Should You Trust Your Therapist? Depends.

Got this excellent question from a blog reader:

I think I have HOCD but I’m not sure. My therapist is doing CBT but I don’t think it’s ERP and it’s making me anxious. Like what if this therapy goes know where and just becomes me talking about my problems.(what happened with my last therapist). Should I trust that she knows what she is doing? Her Website says she does CBT so by saying she does CBT does that mean she is also an expert on ERP?

It’s sad, but so many mental health professionals are not very educated on OCD or how to treat it. CBT (cognitive-behavioral therapy) is a pretty vague, blanket term, whereas ERP (exposure and response prevention) is a specific type of CBT.

Two things I’d suggest:

  1. Read up about ERP. As much as you can. It will help you recognize if it is being done correctly. Start with this article on the IOCDF website. Also read any/all of the CBT/ERP posts at www.jackieleasommers.com/OCD.
  2. Ask your therapist the following questions. These questions– and the answers you should listen for— are pulled from this page on the IOCDF website.
  • “What techniques do you use to treat OCD?”If the therapist is vague or does not mention cognitive behavior therapy (CBT) or Exposure and Response Prevention (ERP) use caution.
  • “Do you use Exposure and Response Prevention to treat OCD?”
    Be cautious of therapists who say they use CBT but won’t be more specific.
  • “What is your training and background in treating OCD?”
    If they say they went to a CBT psychology graduate program or did a post-doctoral fellowship in CBT, it is a good sign. Another positive is if a therapist says they are a member of the International OCD Foundation (IOCDF) or the Association of Behavioral and Cognitive Therapists (ABCT). Also look for therapists who say they have attended specialized workshops or trainings offered by the IOCDF like the Behavior Therapy Training Institute (BTTI) or Annual OCD Conference.
  • “How much of your practice currently involves anxiety disorders?”
    A good answer would be over 25%.
  • “Do you feel that you have been effective in your treatment of OCD?”
    This should be an unqualified “Yes.”
  • “What is your attitude towards medication in the treatment of OCD?”
    If they are negative about medication this is a bad sign. While not for everyone, medication can be a very effective treatment for OCD.
  • “Are you willing to leave your office if needed to do behavior therapy?”It is sometimes necessary to go out of the office to do effective ERP.

 

nOCD, an ERP App/Hero

If you’ve spent time around this blog, you know that I wrestled my life and freedom back from the clutches of obsessive-compulsive disorder in 2008. (Read more about my story at jackieleasommers.com/OCD).

From the onset of my symptoms to my diagnosis: 15 years.
From my diagnosis to appropriate treatment (ERP): 5 years.
From treatment to freedom: 12 weeks. (<–Read that again please.)

Exposure and response prevention (ERP) therapy is powerful, friends.

On average, it takes OCD sufferers 14-17 years to get the correct diagnosis and treatment. This is not okay. 

So many OCD sufferers cannot afford treatment. In some countries, ERP therapy is simply not available. In fact, in some countries, the stigma associated with having a brain disorder like OCD is so strong that sufferers would not dare admit to needing help. This is not okay. 

The creators of the nOCD app felt the same way. One contacted me and said, “Our goal is to reduce the time it takes for people with OCD to get effective treatment (from decades to minutes).” He said, “One thing advocacy has shown me is the need for OCD treatment in other countries! There are people in Bangladesh, India, etc that have literally nobody! My team is actually building a 24/7 support community within nOCD to combat this issue.”

The app is FREE and, I-hope-I-hope-I-hope, going to change the world.

Some of the very best things about this app:

nocd.jpg

Right now it’s available for iPhones, but this fall, the Android version will come out. Please check it out here. And be sure to tell me what you think!

xoxo Jackie

A Reunion with My ERP Therapist

For OCD Awareness Week, OCD Twin Cities had an event– a panel of OCD experts plus one special guest: yours truly. Interestingly, one of the experts on the panel was my own ERP therapist and personal hero, Dr. Chris Donahue. I have not seen him since the last day I graced his office with my presence on the day I finished ERP therapy back in 2008, though we have communicated via email, and I have sent many, many people his way for help.

