Sunday, November 21, 2010

Intensive Treatment Update

So I realize that I haven't really kept up with summarizing my journey on through my intensive treatment program.   I am now at the close of week 3 and much of weeks 2 and 3 were like week 1.  Each week has had its ups and downs but the overall product is certainly progress, progress which at times feels like frighteningly much and at other times like far too little.  Hopefully presenting a brief snapshot of the experience and pulling out some of the highlights will help me focus on the areas where I have succeeded as well as those that still need a lot of work.

I have three home visits each week.  During these sessions, we have sort of been going room by room through my house doing exposures.  Of course, we started with my bedroom which is where I spend most of my time.  I now have an established "circuit" of exposures that I am supposed to do each day in my bedroom.  Mostly it involves touching a lot of things I consider dirty and then indiscriminately touching everything else in my room so that it all becomes "contaminated."  I have done well with this despite my initial resistance, even though it still doesn't completely address the problem of my rules...

The OCD rules I live by dictate that you can't touch this and then touch that, or you have to wash this way and under these circumstances before going on to do or touch other things.  So while completing my circuit of exposures forces me to disobey the rules and get used to the idea of everything being sort of "contaminated," I still have trouble breaking "the rules" except in these very pre-defined ways that are part of my exposures.  I am allowed to break the rules when I do my "circuit" and yet, when I am presented with a similar scenario outside my designated exposure time, I am still very reluctant to break the rules.  Here and there I am beginning to let myself off the hook because I realize that what I would like to do has already been done by means of my exposures.  But I still tend to hold myself to my fairly rigid OCD rules, even if they have already been violated in treatment, and even if the contamination aspect doesn't bother me nearly as much as it used to.  A lot of the time the challenge is simply allowing myself to break my arbitrary "rules" in the first place.  Perhaps the idea is that, with enough practice through exposures, I will gradually change my mind about the rules and be less hesitant to break them.

We have also begun to do some cleaning throughout my home.  I live with three guys (most of whom don't care or don't have time to clean) in a large house that has been inhabited by waves of college students year after year as evidenced by the strange assortment of items left behind - stuff that doesn't seem to belong to anyone who currently lives here and that nobody wants or knows what to do with.  Of course, all that stuff, according to OCD, was (and is) off-limits because I don't know where it's been, who it's been used by, or what's been done with it.  Even if the items themselves don't necessarily bother me that much, the rule still stands and I have long just maneuvered my way around it.  With the help of one of my therapists, we cleared this stuff out and sort of indiscriminately tossed most of it, which is sort of an exposure in and of itself, because, though I'm not a hoarder, I do have issues with doing things the "right" way.  When throwing old items away I feel like I have to first make sure no one still wants it, and then figure out whether it can be given away or recycled and where I could take it if it doesn't just go in the trash.  With the exception of some paint and electronics, we just threw it all out.  No double checking to make sure it's not stuff that anyone in our house might just might want.  They've had years to claim what they wanted, and if they still haven't needed it, they don't need it now.  So out all the old stuff went, and my house's living areas are now far less cluttered.

The real exposure in all of that, however, was not throwing stuff out.  Instead, it was just touching it - picking it up by the armful and subsequently touching my face, my hair, my clothes, after which I would then later touch things in my room.  The boundary between my "clean" stuff and the rest of the world has been breached in ways like this over and over and over.  And though my rules about what can be touched and when still stand strong, I think the repetitive violation of those rules in my home sessions has weakened the them some.  Hopefully as the basis of those rules seems to become less important, I will feel more inclined to let them, just as I have slowly let go of many other things in the process of getting better.

And of course, once we cleared a lot of the collective junk out of the house, things needed to be wiped down and cleaned.  And this has been another exposure, not just because it involves touching dirty furniture and such, but because I have to use chemical cleaners to clean them off.  This is where the OCD rules get really strict!!  Though I have not always been so over-attentive to this sort of thing, I have always been anxiously observant of the "rules" about using chemical cleaners, and now that I have pretty severe contamination issues on top of that, it makes using these cleaners extra-triggering.  I worry if I am using the "right" cleaner, in the "right" way, while taking the "right" precautions.  At the same time, I am worried about the ability of the cleaning chemicals to contaminate other things much in the way the way I imagine microscopic amounts of dirt and germs being spread by my negligence.  It is a mental marathon of trying to keep up with whether this touched that - whether I should have touched that door knob or that light switch or pushed back my hair or scratched my arm after wiping down this table with this chemical and so on.  Even if I logically recognize that it is highly unlikely that the average person considers all these factors when cleaning, and even if I am aware that spreading invisible particles of cleaner throughout my environment probably doesn't matter, OCD still commands that the rules be followed, that I KNOW what I am supposed to do and whether I have somehow done something wrong. 

