Room to Grow

Full grown wax palms in Cocoro Valley in Colombia

Full grown wax palms in Cocoro Valley in Colombia

Blake’s Obsessive-Compulsive Disorder has been in a calmer place for a while now. I say that as an outside observer. I really do not know what goes on in his mind; I only know that our family life has been much less impacted. I do know that there are still lots of little symptoms I observe: he utters a prayer multiple times (presumably because it wasn’t just right the first time), he repeatedly does a ritual hand washing, his entire hamper appears in the laundry room when it is only partially full (that means there is something in there that’s contaminated everything inside). Still, this is a far cry from the days his OCD kept us from going places or had him in a meltdown.

Most of the time, when I notice a little OCD symptom, I manage to keep my mouth closed and just let Blake manage it. That’s generally best for everyone. It was no different when we were recently in Colombia (yes, in South America) on a family trip. Michael was overjoyed to be practicing Spanish, his college major, with the locals and trying out different accents. Blake was there because he wanted to be with his brother while he was on winter break. It was tough for him to be in a very unfamiliar place, and there were trying moments, but he persevered.

One day, we visited a farm that is working to re-establish the wax palm which is a

Baby wax palm we planted in the Cocoro Valley, Colombia

Baby wax palm we planted in the Cocoro Valley, Colombia

national symbol of Colombia and has come to be threatened. One of our tasks there was to plant our own baby palm. Our guide brought our little palm over to us and gestured for all four of us to take hold of it and place it in the ground. I noticed Blake wince and hesitate to reach for the clod of dirt around the plant’s roots. Then I saw him reach out wholeheartedly, grasping the tree with the rest of us. Together, we placed it in the ground and covered it with earth. Blake immediately started wondering where there was some water so he could wash the dirt off his hands. Since we were in the middle of the farm, there was none immediately available, and he seemed to tolerate that just fine. He even walked off to get to know one of the nearby horses.

I snapped a photo of our little palm. With any luck, it will last longer than any of us as it will take about one hundred years to reach maturity. In terms of Blake, there were no words that passed between any of us. I don’t know if anyone besides me noticed that Blake stood up to his OCD in order to help give that little tree its start in life and it really doesn’t matter. They are Blake’s moments to savor and grow from, or not, while I get to delight in my own mind.

Exposure and Response Prevention (ERP) Comes to Our Home (Re-Post)

This post originally appeared on this blog in August of 2013.  It has remained one of my most viewed posts.  The photos of Blake’s hands are probably the most clicked on photos in this blog, and appear at the top of Google’s Images when you search for anything related to OCD and hand washing (and they appear to be the first “real” image of what can happen to a person’s hands when contamination OCD leads to hand washing). I thought it was worth re-posting.

* Advisory:  This post has some photos of hands damaged from over-washing.  They may be difficult for some people to look at.

This is a nearly empty bottle of liquid soap.

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It looks pretty normal sitting on the bathroom counter until you take a closer look.  That brown ring around the bottom of the bottle is dirt from our backyard.

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The bottle of soap caught my eye several days ago and I snapped a few photos of it to remind myself of where we’ve been.  This bottle, with its dirt that is settled all around the bottom has been with us this entire summer – since before I even began this blog.  It is a remnant of one of Blake’s last OCD treatment sessions before we made the  heavy-hearted decision to stop therapy.  I am sharing it with you today, as a way to share what Exposure and Response Prevention (ERP) can look like.

What is ERP?

ERP is “the most important therapy in CBT for OCD,” according to the International OCD Foundation.  In a nutshell, ERP involves a conscious choice for a person with OCD to confront the items (thoughts, situations, etc.) that create discomfort and then not do the compulsions or rituals that would normally be provoked.   The idea is for the OCD sufferer to allow his or her anxiety and discomfort to abate naturally, without using rituals to cope and thereby creating healthier ways of coping.  This is commonly done with the help of a mental health therapist who is trained to do Cognitive Behavior Therapy (CBT) with OCD (for more information, Click Here.  Janet at OCDtalk has also written a thorough post on ERP.).

