It’s Always Darkest Before the Dawn

Image courtesy of Stuart Miles at FreeDigitalPhotos.net

Just before we leave our latest therapy session, our therapist informs Blake he’s going to use a cliche’. It’s been a difficult few weeks, helping our son tiptoe toward better functioning. First there was getting up each morning at the same time. Next, it was about getting in the shower and getting dressed. Then came the difficult job of convincing Blake to choose an activity for himself – something that would get him out of the house, instead of falling back to sleep for hours upon hours.

In this session, Blake tells the therapist that he plans to apply for a job. It was his task since our last session to decide whether he wishes to take a college class or get a job. Blake names a local store that piques his interest, and then he does an amazing thing – he looks our therapist in his eye and gives him his word. I gasp silently.

“This is a big deal,” I say aloud.

“I know it is,” says our therapist. “Blake doesn’t give his word easily. I know if he does, he will stand by it.”

I admire that the therapist has picked this up about Blake. It’s a subtle thing that the casual observer would miss, but this therapist, with his many years of treating OCD has picked up that Blake’s scrupulosity, his need to tell exact truths, prevents him from promising or giving his word on nearly anything. (If that seems strange to the reader, I’ll sum it up that Blake’s OCD says he must be a good person and always tell the truth. Because there may be an unforeseen circumstance that may prevent him from keeping a promise or his word, Blake’s ritual/habit/compulsion is to not make any promises).

And then, it is quiet.

Our therapist pauses, strokes his chin, and notes that he’s now in an interesting position.

“There are fifteen minutes until our time is up,” he says, glancing at the clock. “So, you could let me know if there’s something you’d like to bring up, Blake. The alternative, which I don’t know if you’d like, is that I could ask your parents if there’s something they’d like to bring up…”

“Nope. There’s nothing I want to talk about,” Blake says, and looks in my direction.

“Oh, I do have something I’d like to bring up,” I say, somewhat too excitedly.

“What?” Blake wonders.

“You know, you have been sitting up late at night talking to me about how much despair you are in, how life seems to hold nothing for you, how awful you feel.” I look to the therapist and continue. “There are frequent nights of sobbing his heart out. And, as mom, I’m trying to listen, but there’s a limit to what I think I can do.”

The therapist nods and what ensues is a dance around whether Blake will share what he’s been going through with the therapist, whether he might trust him with his sadness, and the time constraints. In the end, Blake agrees he will meet with the therapist alone during the next scheduled session and at least answer a few questions for the therapist. But Blake is doubtful that it will be helpful.

“It’s difficult to imagine that there is any hope,” the therapist notes to Blake, and then, as we walk out the door, offers him what he promises will be a cliche’. “It’s always darkest before the dawn,” says our therapist.

Blake nods.

“See you at dawn,” says the therapist.

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Don’t Say It’s Not About OCD

Blake sits in his chair looking intently at the therapist. He’s just begun coming with us to sessions and he’s questioning the therapist’s approach (because, well, Blake knows better than the therapist – or mom and dad).

“I don’t understand why my parents are rubbing a tissue on the dogs and putting it on my bedroom floor if I don’t show up for dinner,” he says. “If they wanted me to come to dinner, they just could have told me.”

Well, actually, we did tell him we wanted him to come to dinner. He just wasn’t making it on time most nights.

“But why the tissue?” he wonders.

“Well…” the therapist starts. “Your parents have noticed that there are some behaviors you have that are related to OCD. And they are concerned about them.”

“What?!” His head swivels in our direction. “You’re concerned about them?! Why didn’t you ever just tell me?! Why did you ever let me leave treatment, then?! Frankly, I see nothing wrong with what I do. Dogs are not cleanly and it’s disgusting to have anything from them in my room!”

Well, actually, we did tell him we were concerned about his behaviors and that we encouraged him to be in treatment, but he refused.

As the conversation heightens, the hubby starts to get antsy. He steps into the process.

“Look, I don’t think the primary issue is your OCD right now, Blake. I think your sleep is a huge issue, and your functioning on a day-to-day basis.”

At one point Blake leaves the room in frustration and our therapist looks at the hubby and I.

“Please don’t say it’s not about OCD,” he asks us, “because I’m not so sure it’s not. Blake has a lot of OCD behaviors that he thinks are normal. I don’t want to normalize those and have him think they aren’t a problem.”

