My ongoing therapy dilemma

[gooblax]

For some reason, even though I'd planned to let my psych pick one of the topics, it still felt bad when he went into a chosen topic at the start of the session rather than asking about my list (ie. before I told him he was able to pick a topic).

The topic he picked led to talking about how to set a boundary around my mum trying to pick out clothing for me. He makes it sound so simple but I tried it out last night and really didn't get far.
My mum sent me some ideas for something to wear to an event that's coming up if I still can / want to go to it. I tried to tell her that I'd be responsible for my clothing choices and it's not something she needs to concern herself with anymore. So then she was wanting me to send her photos of what I'm planning on wearing so that she can determine if it's acceptable. "You can wear something pretty and flowing... Don't wear a mens shirt" was the key message. 🙄
Maybe better to just not go to it.

(Of course I'm also back to thinking I don't deserve sessions as much as other people.)

 

[Daniel E.]

How can I set boundaries with my family?

When you grow up around unhealthy behaviors, it is normal to believe that this is just how families are and that you are destined to continue on this path. Two important steps to processing your emotions around your family and making better choices for your own mental wellness are: Being able to...

screening.mhanational.org

If you have to interact with a family member who causes you stress, it may help to write a letter saying everything you want to say to them. You do not have to send it! Just writing it all down can be cathartic. It can also help you plan what to want to say if you choose to have a serious conversation with them in the future.

 

[gooblax]

How can I set boundaries with my family?

When you grow up around unhealthy behaviors, it is normal to believe that this is just how families are and that you are destined to continue on this path. Two important steps to processing your emotions around your family and making better choices for your own mental wellness are: Being able to...

screening.mhanational.org

If you have to interact with a family member who causes you stress, it may help to write a letter saying everything you want to say to them. You do not have to send it! Just writing it all down can be cathartic. It can also help you plan what to want to say if you choose to have a serious conversation with them in the future.

I don't think I feel strongly enough about it for that. She's going to do what she's going to do, and for the most part I'm not in an environment where it matters.

 

[gooblax]

I don't see why my psych wouldn't prefer to not have me as a client when he could see someone more worthwhile who deserves it more and is better to talk to. It sucks knowing how much more important he is to me than vice versa, and like the best thing I could do for him is to disappear.

 

[David Baxter PhD]

I don't see why my psych wouldn't prefer to not have me as a client when he could see someone more worthwhile who deserves it more and is better to talk to. It sucks knowing how much more important he is to me than vice versa, and like the best thing I could do for him is to disappear.

Those are OCD thoughts worrying again. Critical thoughts echoing your own fears and things you have heard or interpreted as heard from others in the past.

They are not based in reality.

 

[Daniel E.]

While we are on the subject of OCD: People with OCD generally have a higher need for approval:

Facets of adult attachment style in patients with obsessive-compulsive disorder

Literature data did not show univocal evidence in discriminating which form of attachment insecurity is involved in obsessive-compulsive disorder (OCD…

www.sciencedirect.com

Higher need of approval was the most important predictor of OCD diagnosis beyond the other attachment facets, and even of the obsessive beliefs.

Similarly with perfectionism. And, of course, people with OCD or anxiety (like myself) also generally have an insecure attachment style, such as a preoccupied/ambivalent:

Attachment Style and Resiliency in Patients with Obsessive-Compulsive Personality Disorder

The goal of the present study was to determine the relationships between attachment styles and resiliency in obsessive-compulsive personality disorder.A random sample of 260 subjects was obtained from the population of undergraduate students of the Nour ...

www.ncbi.nlm.nih.gov

People with ambivalent attachment styles feel constant anxiety, and people with obsessive-compulsive personality disorder feel this same constant anxiety.

This is even more evident in relationship OCD, where the compulsions (e.g. ruminations and reassurance seeking) can become a self-fulling prophecy. The OCD about the quality of the relationship becomes the greatest strain on the relationship.

the best thing I could do for him is to disappear.

“What if there’s nothing wrong with you?” is about building the skill of acceptance.

~ Daryl Chen

And a quote from the founder of ACT:

 

[gooblax]

I don't feel quite as unlikeable in sessions as I did before, because over the past year I've been able to have more genuinely positive conversations and joke around a bit - more like my regular personality. It's taken changing my approach to starting sessions in a way that I think works better with my psych but it's definitely helped. I don't know if he'd still describe me as being difficult to talk to but I know it would've improved.

What it comes down to really is that I'm just not as important as other people are, and my stuff isn't as important or serious as other people's stuff. There are finite resources, and I take more than my fair share.

