My Worst Therapist Appointment: Part 1

In Aesop's Fables, the moral of the story always came last. I'm going to give you the moral first. It's the reverse order that I learned it, but that way maybe you can have it easier! This is part 1 of 2.

The moral I learned: See a therapist who can meet me on my level.

During my most recent OCD crisis in April (mentioned in another post), I found myself in a predicament. I had an urgent need to see my therapist, who, before now, hadn't seen me for a few years. In the interim, however, she moved on to practice strictly as a high school counselor and alas, I was no longer in high school.

My case had actually been closed. To open my case I'd have to be evaluated again. But who should see me?

I had no idea. Up until now I had always seen women, but desperate times call for desperate measures. I would take the first therapist with a degree and a free schedule. I just needed to start feeling ok, and I thought it didn't matter who I told my OCD stories to. I made the call and set up my appointment for a new office.

Scheduling the Appointment
I found him! The mystery guy who would give me just enough reassurance to send me on my way with a few new OCD tools in my toolchest. I took a day off work to visit the office, which was in a shadier part of town. It looked like one of those trailers set up at a construction site--sturdy enough to handle the sudden onslaught of new cases yet curiously rickety enough to make an anxious person feel just a bit worse.

The Woman in the Waiting Room
I took my seat in the waiting room. I was more anxious than I had ever been. I hadn't slept for days, hadn't eaten for just as long, and was having a 72-hour panic attack. I had never felt that way before. My fears were deeply personal, painful, and all-consuming. But the woman sitting in the chair across the room didn't care.

"What are you here for?"
Really? What am I here for? Is it really any of your business? These were words I didn't speak because I knew if I did the devil would erupt from my soul and this woman would be a casualty.
"What medicine do you take?" I just ignored her.

Understand that the healthy me is very, very compassionate, and I have already told you that I was not myself that day. I love people, and I love to help people. Especially at a mental health clinic the healthy me understands that I could encounter other unhealthy minds, and some probably tragically worse than my own. These people may not behave like me, or understand social mores. I feel for those people, and pray for them daily. But on that day the VERY unhealthy me was not prepared to deal with the anxiety caused by the woman in the chair, let alone the man I was just about to meet.

Throwing Punches
He entered the waiting room. Of all the 15 empty chairs, he sat right next to me. I was feeling very insecure, scared, and downright ready to jump out of my skin. Why was this man sitting next to me? I could feel him breathing.

"Why are you here?"
"I'm seeing the doctor." (I thought if I answered his question, he might leave me alone. The woman across the room seemed jealous to be receiving such preferential treatment.) Another man entered the room and looked at me.
"Is that your boyfriend?"
"No."

What followed was a story I can't remember, probably because I had already mentally run out the door. It was something about getting shot in the leg, and his subsequent fight to chase the shooter down. No doubt was the story true--he kicked his leg into the air to show me the scar. With the story came a reenactment of the struggle, complete with flailing arms and the free-flying spit of excitement (not good for a person who, at that time, struggled with contamination.) I thought he was going to punch me, grab me, or do something really bad.

But it SO wasn't him. It was me. And I hadn't even met the therapist yet.

Click to read the conclusion in Part 2.

PRIVACY POLICY

Update: I posted a privacy policy. It lives permanently at the bottom of my blog.

Here it is again:

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OCD: Don't Give Up Hope

Sometimes getting better isn't easy, but it's not impossible. Isn't that how most things are, somewhere right in the middle of easy and impossible? It's just that we've tried so hard for so long, managing OCD looks extremely difficult. We think, "If the road ahead is as bumpy as the road in the rearview, I'd rather pull over into a ditch." Here's a catalog of where I've been as proof that working to get better can take time. Don't be discouraged!

I've been through...

• 6 Therapists. It has taken me this many to find one who specializes in OCD! I've told OCD stories to some good ones and one terrible one. (Thankfully I knew that right away, and only went to one session. More on him in another post, I promise!) 6 therapists in 11 years is a lot, but unless my current therapist retires or moves, I'm sticking with her.