In our situation, Blake was really struggling with hand-washing compulsions (in addition to many others).  It was particularly bad at the time and he ran to the sink to wash anytime he felt the slightest bit “dirty.”  No amount of salves or special creams could heal the damage he was doing to his poor hands.  Below are some photos of how his hands looked around the time.  A reminder, these are 14-year-old hands.  They are painful for me to look at.  Anyone who pokes fun at compulsive hand-washing or thinks it is a joke has never lived with a family member who is suffering because of it.  The pain is real, intense and it interferes with day-to-day activities.

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While Blake’s treatment team had done ERP work with him on the hand-washing at the office (they would touch “dirty” things and then he would not wash), we were seeing little impact of the exposures.  We all agreed at the time that Blake was “white knuckling” it through the exposure and avoiding truly immersing himself in it by reminding himself that he could wash as soon as he got home.  He never gave himself the opportunity to allow his anxiety to come down to a manageable level.  So, it was decided that one of his therapists would make the trip to our home.  The plan was for Blake and the therapist to “contaminate” our entire house so that Blake would not have a place of safety to run to in order to avoid his discomfort.

The Day Arrives…

Blake was in agreement with the plan, until the actual day arrived.  He was tired of painful hands and was hopeful that this exposure would finally put his hand-washing to rest.  He greeted his therapist, happily, at the door.  As they began to prepare for the actual exposure, he began to change his tune.

“I don’t remember actually agreeing to do this,” he told the therapist.  His anxiety was already on the rise, and he was trying to thwart the exposure from going any further.  His therapist and I reminded him of his desire to get better and advised him how important a step this was toward breaking free from the grip OCD had on his life.

Begrudgingly, he followed his therapist into the backyard where both dug into the dirt and began to put handfuls of it into a squirt bottle.  Then they returned to the house where they filled the bottle with tap water and shook it vigorously.  It looked like a muddy mess.  I silently gulped when I saw it.

Are you really going to spray that mess all over my house?

This was not going to be easy – and I really have no problems with dirt.  I can sit in it, get it under my nails, whatever…  But this – even I wasn’t relishing the idea of my house being sprayed with a bottle of dirty water.  The thing is, that was just the point.  Yes, it is uncomfortable to have dirt sprayed in your house.  It’s even kind of over the top.  BUT, it’s not going to kill anyone.  It is survivable – you can even thrive with dirt on your belongings.  The point for the OCD sufferer is to stick with the discomfort long enough to recognize that it abates and that they can have a good life without having to give in to their compulsions.

Reticent as I felt, Blake’s anxiety was rising through the roof.  He now wanted no part of this exposure.

“I changed my mind.  I don’t want to do it,” he stated.

His therapist reminded him that this exercise, as uncomfortable as it felt right now, was going to help put his OCD in its place.  She asked me to bring her all the bottles of liquid soap that were in the house.  I complied and sought them out.  Within a few minutes, I was back.  Blake was not in a good place.

The Battle Begins

While I’d been on my mission, Blake’s therapist had opened my bottle of dish soap (which Blake uses all the time to wash his hands) and poured a good amount of that muddy water right into it.  Blake was going to have none of that and before anybody could convince him otherwise, he’d dumped the entire contents of the bottle down the drain and placed the empty container in the recycle bin.

“Blake,” she reminded him, “we need to contaminate all the things you use to relieve your anxiety.  You remember; we talked about this.”

“No,” he said firmly.  “I don’t want to do it.”

She continued with her task and began to pour muddy water into the liquid soap bottles I had brought to her.  Blake’s face grew red.

“I said, ‘No’,” he stated.  “LEAVE.”

The therapist continued.  She was finished contaminating his sources of washing.  She took a rag and sprayed it with the dirty water.

“Come on, Blake.  Help me.  Let’s contaminate the house together. It’s better if you’re a part of this.”

NO! LEAVE!”  His voice was powerful.  Anxiety was making way for fury.

“Remember?  You wanted to get better.  I’m not going to stop because I care about you.  I care about your hands and I don’t want you to have to keep living with OCD bossing you around and controlling your life,” she told him.

THERE’S NOTHING WRONG WITH ME!!!!  I’M TIRED OF THIS!!! I’M TIRED OF BEING TOLD THAT I’M SICK!!!  SICK! SICK! SICK! LEAVE!!! GET OUT OF MY HOUSE!!!!”

