Wednesday, October 6, 2010

Money Matters

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 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.


  1. Wow - yet another post I could have written myself! I too am on disability and it is running out in another month. Most days I feel as though I am ready to start working again - but part-time only. This will definitely not pay all the bills, so I will be faced with borrowing money in order to pay the bills. Of course - the first thing I think too is "should I be cutting back on therapy? Am I working hard enough? Is it really helping me or could I be doing this on my own? Am I making enough progress fast enough?" And on and on I go!

    Of course I'm sure the financial stress isn't helping, but it is a catch 22 I guess.

    Again - I tell myself it comes down to making the choice and then moving forward with that choice. Your posts are awesome - I sooo can relate. Keep up the great work! If you can look back over the last year and see improvement you are doing well!

  2. If you are making any progress at all, therapy is a good thing to keep up with. If it helps your quality of life, definitely don't drop it or cut back!

    With that being said, if your provider is out of network, you could probably save more money by not having health insurance than by cutting therapy. Gasp! Radical, I know! But, how many times do you go to the doctor? Would you be able to save more by putting the money for the premiums in your pocket? Then, when you did have a medical issue, you could pay for it - because you would have saved the money.
    We finally decided 2 years ago that we couldn't afford health insurance. And even though we've had to pay in full for a couple of ER visits, we've still come out ahead.
    I don't know. Maybe that's not for you. I'm against insurance companies in general because they prey on fear to line their pockets and don't cover anything. But that's my soapbox, and I'll put it away now.
    Good luck with your decisions. This economy is rough on everyone. Hopefully you find a job soon!

  3. Anonymous - It's unfortunate that you're in a situation similar to my own, but I'm glad that there are people out there who can relate! Thanks for your kind words. I like the whole, "it comes down to making the choice and then moving forward with that choice" business. You can make a choice and question whether it was right or wrong, or you can make a choice and hope that it works out for the best. More often than not there is no one "right" answer! Thanks for reading!

    Shana - I'm sorry that you had to make such a tough decision to save money! It just doesn't seem right that health insurance can be so expensive that it can be hard to afford and less expensive to go without! I feel bad for worrying about my finances now because, by chance I actually ended up pretty lucky when it comes to health insurance - it is relatively inexpensive and has great coverage, even of my mental health bills. I just don't think it's right that I, or anyone, would feel "lucky" to have part of their mental health costs reimbursed! When we pay for health insurance, we expect it to cover parts of our medical bills. Why should it be surprising when mental health coverage is also good?

  4. Since I've lost my job I have cut back to sessions every other week with my therapist, but I was also in that transition zone where I was pretty much ready to do this, and the financial situation gave me a little push. But I've been in Exposure therapy for 3 years, and though I felt a similar angst about not "deserving" the expense of therapy, it made all the difference to have a therapist's helping instead of dragging out my recovery even longer by stopping therapy. It IS an investment in your future, and the OCD will give you the run-around about knowing "for certain" if you should keep going--but for me it was worth the risk that I didn't "deserve" the therapy, and I did the exposure of continuing.

  5. I asked for two counseling appointments this week instead of one. And I called the Dr. because of med. trouble. And I went home from work early today because of said med. trouble and the Dr.'s comment. And, yeah, I'm not sure how the paying for it part is going to go. I don't like watching my "savings" disappear, but this is the sort of time I have savings for (even if I was expecting a different sort of time like car trouble or lack of work).

  6. Expwoman - It certainly made me feel better to hear that you have been in exposure therapy for 3 years! At the start of treatment I was told that most people get better in about 4-6 months of CBT. I can see how this might be possible if you had never had OCD before or had had therapy in the past and just had a relapse. For me it seems like so much more though! I feel like not only do I need to overcome my current contamination issues, but also my generally compulsive approach to life that I have adopted over the years. I finally have a therapist I like and who I feel helps me, and I FINALLY know that I have OCD. It's overwhelming to finally have both of these things, and as long as I am making progress I don't want to continue to sort through all of it! It's hard to give myself the permission to keep going, but like you said OCD will always want to know "for certain" whether I should continue, and I just have to accept that risk!

    Abigail - Sorry to hear things are a bit rough! Thanks for the reminder that times like THIS are exactly why I have savings. They were always there for a "rainy day" when needed, and well, this has been one BIG rainy day!! I think mental peace is priceless, and if therapy/meds help it is probably worth the investment.



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