When we leave the room, I begin wondering about what our therapist said. Other professionals have pointed to Blake’s depression in recent years, not so much to the OCD. What is he seeing? So, I observe, and I begin to notice what I’ve stopped seeing in the past four years:

  • Walk into bathroom, wash. Walk out. Walk back in. Wash again.
  • Open car back door. Seat is too dirty. Sit up front.
  • “Mom? What is that on the floor?”
  • “Mom? What is that in the box?”
  • “Mom? Is that color normal?”
  • Open car back door. Seat still too dirty. Sit up front.
  • Say prayer. Pace. Say prayer again.
  • Carry squirming cat downstairs, while holding said squirming cat as far as arms will extend away from you.
  • Open car back door. Seat still too dirty. Get a towel and clean seat before sitting.

Blake’s OCD is still very much there. It’s just been quieter. And he’s accepted it as normal (at least he seems to have). How is it connected to his deep, deep depression? That will be an answer we will have to watch unfold.

 

Well-Intended Advice

Image courtesy of Stuart Miles at FreeDigitalPhotos.net

“Why did you do that? You’ve taken the only thing he had to care about.”

A friend I haven’t seen in a while is trying to convince me that the hubby and I have made an awful mistake by not allowing our son to go off to college in another state this fall. She faces me as we stand at a reception amidst hundreds of people. I feel that feeling in the pit of my stomach – the one that comes when this wasn’t the response I was expecting.

I try to gather myself back together to explain the “why,” but I can’t seem to make any sense to her. I decide to give up trying to explain to my friend the intricacies of our situation.

“Maybe we did make a mistake. I hope not. We made the best decision we could.”

I disappear into the crowd when someone else appears to talk to my friend. I shuffle around, weaving through the others, searching for my hubby. I want to go home. I feel lost and misunderstood.

Making Tough Decisions

My youngest son, Blake, has been struggling with depression for at least two years now. He’s up all night. He sleeps all day. He has little he looks forward to. He also has OCD, which I thought had become a minor issue until we began therapy as a family recently. Blake was accepted this past school year to his first choice college – a small, extremely demanding school without dorms or a meal plan, where he will have to live in an apartment with at least three others and navigate his way to school and around the city.

Although we celebrated his acceptance to the school, the hubby and I were deeply concerned how Blake would go from struggling with his mood and needing constant support to finish high school to functioning in this challenging environment. We spoke with him repeatedly about how important it was to start new habits now, long before he went away, so that he would be ready to function far away from home. He said he wanted to work on it. As a family we implemented schedules, made sure he was reinforced for positive steps, engaged his school’s and his psychiatrist’s assistance, and utilized tools to help with the whole process.

It didn’t work. Things got worse. We asked Blake to get help from a therapist. He balked at this over and over.

“What good will that do? The only person who can help me is me. It’s a self-discipline problem,” Blake told us.

Finally, we had to tell him that we just couldn’t send him to school this fall. We asked him to take a deferment. It was one of the toughest choices we could have made. We wanted him to go. He claimed it was the only thing that he cared about in life. And, yet, his behavior said it was going to be a disaster. Our new family therapist, a veteran in working with extremely tough cases, wondered why we hadn’t made that decision sooner. Why? We didn’t want to break his heart. And, indeed, when we delivered the news, Blake cried for days.

Giving Advice

When my friend wandered up to me at the event and wanted to know how Blake was, I just figured she’d understand that we’d looked at every other option before deciding to ask him to wait a year. I figured she’d know the amount of soul searching the hubby and I had to do, and how much courage it took to make the decision and stand firm – and then to stand back and watch our son’s devastation as he refused comfort from us.

Instead, she admonished me for having made that decision.

“You took away the only thing that mattered to him. You should have let him go. He might have surprised you and risen to the occasion.”

Sure. He might have. Don’t you think that the wish that kept us from making the decision sooner was that he would show us he could do it?  He’s struggling with mental illness. He can’t force himself to function. If he’d been able to, he would’ve shown us that he could do what was needed when we told him that school next year was on the line. He has work to do first. He has to get healthy.

