I Just Wash More Than Other People

We pull into the parking lot and get out of the car. I notice that I’ve parked kind of crooked, so I climb back in, start the car up again, and straighten it out. Blake raises a hand to signal that I’m okay now. I notice the glove. It’s stretched out and missing the tip of the thumb where Blake has pulled a thread and the glove has begun to unravel.

As I climb out of the car and we make our way to the therapist’s office, I notice that both gloves are misshapen. The wrists sit limply against Blake’s skin, like they’ve been tugged at too many times and any elasticity is long gone.  Blake is dressed in a short sleeve t-shirt and cold weather gloves. I think he stands out in this appearance, particularly with his thumb halfway protruding from the shredded threads. I don’t say anything. I know better.

I gave these gloves to Blake a few winters ago. His hands get especially chapped and painful for a few months each year. He slathers them in petroleum jelly at night and pulls the gloves on to keep the goop from getting all over everything else. Today he’s wearing them out of the house; his hands must feel extra painful if he’s wearing the gloves during the daytime.

I Just Wash More Than Other People

As we sit in the therapist’s waiting room, I am certain that The Doc is going to comment on the gloves. Anyone who has ever dealt with OCD treatment knows that embracing uncertainty is paramount, but there are few things I can feel more confidently certain about than the therapist honing in on these gloves. In a few moments, my prediction is confirmed. The Doc steps out into the waiting room and, almost immediately notices Blake’s gloved hands. He steps closer to Blake.

“What’s this?” he asks.

“Oh,” says Blake casually, “my hands get really chapped and sore this time of year.”

“Why is that?” the therapist wonders.

“I don’t know. It’s just the weather.”

“My hands don’t do that.” He holds out his own hands.

Blake removes his gloves and displays them for us. They are red and raw. It’s obvious they are painful.

“Have you been washing a lot?”

“My hands have always gotten like this in the winter.”

“How long has that been going on?” asks The Doc.

“Always,” says Blake.

Indeed, I don’t think Blake can remember a winter where his hands weren’t painful, raw, or bleeding. His hand washing at age six was my first big sign that he had OCD. It was something I’d hoped would go away. Despite education and treatment, it is still here, twelve years later. Blake knows nothing but painful winter hands.

“Maybe you’re washing too much,” suggests the therapist.

“It’s not that,” Blake says. “I just wash more than other people, that’s all, but that’s not why. The weather just does this to my hands.”

“You know,” suggests the therapist, thoughtfully, “you could try an experiment. You could decrease or stop washing and see what happens. Then you’d know if it’s the weather or the washing.”

“I don’t want to. That’s disgusting.”

To Purchase New Gloves or Not

After therapy, as we drive home, I note to Blake that his gloves have seen better days. It’s time to toss this pair out.

“But they’re the only pair I have,” he laments. “Do they really look that bad?”

“Yes, they do.”

Blake reluctantly tosses his gloves in a trash can later that day and sadly wonders what he will do to protect his hands. I ponder whether I should buy him a new pair. My inclination is to purchase them (mind you, we live somewhere where the daytime weather rarely gets below the 50’s Fahrenheit), but I wonder whether I’m accommodating his hand washing behavior if I do. He hasn’t asked for new gloves, nor has he said anything about going to purchase them himself. For now, I’m waiting.

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I Matter, Too

Image courtesy of digidreamgrafix at FreeDigitalPhotos.net

“More importantly, how are you doing?”

This question from Blake’s therapist takes me by surprise and throws me off balance for a moment. Blake has just walked out of the room, shutting the door behind him. Nature calling. I’m just finishing paying for the session, thinking I’m about to walk out the door, too. The therapist isn’t quite done yet.

“What do you think?” he asks, and then he points out, “He’s talking about serious stuff now.”

He’s correct. Blake only started coming to therapy when he wanted to take some control of the interventions his therapist, his dad, and I were implementing. He was angry. He came to bargain. In recent sessions, he’s talked about depression, his dislike for himself – just the mere concept of “Blake,” about his disconnection from the world. Today was no exception and, as has begun to be our routine, I sat like a fly on the wall watching the interaction between Blake and The Doc, wondering what I was doing in there. Although the therapist in me is fascinated by observing what’s going on.

It’s Not About Me, Right?

We’ve been seeing this therapist in hopes that our 18-year-old can overcome his OCD and severe depression and ready himself to live in the world.  So I just didn’t expect it when the therapist asked about me.

“I have good days and not so good days,” I answer.

“Well that’s a pretty non-specific answer,” the therapist says with a smile.

