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Daniel

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On Obsessions: A Phenomenology of Doubt, Images, and the Obsessive-Compulsive Chronological Structure in Obsessive-Compulsive Disorder
2020-04-22

Obsessive-compulsive disorder (OCD) is a debilitating disorder that is heterogeneous in presentation and difficult to treat. Nearly half of treatment-seeking individuals do not benefit fully from therapy, and success rates have changed little over decades despite ongoing research into obsessions. These outcomes suggest that aspects of the OCD experience are being overlooked and not addressed in therapy, highlighting a need to revisit core assumptions the cognitive behavior therapy (CBT) model makes about the disorder. Indeed, there are significant gaps in the literature, revealing a lack of phenomenological grounding to support key assumptions made about obsessions and how they interact with compulsions in the model.
 

David Baxter

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Nearly half of treatment-seeking individuals do not benefit fully from therapy, and success rates have changed little over decades despite ongoing research into obsessions. These outcomes suggest that aspects of the OCD experience are being overlooked and not addressed in therapy, highlighting a need to revisit core assumptions the cognitive behavior therapy (CBT) model makes about the disorder. Indeed, there are significant gaps in the literature, revealing a lack of phenomenological grounding to support key assumptions made about obsessions and how they interact with compulsions in the model.

That's because almost every therapist is taught (and believes) that Exposure and Response Prevention is the gold standard treatment for OCD. That may work for pure compulsive forms of OCD but in my experience those are few and far between. Most individuals have at least an obsessive component and there are a lot more Pure "O" OCD cases than generally believed. I have never seen evidence the ERP does anything at all for obsessions, intrusive thoughts, etc., and simple CBT is not especially effective at treating those either.

The Brain Lock concept can lead you to the most effective strategy, in my opinion, and it is underused. I think this is partly due to misunderstandings on the part of many therapists about what OCD actually is, and laziness in questioning and researching accepted doctrine about CBT and ERP.
 

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Sorry to hear that Daniel. Two sessions isn't many, but it's certainly disheartening to feel alone/unheard.
The 'personal trainer' sounds good though even if it's just for overall mood and health.
 

Daniel

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it's certainly disheartening to feel alone/unheard.

It reminds me that I miss the University of Florida, when I was there many years ago. They had experts on OCD there at their Brain Institute. Though they were not particularly helpful (since, at the time, their specialty was neurosurgery/cingulotomy that was reserved for the worst cases of OCD), they at least validated my struggle with OCD.
 

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I am only going to see psychiatrists from now on, though more frequently than before.

The one-star review I left for the psychologist:

If you have a serious mental illness, keep looking. I am a former patient of hers because she doesn't even try to understand OCD. She also doesn't realize how hard it is growing up gay or living in a hetero-normative culture. And her student intern seemed to know more than she did.

I was going to file a complaint about her talking down to me, but it's her word against mine. She is also very defensive and only wanted me to talk to her over the phone about my concerns -- nothing in writing/email.

I went looking for help, not judgment. I left feeling small and defeated -- like having talked with my mother, not a therapist.
 

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Of course, I took down the negative review. Too dramatic, even for me :D But I did enjoy venting as if Google Reviews was an open-book journal :)
 

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The American in me can't help it. My new, 3-star review for her (showing only my initials) since I wished someone had warned me about her:

Like most therapists, she is not good at even trying to treat OCD. Apparently, these days, it is a mistake to expect a clinical psychologist to be able to treat a condition that is more common than bipolar disorder.

Thanks to her lack of understanding about OCD, she conjectured I may have so-called high-functioning autism. When I tried to explain I had been evaluated by numerous people (with credentials better than hers, including a psychiatrist/professor who became a director of the National Institutes of Mental Health), she seemed dismissive. With me having worked as a full-time caregiver to an adult with formerly-called Asperger syndrome, I was especially surprised that she thought I was ignorant about the matter.

If you have OCD, you are better off with self-help books and Youtube videos (such as by Martin Seif) and a wounded-healer therapist who has a touch of OCD themselves. Most therapists have no idea of the different subtypes of OCD like harm OCD, hyper-responsibility OCD, relationship OCD, existential OCD, suicidal OCD, etc.

I was going to file a formal complaint, but I feel it is simply better to warn others to stay away from her if you have OCD given her lack of experience and interest in the matter.
 
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Daniel

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OK...I compulsively edited my review for the last time.

Now it is a 5-out-of-5 star review so that I have closure on a high note:

Dr. _____ is an excellent therapist in general -- so much so that I changed my insurance to a PPO so that I could see her more often. If I was a pre-adult, her warmth and empathy would be even more valuable. And in my memories of seeing therapists over two decades, her sessions were the most grounding.

But like almost all therapists, her mindfulness approach is relatively indirect concerning OCD -- which is not necessarily a bad approach since many issues can be psychologically outgrown and almost everyone with OCD -- including myself -- resists behavior therapy to some degree. Personally, I am better off with self-help books and Youtube videos (such as by Martin Seif) as a way to increase much-needed insight and seeing a therapist who has a touch of OCD themselves. (For example, most therapists are not aware of all the different subtypes of OCD, such as harm OCD, hyper-responsibility OCD, relationship OCD, existential OCD, and suicidal OCD.)

As far as therapy, I see another therapist I have seen before in a week or so. This will at least help me forget about the last therapist and move on. So that I don't get off track in therapy (rambling about philosophy, etc), I will be bringing in a copy of self-help workbook on OCD to go over with him.
 

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In retrospect, I wonder if my strong reactions to therapists have been a way of experiencing ROCD (relationship OCD), especially now that I am getting along better with my husband. At least my husband has enjoyed not being a target of my interpersonal issues lately :D
 

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Sounds like the review ran the gamut there.