Blake was absolutely getting out of control at this point.  He’d never said an angry word to his therapist before.  Now, he was screaming at the top of his voice and looking like a maniac. My heart was breaking for him.  I didn’t know whether to cry or burst out into giggles at the sheer anxiety the whole thing was creating in me.

His therapist continued with her quest.  She carefully wiped the dirty cloth over all the furniture, the walls and our personal belongings.  Our entire family was going to be in on this exposure.  But was Blake going to buy into it?

Blake Hits His Breaking Point

“I TOLD YOU TO LEAVE!!!  I CAN’T TAKE THIS ANYMORE!!  I’M JUST GONNA…”

Blake lunged for the pencil cup on top of the cabinet near him.  In one swift move, he pulled out the sharpest pair of fabric shears in the house and raised it up over his head, as if he were about to plunge it into someone.  But it wasn’t clear to me if he was going for his therapist or himself.

“Put it down, Blake!” I commanded, but my words weren’t necessary.  Blake’s hand hesitated in the air and his expression turned to horror and he began to tremble.

“What am I doing?  What am I doing?”

He ran down the hallway to the living room where he started sobbing.

“I’m sorry.  I’m sorry.  I’m sorry,” he repeated.

The therapist stepped outside to call her supervisor.  Blake looked at me through his tear-filled eyes.

“I wouldn’t have hurt myself,” he said.  “I just wanted her to stop.  I can’t believe how far I went to protect my OCD.”  He cried quietly for a few minutes until his therapist stepped back into the room.

“Do you want to talk?” she asked him.

“I’m so sorry,” he said.  “I wouldn’t have done anything.  I know what I need to do now.”

He walked down the hallway with a half-smile on his face and picked up the abandoned squirt bottle.

“May I?” he asked.

“Of course,” she answered.

He began to make his way through the house, squirting that dirty water on the walls and the countertops.  He covered his game consoles in it and his favorite sitting areas.  Tears streamed down his face, but now they were tears of relief.  He knew this was what he needed to be doing.  Then, he directed the therapist to his room.

“We need to do my room,” he told her and he contaminated his entire room with that water, making sure he didn’t miss a thing.

The Aftermath

Blake adjusted relatively quickly to his contaminated surroundings (although I did put away all sharp objects, just in case).  He didn’t care that there were pieces of dirt in the soap bottles.  He relished it when I reminded him that our entire home was contaminated.  He’d won another battle in the war on his OCD.  His hands healed.

But the other areas his OCD affected were untouchable.  He wouldn’t budge on them; held onto them like a badge of courage and battled us to keep them.  Of course, this lead to us ultimately discontinuing treatment and to being in the limbo that we are in.

Today I still find remnants of that exposure, though it is about 3 months in the past.  There are still places that are too high for me to reach where he aimed that squirt bottle – and I kind of like the bits of dirt that remain anyway because they remind me that we still live with contamination to some extent.  They also remind me how far Blake was willing to up the ante to protect his OCD, how powerful the disorder can be in asserting itself.  And I wonder when Blake will grow in his own power and desire to take it on.  We can only wait and see.

Wake Up!

I stumble out of bed, take a quick shower, and make my way down the hallway.  I knock on the door.  I wait. No answer.  I open the bedroom door and peek at the sleeping teen in the bed.  I glance at the clock.  7:23 am.

“Blake.  Wake up,” I call.

No movement.  Today is the same as everyday. No reply to the knock.  No response to the name uttered.  I sit on the side of the bed.  I talk.  I tickle. I finally count to three and hoist my sixteen-year-old into a sitting position.  He’s semi-conscious and he continues to try to sleep while sitting up.  I talk for a few minutes more.  I chatter to the cat, who has come to inspect us and the room.  He jumps on the bed.  This is his morning routine, too. He comes to wake his boy, as well.

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Finally, I I tell the teen that he must get out of bed now.  Slowly, ever so slowly, he raises himself off the mattress, uttering a closed-eye prayer under his breath as he does, and walks into the bathroom.  I leave – for the moment.

This may sound familiar to many.  The teen who just wants to sleep in.  Wait.  Read on. Then, we’ll see…

Will He Ever Make It Downstairs?

Five minutes later, I pad down the hallway again.  I knock on the door.  No answer.  I peek inside.  The body is back under the covers, deep asleep once again.

“Blake.  Blake!  Get into the shower.”

