December 11, 2010

OCD & Other Therapies.....

I’m not sure if this is a common symptom of all people who suffer from OCD, or just people who suffer from the Pure O sub-type, but my OCD and anxiety is driven by an urgent need to know, figure it out, or find the answer – now.  I suppose that need is common with everyone who suffers from OCD.  After all – it is an anxiety disorder, and my hunch is that it is the anxiety that is driving the need.   
As I stated in my last post, my OCD has flared up substantially in the last several days.  Which makes me wonder:  “What am I doing wrong?  Why isn’t this going away?”.  One of my big OCD fears is that I am somehow avoiding facing “something” (I’m gay, I’m in the wrong relationship, I’m not living the life I truly want etc.) – or another way of looking at it – that I’m actually avoiding finding the answer.  I cannot deny that one of my main OCD compulsions has been to avoid… I guess none of these feared consequences are out of the realm of possibility.    
When I struggle like this I often start to doubt my therapy and the CBT approach.  I have thoughts like: “You’re not getting better – maybe this is the wrong therapy for you.  Maybe you have some real, deep seated issues that need to be resolved in order for your OCD fears to go away.  Maybe CBT helps with OCD, but there are plenty of people out there who claim to have figured out the key to happiness, and life, and anxiety.  Maybe the approach you are taking is wrong, and you’re avoiding trying a different type of therapy because you might find out that deep down inside you’re really a lesbian or you’re really in the wrong relationship and you’ve been lying to yourself all along.”  Psychodynamic therapy is all about “finding the answers” and “getting to the truth”, and for someone with my type of OCD, the option of going to psychodynamic therapy is always lurking in the back of my mind, tempting me during difficult times.  I suppose for me, a psychodynamic therapist is the same as a physician for people with health related OCD;  they go to the doctor to try and find their "answer" when really - no one can tell them with absolute certainty whether their symptons are a sign of cancer or simply an upset tummy.   
Certain people (friends, relatives) really spike me in this area – those who have gone through years of psychodynamic therapy and who claim to have it all “figured out” and who seem to be incredibly happy.  After all – they’ve found the answer – why shouldn’t I?????  My OCD mind goes like this:  “She’s managed to overcome her issues and she’s dealt with it through new age and psychoanalysis methods.  Why do I still have the anxiety defense mechanism that she claims to have let go of?  What’s wrong with me?  What issue in my life am I not letting go of?  Am I still trying to control things too much?  Am I in denial because I’m scared of facing the truth?  Maybe I’m not letting go of my defense mechanism because if I do I’ll realize that I’m a lesbian.  Am I staying “stuck” because I’m not ready to work through some emotional road blocks and face reality? Am I scared of facing difficult feelings?”  And on and on it goes.  Of course – this sets me on an endless quest of mental checking – trying to alleviate some of my anxiety and the horrible questions that spin around in my head. 
To tell myself that I don’t know the answer to these questions just makes me feel horrible.  To hear “it’s not possible to know the answer” doesn’t make me feel any better either.  After all – my friends/family have found the answers haven’t they?  To face the fact that these thoughts might actually be true, that I might never know, and that at the end of the day I really might not find the answer – is hell for me.  Then on top of it all I have to make a choice;  A choice about what path to take – when both of the options seem horrible.  On one hand – I can choose to treat my OCD (if this is in fact OCD) with CBT (the proven technique), and take the risk that I may never figure out the answer or any of my deeply hidden emotional issues (if there are in fact any to begin with), which might completely screw up my life.  Or – I can choose to go to psychodynamic therapy (which is not only known to not help with OCD – it can in fact make it worse) and I could make my OCD worse and go off the deep end and still not find the answer.  Then I think – maybe it comes down to answering the question - What am I treating here?  Am I treating the symptom or the problem?  Ugh!  My mind could go on forever with analysis – just digging myself deeper and deeper into a hole and the depths of hell. 
I’m not sure what my ultimate feared consequence is here – the fear that I’ll live in the dark, unhappy and in denial forever?  Is this just an extension of the same HOCD and ROCD?  And what do I need to do for exposure?  I have been trying really hard not to avoid the people who trigger these spikes, but holy – on top of everything else – this is hard. 
Will a day come that I feel that I too “have it all figured out” and I too learn to “trust the universe”?  That sure seems really hard for me right now. 


