CBT prep …

  I looked at the back cover of Freedom for Today’s Obsessive-Compulsive.  Apparently Steve Jewett and James Nash were some big names in the OCD world.  “Open this book,” the back cover read, “and unlock the doors of your mind’s prison.  What lies ahead of you is freedom.”  The goal was appealing, and I liked the confident wording.  Just straight to the point: “What lies ahead of you is freedom.”  Well, okay.

            I opened to a random page and read, If I were to say to you, ‘Don’t think about a red unicorn,’ what would happen next?  Why, immediately, you’d begin to think of a red unicorn!  In fact, I’m sure that’s what’s in your mind’s eye right now as you continue to read this page.  That is what we’re dealing with as we fight OCD.  An obsessive-compulsive experiences an intrusive, unwanted thought, and because it is intrusive, he feels disgusted by it, wants to stop thinking that particular thought.  But just as my telling you, ‘Don’t think about a red unicorn’ results in your immediately doing so, the obsessive-compulsive’s panic and desire to stop thinking the intrusive thought actually drive him to continue thinking about that very thing.”

            Well, that was certainly true enough.  When my worst thoughts arose in my mind and I tried to stamp them out, it was a battle of escalation.  The harder I fought, the harder I needed to fight. 

            “In cognitive-behavioral therapy (CBT),” the book continued, “we encourage the obsessive-compulsive to give in to those intrusive thoughts, to stop fighting them.  Time and time again, CBT experts have found that it is when an obsessive-compulsive stops fighting the intrusive thoughts and actually embraces them that he finds freedom from them.”

            Oh gosh.  I set the book down, my heart beginning to race.  It wasn’t new information to me—Ruth’s brochure had given me the basics of behavior therapy—but the way it was worded gave me a chill.  “Give in to those intrusive thoughts.” 

             “So I’m reading this book for Dr. Foster, right?” I said a couple nights later at Rosie’s Place to Stella before she opened her laptop.  “It’s like reading my own biography.”

            “Yeah?” she asked, taking a sip of something foamy.  “What do you mean?”

            “Well,” I said, “you know how all my ‘issues’ seem so bizarre?  Some of them are not bizarre at all, I mean in the world of OCD.  I’m textbook.  It’s crazy really.” 

            “Like?”  Stella began to sort through the tangled mess of beads she was wearing—black, red, maroon, picasso jasper.  These, in addition to a floral chambray shirt and hiking shorts.

            “Okay,” I said, “so there are all these made-up scenarios, and the book circles back to revisit these same examples.  One of them is a dad who’s sure he’s going to kill his baby girl, so he won’t even hold her.  He gets all these images in his head of suffocating her, stabbing her in her little chest, shaking her, drowning her.”

            “Ew,” she said, still fussing with her beads.

            “Yeah, but these thought make him completely sick,” I explained.  “It’s clear to everyone else, including his wife and therapist, that he would never ever hurt his daughter.  I mean, they’re not freaking out.  He’s the one avoiding alone time with his daughter.

            “And there’s this lady who thinks she might be a lesbian even though she isn’t attracted to women.  Every woman she walks by, she thinks, ‘Am I attracted to her?  Do I want to kiss her?’ then she imagines herself kissing that woman.  She’s just sick over it, but instead of thinking, ‘Oh, I guess not.  That’s not a pleasing image to me,’ she thinks, ‘I must be gay.  Why else would I be thinking so much about kissing women?’  This is called HOCD—homosexual OCD.

“But then get this.  One of the example scenarios is about this girl who has these blasphemous images attack her mind.  She … she pictures herself having sex with Jesus.”  Stella looked bemused, but I continued.  “She doesn’t want to think about that, but there are all these triggers in her normal day—when she sees someone praying, or a cross around someone’s neck, or a kissing scene in a movie or on TV.  And whenever there’s nothing else to think about, that’s where her thoughts go.  She believes that her thoughts are blasphemous, so she believes that she will go to hell.  She thinks about hell all the time.  The book even said that she confessed to her priest, and even he said she was fine, but she couldn’t believe it.  Whenever the image of having sex with Christ came into her head, she said a Hail Mary to alleviate her guilt and drive the image away.  Eventually she had to quit her job because she was too distracted saying her Hail Marys to get work done.”