 

[Daniel E.]

You Need to Know This About OCD

Is your OCD returning? I will tell you exactly how to know.

www.psychologytoday.com

This sneaky way that OCD tries to change and disguise reminds me of a quote that I saw in one of my favorite movies of all time. In the film, The Usual Suspects, the main character, Keyser Soze says, “the greatest trick the Devil ever pulled was convincing the world he didn’t exist.” I see OCD as being the same. The last thing your OCD wants is for you to realize that it is the OCD causing all the torture and creating all the havoc. OCD would definitely rather you believe that what it is you are obsessing about is actually quite likely to happen as opposed to realizing that it is the OCD hard at work...

Some people are fortunate enough to have close people in their life that will tell them directly they think the OCD is back again. If this happens try not to get defensive and dismiss their concerns. Rather, view their feedback as information that you need to have in order to acknowledge that something is wrong.

 

[David Baxter PhD]

What it comes down to really is that I'm just not as important as other people are, and my stuff isn't as important or serious as other people's stuff. There are finite resources, and I take more than my fair share.

That is OCD worrying and old negative self-critical scripts dating back to your childhood talking again, not reality.

You need to keep reminding yourself of this fact. Because it is a fact. That is what is so insidious about OCD: it presents itself as speaking truth and facts but it's nothing of the kind.

 

[Daniel E.]

Fortunately, the treatment for OCD is basically the same as generalized anxiety and depression. Take your negative thoughts less seriously, etc. And there are countless coping tips for mental health, e.g. having a routine of behaviors that are anti-ruminative or even just leaving a TV or music on in the background most of the time.

For me, the problem is having the insight/motivation to go against my predispositions. Like having an argument with my husband's bipolar disorder -- I've learned the hard way not to engage since his ability for insight is offline at the time. And I am still learning not to engage my OCD, e.g. avoiding episodes of rumination since it's always a "rabbit hole" or "turtles all the way down."

Because of human nature, I think everyone gains insight mostly the hard way. In any case, self-acceptance generally increases with age/experience/habituation.

 

[Daniel E.]

What it comes down to really is that I'm just not as important as other people are, and my stuff isn't as important or serious as other people's stuff. There are finite resources, and I take more than my fair share.

You can rationalize feeling bad/upset/frustrated/depressed/anxious all kinds of ways. Your inner/OCD bully can put yourself down all kinds of ways. What you did do -- or didn't do -- today or yesterday or 10 years ago or something awful yet to come. Shame, guilt, regret, self-downing, self-depreciation, anxious anticipation, etc. Harm to others in the gone past or imagined future.

With mindfulness or mini mindfulness, one way out of everyday obsessiveness (or "thinking thin" -- a "spiritual starvation") is to just allow the present moment for a while -- where there is no "self" to put down but rather an experience of life itself as flowing, always changing, and beyond words -- a peace beyond understanding. Everyone has these experiences, but a goal is to have more of them as opposed to episodes of self-downing rumination.

In other words:

"Out beyond ideas of wrongdoing and rightdoing, there is a field. I'll meet you there. When the soul lies down in that grass, the world is too full to talk about." ~ Rumi

"We're so engaged in doing things to achieve purposes of outer value that we forget the inner value, the rapture that is associated with being alive, is what it is all about." ~ Joseph Campbell

“One of the main discoveries of meditation is seeing how we continually run away from the present moment, how we avoid being here just as we are.” ~ Pema Chödrön


Anything that breaks the OCD trance can be helpful. For me, going to Panera Bread for a coffee and a bagel is almost a spiritual experience Driving in the mountains (which I have to do just to get to Walmart) is another anti-ruminative thing I do since I am so focused on the road. And, over time, being with my pets has become more and more calming/grounding.

 

[gooblax]

Just because it's a recurring thought that is annoying when I talk about it doesn't mean it's OCD.

 

[Daniel E.]

Intrusive/unwanted/recurring thoughts are not problematic per se. It is the pathological/unhelpful ways of coping, e.g. compulsive rumination.

In any case, the treatment is the same for depressive or anxious rumination as it is for "pure" OCD.

 

[David Baxter PhD]

Just because it's a recurring thought that is annoying when I talk about it doesn't mean it's OCD.

That may be true. But in this case it's almost certainly OCD.

 

[Daniel E.]