He looks at me, a bit confused, and he rises from the bed, walks into the bathroom, and slowly shuts the door.  I go back to my room to put on some makeup.  I’m back at Blake’s door within ten minutes.  I knock.  No answer.  I open the door.  Blake is asleep again. His sheets are blotched with water.  He’s showered and, soaking wet, gotten straight back into bed.  I’m frustrated.

“Blake!”

“What?” He bolts upright, stunned by the loudness of my voice.

“Get dressed – NOW.”

Five minutes later, I’m back at the door once more.  I knock, yet again.  No answer.  I open the door.  Blake is in his underwear, asleep on the bedroom floor.

“Put on some clothes.  I’m going to stand outside the door.”

I close the door.

“Are you up?  Are you putting clothes on?”

“Yes,” comes the answer from inside the room.

“Okay, I’m going to keep standing here and talking to you until you are ready.”

Finally!…Or, Maybe Not

I chatter on with him from outside the door, directing him to keep dressing, until he finally emerges from the room.  We make our way downstairs. I begin to take care of our menagerie of pets – feed the dogs, clean the turtles’ water dish. I walk in and out of the kitchen, where Blake is supposed to be eating breakfast, saying his morning prayers, and starting his school work for the day.  Each time I leave the room, Blake has begun part of a task.  I return a few minutes later only to find him asleep once again.

“Blake.  No sleeping.  Get off the sofa and back to your routine.”

“Blake get off the floor.  Wake up.”

“Blake, you’re not studying if your eyes are closed.  Blake?”

I give up on getting anything done  but the basics.  I stay close by to keep my son awake. He looks miserable.  He tells me he feels like he’s flown to a foreign country and that he’s struggling to stay awake so that he can adjust to the new time zone.  Time and time again, I wake him.  I send him outside for a walk around the neighborhood.  He comes back and starts do work again.  Within minutes he is asleep with his head in a book.  Frustrated, I wake him yet again.

We go on like this day after day.  I’m exhausted because, at the other end of the day, Blake can’t (or won’t) go to sleep.  The hubby and I keep going into his room telling him to turn the light out.  But he doesn’t want tomorrow to come.  He doesn’t want another day like today was, so he drags it on and on, never comprehending that he is digging himself deeper and deeper into this hole.  He doesn’t listen to our words, or the words of his doctors who tell him that he must sleep.  And so, I stay awake at night, continually cajoling him to turn the light out. I cannot rest until I know that he’s finally turned it off.  If I don’t stay on it, it will go on until 2 or 3 am – as if 12:30 a.m. wasn’t late enough.

I rearrange my schedule.  I do my best not to have to leave the house before noon.  It’s worse if I leave the house in the morning.  I can leave what seems like a fully awake young man studying or feeding the dogs only to return to find him fast asleep on the kitchen floor or the family room couch.

Image courtesy artur84 at freedigitalphotos.net

Image courtesy artur84 at freedigitalphotos.net

At first, my hubby and I think we are dealing with defiance.  Maybe we are.  We are also dealing with profound depression.  Blake does not see anything positive in this life.  He sees nothing but the dreariness of schoolwork day after day.  Other teens don’t interest him.  He cannot imagine the future being any better.  There is nothing he wants to do. The possibility of college sounds like continued torture.  He escapes into the world of YouTube.  He cries, he yells, and he stomps out of the room a lot.  He threatens to run away.

“Put away the knives,” Michael advises me before he leaves for college.

We need more help, I realize.  We definitely need more help.  Will we even be able to do it here at home? Are we looking at hospitalization?  Residential placement?

The final straw happens one day when the hubby and I have a commitment to get to.  We will be away for six hours.  Blake is up, into the full swing of his morning routine.  We feed the animals and let the dogs out into the back yard.  As we leave, we ask Blake to let the dogs back inside in a few minutes.  He agrees and we go off to our appointment.  The temperature soars to 103 degrees.  When we arrive home, I learn that Blake fell back asleep on the floor for five hours while the dogs scratched repeatedly to come inside.  He never heard a thing.  I realize how serious the situation is.  I cannot leave my sixteen-year-old alone in the morning.  And I can’t do this alone.  I call my friend – a mental health professional with lots of experience with kids with serious emotional issues – and I cry, really cry, for the first time in a long time.  She props me back up and puts me on the road to action.  I am not alone.