I only joined the panel for the last fifteen minutes or so. For the majority of it, I was in the audience. There was this weird dichotomy going on for me: on the one hand, I was listening to this man who saved my life, who changed everything for me, who pulled me out of darkness and into light, out of slavery and into freedom; on the other hand, his voice is the voice of my exposures (I did imaginal therapy, listening to an audio recording … and it was in his voice), which were some of the most difficult things I’ve ever, ever had to do in my life. So there was this push-pull thing going on while he spoke.

Then, later, I joined him. I was able to sit next to my hero and publicly tell an audience, “This is what this man did for me. This is what life was like before, and this is what life is like now, and they are unrecognizable.” I turned to him and said, “Thank you.” He said, “You’re welcome.” It was a simple exchange … but so layered. So many things going on in my head and heart.

In any case, I am grateful. With every year that goes by of freedom, I more and more shed my identity as someone in bondage. ERP therapy saves lives. For some of us, it changes everything. It did for me.

For lots more information about OCD and ERP, go to jackieleasommers.com/OCD.

dr donahue 2

Sweet Freedom

freedom in redAlison Dotson, president of OCD Twin Cities, and I were emailing recently about how sometimes we feel as if we say the same thing post after post, article after article, especially since they usually involve our own stories with OCD, and history doesn’t change.

But I reminded her that even if we’ve heard our stories over and over, someone else might be hearing it for the first time. Not to mention that sometimes those of us with OCD need to hear the truth multiple times before it is finally able to sink into our heads and hearts.

So here it is again:

I was in bondage to obsessive-compulsive disorder for twenty hellish years. I was plagued by ugly, intrusive thoughts that caused me intense anxiety and even terror. Many days I felt completely out of control of my own thoughts, and I hated the ugliness that polluted my mind. I was sad, lonely, depressed, lost, engaged in an ongoing war where the battlefield was my own brain.

And then an amazing psychiatrist named Dr. Suck Won Kim gave me not only a prescription but also the phone number to a cognitive-behavioral therapist in the area, along with the warning that ERP therapy “will be hell” and the encouragement that I had to do it anyway.

And I did. For twelve grueling weeks, I practiced the exposure therapy assignments set out by Dr. Christopher Donahue, and after twelve weeks of hell … I was free. Free for the first time since I was seven years old. I could barely even remember what freedom felt like, what it felt like to be master of my own thoughts, to rule over my OCD instead of having it rule me, and so it was actually a little scary at first.

But let me tell you: you get used to freedom, joy, and light pretty darn fast.

The last five years have been magnificent.

Please, please ask me questions if you have them.

For (lots!) more about OCD and ERP, go to jackieleasommers.com/OCD

Image credit: Jesus Solana

A War in the Mind

war in my mindI remember the Sunday mornings in church when my mind was a war zone.

An intrusive thought would show itself, and with my Pure-O compulsions, I’d mentally bat it down (usually with repetitive prayer).  I was a ninja with my compulsion moves, but OCD was just as fast and furious.  Back and forth, back and forth, like a relentless game of Whac-a-Mole.

And no one knew.

All these happy people around me, worshiping God, taking in the sermon, happy and safe in their suburban church sanctuary– and, for me, it was a battle field.

Pure-O: so invisible, so dark, so exhausting.

I praise God that those days are a part of my past.  If you want to learn how I survived (and WON) this war, click here.  Your mind doesn’t have to be a scary place.

For (lots!) more about OCD and ERP, go to jackieleasommers.com/OCD.

Image credit: unknown.

A Metaphor for Obsessive-Compulsives

A new friend came over to my apartment the other week, and we got to talking about Exposure and Response Prevention (ERP) therapy, and I shared a metaphor with her that I’d like to share with you now.