Also:

Ten Things You Need To Know To Overcome OCD

Ten Things You Need To Know To Overcome OCD By Fred Penzel, Ph.D Because of the length of this excellent and insightful article into some of the realities of OCD, the entire article is attached as a :acrobat: file for download / viewing / printing. Here is an excerpt: Some of these points may...

forum.psychlinks.ca

Therapists with patients who may have high guilt sensitivity should help them focus on strategies for challenging their feelings of excessive responsibility to others and cultivating a greater acceptance of guilt.

Brain scans reveal why it is so difficult to recover from OCD

Brain scans reveal why it is so difficult to recover from OCD and hint at ways forward by Annemieke Apergis-Schoute The Conversation March 7, 2017 We often refer to people who are extremely neat or organised as “a bit OCD”. But the reality of living with obsessive compulsive disorder is a very...

forum.psychlinks.ca

Self-confidence is reduced in OCD. The person’s power to act in the world is severely diminished by their illness.

OCD - Thinking the Unthinkable

Thinking the Unthinkable by Steven Phillipson, Ph.D., Center for Cognitive-Behavioral Psychotherapy Originally printed in the Obsessive-Compulsive Newsletter, 5 (4), 1991 As I conceptualize Obsessive-Compulsive Disorder, the tree of the overall syndrome has three main branches: the...

forum.psychlinks.ca

Self-doubt (or an ambivalent self-view) likely influences the nature, as well as the interpretation of intrusive thoughts, and this appraisal and the presence of ongoing intrusions perpetuate the self-doubt beliefs...

A sample of this thread -- more recently:

What it comes down to really is that I'm just not as important as other people are, and my stuff isn't as important or serious as other people's stuff. There are finite resources, and I take more than my fair share.

I don't see why my psych wouldn't prefer to not have me as a client when he could see someone more worthwhile who deserves it more and is better to talk to.

maybe he could be feeling something positive and caring a little bit about me as a client. So maybe it's just my thoughts being total assholes.

I feel like I need to shield him from the negative things that are associated with me, though. Like he would be happier if he never needed to deal with me again and it's my responsibility to help with that. I want him to be happy even though the way for me to help with that is going to hurt me. Maybe you don't see it as logical but it's about doing the right thing, or really my selfishness in not being strong enough to do the right thing.

It's hard to ignore the thoughts that say that I'm a negative in my therapist's schedule so I'd be doing him a favor by cancelling. But as long as I delay making the decision I'll end up at the appointment.

Because other people's stuff is more important than me. So I should care about their stuff and not the other way around, and so wanting their help /attention is selfish and disgusting.

Anyway... Last night I made myself upset thinking about leaving my psych, again. Seems to be a pretty effective form of low grade torture.

No one can be sure that my 'problems' are legitimate and I should be better than that.

Tonight I'm having a lot of trouble with not agreeing with the "weak coward" thoughts. I don't know how to do things and not be like that.

Another roller-coaster day with the therapist thoughts.

This is a ridiculous form of internal torture, that's for sure.

And:

That sounds like the textbook definition of Pure "O" OCD to me. The fact that your therapist "doesn't think [you] have it" doesn't surprise me: Many therapists know little about it and tend to dismiss it unless there are obvious compulsive disorders, which is one of the main reasons that it is often misdiagnosed as "just" general anxiety.

How Undiagnosed Pure O (Obsessive Compulsive Disorder) Sabotaged My Eating Disorder Recovery | The Temper

53% of those with an eating disorder will have an anxiety disorder, and 18% of those who struggle with eating disorders will also be diagnosed with OCD.

www.thetemper.com

Pure Obsessional OCD — Symptoms and Treatment

National newsmagazine committed to enhancing the entire social work profession by exploring its difficult issues, new challenges, and current successes.

www.socialworktoday.com

Pure O - My Lived Experience - Part 1 of 3

www.anxietycanada.com

Primarily obsessional obsessive–compulsive disorder - Wikipedia

en.wikipedia.org

Differences and similarities between obsessive and ruminative thoughts in obsessive-compulsive and depressed patients: a comparative study - PubMed

Repetitive, intrusive cognitive phenomena are central both to obsessive-compulsive patients - typically as obsessive thoughts - and to depressed patients - typically as ruminative thoughts. The objective of the present study is to compare obsessive and ruminative thoughts in non-depressed...

pubmed.ncbi.nlm.nih.gov

In depressed patients, obsessive thoughts occurred infrequently and were not associated with high negative emotions.

Is It OCD or an Anxiety Disorder? Considerations for Differential Diagnosis and Treatment

While it may be challenging to differentiate between OCD and other anxiety disorders, using a multi-informant assessment and understanding the content of a patient’s fears is a fundamental start to outlining an effective treatment plan.

www.psychiatrictimes.com

Given the high comorbity between anxiety disorders and OCD, if a patient meets full criteria for both OCD and an anxiety disorder both diagnoses should be given.

