His Own Initiative

Our oldest, Michael, left the country one week ago today with excitement over studying and living in another country and a passion to become more fluent in another language. The hubby cried as he hugged our son goodbye, then cried more as we drove home, and once again as he searched birthday card after birthday card in pursuit of a suitable one for our younger son, Blake’s, nineteenth birthday. The hubby’s tears reflected many things: the sadness at watching Michael leave after several weeks in which they spent many close moments together, the bittersweet realization that we will be empty-nesters in a few short weeks, the juxtaposition of the personalities of our two young men – one who craves new experiences in the world and one for whom his bed and our sofa seem experience enough.

Michael’s parting recommendation to his brother had been that he begin to venture out into the world, that he practice the skills he will need when he moves to college in another state next month. He’d worried lovingly about his brother and whether he’d have the skills to live in his new environment. He’d proposed a plan to his brother in which Blake would go out of the house, perhaps a couple of times each week, so that he might gain experience and confidence, and perhaps a little momentum. Blake initially embraced the idea, but it quickly seemed to fall flat as I wrote about in my previous post (“A Plan That Lost Steam“). Depression and anxiety seemed to win out.

A Flash of Hope

I had resigned myself that Blake was not going to follow the plan he and his brother had plotted out. I expected to see him step back from life even more. The hubby and I were true to what we had promised and did not bring the plan back up. To be honest, I even stepped back on our therapy-planned morning routine of waking Blake up. Sure, I still saw that he got up and out of his room, but with much less rigidity and urgency. I felt deflated and spent time searching my mind as to how I would live as meaningfully as possible regardless of what would come with either of my sons in the months ahead.

Still, there were things to be done before Blake can leave for college. There were apartment supplies to be ordered and bank accounts to be transferred (Blake still only had a custodial account in my name). So, I continued to go through the motions of preparing for the move. On Monday morning, Blake and I prepared to go to the bank to get things in order so that he might obtain the all-important debit card.

“Do you want to go grab a coffee afterward?” I asked him just before we left.

“Oh, I was planning to go there myself as a way to get out today. You know, like we talked about with Michael. Is that okay?”

I was a bit startled, a little excited, but tried not to show it.

“Of course,” I said. “Do you want to take separate cars and meet me at the mall, then? We can walk over to the bank, then grab a coffee, and I then I can leave so you can have your time.”

So, we did. Blake navigated his way to the mall parking lot and we met up and walked to the bank and completed the business of transferring his account into his name. Then we walked back to the coffee shop, where I grabbed an iced coffee and quickly made myself scarce. Blake set up his computer at a table.

“I wish I’d brought a chess board,” he noted. “I’d ask someone here to play with me.”

When I got home, I dashed off an email to the hubby at work: “Thought you’d want to know…

And Then Another

On Thursday, he did it again.

“Mom, since we need to go out on another college planning errand today, can I use it as a way to launch into going out on my own again? It kind of helps ease me into it. I mean, since we are going out already, I can just go off on my own when we’re done. I’d like to go to the board game store.”

“Sure, honey. Let’s meet up at the store. We’ll pick out supplies and then you can head on your way,” I’d suggested.

About a half hour later, Blake showed up to meet me.

“Twenty-five minutes to find my way here!” Blake shook his head.

“Hey, you found it and you did it safely,” I replied.

Then we proceeded to giggle our way through the store, Blake being more frugal than I, me reasoning that the slow cooker he was choosing was going to be too small. As we finished, I bid him fun on his adventure. A couple of hours later, he was back home. He’d completed his mission, and had even observed a group at the store playing a Dungeons and Dragons game.

“I tried to join in,” he said, “but they were already too far in. They have a board game night there every other Thursday.”

Whether Blake will continue his missions out into the world we shall see. This week, my son, the one who prefers his bed and the family room couch, went out twice – for no reason other than to practice doing it. No one cajoled him or made suggestions. He just did it himself. While we cannot show great excitement because we know, from experience, that this will just send him back into hiding, this weekend the hubby and I are doing happy dances when no one is looking.

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A Plan That Lost Steam

Michael, our 21-year-old, is getting ready to leave to study abroad for the remainder of this summer. He sat the hubby and I down the other day and told us he was worried about Blake’s emotional state and his upcoming move out of state to begin college.

“He’s really not ready to go,” Michael observed. “He feels like a disappointment to you guys, especially when it seems that everything is based on whether he gets up in the morning or not. And he doesn’t respond well to tough love. It just makes him shut down more.”

“So what are you thinking?” I asked him, as the three of us sat on our back patio.

