CBT intake

“This will be different from other kinds of therapy, Neely,” said Dr. Foster, as if he could read my mind and there see my image of Ruth.  “You’ll have homework and be expected to go through various exposures when we meet together.”  He picked up the top coaster off a stack of them on the coffee table between us and set his coffee mug on it.  It had had writing on it.  I looked at what was now the top coaster on the stack.  It read, “Uncertainty and mystery are energies of life. R.I. Fitzhenry.”

For the next hour Dr. Foster tuned in carefully for any mention of rituals, anxiety, and triggers.  I knew that he was combing through my words for his options, already working on his plan of attack for how he would prompt anxiety in me like a gun’s trigger, asking over and over, “If you couldn’t do that, would you have a lot of anxiety?” I blathered, but he was only seeking one thing: what would stress me out to the max.

“When I hear words that start with the f sound, I start praying over and over again in my head,” I revealed.  

“How would you feel if you were prevented from repeating the prayer at those times?”

My heart clenched a little in my chest.  My prayer was the key to counteracting the whole chain of ugliness that lead to blasphemy and hell.  “Um, anxious, nervous, crazy.”

“Mmm hmmm.”  Dr. Foster was jotting notes furiously.

“It’s because of hell,” I shared, explaining how curse words and the sound of the letter f  made me think of cursing the Holy Spirit, which I believed to be unforgivable.  “I’m always scared of hell—only sometimes it’s in the background, like elevator music.”

 He continued to write and encouraged me to keep talking.  “When you’re nervous about going to hell, how do you calm yourself down?”

 “I can’t calm myself down,” I admitted.  “But I ask my friends and family what they think.  Even though it doesn’t convince me, I still like to hear them say I’m okay.”

 “Hmm,” said Dr. Foster in recognition.  “Seeking reassurance is another of your compulsions, another thing you do to ease your anxiety.  Pay attention this week—I bet sometimes you do this passively, like mentioning that you’re a bad person.  Watch for it.”

 We continued on this way, Dr. Foster asking the questions and me providing the answers, feeling ridiculous and unhelpful and as if I were maybe wasting Dr. Foster’s time. 

 “Do you have any questions?” he asked as we were wrapping things up.

 “My faith plays a huge role in my OCD,” I said.  “Do you … ”                                  

 “I believe in God, yes,” he interrupted.  The way he spoke made me certain that he did not feel about God the way that I did.  I gulped.

 “Ninety-nine-point-nine percent of people are skeptical going into this,” he told me, his face like a stone.  I wondered if he ever smiled, even at home.

 “Okay, because I am,” I said.  It felt appropriate to tell him this, even though I was intimidated by his seriousness.  “I think I understand how this works,” I said, “but I’m a little confused.  Like, for example, a washer would be prevented from washing, and then they’d realize that nothing bad happened when they didn’t wash—they still lived.  So how will that work for me?”

 “You’re misunderstanding a fundamental part of cognitive-behavioral therapy,” said Dr. Foster, folding his hands across his stomach.  “The point is not to take away the person’s uncertainty.  The point is to make him or her okay with uncertainty.”

Well.  That didn’t sound so good.

He continued, “Just because a washer doesn’t get contaminated after being prevented from washing one time doesn’t mean that the person won’t still fear a deadly disease the next time.  Each time is a new adventure.”  He raised his eyebrows.  “And with you, well, we can’t fast-forward to the end of your life and see whether you’re going to heaven or hell.  CBT will teach you how to live with uncertainty.”  He tapped on the top coaster in the pile.  “Energies of life.”

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