            Stella’s eyebrows furrowed.  “Gosh, that does sound like you!”  She abandoned the necklaces she’d been working on and clasped her hands together on the table between us, leaning forward as she listened.

            “I know!  I mean, elements are different, for sure, but the basic idea is the same.”

            Stella sighed.  “I used to think that OCD meant that people were super clean.”  She chewed on the inside of her cheek.  I knew what she was thinking, even though she didn’t say it aloud: It’s so much worse than that.

            “Yeah,” I said, agreeing both with what was said and unsaid.  “Even the people who are really clean, or who wash their hands all the time—they’re driven to it.  They think something horrible is going to happen if they don’t do it. It’s so much bigger than just being a neat freak.  It kinda drives me nuts when people with quirks say, ‘I’m a little OCD myself.’”

Stella nodded violently.  “Remember that receptionist job I took at that plastic surgeon’s?  One day this nose-job lady came in, right?  She sat beside a burn survivor, pointed at his dressings, then at her own protective shell covering the bridge of her nose, and said, ‘I know how you feel.  Hang in there.’”

“I don’t believe you,” I said, jaw dropped.  “You’re joking.”

“I’m not,” she said.  “I’ve never been so pissed at a job site before.  I’d take the call center perverts over those rich bastards any day.”  She shook her head in disbelief.  “So … therapy?”

            “Therapy,” I said.  “I guess it’s like a pyramid, and you climb to the top, step by step—if you don’t reach the pinnacle event, CBT probably won’t work.  In the book examples, the dad had to write down all the ways he was going to murder his daughter—graphically!—and then record himself reading it, and he had to listen to it over and over.” 

Stella looked disgusted.

            “The HOCD person had to rate women’s butts and record everything in a notebook, and she had to read a couple LGBT novels.  And the one with religious obsessions had to write a story about having sex with Jesus Christ and then read it over and over again without saying any Hail Mary prayers.”

            Stella made a face but nodded slowly.  “So what will you have to do?”

            I shrugged.  “All I know is that it will be terrible.”

            And for once, I appreciated it when Stella didn’t reassure me.  There was more strength in knowing she agreed.  “I don’t know what to do,” I confessed. 

            “Write about it,” she said.  So I did.


OCD

There he is, that scarlet beast,
black horn like a railway spike.
I check myself against the blood-red giant,
close my eyes, cover my ears,
two-thirds of the famous monkey trio
where I sit cross-legged between cloven hooves.
Do not think of a red unicorn.  Do not do it.
But I can feel his wet, warm breaths like humid whispers

as he lowers his nostrils to my neck, crimson ears at salute
like a maddening accusation.

4 thoughts on “CBT prep …

  1. I like how you said..”I mean in the world of OCD. I’m textbook. It’s crazy really.” I’m finally caught up, and I’m intrigued by what you have to say. OCD is WAYYYYYYYY more than I ever thought. I’m being educated….thanks Jac’

  2. Your blog is just sooo great, Jackie. Reading this entry made me realize that I’ve been struggling with intrusive thoughts that are related to *my* OCD. I can’t believe I didn’t realize until NOW why I couldn’t get these thoughts to go away…they’ve distracted me from work and school and kept me up at night. For a long time, I thought I’d battled my OCD by giving into my fears — much like the characters in your novel. But now I realize that this is not something that’s ever truly going to go away, and I need to realize how my mind is going to find new ways to manifest the OCD. As soon as I let go of one, another pops up. Thanks for writing this wonderful book. You are an inspiration.

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