• 4 Anti-Anxiety Medications. Given that it's not safe to hop on and off anti-depressants, it can take a long time to find one that works for you when you consider the time it takes to wean yourself off of one. Now I've found one that works for me and I'm willing to tolerate the minor side effects.

• 4 Severe Crises. I use the word crisis because that is the most effective word to describe the intense hold the OCD had on my life in these instances. I literally hit bottom. The first time lead me to learn that I had OCD at age 13. Then came going to college. Then came another crisis during college. The death of my grandfather was my most recent breakdown, which resulted in desperate visits to the doctor's/emergency room, panic attacks, loss of 10 pounds in one week, intolerance to food, 4-5 days of nights without even a few minutes of sleep, and 4 missed days of work.

The crises aside, even when I'm doing well, having OCD would make a great full-time job. But though it might not seem like it pays, consider that the work we do in getting better has lifelong implications. So no matter how many therapists you go through, no matter how many meds you've tried, no matter how many times you've hit bottom, there's still plenty of time to wake up tomorrow and keep trying.

Support Groups: A Helpful OCD Treatment for You?

Like my profile says, I've had OCD since I was 13. Since then, therapists have recommended finding a support group. Only during my last severe regression in April of 2008 did I seriously consider it. I love my support group, and I've been going ever since. But it took a fit of desperation one day at work for me to find mine on the internet. Looks like you're in just the right place to find yours, too.

If you're considering a support group as a form of OCD treatment, perhaps these points to ponder will help you make the decision quicker than I did.

Support groups provide community.
I know OCD can make us feel lonely, stupid, and codependent. It closes the world in around us, isolating us. But at group I've met people who can sometimes think the same irrational way I think. I understand them, too. Bottom line: Join a group and if you were alone in your OCD before, you aren't anymore.

Support groups give you objectivity.
Join a group and you'll encounter all types of OCD--the hoarders, the scrupulous, the contaminated, the guilt-ridden, and those who can't be labeled. You'll hear all types of OCD stories. You'll see what it can be at its best, and you'll see what it can be at its worst, and hopefully identify tendencies in yourself so you can learn to keep the OCD in check. It's like looking in a mirror. If you see that a hair is out of place, you fix it.

Support groups let you see what works.
Before attending group, I had never heard of ERP, or Exposure/Response Prevention (more about that in a later post). My therapists through the years had always used Cognitive Behavioral Therapy, or CBT, the other part of the OCD treatment dichotomy. I never even knew that this other kind of therapy existed, or that it could benefit me. Join a group and you can discuss treatment styles, therapists, and mental exercises and analyze what works for you.

Support groups give you accountability.
Every week at group we get together in small clusters and set goals, and check in on last session's goals. If needed or wanted, group members exchange numbers to serve as checkposts with whom to check in and record progress. Conversely, if we want to sit a week out and not give ourselves a goal, we allow that. We understand that each of us is choosing to be here, and choosing to get better. There's a lot of power in that, and a sense of control over what feels out of control.

If you are not a member of a support group as a means of OCD treatment, click here to visit the OC Foundation's "find a support group" page. Until then, if you're reading this blog, feel free to call what we have going here our little support group. : )

OCD Misunderstandings

I'm sure you've heard it: People using OCD as an adjective.

"I'm really OCD about my apartment." "She was really OCD over him." "I'm really OCD about paying people back when they lend me money."

These people have some vague idea that OCD has something to do with needing order, being particular, or washing your hands repeatedly. This knowledge qualifies them to use "OCD" willy nilly. While this doesn't bother me nearly as much as it bothers my husband (in noble defense of me and my feelings), it's not the worst way that OCD could be misunderstood.

Jumping to Conclusions
The other day I was working on a project in my parents' basement. My dad was down there, too, organizing the newest toolboxes he acquired. It was chilly, so he set up a space heater for me. Using care to situate it just right so my legs would be warm, he put it under the table I was working on--except that it was just a little too close to some papers and cardboard for comfort. I said, "No, move it up a little bit. A person with OCD doesn't like that those papers are so close to the back of the heater," hinting at the fire worry that a lot of us have. It didn't really bother me, but I guess I was taking a little advantage of my habits. I was warmer, so I started working.