You Don’t Know Where That Dollar’s Been

Image courtesy zdiviv @ freedigitalphotos.net

Image courtesy zdiviv @ freedigitalphotos.net

I seem to have written mostly about the part of Blake’s Obsessive Compulsive Disorder that takes the form of scrupulosity lately.  Yet, that is not the only way OCD affects him (and our family).  Rarely does OCD affect an individual in just one way.  Someone who fears catching a disease and frequently handwashes can also be afraid to touch something using their “bad” side.  Someone who fears they will accidentally shoplift can also feel the need to check the stove repeatedly to be certain it was turned off.  And someone who is scrupulous and fears offending God, like Blake, can also fear contamination.

Case in point, a little bit ago I gave Blake a dollar bill as change for a video game he purchased.  As I reached out to hand him the dollar, he motioned for me to set the bill down on the sofa next to him.

“Blake, just take the dollar.”

He pulled his shirt sleeve down to cover his hand.  Now protected, he reached for the dollar.  Instinctively, I withdrew my own hand.  I knew what was happening.  Contamination. He was sure the dollar was contaminated (I realize there is logic behind that. Money is one of the dirtiest things out there, right?).  I didn’t want to play OCD’s game, but maybe I was playing it by refusing to just give him the dollar.  Perhaps I should have just handed it to him and been done with it.

Blake saw that I was on to this whole contamination thing.  He pulled his shirt sleeve back up.  He reached out and took the dollar with his bare hand. Great!  No. Wait.  Too soon.  He immediately got up from the game he’d been playing and began to make a run for the sink.  Time to wash off those germs.

So what did I do?  Oh yes, I was brilliant.  I quickly moved into his path.

“You don’t have to wash, Blake.  You can fight this one.”

Why, oh why, am I so tremendously stupid sometimes?  I have promised this young man that I will stay out of his OCD and let him decide how to fight it and when to fight it.  There I was, breaking my word.  Ugh!  And, realizing I was breaking my word, I continued to stand there and encourage him not to wash.  He looked at me like I was a minor irritation, moved around me and washed that hand right up.

Great job, mom!

Okay, big deal, he washes his hands after he touches money.  Shouldn’t we all wash our hands after we handle money?  Probably – before we eat or some such thing – but if we can’t handle a dollar bill without running to the sink or if we interrupt a favorite activity to wash our hands because we feel a wave of panic over touching money, there’s something more going on. And, if our hands are cracked and bleeding from washing so much, we may just have a problem.

In Blake’s case, he still doesn’t see this as a problem.  At least, he doesn’t see it as a problem worth doing anything over.  I wish I could finally get over it and stop feeling a sense of responsibility for helping him deal with his OCD.  I certainly counsel parents in my practice not to take responsibility for their children’s OCD, especially when their children have no desire for things to be different.  My personal experience, however, lets me know how very difficult it is to really remove yourself from the situation.  We parents love our kids.  We want the best for them.  Sometimes what is best is to let them deal with that dirty dollar bill any way they choose and stay the heck out of it. 🙂

 

An Old “Friend” Returns

IMG_1917[1]Blake comes rushing into the kitchen.  I’m sitting at the kitchen counter directly opposite the sink, so I have a front row seat for the action. I quietly watch.  The faucet comes on.  The water comes pouring out.  Pump, pump, pump goes the soap.  A quick rub of the hands, then Blake picks up a cup on the side of the sink. He fills it with water.

Pour, pour, pour.  The water runs over Blake’s first hand.

Pour, pour, pour.  It runs over the second.

I hear him whispering a prayer.  Then he goes to towel dry his hands.

Wait.  That must not have been quite right.

Blake rushes back to the sink.  Pump, pump, pump then pour, pour, pour.  The prayer is whispered again.

This time he doesn’t even move to dry his hands.  He begins again. The water is pouring out of the faucet – and we are in a serious drought.

Pump, pump, pump.

“Blake!  Enough!  This is way more than a simple hand washing.”

He stops.  It’s like he’s just been woken from a daydream and suddenly realizes what he’s doing.

“You’re right,” he says.  Then he goes on to some other activity – far away from the sink.  I know he’ll be back.