We put out fires, but what we need to do is shoot the arsonist.

arson

The problem with attempting to “solve” an OC’s obsession is that, as soon as it’s solved, a new obsession will take its place.  In that way, you’re only putting out fires, not dealing with the root issue, which is an inability to handle uncertainty.  For years and years, I watched my obsessions hop from one thing to the next.  My compulsions– and even my talk therapy sometimes– were shortsightedly stamping out the flames in one corner of my mind while OCD set a new fire in another corner.

How can you possibly manage to keep up that way?  It’s not sustainable.

That’s why I agree with so many of the OCD experts in this country that the best way to fight OCD is with Exposure and Response Prevention therapy.  ERP is so very different from most standard therapies.  In it, obsessive-compulsives are exposed to a trigger that prompts in them deep anxiety; then they are not allowed to respond with an anxiety-easing compulsion.  Instead, they are forced to sit in that discomfort.  Doing this repeatedly actually re-wires the obsessive-compulsive’s brain in a way that they learn to live with uncertainty and their quality of life improves dramatically.

It’s been four years since I turned my attention from the bonfires to the disorder that was setting them.

It’s been a good four years.

ERP & Imaginal Exposures

I’ve written elsewhere on this blog about Exposure and Response Prevention therapy (ERP) and how different my life is after I underwent an intense 12 weeks of this type of cognitive-behavioral therapy.  ERP is exactly what the name says it is: you are exposed to something that will trigger your obsessions and then you are prevented from responding with a compulsion that will relieve your anxiety.

For example, someone who has contamination obsessions and hand-washing compulsions might be made to touch garbage and then is not allowed to wash her hands.  Instead, she sits with that anxiety, feeling it intensely.  If someone has HOCD obsessions and seeking reassurance compulsions, she might have to look through a Victoria’s Secret catalog and is not allowed to ask, “Am I gay?  Am I straight?”

So, what happens when you have Pure-O obsessions?  What if your obsession is that you will kill your newborn daughter and your compulsion is to stay away from her crib?  What if your obsession is that you’re going to blaspheme God and go to hell and your compulsion is repeating a prayer in your head?

Then what?  You can’t really kill your daughter (um, big DUH there, but you get it!) and you can’t really go to hell, so how in the world are you able to practice an exposure then?

"little sad song" by *TrixyPixie on deviantART

“little sad song” by *TrixyPixie on deviantART

Imaginal exposures, baby.  Brilliant and brutal.

In situations like these, what you might be expected to do is to write down all the ways you could kill your daughter, read it into a digital recorder, and then listen to it over and over.  Or maybe you’ll create a story in which you go to hell, where you’re forever condemned, and you read that story again and again.

If you’re an obsessive-compulsive, trust me, these imaginal exposures are going to FREAK. YOU. OUT.  They will be so triggering and so terrifying that your anxiety is going to spike, no problem.

Meanwhile, no compulsions allowed.

Meanwhile, ERP is re-wiring your brain.

Meanwhile, you’re stepping toward freedom.  And “all” you had to do was listen to a story.

This was my particular brand of ERP actually.  I had to listen to my recording for about 80 minutes a day until my anxiety levels (self-measured at the beginning, middle, and end) decreased by 50%.  For the first ten weeks or so, my anxiety levels were NOT dropping, and I very nearly gave up.  I mean, why put myself through this misery and terror every day if it was doing no good?

But then.

Sometime during week eleven, those anxiety levels started to drop.  I developed a whole new way of looking at my intrusive thoughts.  I tiptoed up to OCD.  I can still remember the day when I was listening (again) to that horrid recording, and instead of feeling anxious, my thought was, “This is getting so annoying.

And then I laughed … because … because finally.  You know what I mean.

OCD Stockholm Syndrome

First things first, I am a guest blogger on Monday at my friend Hannah’s blog, Prayers of Light.  Over there you can read a little something I wrote about Digory Kirke, about finally getting to hear the rest of the story.  Fellow Narnia geeks like me and Hannah are more than welcome to check it out!

Let’s talk about OCD Stockholm Syndrome, yes?

OCD.  Obsessive-compulsive disorder.