I was soldering metal for a project I'm working on. To do so I first clean the metal with flux, a liquid that roughs up the surface so the metal will stick. I accidentally dropped a Q-tip I was using to apply it into the flux bottle. Knowing my dad solders and welds and is generally a knowledgeable guy when it comes to the practicalities of tools and such, I sought his advice.

"I just dropped the Q-tip into the flux and I don't know if I can get it out. Do you think that matters?"

--an abrupt "Don't worry about it."

Worry? He said it as if I had some wild idea conjured up, like this Q-tip in the plastic bottle would start a fire, or someone would decide they needed to clean their ears with this very Q-tip.

"I'm not worried about it, I just wondered if it would ruin the flux." Purely a pragmatic concern; I didn't want to be out $8 for a brand new bottle of flux now ruined. He didn't believe me.

"Don't worry about it."

Not Qualified to Judge
Now, as a person of frequent irrational thinking, it would not have been unlikely that I was obsessing over impossible situations that could happen as a result of this Q-tip having fallen into the flux. I can admit that. And my dad knows me, and he knows what my OCD is capable of. But this was not one of those OCD situations! But in his mind it was, and his prior experience with my OCD made him feel qualified to judge so he quickly chocked it up to obsession.

This is the kind of OCD misunderstanding that hurts most. It's different than a person thinking he knows how to use the term "OCD." It's thinking he know when to use it.

Tip #1: Accept that people will misunderstand sometimes.
OCD is nothing to hide, but surely I keep it private from most people for this reason exactly: I cannot trust that they understand it. Of all the people that are close to me, my dad has been through it with me the longest, yet he still can be quick to judge my feelings and make assumptions--proof that even those who think they "get it" will sometimes misunderstand. It's ok to let them.

Tip #2: Be assertive.
If a misunderstanding arises, express your feelings. Assertiveness shows mental clarity, and mental clarity is never present during an obsession. I gently said, "You know, sometimes I wish you didn't know me so well."

"Did I hit the nail on the head?"

"No, you didn't, actually. And it's not always nice to be discounted like that." Point taken, and he didn't say anything about it. He's not a man of apologies, so I didn't expect one. The satisfaction that I had expressed myself was enough.




*Footnote for loved ones of OCDers*
Yes you've been through a lot with them. They have shared a lot of deep feelings with you. You know they trust you. But you don't know what they're thinking. Let the person with OCD have her feelings, and share with you what she feels comfortable sharing, but don't ever jump to conclusions. Listen, love, and offer advice.

OCD: Knowing My Limitations

When I was 12, my dad worked for a condiment manufacturer. One day he brought home a box of 60 mini ketchup bottles. I remember thinking how perfectly diminutive they were, each one large enough for just a few burgers. There was also something satisfying about the sheer quantity of bottles. 12 rows of 5 each, all snugly aligned in the cardboard box. It was more ketchup than we would ever need, but looking at this box it felt like I had accomplished something. It was just an inkling of satisfaction, but it was the satisfaction of having something. If my OCD issues were different, could this have been the start of a hoarding problem?

Having obsessive compulsive disorder, I want to stay aware of my tendencies, especially the ones that don't make sense or feel odd. I know I have an addictive personality. It's hard to deny doubt. It's hard to stop doing things that could be bad for me. It's hard to turn my back on satisfaction, no matter how destructive. Therefore, here's what I'm paying attention to:

• Urges to Shop. I'm the type of person who is sometimes stricken with a sudden urge to "buy stuff." It's satisfying, even when I don't need the purchase. When I worked in the "mature women's" section of a department store, I found myself eyeing up too-large sweatshirts though I'm decades too young for that clothing. Most of the time it's driven by the same 5 emotions that drive my obsessions: hunger, anxiety, loneliness, tiredness, or boredom.* When these emotions creep up, they often bring OCD issues with them. But if I take the emotion out of shopping, it's not as satisfying. Call it stoicism, but that's why I decided to make a habit of monitoring my shopping habits so as not to develop a compulsion.