Blake’s first OCD symptom that I actually recognized as OCD back when he was seven was hand washing.  He’s been through exposure and response prevention therapy for this a couple of times.  He’s eliminated it both times, but it seems to be the symptom that just keeps cycling back in.

With Blake refusing to fight his OCD, his hands are in jeopardy.  So is my soap dispenser.  It is teetering on its last hold on life.  The incessant pumping is more than it can take.  The water puddles on the kitchen counter.  This is one old “friend” I’d like to send packing.  I hope Blake sees through him and sends him on his way soon.

It Must Be The Weather

IMG_1917[1]That hand washing and Obsessive-Compulsive Disorder are so commonly linked sometimes seems cliché. Think of OCD = think of hand washing.  While OCD can manifest itself in a seemingly infinite number of ways, one reason hand washing has become so linked with the disorder is that it happens to be a common compulsion.  In fact, although Blake showed symptoms of having obsessions (intrusive thoughts) for some time before we noticed compulsions, it was his frequent and excessive hand washing that finally tipped us off (I shudder to think how much longer it would have taken me to wake up if his obvious compulsion had been something other than hand washing).

Over the years, Blake has had numerous obsessions and compulsions.  They morph frequently.  OCD likes to play that trick.  One obsession or compulsion disappears.  As a parent in the early stages of dealing with this disorder, you can almost be tricked into breathing a sigh of relief.  You think, “Ah, I’m so glad that’s gone.”  But then, something else arises.  Washing makes way for tapping.  Tapping makes way for bowing.  Bowing makes way for pushing in every chair in the entire restaurant.  After a few of these incarnations, you learn that OCD is an evolving disorder that leaves you guessing where it is going to pop up next.

Over the years, Blake’s hand washing has waxed and waned.  Over the past year it has taken up residence again.  Blake’s poor hands looked weathered and chapped.  They are cracked and rough with hard patches that I’m not sure will ever return to normal.  One day, a few weeks ago, I noticed how awful his hands looked.

“Your hands look like they really hurt, honey.”

“Yeah, I don’t know how that happened.  It must be the weather.”

“Ummm…I think that’s more than the weather.  You’re probably doing a lot of washing.”

“I don’t know when, Mom.  I really don’t.  At least I’m not aware of it.”

I think he meant it.  I actually think he’s not aware of his hand washing.  That’s how automatic it’s become for him.  Or maybe he doesn’t want to know…

I do know, though.  After his statements, I became sort of curious about this hand washing thing.  I mean, I’m living with the same weather.  Plus, my hands are in the water all the time.  I wash most of the dishes.  I clean the turtles’ yard.  I wash out the cat litter boxes.  I bathe the dogs.  At worst, my hands get a little rough.  What was he doing that his hands were in that state?  So I started to take better mental notes and then I documented what I noticed.

– He pet the dog.  He washed his hands.

– He touched the laundry in his hamper.  He washed his hands.

– He put a dish in the dishwasher.  He washed his hands.

– He went to the bathroom and washed his hands.  He washed them again when he  made it to the kitchen.  He winced in pain.

– He came back to the sink right after that and washed again.  He winced again.

– He wiped down the kitchen counter with  sponge.  He washed his hands.

– He touched the pantry door.  He washed his hands.

– He got up from the couch where he’d been reading.  He washed his hands.

– A napkin I’d been holding brushed past his face (it wasn’t dirty, by the way).  He washed his face – and his hands.

Blake may say that the weather is the reason for the condition his hands are in. He may even believe that.  His behavior tells a different story.  He is so locked up in automatic washing that his poor hands don’t stand a chance.  However, since he insists he’s got his OCD managed and his dad and I have pledged to let him manage it in his own way, we don’t point this out.  We wait, instead, for Blake’s own awakening.  Until then, he will continue his absent-minded washing.  Or perhaps it will morph into something new, and something new again – on an ever-renewing journey until Blake decides he’s had enough.

Exposure and Response Prevention (ERP) Comes to Our Home

* Advisory:  This post has some photos of hands damaged from over-washing.  They may be difficult for some people to look at.

This is a nearly empty bottle of liquid soap.

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It looks pretty normal sitting on the bathroom counter until you take a closer look.  That brown ring around the bottom of the bottle is dirt from our backyard.