“I worry about him,” I say, “but I’m learning patience.”

The truth is, I’m kind of disconnected about how I am. I’ve been so mesmerized by the therapy session, I lost myself a bit. It’s only later in the day, as I ponder the question, “More importantly, how are you doing?” that I think over my frustration at watching my son climb back into bed multiple times each morning. It’s later that I recall the heartbreak at hearing my son talk about how life isn’t worth the good moments when he considers how awful the bad moments are. It’s later that I remember part of me sinking inside as I watch my son wash his hands immediately after handling money or tiptoeing around areas that the dogs might have contaminated.

At the same time, I’m touched by The Doc’s inquiry. As much as my son is suffering, family members are, themselves, affected when their loved one has OCD, depression, or other mental illnesses. If we aren’t directly involved in rituals, or trying to get them out of bed, we are worrying about them. So I’m appreciative of this simple act of kindness and caring. It resonates in me. It reminds me that we family members have to remember to care for ourselves in the face of our loved ones’ struggles. We have to be mindful of our own well-being. If we aren’t, we can become impatient, bitter, angry – basically of little use in this war called mental illness.

So, thank you, kind therapist, for reminding me that I matter, too. It opened something up inside of me and I feel just a little more alive and grounded. I feel less stuck in the mess with my son, and more like myself. And this morning, when I allowed myself to take a long hike in the nearby mountains, I was just a little more open to taking in the scenery and appreciating it, instead of having the specter of depression and OCD hanging over me. Yes, I matter, too.

So Lonely

Image courtesy of Ohmmy3d at FreeDigitalPhotos.net

“I’m just so lonely,” says the young adult in front of me, the despair apparent as the words sit in the air between us.

I’m sitting in the living room of my patient’s family home during one of my recent treatment visits. This past week has been one with slips backward and, to one so new to OCD treatment, they are demoralizing. OCD has taken such a huge toll on this young person’s life that friends and social activities have become a distant memory. OCD demands almost every waking hour and the rituals only end when sleep wins out in its urgency.

I’ve stopped doing exposures at this point in our session – I’m here to do exposure and response prevention (ERP – if you don’t know what this is, you can read about it by clicking HERE) work. My patient wants to do more, wants to move on and get better as fast as possible, but I realize it’s time to step back, time to help paint a clearer picture of what to expect. OCD treatment is not a race to the finish. It is about learning new healthier ways of managing discomfort. In this young person’s case, it is about rebuilding a life worth living – and that takes time and patience.

So, I’ve stopped the session. I’ve changed course. Sometimes OCD recovery is not all about exposures. Sometimes it’s about caring for the whole person and finding something to live for in the moment. Why do the hard work of beating OCD when there’s not something keeping one moving forward right now?

We sit on the sofa. We explore what’s going on. We connect. We realize my patient misses other people, misses being involved with something that is connected to the bigger picture. We brainstorm. We find a regular activity that is doable and that will provide uplifting moments. We look at when the next time there’s an activity available. We arrange for transportation and a companion to go with. For the first time in this hour, my patient smiles.

I get ready to leave and, suddenly, the twenty-something is standing in front of me, apologetic that we didn’t do more exposures today and didn’t get further in treatment. I gently and optimistically adjust that perception. We DID get further in treatment today. We addressed something that needed to be addressed. I encourage my patient to be kind to themself and I note, on the way out the door, that I will look forward to their renewed energy the next time we meet.

When Words Don’t Mean What We Think They Do

I was recently reminded that some of the most simple things we say to one another, words that are meant to inspire, connect, or that are simple formalities, can mean something very different to someone struggling with depression or other mental health issues. On a daily basis, there are words that pop out of our mouths out of habit. We usually don’t give them much thought, yet just last week, Blake gave me a window into a different perspective on words that I use.

“There’s something that I’ve been struggling with a lot recently,” Blake says. “People keep asking me how I’m doing.”

“Yes, they do that,” I say.

“Well, the thing is. I’m not sure what to say. I mean, what do you say when the answer to that question, ‘How are you?’ is, ‘I’d rather be dead?’ I don’t think that’s what people want to hear.”

He repeats this quandary to his therapist.

“Yes. It’s one of those formalities,” the therapist says. “I sometimes answer, ‘More or less.’ It confuses them.”

Blake laughs at this response, and then says, “There’s another thing people say. When things go wrong they say, ‘That’s life.’ ” Then he sighs and hangs his head. “That’s life.”

