A look at “How do I manage reasonable adjustments for clients with ADHD?” by Sally Brown (2026)
Here’s a scenario many ADHDers will recognise with a wince. You’ve booked therapy, fully intending to go. Then a work meeting you’d completely forgotten about pops up, and you cancel two hours beforehand. Your therapist’s contract says late cancellations are charged in full. Is that fair when ADHD makes managing time and diaries genuinely harder?
That’s the question a therapist put to Therapy Today‘s advice column, and the answer is a thoughtful look at where the law, ethics and the therapy relationship meet.
What it says
In the UK, the Equality Act 2010 requires service providers, including private therapists, to make reasonable adjustments for disabled people. ADHD can count as a disability under the Act if it has a substantial, long-term effect on everyday life, and you don’t need a formal diagnosis to be protected.
But “reasonable” is the key word. The author argues that therapists can’t simply refuse to adjust anything; that would likely breach the law. Equally, they aren’t obliged to scrap cancellation fees entirely if that would make their practice unsustainable.
Instead, she suggests a range of middle-ground adjustments:
- Multiple reminders, such as 48 hours before, 24 hours before and on the morning.
- Adding sessions to your digital calendar so your devices nudge you automatically.
- A reduced fee for late cancellations rather than the full amount.
- One “free pass” per quarter, recognising that occasional slips are part of the condition.
- A quick scheduling check at the end of each session to spot clashes in advance.
- Moving the session time if work regularly gets in the way.
Above all, she encourages therapists to treat it as a collaborative conversation, making the client “an equal partner in problem-solving rather than someone to whom things are either granted or denied.”
A grain of glitter ✨
This is a balanced, practical and refreshingly concrete piece. But it’s an advice column written for therapists, not legal guidance or research.
Some of the reasoning deserves a gentle challenge. The author wonders whether the client might have been “subconsciously avoiding” therapy, and warns that removing all consequences might “reinforce helplessness”. Those are fair things to stay curious about, but they can slide into interpreting a disability as a psychological defence. For many ADHDers, forgetting really is just forgetting, and having it read as resistance can feel invalidating. The piece does acknowledge internalised ableism and stereotyping, which is welcome.
A second opinion: in a reader response in the same issue, “Allowing a client to break boundaries risks disempowering them”, counsellor Alison Howard took a firmer line. She argued that waiving the fee entirely wouldn’t be a reasonable adjustment and that the client should pay for the missed session, followed by a conversation about adjustments such as reminders. She also suggested gently exploring how the client feels about their ADHD. It’s a useful reminder that even affirming practitioners can disagree about where the line sits.
Why this matters
If you have ADHD (diagnosed or not), you have every right to ask a therapist what adjustments they can offer, ideally at the start, but at any point really. A good therapist won’t treat that as awkward or demanding. They’ll see it as part of building a relationship that actually works for you. And if forgetting sessions is a recurring struggle, that’s something you can explore together, without shame.
Even the most magical unicorn occasionally gallops off in the wrong direction. A good stable leaves the gate open and sends a friendly text reminder.