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The bottle of soap caught my eye several days ago and I snapped a few photos of it to remind myself of where we’ve been.  This bottle, with its dirt that is settled all around the bottom has been with us this entire summer – since before I even began this blog.  It is a remnant of one of Blake’s last OCD treatment sessions before we made the  heavy-hearted decision to stop therapy.  I am sharing it with you today, as a way to share what Exposure and Response Prevention (ERP) can look like.

What is ERP?

ERP is “the most important therapy in CBT for OCD,” according to the International OCD Foundation.  In a nutshell, ERP involves a conscious choice for a person with OCD to confront the items (thoughts, situations, etc.) that create discomfort and then not do the compulsions or rituals that would normally be provoked.   The idea is for the OCD sufferer to allow his or her anxiety and discomfort to abate naturally, without using rituals to cope and thereby creating healthier ways of coping.  This is commonly done with the help of a mental health therapist who is trained to do Cognitive Behavior Therapy (CBT) with OCD (for more information, Click Here.  Janet at OCDtalk has also written a thorough post on ERP.).

In our situation, Blake was really struggling with hand-washing compulsions (in addition to many others).  It was particularly bad at the time and he ran to the sink to wash anytime he felt the slightest bit “dirty.”  No amount of salves or special creams could heal the damage he was doing to his poor hands.  Below are some photos of how his hands looked around the time.  A reminder, these are 14-year-old hands.  They are painful for me to look at.  Anyone who pokes fun at compulsive hand-washing or thinks it is a joke has never lived with a family member who is suffering because of it.  The pain is real, intense and it interferes with day-to-day activities.

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While Blake’s treatment team had done ERP work with him on the hand-washing at the office (they would touch “dirty” things and then he would not wash), we were seeing little impact of the exposures.  We all agreed at the time that Blake was “white knuckling” it through the exposure and avoiding truly immersing himself in it by reminding himself that he could wash as soon as he got home.  He never gave himself the opportunity to allow his anxiety to come down to a manageable level.  So, it was decided that one of his therapists would make the trip to our home.  The plan was for Blake and the therapist to “contaminate” our entire house so that Blake would not have a place of safety to run to in order to avoid his discomfort.

The Day Arrives…

Blake was in agreement with the plan, until the actual day arrived.  He was tired of painful hands and was hopeful that this exposure would finally put his hand-washing to rest.  He greeted his therapist, happily, at the door.  As they began to prepare for the actual exposure, he began to change his tune.

“I don’t remember actually agreeing to do this,” he told the therapist.  His anxiety was already on the rise, and he was trying to thwart the exposure from going any further.  His therapist and I reminded him of his desire to get better and advised him how important a step this was toward breaking free from the grip OCD had on his life.

Begrudgingly, he followed his therapist into the backyard where both dug into the dirt and began to put handfuls of it into a squirt bottle.  Then they returned to the house where they filled the bottle with tap water and shook it vigorously.  It looked like a muddy mess.  I silently gulped when I saw it.

Are you really going to spray that mess all over my house?

This was not going to be easy – and I really have no problems with dirt.  I can sit in it, get it under my nails, whatever…  But this – even I wasn’t relishing the idea of my house being sprayed with a bottle of dirty water.  The thing is, that was just the point.  Yes, it is uncomfortable to have dirt sprayed in your house.  It’s even kind of over the top.  BUT, it’s not going to kill anyone.  It is survivable – you can even thrive with dirt on your belongings.  The point for the OCD sufferer is to stick with the discomfort long enough to recognize that it abates and that they can have a good life without having to give in to their compulsions.

Reticent as I felt, Blake’s anxiety was rising through the roof.  He now wanted no part of this exposure.

“I changed my mind.  I don’t want to do it,” he stated.

His therapist reminded him that this exercise, as uncomfortable as it felt right now, was going to help put his OCD in its place.  She asked me to bring her all the bottles of liquid soap that were in the house.  I complied and sought them out.  Within a few minutes, I was back.  Blake was not in a good place.

The Battle Begins

While I’d been on my mission, Blake’s therapist had opened my bottle of dish soap (which Blake uses all the time to wash his hands) and poured a good amount of that muddy water right into it.  Blake was going to have none of that and before anybody could convince him otherwise, he’d dumped the entire contents of the bottle down the drain and placed the empty container in the recycle bin.

