Wednesday, October 6, 2010
Though I have been looking for part-time jobs and have some promising prospects, I am gradually becoming a little bit more nervous about my financial situation. I have savings - gifts from relatives from over the years given for holidays and birthdays, extra savings here and there from summer jobs. I was a relatively frugal kid/teen and my parents took care of paying for my food/clothing so I didn't need to spend a lot of money. But now, well, I am paying for almost all my expenses, BUT I don't have a job!
On the one hand I feel like I should consider myself lucky - I don't have student loans to worry about paying back like many of my friends. Scholarships greatly reduced my college tuition and my parents could afford to pay the difference and were kind enough to do so. But even though I don't have to worry about loans, it's hard watching my savings gradually disappear - mostly to rent and health insurance and the cost of therapy. Rent is sort of an unavoidable expense as long as I want to live on my own (and as long as I want to remain close to my friends and therapist). Health insurance is also a necessary and unavoidable cost. And that leaves therapy - oh, therapy. And I start to wonder, should I be cutting back? Am I working hard enough in treatment to warrant going so frequently and spending so much? What if I don't deserve it because I don't make enough of my frequent visits? Cue guilt and anxiety.
My therapist is definitely inexpensive as far as therapists go, and though insurance is not accepted, I can submit payment claims and my health insurance will reimburse me for part of the cost. Though the amount that insurance pays for mental health related expenses is probably far from on par with that paid out for "regular" health expenses, in the grand scheme of insurance, my coverage and reimbursement is amazingly generous. (Isn't that messed up? The fact that mental health coverage is often so limited that, even though my rate of reimbursement is probably less than that provided for "normal" care, it still seems amazing?). Yes, I probably could have found somebody in network. But could I have found someone in network who specializes in treating OCD? Kind of unlikely. And trust me, I tried - or rather the frustratingly ignorant employee health social worker I first sought help from tried. He searched to find someone who specialized or had experience in treating OCD for me, and even he had difficulty locating anyone in-network who definitively treated the disorder. By the time I had gone to see him a few times and by the time he offered me referrals of questionable expertise, I was so desperate that I couldn't wait any longer. I went out of network because I didn't have anymore time to waste. My quality of life was deteriorating so fast that I needed help ASAP. (The limits of mental health coverage, as well as the lack of knowledge about OCD even among mental health professionals, are both topics that probably warrant whole separate blog posts. I'll stay off my soap box for now...).
Anyways, I have to eat. I have to have a roof over my head. I need health insurance (and it helps pay for my therapy costs), so that leaves therapy and the bothersome worry of whether or not I am working hard enough to warrant going so frequently and spending as much money on it as I do. Throughout the fall and spring I was not only going to therapy up to 2 times/week, but I was also sometimes paying for home visits, which were always incredibly helpful, since the my highly nuanced and home environment-specific contamination cues were sometimes hard to accurately capture and develop exposures for in the office. Once I went on disability (I used to have a full-time job) because I wasn't getting better at a rate fast enough to maintain the duties of my job, I switched to 1 session/week for a while, but I often found myself getting stuck between sessions, making no further progress until I could address those problems at my next appointment, and sometimes getting worse in the meantime. So I am again going twice a week. But I still wonder...do I deserve this? Do I need to find a way to push myself more to warrant going so frequently? Do I really need this?
This is all compounded by what are probably other OCD fears (fears that I have discussed with my therapist now and then as they have waxed and waned in the background of my primary contamination concerns) like "What if I am intentionally avoiding getting better?" When I still had a job, it was sometimes, "What if I am just trying to get out of work and am making this all up (the OCD, that is)?" Or, "What if I am not putting as much effort into getting better as I should be?" And occasionally it has been, "What if I just like talking to my therapist and am just going to hang out and talk?" And now it is, "Am I really working hard enough to continue going twice a week, even if I feel like it probably helps?" Or, "Am I intentionally prolonging my OCD and not trying harder to get better because I am afraid of working full-time again and/or like having an excuse not to?"
I'll be honest, OCD and OCD treatment have kicked my ass. Not only that, but I have a hard time judging and understanding whether I am getting better reasonably "fast enough" given the initial severity of my latest OCD episode and the fact that I have had untreated OCD for most of my life. I am used to judging myself through comparison. I have looked at the progress/achievements of others to gauge my success for far too long. Given the obvious reasons of confidentiality and the fact that everybody's OCD is different, I don't really have a strong benchmark for comparison (which from an OCD standpoint, is probably a good thing - comparing yourself to others to determine your relative success is usually more problematic than helpful). This leaves me wondering if I am progressing "fast enough" or if I am working "hard enough." My therapist often tells me that he could be going harder on me, but without being able to compare myself to others - the difficulty of their assignments and their rate of compliance - I have a hard time understanding what this means. So sometimes I wonder, if I could compare my success or lack thereof to that of others who are still struggling and seeking treatment, if I would be more motivated to work harder. I don't like feeling like I am behind and I like being able to keep up with others, but maybe not having others to compare myself to is good practice in just accepting uncertainty and doing the best I can. I'm not really sure what to think.
That said, I like going to therapy frequently not only because I still need a lot of help and improvement in the area of my current OCD issues, but because finding out about my OCD - giving a name to this thing that was always there directing my choices and actions - has really changed how I look at what I do and why I do it. There are so, so many things I want to work on and talk about and do to make my life better. I am genuinely excited at the prospect of the all positive life changes I could make now that I know that I have this disorder and now that I have a really insightful therapist who makes me want to overcome those challenges and live a better life. Maybe I am foolish and naive to believe that so much can be or needs to be changed, but I feel like the general approach I have taken to life was so heavily entrenched in OCD and perfectionism that I have a lot of room for improvement, a chance to really positively influence my quality of life. I really like going to therapy for all of these reasons - there is so much hope and excitement in it, but then I wonder if I am going too much, if I am really working hard enough in between my sessions to warrant the expense.
Tomorrow will mark one year since I was finally diagnosed with OCD and entered treatment. It was a monumental moment in my life. Since then so many things about me - past and present - seem to have fallen into place, to suddenly make sense. I am so, so, so much better than I was this time last year, but honestly I thought I'd be better a lot sooner. It has been a long and difficult fight during which I have often questioned my motivation and work ethic. I am a generally dedicated and hard-working person, so it is strange to me to not yet have conquered this nasty and most recent episode of OCD. Because I am not used to having something kick my ass like this, I tend to question whether I am working hard enough, if my heart is in the right place, and if I am going to therapy for the right reasons and the right amount of time. It's a tough one.
I like to think of the money I'm spending now as an investment in my future - the more OCD tricks I can learn to fight now, the less suffering and unnecessary loss I will face in the future. I try to tell myself that I deserve to spend this money on myself, even if it is a considerable expense that further eats into my savings. I genuinely feel like it is a really positive influence in my life, but will there ever be a point where I will feel like I actually need less therapy? Or do I need to start weaning myself off even if I don't feel ready, even if I still have a lot of things to overcome, because there will always be more OCD no matter what and because there may never come a time when I want to go less? It's a difficult one indeed.
The guilt, the constant self-questioning, and doubt surrounding this subject is sometimes pretty bad and can raise my anxiety, making my other OCD concerns harder to fight. And then when I don't fight as hard to challenge my OCD, I start to question my devotion and the effort I put forth into getting better (even more than I was before), and around and around I go. Writing about it here helps though. It aids me in sorting out my thoughts and recognizing why I feel guilty or unsure in the first place.