I know my friend’s advice was well-intended. I know she has my best interests at heart, and Blake’s, too. I also know she had to make a tough decision about sending her own young adult child back to school.

Hearing this unexpected response from my friend has toughened my skin a little bit. It’s made me realize that I have to be firm in the decisions our family makes and recognize that others won’t always understand the in’s and out’s of those decisions. It’s made me recognize how important it is not to judge the decisions others make for their families. And it reminds me the importance of not offering advice unless I’m asked. I love my friend, but her reaction still stings a bit – and it’ll just take time for that to fade. In the meantime, our job is to keep working in therapy and applying what we are learning every day.

Fingers crossed that Blake will be ready to head off to school in Fall of 2018!

“You’ve Hired a Dog Trainer!”

Blake is furious. Yet, he’s remarkably composed at the same time.

“You’ve hired a dog trainer! I won’t take this anymore! What’s the therapist’s phone number?”

I give him the number and Blake calls the new therapist that the hubby and I have been seeing to help us work on getting Blake moving toward functioning. Our boy has been spending all day in bed and all night up doing who knows what. I see him for dinner and before I go to bed. He has few activities. He’s miserable.

Blake gets the therapist’s voice mail system. He leaves a message saying he doesn’t agree with what the therapist has his father and I doing. Blake suggests we all need to meet to talk this over.

Why Hasn’t He Called?

Nearly a week has passed and Blake has grown impatient. The therapist has not responded to his voice message.

“Why hasn’t he called back?” he wonders.

I have my suspicions. Blake rejected therapy when we brought him in to see this therapist. Now the hubby and I are the patient – in a manner of speaking. I imagine the therapist wants to talk to us first. We’ve been slowly implementing increasing demands on Blake. Each comes with an unpleasant consequence that targets his OCD if he does not participate. He’s gotten furious with each new step, but he’s been complying.

When the day of our appointment arrives, Blake demands to come with us.

“You’re welcome to come,” I tell him. “I’m sure the doctor will want to talk with Dad and I first. You might be invited in. You might not.”

“I’m willing to take that risk,” he says.

The Appointment

We arrive at the appointment and the therapist, the hubby, and I talk this over.

“Let’s see what he has to say,” the therapist says. “If he is willing to work with us, then we will have him stay. If he just wants to try to keep things the same, then we know he’s not ready to participate.”

He invites Blake in. Blake begins in a composed way, but he’s angry and he loses his temper. The therapist observes that our family spends a great deal of time going over what the problems are, but getting nowhere. He asks us to agree not to talk about the problems just until our next appointment. The hubby and I agree. Blake is having none of it.

“We have to talk about it! I can’t go a week without finishing this! I can’t! I won’t agree!”

And he storms out.

The hubby and I agree once more with the therapist that he and I will not talk about the problems or about what happened in the session. Blake is outside the building. He refuses to speak at all. He and I take off for home while the hubby goes back to work. Blake is silent for half the 45 minute ride home. Then, he apologizes.

“I’m sorry I exploded in there, Mom.”

“You were upset.”

“I know, but I really didn’t have a good reason to react the way I did. I agree. I’ll wait until next week to talk about things.”

“You’re coming back?”

“Yes. I’ll be there.”

So now Blake is in therapy with us. It’s not something he really wanted, but he wants more control than he’s had since the hubby and I have been going alone. That seems like a good place to start.

The First Step

Recently, after more than three years of Blake refusing treatment for his OCD, and for the depression that ensued later, the hubby and I made the decision to return to treatment. We didn’t give Blake a choice; we just told him we had an appointment with a specialist who might help us all find a way to do things in a better way. He entered the room on his own, but left in a rage after the therapist called us in to plan together (actually, he left when the hubby and I agreed to a plan the therapist had suggested). When Blake refused to return, the hubby and I became the patients, with the therapist directing us on how to shape our son’s behavior.

The first step was for the hubby and I to make a list of what Blake was not doing – where he was falling down in functioning (like sleeping all day and being up all night). We were also to list the things he was doing (for example, serving as a moderator for a special interest website) and, interestingly, what OCD behaviors we saw that he still had. That last part was odd to us. We hadn’t come to therapy to address OCD. We were more concerned that Blake was depressed and was barely carrying out the basic tasks of living. The therapist wasn’t as sure as we were that OCD wasn’t important.