“Blake,” she reminded him, “we need to contaminate all the things you use to relieve your anxiety.  You remember; we talked about this.”

“No,” he said firmly.  “I don’t want to do it.”

She continued with her task and began to pour muddy water into the liquid soap bottles I had brought to her.  Blake’s face grew red.

“I said, ‘No’,” he stated.  “LEAVE.”

The therapist continued.  She was finished contaminating his sources of washing.  She took a rag and sprayed it with the dirty water.

“Come on, Blake.  Help me.  Let’s contaminate the house together. It’s better if you’re a part of this.”

NO! LEAVE!”  His voice was powerful.  Anxiety was making way for fury.

“Remember?  You wanted to get better.  I’m not going to stop because I care about you.  I care about your hands and I don’t want you to have to keep living with OCD bossing you around and controlling your life,” she told him.

THERE’S NOTHING WRONG WITH ME!!!!  I’M TIRED OF THIS!!! I’M TIRED OF BEING TOLD THAT I’M SICK!!!  SICK! SICK! SICK! LEAVE!!! GET OUT OF MY HOUSE!!!!”

Blake was absolutely getting out of control at this point.  He’d never said an angry word to his therapist before.  Now, he was screaming at the top of his voice and looking like a maniac. My heart was breaking for him.  I didn’t know whether to cry or burst out into giggles at the sheer anxiety the whole thing was creating in me.

His therapist continued with her quest.  She carefully wiped the dirty cloth over all the furniture, the walls and our personal belongings.  Our entire family was going to be in on this exposure.  But was Blake going to buy into it?

Blake Hits His Breaking Point

“I TOLD YOU TO LEAVE!!!  I CAN’T TAKE THIS ANYMORE!!  I’M JUST GONNA…”

Blake lunged for the pencil cup on top of the cabinet near him.  In one swift move, he pulled out the sharpest pair of fabric shears in the house and raised it up over his head, as if he were about to plunge it into someone.  But it wasn’t clear to me if he was going for his therapist or himself.

“Put it down, Blake!” I commanded, but my words weren’t necessary.  Blake’s hand hesitated in the air and his expression turned to horror and he began to tremble.

“What am I doing?  What am I doing?”

He ran down the hallway to the living room where he started sobbing.

“I’m sorry.  I’m sorry.  I’m sorry,” he repeated.

The therapist stepped outside to call her supervisor.  Blake looked at me through his tear-filled eyes.

“I wouldn’t have hurt myself,” he said.  “I just wanted her to stop.  I can’t believe how far I went to protect my OCD.”  He cried quietly for a few minutes until his therapist stepped back into the room.

“Do you want to talk?” she asked him.

“I’m so sorry,” he said.  “I wouldn’t have done anything.  I know what I need to do now.”

He walked down the hallway with a half-smile on his face and picked up the abandoned squirt bottle.

“May I?” he asked.

“Of course,” she answered.

He began to make his way through the house, squirting that dirty water on the walls and the countertops.  He covered his game consoles in it and his favorite sitting areas.  Tears streamed down his face, but now they were tears of relief.  He knew this was what he needed to be doing.  Then, he directed the therapist to his room.

“We need to do my room,” he told her and he contaminated his entire room with that water, making sure he didn’t miss a thing.

The Aftermath

Blake adjusted relatively quickly to his contaminated surroundings (although I did put away all sharp objects, just in case).  He didn’t care that there were pieces of dirt in the soap bottles.  He relished it when I reminded him that our entire home was contaminated.  He’d won another battle in the war on his OCD.  His hands healed.

But the other areas his OCD affected were untouchable.  He wouldn’t budge on them; held onto them like a badge of courage and battled us to keep them.  Of course, this lead to us ultimately discontinuing treatment and to being in the limbo that we are in.

Today I still find remnants of that exposure, though it is about 3 months in the past.  There are still places that are too high for me to reach where he aimed that squirt bottle – and I kind of like the bits of dirt that remain anyway because they remind me that we still live with contamination to some extent.  They also remind me how far Blake was willing to up the ante to protect his OCD, how powerful the disorder can be in asserting itself.  And I wonder when Blake will grow in his own power and desire to take it on.  We can only wait and see.