 

[gooblax]

Maybe it's that I don't really understand how you're defining rumination or worry, or vice versa.

I definitely wouldn't describe my thoughts and feelings as worry. To me that is "what if?" thoughts and "oh no" feelings of nervousness, anxiety or fear, which is not what I experience with this stuff. This is also how I interpret things I've read about OCD, so I don't relate to what I've read about it.

As for rumination, I'll give that more leeway for how that applies to me. But mostly as short duration repetitive rumination unless something's gone particularly badly for me to keep thinking about for a longer time in one go.

 

[Daniel E.]

Identifying more with rumination than worry is compatible with OCD as well as "high vulnerability in metacognitive beliefs."

My guess is people with "pure O" are generally more "high functioning," including at compensating or camouflaging as a way to adjust. Also, there are times where "the OCD sufferer starts to experience less anxiety in response to their unwanted thoughts."

In any case, transdiagnostic solutions/tools/therapies are an ongoing trend, including ACT, DBT, solution-focused therapy, metacognitive therapy, and contextual CBT -- all of which can help anyone on the planet. All these therapies (and related phone apps) can help with self-acceptance, psychological flexibility, frustration tolerance, emotion regulation, and other transdiagnostic goals that are staples of mental health. Similarly, we can learn lessons from other disorders -- even if we don't have them. Just like one can increase focus by reading tips on having ADHD, even if the lack of focus is caused by something else.

There is also the trend in supporting neurodiversity and diversity in general: "Mental health symptoms often arise in those who have never found their fit...Counseling alone is not going to work with someone who has never found their 'fit', their 'tribe', and the optimal environments for their way of being."

A reminder:

OCD Expert Paul Salkovskis

Professor Paul Salkovskis is most known for his inflated-responsibility model of OCD: https://www.sciencedirect.com/science/article/abs/pii/S0005796799000716 In the talk below, he discusses the "collateral damage" (human cost) of "clinical pessimism" and the general lack of early...

forum.psychlinks.ca

We discover why OCD is an “affliction of the nice”, why the average sufferer waits 11 years before seeking treatment, why the media and general public think it’s okay to mock the condition, and why ultimately OCD is "an unnecessary illness".

OCD Isn’t a Thought Problem, It’s a Feeling Problem

OCD Isn't a Thought Problem, It's a Feeling Problem Stronger than Fear blog by Kevin Foss, MFT The real culprit of OCD may not be what you originally thought. It is not uncommon to hear an OCD sufferer make a comment such as "OCD thoughts are ruining my life," or "I have to get rid of these...

forum.psychlinks.ca

OCD is not a thought problem -- it's a feeling problem. In other words, if the thought did not have the accompanying painful feeling, you would ignore the thought, call it "weird," and simply move on without compulsions or a second thought.

OCD's deception is that you have to struggle with and resolve the content of the thought. You have to clarify, rectify, and examine the thoughts to determine whether they are true or false...

When you scapegoat the trigger as the problem, you believe minimizing your contact with it will make the obsession about it go away. Unfortunately, avoiding the trigger leads to isolation and reinforces the false notion that the trigger is the problem, resulting in greater fear of the trigger and the feared story it spawns...

Generally speaking, people with OCD are capable of combating their feared thoughts with rational alternatives. However, compulsions exist because a feared thought comes with, or takes the form of, an uncomfortable and unwanted feeling that overwhelms the sufferer.

Despite developing a list of rational observations and objections to the Feared Story, it does nothing long term because the issue has never been a matter of "right thinking," but of an intolerance of the feeling brought on by the Feared Story...

When it comes to OCD, sometimes the feeling isn't just anxiety, but sadness, loneliness, anger, apathy, or emptiness...

Stand firm and let the storm pass.

 

[gooblax]

Gotta love billing day when my therapist catches up on unbilled sessions. $480 in one hit, times however many clients.

I'm still not 100% sure if I have a session booked this week, but I'll find out via auto sms tomorrow.

 

[Daniel E.]

in one hit, times however many clients.

With that much due, I guess he will be more client-centered for a while, especially with Black Friday only a month away

 

[gooblax]

I have a session today. Not sure what I want to talk about although I have some ideas, if I decide that they're useful.
Last night I had another struggle with the delta between how important he is to me than vice versa, and that quitting is the only way out of the pain except not really because I'll still be stuck with it. This "attachment" stuff is incredibly shit.