Stockholm Syndrome.  When hostages love their captors/abusers.

OCD Stockholm Syndrome.  When obsessive-compulsives ironically cling to the disorder that holds them in bondage.

“OCD Stockholm Syndrome” isn’t a real term, but it’s a real thing– and one I don’t think we talk about that often.  It’s confusing and senseless, and I don’t claim to understand it myself.  But this blog is in the business of shining light in dark places (mmm, lights all around!), so I thought I’d write about it.

I hate OCD.  I really do.  I think it is an ugly, vile, reprehensible disorder that steals joy and leaves people in shackles.  So, tell me why it is that, after my cognitive-behavioral therapy was over, I asked my therapist, “Do I still have OCD?” and when he said, “Yes,” I felt relief.

I think I was worried about what I would lose.  OCD had woven its way through me and entangled itself so deeply through me that a big part of me was worried that I would lose my personality if I lost OCD.  I also thought I’d lose my reputation as the “thinker” amongst my circle of influence.  As a Christian, I worried that I would lose my desperation for Christ if this disorder vanished because, after all, hadn’t it motivated me toward loving my God?

Once I watched a talk show where an audience member asked a question to the girl on the stage suffering from anorexia.  The audience member had formerly been through treatment for anorexia herself, and she asked (with incredible insight), “Sometimes don’t you feel like anorexia is your best friend?” and the girl on the stage answered, “Yes.”

At the time that I watched this talk show, I had not yet undergone ERP, and I remember thinking, I understand that.

It’s bizarre, I know.

When I communicate with other obsessive-compulsives, there is often a theme of therapy-avoidance that runs deeper than just a distaste for the hard work and anxiety that characterizes Exposure and Response Prevention therapy.  There is this deep-seated worry that ERP will not only erase OCD and anxiety from their lives– but a part of themselves.

I didn’t like to talk about this with people because it seemed so contrary to everything I stood for.  How could I hate OCD with everything inside of me– and yet still cling to it with such a quiet desperation?  It made no sense, and even to this day, I still have not figured it out.

freedom

But I wanted to talk about it on my blog because it’s a real thing– a real thing that sometimes prevents sufferers from the relief that is available to them.  I don’t know a lot about this strange phenomenon, but I do know this: I was worried about losing my personality, reputation, and desperation for Christ, but now that my OCD is under control, I am finally the Jackie I was supposed to be; I am still a deep thinker but now my thoughts are productive and not circular, and I actually have a greater capacity for deep thought because I am not sent reeling in terror by my thoughts; and I finally feel the nearness of God.  Whatever was lost doesn’t compare to what I gained.

When Thinking Hurts

wanttostopthinkig

I remember days when my brain worked like a manic assembly line, working, working, always working– and not in a good way.  Those days, I’d carve out time reserved for obsessions, for list-making, for mental reassurances.  Car rides were killer– especially those long stretches on boring I-90– and could throw me into panic mode.  At night, I’d lie awake in bed, drowning in circular thought.

And that was the thing: my mind was racing, but it never got anywhere.  Ten minutes or an hour or a week later, I’d still be chewing on the same things, exerting so much effort for no gain.

I was programmed.  When there was a moment, a pause, a hesitation, my head would fly to a dark place.  And then it would battle its way back out.  Over and over and over (and over and over and over and over and over …).  So useless, so fruitless, and so much energy spent, so much time wasted.

The by-products of OCD are not worth the efforts.

These days, my mind is still working hard– but in a good, healthy, productive way.  I listen to audiobooks while I get ready in the morning, in my car, while I exercise, as I fall asleep.  I let the wonder of literature engage my mind and thoughts, and it feels healthy, like solving a difficult puzzle or marveling at philosophy.  I write every day– blogging, poetry, my novel– and it’s like climbing a mountain.  My brain is a muscle, flexing and growing stronger.  My conversations with friends are deep and meaningful and far more important than just seeking out temporary comfort.  

When thinking hurts in a bad way, you need to re-wire your brain.