In this area some of the exposures have been more difficult.  As part of my daily homework, I am supposed to be cleaning something with Windex and then not washing.  This is triggering for a number of reasons.  One, because I feel like I am "supposed to" wash my hands after Windex-ing something.  Two, because I feel that whatever I touch afterward is then contaminated with Windex even if I'm not certain I got any Windex on me in the first place.  And three, because I feel like, if I am breaking the "touch absolutely nothing until you have washed after using Windex" rule, I feel like I have to be vigilant of what I touch.  Each time I touch something I question - am I really willing to take this risk?  Can I touch this closet door knob so I can put the Windex bottle away?  Can I touch the sink handle before washing my hands when I do finally wash?  There are a million and one questions like this.  And to some extent, the cross-contamination issues are still about more than just rules in my mind.  Sometimes I really do feel like I might be doing something wrong and getting things dirty in a way I shouldn't.  So yeah, whether it is simply breaking the rules that bothers me or if it's the idea of contaminating things that put me on edge, either way the exposure makes me feel "off."  And that feeling is what I am doing exposure to, in addition to the exposure of not following every single OCD rule.

What else?  I don't know.  I'm sure I am leaving out key details, but I'm still so involved in the process that it's hard for me to step back and see the big picture.

One other note though:  I tend to get tired during this process.  Before I started this program, I would do exposure and then have time to make myself feel "right" about it again, usually by undoing half the work that was done and maybe, just maybe actually habituating to what was left.  Now, I have exposure day after day after day, either with one of my therapists, or on my own.  I don't really have a chance for my mind to catch up completely, for me to make things feel "right" ever.  Things are in a perpetually sort of "off" state, but I guess that's kind of what we're going for.

Some days I feel like I can't do my exposure homework on top of everything else that we have already done.  Some days I do my exposure homework and am made anxious by the fact that my homework doesn't make me that anxious.  That's when the thoughts of, "Oh know?!  Do I not have OCD anymore?  Am I getting better too quickly?  Am I allowing myself to be too careless too easily??" start messing with my mind.   But I guess those feelings are all part of it, too.  It's just more exposure to yet another type of unwanted thought.

Right now I'm just trying to do my best each day without worrying about what comes next or what I might have done wrong the day before.  I often feel like I'm not doing enough, that I should be working harder, but since I also fear that if I really just tried "for real" that I could just "snap out of this" immediately, these feelings of not working hard enough are probably to be expected.  And usually, when I start to question myself about this, wondering if I just got "mad enough" at myself or put the "right" amount of effort in at the "right" time, if I could be better NOW, I usually just get even more anxious which results in greater compulsivity.  The fear that I could "just stop" if "actually tried" is just one more that I have to face during this process.

Maybe if I did "just make myself stop already," I would suddenly be OCD free.  Maybe not.  Evidence suggests that this is probably not the case.  That gradual and repeated exposure to OCD triggers is how the disorder is best overcome, not by convincing oneself in one day to "just stop."  It might work for someone out there, but as much as I feel like I should force myself to stop all at once, past personal experience shows that it usually just exacerbates my symptoms rather than eliminating them.  It's a continual battle in my mind, but I try to remind myself that if there's anything I "should" make myself do, it's my exposure homework.  If I feel like I'm not trying hard enough, then I should try to do more exposures rather than debating whether I am a horrible person for not being able to just stop any and all compulsions cold turkey.

It's a fine line to walk.  If I let myself off the hook too much, I shy away from doing the exposures that I want to succeed at.  If I get mad at myself for "not working hard enough," I often get more anxious and am less receptive to doing ERP, which then makes me even more mad at myself, less willing to endure the discomfort of doing my homework, and even MORE frustrated with myself, and on and on and on.

In general, things work better when I'm nicer to myself, when I take notice of my continual scrutiny of my intentions and effort, but don't try to prove it right or wrong, one way or the other.  I have to remind myself that the point is to just DO, and that discomfort is to be expected, even if that discomfort doesn't come in the form I was expecting.  OCD is devious and constantly comes up with additional reasons to perform compulsions, new reasons to shy away from my homework.  I just have to do my exposures, and accept that I may not have addressed every single question with my therapist, every possible reason to NOT do each part of my homework, and that I may never address them at all.  I just have to accept this and move on anyway, not knowing whether I am doing the "right" things the "right" way at the "right" time.

4 comments:

  1. Wow, that sounds really amazing and really hard. Thanks for the update!

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  2. Wow! I agree with Ann that this is amazing! Thank you for the update. I've been thinking about you. When I started realizing that "feeling off" was part of my exposure, it really helped me move forward. I expected myself to "instantly" change(and like you then, I'd worry that if I did change, this meant I should've done it sooner. . .)something along the lines of Star Trek's teleportation. That's really big that you are keeping moving, regardless of the imperfection of the exposures.

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  3. Thank you both for your comments! They made me smile! I'll keep them in mind as I try to continue to push myself forward. Thanks!

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  4. Wow, sounds like hell, in my opinion. But I sure hope it helps! Keep us updated, and give yourself a pat on the back.

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