Date of Award


Document Type

Doctoral Research Paper

Degree Name



Graduate School of Professional Psychology

First Advisor

Judith Fox, Ph.D.

Second Advisor

Neil Gowensmith, Ph.D.

Third Advisor

Amy King, Psy.D.


Public stigma, Self-stigma, Therapeutic alliance, Intersubjectivity, Adolescence, ADHD, Trauma

Publication Statement

Copyright is held by the author. User is responsible for all copyright compliance.

Copyright Statement / License for Reuse

Creative Commons Attribution-No Derivative Works 4.0 International License
This work is licensed under a Creative Commons Attribution-No Derivative Works 4.0 International License.


Public stigma and self-stigma are major factors that impede the seeking of mental health treatment as well as the development of an effective therapeutic alliance. This paper explores the co-creation of stigma dynamics from an intersubjective systems theory lens suggesting these dynamics may play a role for adolescent clients who have experienced significant trauma. Specifically, the potential overlooking and/or misdiagnosis of trauma-related experiences and symptoms often occurring with adolescents diagnosed with ADHD may be contributing to a co-constructed dynamic between the therapist and client to avoid an exploration of trauma that would be experienced as more stigmatizing, more threatening, and more difficult to treat. A clinical vignette is offered to exemplify this co-construction and the potential impact on the therapeutic relationship. Recommendations are then offered in order to prevent possible misdiagnosis and decrease stigma within the therapeutic relationship.


41 pgs

Paper Method

Theoretical Analysis and Synthesis