An entire conversation about depression ensued after that, but I took something away from those moments. It made me realize, more than ever, the power of words and how they may be construed by someone who is profoundly depressed. I realized that by saying “That’s life” to someone who is struggling to find even one reason to live, I may be reinforcing that life is nothing more than a series of bad stuff. I may be reinforcing the view of a world the depressed individual already finds so oppressive, so defeating. “That’s life. First it sucks, then it sucks more.”

I also thought about the power of asking, “How are you?” When we ask, do we really want to know? I thought of the depressed individual knowing what the socially appropriate answer is, and recognizing that, by giving it, they are telling a lie. Maybe there’s the feeling of being a misfit in a world where most people seem to be able to answer, “Good,” or “Fine.” Perhaps there’s a desire to say how awful they feel, but not wanting to be rejected for saying so.

I’m not suggesting we stop asking, “How are you?” Nor am I implying that we should drop, “That’s life,” as an expression when we want to explain to someone that the world is not perfect. I’m just taking a step into another frame of reference and, perhaps, taking you there with me for a moment. I just hadn’t ever realized quite the way my profoundly depressed 18-year-old son hears things, and I was given the opportunity to step into his perspective ever-so-briefly.

Of course, for Blake, it doesn’t end there. In his therapy, he is learning how to respond to the “How are you’s.” He is learning that there are some people he can be honest with, and other instances where he might give a social answer. He is also learning to challenge his view of the world. He is learning that “life” is not made all dark by some challenging moments. He is learning that there are shades of gray, and he is even beginning to notice moments of joy. For his father and I, it is a privilege to share in the journey.

I Don’t Want To, But I Have To

“I really don’t want to be here, but I have to…”

It’s another Thursday afternoon and, as usual, Blake, the hubby, and I are sitting in our therapist’s office. In what’s become a more and more commonplace occurrence, the hubby and I are sitting quietly on the sofa. Blake is in a chair hunched over his knees. The therapist is sitting close to Blake and is locked in conversation with him.

I’m not sure why the hubby and I are in the room sometimes, lately, but Blake wants us in there. The hubby allows his eyes to close; I think that’s how he focuses on the intimate conversation taking place to our left.

The topic, as it has been lately, is depression. Blake is describing the all-too-familiar pattern of following his depressed, dark thoughts down an endless rabbit hole of despair. Our therapist is gently directing Blake toward possibly confronting this pattern. Blake shares his perception of life holding no positive meaning. Suddenly, he seems a little breathless.

“This is really uncomfortable to talk about,” he notes. “I really don’t want to talk about it, but I have to.”

I watch him gather himself and continue. He pauses again, later – and, again, he comments. “I don’t want to, but I have to.”

I take this as a sign of bravery, a sign that Blake recognizes that, in order to gain the upper hand on his depression and his OCD, he has some very uncomfortable work to do. Later, I ask him about it, and he confirms this interpretation to me. Blake understands that he must share how he thinks, even though it is incredibly uncomfortable, so that he can move forward and begin the process of healing.

Honestly, this is remarkable to witness. We, as a family, have been though years of struggle. We’ve watched Blake succumb to OCD thinking, and then to depression. He has battled facing anything that is even the slightest bit uncomfortable. Yet, now, at age 18, there are glimmers of willingness to do the hard work – to fight for a life worth living. I recognize that there will be more struggles and steps backward, and that this will be a process. Yet, this is new and it is something I don’t think I’ve ever seen in my son before. I am so very proud of him.

This Week

“How was this week?” our therapist asks Blake.

“It was a little better,” Blake replies.

I don’t think I’ve heard those words out of Blake in two years. Maybe more. The final year of high school was a struggle to the finish. The summer was a descent into days spent with my newly graduated young adult sleeping all day (sometimes until 10 p.m.) and awake all night. He was angry with us, but couldn’t show it most of the time. We had taken college from him because he hadn’t been ready to leave home and now life seemed useless to him. Days were nothing but drudgery – nothing to look forward to.

Six months ago, Blake, struggling with both Obsessive-Compulsive Disorder and Major Depression, refused to attend therapy. When his father and I went alone and started acting more like parents, setting limits and applying consequences that made little sense to him, it got his attention. He came to therapy grudgingly, but determined to get us off his back, and to take back some control.

Little by little, he started to be awake more of each day – most days (there are still setbacks, for sure). He started to create a schedule for himself. For weeks and weeks he fought the schedule, but then it started to get a little exciting. This past week, he completed a short story and it actually felt good. It’s a horror story and, truth be told, it’s compelling and terrifying (yes, he actually let me and the hubby read it).