Maybe having "strong reactions to therapists" is contagious over the internet and you caught it off me ;)

Or a measure of the delta between the help you need vs. the help you've received from them.
 

Daniel

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Sounds like the review ran the gamut there.

Yeah,it was like a slower version of an argument with my husband. First, he may seem like a no-good narcissist and then the black-and-white thinking can only become more grey from there :)

When I worked in group homes, I was usually the only one who would have to re-write the incident reports since my first submission sounded more like a soap opera than boring statements of fact :D

Maybe having "strong reactions to therapists" is contagious over the internet and you caught it off me ;)

Haha! Reminds me of an old Irish saying: "Is this a private fight or can anybody join?" :D

And for me, I have a pet theory that some of my OCD issues (like relationship OCD or existential OCD) are a welcome break sometimes (relatively speaking) from whatever may seem more stressful/overwhelming at the time (like harm OCD). Just like how the "joy of philosophy" or the joy of socialization can be a distraction from daily worries.

Or a measure of the delta between the help you need vs. the help you've received from them.

Yes, that too. And that delta seems quite variable depending on my level of acceptance, optimism, and what's on the news :)
 
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David Baxter

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Sounds like the review ran the gamut there.

Maybe having "strong reactions to therapists" is contagious over the internet and you caught it off me
wink.png


Or a measure of the delta between the help you need vs. the help you've received from them.

Any or all of the above. Plus sometimes it's just not a personality match. Like any other relationship in life.
 

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From Psychotherapy.net:

"Stopping obsessional thinking patterns is one of the most vexing challenges people deal with, and most therapists are equally mystified about how to really help their clients free themselves from the torture of fearful thoughts."

"Although for most psychological disorders, common factors such as the therapeutic alliance are more important than the particular approach, in the case of OCD there is substantial evidence that cognitive-behavioral approaches are the most effective treatments we currently have."
 

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Positive update:

I have had three sessions with my new-old therapist, who I now like (again) and originally saw last year for a few sessions. He seems like a different person compared to a year ago, when I had less patience/insurance. It also helps that I have a better understanding of where he is coming from. His perspective is largely a mix of existential and ACT, which came across more like redneck last year.

P. S. Interestingly, my psychiatrist and therapist have the exact same name. They both deny being related.
 
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Daniel

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I quit my therapist -- again. He was too pushy, and I had already given him a second chance.

Lately, my depression is worse than usual, partly because of the therapy making me even more self-consious. So I don't have much tolerance right now for dealing with therapy pet peeves.

I am going to look into the nasal spray for ketamine (esketamine) and try that.
 
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Daniel

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I have literally raised the volume on my Spotify music. And I have been spending more time with the chickens. I may start doing my mite prevention. Since there is one chicken that doesn't dust bathe, I will dust bathe him today so the mites won't have a chance when it gets warmer.

I am also going to ask my psychiatrist about going back on a low dose of Abilify since that helped with the suicidal thoughts/obsessions before. It's a process to get access to the esketamine nasal spray since only one place around here has it. And it's an insurance nightmare I'm sure.
 
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Daniel

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The fog/depression lifted. I had a great day, especially with my visit to a used book store. The owner was a hoot. And she has a very friendly Himalayan cat who "works" there as a greeter.

To replace individual therapy, I have joined an online/Zoom peer support group run by OCDPeers, which has all kinds of OCD groups.

I am also going to use and review this OCD self-help service that was only $20:

 
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gooblax

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Great to hear that you had such a good day. I wonder if the used book store lady has realised that the cat is actually the 'undercover boss'.

Sounds like a good plan with the peer group and service, since you haven't been getting what you need from individual therapy.
 

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Today is/was my birthday. I yelled at my husband this morning because he was rushing me and getting loud at me -- to take him to his three medical appointments that he scheduled on my birthday. I told him, just go yourself since I was still taking care of the dogs and we were still running early. His response: If you don't go with me, I will just stay home. Should have called his bluff and been less codependent or enabling or whatever.

When I went back to the used book store to buy books for my birthday, he was surprised I spent $40. This was to be my gift from him. But he wanted to spend $50 on more pot. I was already unstable from therapy or whatever, so I just took off my wedding ring (again).

In any case, I was referred to another therapist by a free therapist-matching service, and she is going to call me tomorrow afternoon for a free initial consult.

I am so tired of my confusion/ambivalence. I don't know if I should stay married or even alive. The reasons for leaving my husband are just as distressing as my other "problems of living." I read recently that people with OCD are low in reward seeking, so it figures.

I would have been happier staying at home with the chickens than dealing with my husband. We shared a $10 pizza for lunch, which was fine. But if I had spent only $10 on his birthday lunch, I would have been told off.

My guess is that the therapy "helped" me switch OCD themes. Like some of the existential OCD became relationship OCD, including in dealing with my therapists. So my normal frustration tolerance in dealing with people is gone. And I am sick of everyone. But I am also depressed and part of me wishes I was dead. I see my psychiatrist on the 15th for an antipsychotic or whatever to add to the Prozac 80mg/day.

Part of the reason therapy has been triggering is that I am reminded of how unmotivated I am for most things compared to my desire to ruminate, etc. There are billions of people on the planet, and so I am just a drop in the ocean anyway. And our universe is just one ocean. Seems almost immoral to subject myself to more suffering. The challenges are many but the rewards seem few.

When I do feel better, I will still be struggling with some OCD theme. Like wack a mole. And even when I am acting "normal" and somewhat productive -- I still feel like life is overrated on my good days.
 
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