When we showed up with our lists, he took time to review them.

“Let’s start with something Blake can be very successful at, like getting to the dinner table on time,” he suggested. “Now to chose what happens if he doesn’t make it on time. Hmmm… How bothered is he by the dogs?”

“Just a little,” we noted. “He always washes after he touches them, but it’s not like he runs to do it.”

“Okay, how about this? If he is late to the dinner table, you are going to rub a tissue on the dogs. Then you will break it into several pieces and place them on his bedroom floor.”

“What? How is this related to not getting out of bed?” the hubby wanted to know. “Why are we focusing on the dinner table and his dog contamination stuff when we want him to get out of bed?  And how does rubbing a tissue on the dog even relate logically to getting to the table on time?”

“It doesn’t.”

“Then why are we doing it? Shouldn’t the consequence be logically tied to the behavior?”

“Natural and logical consequences haven’t worked with Blake,” he reminded us. “We can’t try the same old thing.”

The hubby wasn’t convinced, but he was willing to give it a try. I was intrigued and kind of confused, but I understood that Blake had been unmoved by the natural consequences that had been coming to him, or any consequences that the hubby and I had employed that were logically connected to his behavior. The therapist wrote the plan down. All that was left was to inform Blake of the plan.

Blake Explodes

Blake was infuriated by this new plan. He didn’t even make it to dinner that night. He went upstairs to his room. He slammed his door and his shutters, and he threw things everywhere. Then he came back downstairs like nothing had happened.

The hubby and I carried out the consequence as directed. We didn’t make a big deal out of it to Blake. We simply quietly wiped a tissue on both our dogs’ fur, then cut it apart into several pieces. Then I went upstairs and placed those pieces on his floor. Blake responded by pouring Nature’s Miracle all over his carpet.

The next night, he showed up to dinner on time. And the next. And the next. And our dinners were actually pleasant. The hubby was still confused about the plan and wrote to our therapist.

Why again are we using Blake’s OCD as part of getting him to come to dinner? It just doesn’t make sense to me.”

Remember, Blake hasn’t been functioning and he hasn’t responded to regular consequences. We are trying to prevent you from having a 35-year-old who hasn’t launched.”

The rest of the week continued without incident. We felt just the littlest bit hopeful. It was a baby step. It wasn’t the big goal we wanted. We could only hope Blake would respond well to what came next.

Moving Forward

Image courtesy of ddpavumba at FreeDigitalPhotos.net

When I last wrote, we had just begun to see a new therapist, and I was having the first glimmers of hope in the midst of my own depression. I can share that my depression is much better, and we are still in therapy with the new therapist. At the same time, frankly, this has been a couple of the toughest months I’ve faced as a mom.

First, there was the matter of what practically felt like pushing Blake to the finish line for high school graduation. Every single last assignment felt like a mountain that he wasn’t going to climb, but with tremendous support from all sides he did. He walked in his graduation ceremony, and he even won the founder’s award for his school – with a little bit of scholarship money.

And Then, There’s Therapy:

The toughest thing we have faced has been therapy. The therapist warned the hubby and I that what he would be asking us to do was going to be incredibly difficult. He warned us that the progress would likely be painstakingly slow. With Blake refusing treatment, forward movement would be up to us. We would have to change many of the things we do as parents. And he told us that we had to give Blake the toughest news of all – that we wouldn’t be sending him to college next year.

I looked at him in that session, asking him what he thought.

“As things are, he’s in no way prepared to leave home, go over a thousand miles away, manage in an apartment with three or four other guys, or take care of his own hygiene – not to mention get up out of bed each day and make it to class. What do we do?” I asked.

At that point in time, Blake wasn’t getting out of bed unless the hubby and I got him up. And he was only staying awake with much assistance. On the other end of the day, he was resisting going to sleep as much as possible.

“I don’t want the next day to come,” he would say to me.

“You’ve known for months what you need to tell him,” the therapist told the hubby and I. “You just haven’t wanted to tell him.”

And so, that next night, we delivered the news – and a firestorm ensued.