• Alcohol Consumption. Alcoholism runs in my family. Pair genetic predisposition with my already compulsive tendencies and I could end up with a serious problem. Even without the genetic factor at play, anything more than moderate alcohol consumption would be dangerous to me; after all, I can't even stop biting my nails. I'm thankful to God for the wisdom of this fact, which leads me to limit how often I drink alcohol.

• Reading Online Medical Articles. Seems like anyone with any obsession will find their fears increase after reading an article about it. Say I feel sick. Could it be cancer? The internet answer is always yes. If I look *obsess* long enough, somewhere, in some article, I'll come across the answer. Not "yes, it is cancer," but "yes, it could be cancer." But to the OCD in me, the fact that the possibility is there, no matter how remote, means that it is definite. There's that inflated risk issue again. OCD wants to defeat us, and it defies our reason in order to accomplish that end.

But Isn't This Just Avoidance?

In my therapy sessions I'm taught not to avoid my triggers or my obsessions. What if I avoided harmless people or places because they feel contaminated or unsafe? Just like doubt always breeds more doubt, avoidance breeds avoidance. Soon my world would close in around me, nowhere safe to go, nobody safe to trust.

But there is a difference between compulsive avoidance and informed avoidance. Unlike the example above, I can't see any negative effects of making informed, wise choices about my life. Because OCD knows a shortcut to ramping up my anxiety and keeping me in submission, I have no problem cutting it off at the pass.

*My therapist taught me to use HALT-B (acronym for hungry, anxious, lonely, tired, or bored) to identify when I'm susceptible to obsessions. I'm not sure who coined that phrase, or if it's trademarked, but if you do please let me know!

Better safe than sorry? No, sir.

Sometimes I wish I'd never learned the proverb "It's better to be safe than sorry," because it's become my enemy. It's pretty much the worst thing a person with OCD could ever be told.

Say I went to a party last night. I wake up this morning replaying the events of the whole party over in my head. Did that one comment I made about the host's home come out wrong? Were people offended? Did I look like I thought his house was a mess? I had better apologize when I see him because it's better to be safe than sorry.

Or what if I'm cooking dinner, and the thought occurs to me that maybe I didn't wash my hands after touching the raw chicken. Then I touch the outside of a bag of flour. To a healthy mind it's no big deal if I didn't because I'm not serving dinner yet and I'm really only touching the pan handle with my chicken hands. Well, just in case, I'd better wash my hands anyway. Better safe than sorry.

But Am I?
These tendencies to "re-check" and "re-do" are my rituals. I can check anything, depending on what I'm worried about. As a person with OCD these rituals are soothing, but I'm addicted to the relief of doubt they give me...until I doubt something else.

The more I check, the more doubt takes over and I fall victim to checking things repeatedly, or worse: fearing things that cannot be checked-away. Soon the snowball effect of anxiety and depression consumes me. Depending on what I'm worried about I might land myself in an emergency room, 10 pounds lighter (read: sicklier).

The Problem of the False Premise
While "Better safe than sorry" is a helpful rule for the healthy mind, it's poison to the obsessive-compulsive mind. Checking and rechecking everything is a misapplication of the rule to situations that don't warrant it. I can check that I've turned the stove off, but what is the liklihood that I wouldn't see its glowing coils when I turned off the kitchen light? Pretty unlikely. The axiom assumes that every situation is highly risky, when in most cases it isn't.

A Different Kind of Relief
As part of my constant recovery I am taught to go towards the anxiety. Going toward it means flat-out avoiding the tendency to recheck. It teaches me to accept doubt. Accepting doubt flies straight in the ugly face of the proverb and my perversion of it...but it feels great.

I take a look at my life from a wider angle: How is it better to let doubt control me? If I'm certain that my purpose is not to live in suffering, and I am not living my full potential if I am paralyzed by worry, then it would follow that being "better safe than sorry" is, in fact, a lie.

Whew, what a relief.