an agreement with your therapist that you won’t cancel just because you “don’t feel like it.” Even if you feel like skipping, show up and talk about why.
• Remove the option to opt out. This isn’t an “if I can fit it in” situation—it’s locked in.

💡 Ask your therapist:

"Can we set a standing session at the same time each week? And if I start avoiding sessions, can we talk about what’s going on instead of just cancelling?"

2. Set Up ADHD-Proof Reminders

Let’s be honest—your brain will forget, and you’ll be tempted to no-show. Don’t rely on memory. Set up external cues to make sure you actually log in:

• Multiple alarms: One the night before, one an hour before, and one 10 minutes before.
• Visual reminders: Sticky notes, a whiteboard, or a calendar alert that’s impossible to ignore.
• A pre-session routine: Example: Five minutes before, make a tea, put on comfy socks, and log in—same steps every time.

💡 Ask your therapist:

"Can you ensure I’m set up for a text reminder two hours prior to the session from Janeapp? If I am late for the session, will you call me on my cell at the five-minute mark? If I forget about the session, can you ask me to slow down, take a breath, and attend with the remaining time left—even if that’s 10 minutes?"

3. Have a Backup Plan for Low-Energy Days

Some days, logging into therapy feels impossible. But instead of cancelling, have a Plan B:

• Tell your therapist in advance that on hard days, you’ll still log in—even if you have no idea what to say.
• Allow yourself to be low-energy. You don’t need to be “on” for therapy to be helpful.
• Keep a therapy notes section in your phone with random thoughts throughout the week so you have something to talk about even if your brain blanks.

💡 Ask your therapist:

"If I’m struggling to show up, can we have a plan in place, like starting sessions with a check-in question to get me talking?"

4. Reframe Therapy as a Task, Not Just a Chat

ADHD brains engage better when things feel structured. If therapy feels too open-ended, it’s easier to disengage. Try making it more active:

• Set short-term therapy goals. Instead of “get better at handling stress,” try “learn one strategy this month for managing overwhelm.”
• Ask for concrete takeaways. We love action items—therapy should feel like something you do, not just something you talk about.
• Reflect on progress regularly. A quick “What’s one thing that’s improved since the last session?” can keep you engaged.

💡 Ask your therapist:

"Can we set small, clear goals each session so I stay engaged?"

5. Accept That ADHD Will Make This Messy—And Keep Going Anyway

Some weeks, you’ll forget. In some sessions, you won’t feel like talking. That doesn’t mean therapy isn’t working—it means you have ADHD. The key isn’t perfect attendance; it’s learning how to come back when you get off track.

Therapy isn’t about being the “perfect client.” It’s about showing up however you can, even if that means logging in five minutes late in your pyjamas. ADHD makes consistency hard, but that doesn’t mean therapy isn’t for you.

Make a commitment to your therapist and yourself—this time, you’re sticking with it.