Ugh, ugh, ugh. I have things to do today and have already spent a significant amount of time on my computer this morning, so I will try to make this quick. I probably shouldn't even be writing this...I should probably just be sitting with the bothersome feeling of anger and the need to express my opinion about it...since that seems to be my weakness...just sitting with and accepting discomfort. But here I go...but I am giving myself a time limit!
Perhaps it is because I feel that I would have been in the same position, or perhaps it is because I often question whether I am actually trying hard enough in treatment, but the attitude taken towards Kristen's behavior on this episode was extremely frustrating for me. I disagreed with so much that was said and so much that was suggested about her. I have talked to my therapist about this notion that sometimes what someone with OCD needs is a good dose of "tough love." Sometimes I feel like if someone would just yell at me and scare me into submission, I would get better. Sometimes I question whether I need "tough love" and whether I am just putting on a "princess act" as they suggest Kristen is doing here. Sometimes the "tough love" voice in my head berates me for not trying harder, for being non-compliant, but this never helps. It only heightens my anxiety and my anger at myself, which in turn, makes it more difficult to stay calm, stop ritualizing, and do what I know I need to do to get better.
When I suggested this idea to my therapist, that I was afraid that what I really needed was someone to harshly whip me into shape, he told me that he could think of almost no examples of where "tough love" was actually that successful in getting people to change their behavior. I suspect that for me, like Kristen, this sort of either all-or-nothing approach would not have been helpful. But what is most frustrating for me in this episode is the insistence on using this approach over and over and over - either get with the program or forget it! Either fight OCD or don't.
Maybe Kristen could have been working harder. Maybe not. She was probably just doing the best she could. I mean, who really wants to have to perform compulsions? Who really wants to feel like they need to throw away or wash everything they own if they ever want to be able to use it again? That is a terrible, horrible feeling. I have never had to do anything as extreme as the exposures Kristen was asked to do in this episode, but I have still had that feeling of "Crap! Now I am going to have to wash EVERYTHING that has been touched or throw away all sorts of things that I still really want and use!"
Why didn't anyone seem to consider that this approach didn't seem to be working for her? No matter whose fault it is, whether or not you can determine whether someone is working hard enough, or whether or not it is just that much harder for them, shouldn't it be the therapist's job to recognize when the client is struggling and then respond and adapt the approach so that the client can be more successful in treatment? Yes exposure and response prevention is a proven method for reducing OCD symptoms, but does it have to be done in this way? I don't think so.
When I watch Kristen's home visit I see many of my own symptoms mirrored in her protection of her home environment. My therapist made regular home visits when I was at my worst, and when I watch the OCD Project it's hard for me not to think about how I think my therapist would have done things. If I balked at the idea of doing something he wanted me to do, he didn't yell at me. He didn't tell me that I needed to get with the program or fire him. He said, well, if you don't feel that you are capable of doing that much, what can you do that is in the same vein of exposure but not as difficult for you? We would then start with that and gradually work our way up, and often, I would end up doing the hard exposure he had wanted me to do in the first place, but without the yelling, without the crying, and without any sort condemnation of the client, their attitude, or their failure to comply immediately and without protest.
The all-or-nothing point of view is one of the cognitive distortions that OCD feeds on in the first place. And when watching Dr. Tolin attempt to force Kristen to do something over and over and over instead of adapting his methods to suit her needs and to maximize her success, I can't help but be reminded of my stubborn attempts to get a ritual right over and over and over. The answer doesn't lie in a rigid attempt to do something again and again in a certain way until it works. Rather, the answer lies in the ability to recognize that a certain strategy isn't working long enough to step back, adjust your mindset, and try something new. Whether it involves stepping away from the sink before it feels "right" or stepping away from a hard-nosed approach to treating OCD, I think flexibility and the ability to adapt the solution to the problem at hand is an invaluable tool.