  1. I don't think any of us will ever have it all "figured out." And as for those people who say they have "figured it out," I suspect that there are still some things they struggle with. We all do. Or, perhaps to them "having figured it all out" means that they are way better off than they were before, which sounds like a reasonable outcome from having years of therapy. But just because they found one approach helpful doesn't mean that you have to take the same approach to get there.

    As much as I know it sucks, I think you just have to let the anxiety of not knowing if you have made the right choice be. Accepting whatever choice you have made, and going along with it is probably your best bet. Compulsively jumping around because of doubt and uncertainty is likely just to fuel the doubt further.

    I know I struggled for a long time wondering if I had found "the right therapist." I loved the therapist I was (and still am) seeing, but there was always that questioning in the background: "He seems great but he's pretty new to this. What if you had been willing to pay more? What if you had gone with one of the more experienced (and more expensive) therapists in his office? Would you already be better? Are you still struggling because your OCD is really bad and really complicated, so complicated that he doesn't have enough experience to find the perfect approach to set you free from OCD?"

    I struggled with those thoughts for quite a while. Even recently when I started my intensive treatment regimen and had to ask my parents for financial support, I had to endure some pretty trigger-inducing questions that challenged my acceptance that I would never know "for sure" that I had made the right decision: "Are you sure you should stick with the same therapist? Are you sure it's not time to move on? You've been going there for a long time now and you are still struggling. Would someone else be better?"

    Those words really hurt me and threw me for a loop, fueling the doubt, but what it has come down to is using what I know and making the best guess. I thought that with more intensive therapy I could do better. I had improved a lot over the last year and had built a lot of trust in my therapist, so even if I wasn't "completely better" it seemed to make sense to stick with what I had despite the doubts that I had heard voiced. I knew my therapist was very knowledgeable about OCD and I suspected that he was quite good at his job. I just had really resilient and tough to crack OCD that I was just learning to fight after living with it for almost two decades.

    Sometimes that's the best we can do. I chose CBT because everything I read suggested that CBT is what works for OCD (plus once I got started, it seemed to make so much sense compared to the other rather unhelpful experiences I had had with other therapists without CBT). That's not to say that people don't improve with psycho-dynamic therapy. I've been told it can work, but not for OCD.

    Maybe one day you'll change your mind. Maybe one day you'll decide that you want that type of therapy. Maybe it will even help with other issues in your life. But right now you have chosen a therapist who specializes in treating OCD with CBT and are doing the best you can with what you have been told and with what you have learned. You believe that you have OCD (even though, like anything else, you can't know with 100% certainty) and based on that belief you have chosen the therapy that seems the most likely to help you based on what you know. That's what I call doing the best you can.

    Sometimes you just have to make a choice and stick with it. Sometimes you have to do the exposure despite all the doubts in your mind about whether or not it will be effective. Sometimes the exposure in and of itself is sticking with the path you have chosen despite your doubts.

  2. Fellow - you are right - I do have to live with the anxiety of not knowing for sure. The way I look at it - this is just another way that OCD has taken over my mind. I'm feeling better today - after I wrote this post it really helped to get some perspective on my thoughts. And you're right - those who think they have it "figured out" - may actually - momentarily think they do! Everything passes....I've been there too!

  3. I was so relieved to find your blog. My thoughts run to eternity and back; although I do not have extreme PANIC from them as I used to, I HAVE to find the answer which drives me crazy. I sometimes also wonder if I really have OCD (since I don't experience the intense panic I used to). Of course, the "HAVE TO FIND AN ANSWER" does interrupt my life and doesn't feel good. But I don't find that many people like me (and you, and others of course) that have this intense need to pull every thought apart. thank you thank you thank you for blogging!