Dealing With Depression

When we went to therapy one week ago, Blake shared with our therapist about his depression loop.

“I feel lousy and then I realize that it’s stupid to feel depressed about what I feel depressed about. So, I get upset with myself for being depressed…”

“And then you keep going on a downward spiral,” the therapist noted.

“Yes,” Blake had answered. “I just feel worse and worse.

“This is actually great that you recognize the process,” the therapist told him, “because once you recognize it, you can change it.”

“How?” Blake had actually been intrigued.

“Once you know the pattern, you can catch yourself. You can tell yourself that this is your depression pattern, and then you can remind yourself that you don’t have to make yourself feel worse for what you are depressed about. You can remind yourself that you have depression and that this is what it does, but you don’t have to follow it and make yourself feel worse. You can begin to change direction.”

Blake had considered this. He actually invoked it in the week following that session. And that week, he wrote more than ever.

This Week

“It was a little better.”

The words resonate in my brain.

“A little better is a nice place to be,” the therapist acknowledges.

“Yes, I guess it is,” Blake agrees. Then, amazingly, he goes on to actually talk with the therapist for the entire hour. I watch them interact as they discuss plans for the week, specific ways the hubby and I are a pain as parents, and Blake’s love of video games. I am amazed as I watch my son engage. 

Spontaneously, Blake and the therapist get up from their chairs and head to the therapist’s computer to watch an animation the therapist wants to show Blake. I stay behind for a minute or two and observe. I feel my eyes burn and well up with tears. I haven’t seen this in so long and it feels so good to see glimmers of happy on Blake’s face. And then I stand up to join them.

Showdown and Shooting

Brand new baby box turtles

I found last week a difficult week to post. Blake and I had some serious run-ins, and our community was greatly affected by the massacre in Las Vegas. My attention was on home and community and I’m just now feeling like I can give a bit of attention to my blog.

On the Homefront

Blake continues to attend therapy, yet he is really not completely on board. I heard last week that the hubby and I “smother” him – his term. It’s probably true.

“You and so many others keep trying to help me. It’s like life rings are getting thrown at me from so many directions. I’m overwhelmed. And I almost feel like drowning just to get you to leave me alone!” he told me one evening.

I told him I appreciated knowing that he feels smothered by us.

“I feel like I’ve never done anything on my own. I wish you guys would throw me out so I’d be on the street and prove that I can make it.”

“I get it that you want to prove that you can make it, Blake. It just makes me wonder, does the only way you’ll be able to take charge of your own life and make of it what you want have to involve living on the street? Or can it happen with a roof over your head and food to eat?”

When our therapist heard Blake’s reasoning for continuing to resist getting better, he commented, “I guess you’ve got a lot of evidence to prove that continuing to drown does not get people to back off.”

Then he kicked the hubby and I out of the therapy office and met with Blake alone – which was actually quite nice, oddly enough.

In the Community

While Blake was begging for us to leave him alone, the community came calling. Thirty-six hours after the Las Vegas shooting, a colleague reached out. At least ten members of our community had been shot. Many more had been at the Route 91 festival.

“Can you let me know of any Las Vegas debriefing sessions in {our community}? I have one client who was there…another coming in. You are so connected. I know you may hear of something.”

Up until that point, I’d felt helpless. As a psychologist, I know the effects of an event such as this, but I didn’t know how I could help. Suddenly, I knew. I contacted our local community mental health center, a place I used to work and serve on the board of directors. I asked whether they would be offering any community support events. Two days later, I found myself on a panel discussing ways to cope, how to help our children, what we might expect in the days and weeks ahead.

The next thing I knew, I was publicizing support events to our local mental health community, listening to survivors’ stories, showing up on the local news, and connecting those with the resources to those who needed it. Someone added me to a Facebook group for survivors and helpers. There are nearly 350 people in that group. How did so many of our community members happen to be at this event? It felt like a mission. I became consumed with helping.

…And then I kind of crashed. I don’t know if it was compassion fatigue, but I needed to disengage for a bit from the tension in the house and the craziness in the world.

New Life

Just when I felt at my lowest, nature sent me a gift. I stepped into our backyard just before a meeting and was greeted by two, silver-dollar sized baby box turtles. For a moment, my heart raced with joy. Three months ago, I watched in amazement as my thirty-something-year-old turtle laid a clutch of eggs and buried them in her enclosure. Now, two hatchlings sat in the yard, covered in dirt – a beautiful reminder of how life renews itself. A chance for me to step back and breathe.