You’ve taken away the only thing that meant anything to me!” he screamed at us. Then, he proceeded to trash his room, slamming doors and shutters. He threatened that he would leave home and go to school in the fall anyway. He would live on the streets, he proclaimed. Anything was better than being here with us. He wasn’t going to be the ONLY kid who didn’t leave and go away to school (it didn’t matter that many of his peers were staying local or working or taking a gap year). He even told his psychiatrist at his medication check up that he was moving out.

Yet, when the deadline came, he filed for a deferment from school for one year, and he requested a refund on his housing deposit. I think on some level he knew that he wasn’t ready. His anger with the hubby and I remained, though, which, in some ways, I was happy to see. Blake has always had a difficult time being angry with us; he usually takes the anger out on himself and becomes more depressed.

In terms of therapy, that was only the beginning of what the therapist had in store for us. I will document that in future posts.

Lifting the Fog

My Own Depression

In my last post, a little over a month ago, I shared that I was dealing with my own major depressive episode. The reason I haven’t posted is that, frankly, I haven’t felt able to write until today. Depression is one weird state of being. I’ve been here, but haven’t felt here. I’ve been going through the motions, doing the things I’m supposed to do (well, most of them) when one is depressed. I’ve been keeping my engagements, eating as well as I can, getting out for walks, trying to get enough sleep.

The thing is, no matter where I’ve been, or who I’ve been with, I haven’t felt present. I’ve laughed, but I didn’t feel the humor; I went to dinner with friends and talked, but I slowly disappeared from the conversation as I found it more and more difficult to interact. I slept, but I constantly felt as though I could fall right back to sleep.

Therapy. I went to therapy, too. Twice. The therapist was nice enough, but I don’t think that she understood the depths of my despair. My office mate, a seasoned child psychologist, says that she believes we psychologists make difficult patients. We know how to avoid, we are critical in the consulting room of what we are experiencing, and we are thinking ahead of the therapist we are seeing. Maybe that’s all true. So I’m looking for someone who can really call me on my stuff – someone who is more experienced as a therapist and parent than I am.

A Little Light

At the same time, just yesterday I experienced a little lifting of my mood. Even the hubby noticed it. The reason, I’m pretty certain, is that I found something that’s given me just the tiniest bit of hope, and the belief that there is something we can do to begin to make changes with what’s been going on with Blake. I feel just a little bit empowered.

A few weeks ago, while I was at a professional conference on anxiety, I met a very experience therapist at dinner one night. As we got to know one another and shared about our respective children, I shared a bit about what we are experiencing with Blake – days where he doesn’t get out of bed, his despair about life, his frequent missing events that would have been important to him.

“I’m not letting you go through this alone,” she said, reaching out to me, as she shared a bit of her own personal story. “This isn’t going to continue. We are going to get him help and I’m going to stay with you through the process.”

That evening, we plotted and planned. We agreed on who I should call. And I promised to stay in touch and follow through. Within a week, the hubby and I had an appointment with Blake with a longtime expert on kids and young adults who, like Blake, have a mixture of depression on top of OCD. What’s more, he’s had lots of experience with treatment refusers. We went with hope that, this time, Blake would agree to getting help.

Blake Rejects Treatment

Blake rejected treatment – no surprise there. On the way out the door he claimed to understand how “desperate” his dad and I are. He promised he would change things, but offered no concrete example of how he would do so. And then he fell asleep at 7 pm that very evening, missing dinner and sleeping until 3 pm the next day, forgetting he had a lunch date with his grandparents who were in town. And then he did the same thing the next day, missing his beloved grandparents once again.

Meanwhile, the hubby and I haven’t given up. Yesterday, we saw that expert on our own. He is prepping us to gradually work to increase the likelihood that Blake will enter treatment willingly and ready to work. We don’t know if it will actually work, only that we have several assignments to do ourselves over this next week. We also know that this will be itty bitty steps. Yet, I left the office yesterday feeling just the tiniest bit better. I have something to do, a direction to go in.

I noted to the therapist yesterday that the saddest part of the last two years is that we’ve been repeatedly told that there is nothing to do if Blake doesn’t want treatment. He shared with us his belief that the population of depressed/anxious young adults (and teens) whose lives are spiraling rapidly downward has long been neglected. For now, the hubby and I will be the catalysts for possible change. I understand that it is going to be a difficult road – but I’d rather be moving toward something than sinking deeper into the the muck that I’ve been in.