“I think he needs a mission, a purpose. You know, little tasks to get him out of the house. Things he needs to practice to live away from home. He can go buy his groceries so you can get an idea now what he’ll need to spend on them and so that he’ll get used to buying what he needs. And he can go to the library or the coffee shop and set up his computer and practice writing from there. You could give him a small stipend each week so he could practice. I think it would make him feel accomplished. But,” Michael continued, “I don’t think it should come from you guys.”

“What do you propose?” asked the hubby.

“I’ll talk with him tonight,” Michael noted. “I’ll see what he thinks and help him to make it his. If it’s his idea, he might be willing.”

So, we parted leaving this between the boys.

Michael Makes Inroads

The next morning, Blake stopped me early.

“Mom,” he said, “Michael and I were talking last night about ways for me to get ready to leave for school. Can we talk with you and Dad tonight about it? I think it’s a good plan.”

“Sure,” I answered. I tried to sound calmly enthusiastic, but inside I was kind of excited. Was my son who regularly chooses bed and the sofa to leaving the home actually wanting to launch a little bit?

The four of us met last night and Michael and Blake led the talk. Michael shared how doing these kinds of things would have helped him make the transition a little easier when he left for college. He thought it would give Blake more confidence to live in the world

And Then I Watched it Happen…

Blake went from mildly enthusiastic to questioning to looking downright terrified. He started finding reasons it wasn’t a good idea. He started worrying he’d be judged and held to this standard. He worried he’d fail. It didn’t matter what anyone said. The hubby and I noted we wouldn’t hold him to anything. It was his plan, and if he followed it, we would cheer him on. If he did not, we wouldn’t comment. Michael stayed positive and light and shared how beneficial it could be. I was proud of how he held his own and supported his brother. In the end, we left it that Blake could decide whether he did it or not.

And then, as I got ready for bed, he called me into his room.

“It’s just so hard to get out of bed,” he said, staring off into space. “Bed is the only place that feels good. It’s like having a hug and having to leave it. Nothing in the day feels good and I just distract myself with YouTube or games all day. And then it’s even hard to go back to bed knowing I’ll have to do the same thing again tomorrow. Living is hard and I’m too scared to die – so I’m just in that in between space.”

And there was little more I knew to do for my son than listen, acknowledge, and snuggle him with a tight squeeze until he dismissed me with a, “Good night, Mom.” For all my professional training and experience, I do not know how to move my own son from here to there. And right now, I don’t know that there is anyone else who knows how to either.

Which Way From Here?

Sometimes treatment moves along at a snail’s pace – or even seems to go backward

When I began writing this blog five years ago, my son, Blake, was 14 years old and had recently refused treatment for his Obsessive-Compulsive Disorder (OCD). He’d had a relapse over the previous school year and, despite access to terrific treatment from specialists in Exposure and Response Prevention (ERP), he ultimately wanted to do it his way.  I started writing as a way to express what was going on in my head, to document what was happening, and to sprinkle in stories of being an OCD specialist while living at home with OCD.

As time passed, my writing shifted. In many recent posts, I’ve focused on the depression that settled in over Blake, causing my hubby and I to make the decision to ask him to defer enrollment in college so that he might take care of himself and gain some skills. We entered therapy as a family. First, Blake refused to participate, and he launched into 18-year-old sized tantrums – turning over the belongings in his room, slamming doors and shutters – each time we introduced a new expectation that was meant to move him toward improved functioning. Finally, he came to treatment as a participant and even started meeting with the therapist without us. I’ve documented his struggles, our struggles, and his progress.

Now, Blake Turns 19…

In about a week, Blake will turn 19-years-old. I haven’t talked much about his OCD lately because we’ve mostly been dealing with depression. Blake’s sleep schedule became greatly dysregulated at the end of tenth grade. He sometimes slept until 10 at night; he was up until 3, 4, or 5 in the morning. Over this past year, he’s been awake all day most days. This has mostly been due to my waking him each morning if he doesn’t get up with his alarm. It’s something we agreed on with his therapist: no sleeping all day in this house; if you don’t get up on your own, we will wake you up. But that last hurdle, getting up on his own and staying awake, has been a challenge. Sometimes he does it. Sometimes he does not. In recent weeks, there’s been a slide backwards. He hasn’t gotten up on his own, and he falls back to sleep all over the house for great chunks of the day.

In our most recent therapy session, I joined Blake and the therapist and we focused on where things are at. Blake was dug deep into his position that “nothing” will work and, yet, he was unwilling to try anything new. Top that off with an essential element: Blake does not really want to accept that anyone else might know better than him and what his head is telling him. His brain tells him he’s a worthless screw-up and that it’ll never get better – and he listens to it. I will vouch that this young man is not worthless in any sense, but many steps forward that he has taken have been with pressure from others. I cannot recall a moment where he has honestly said, “I need help and I’m willing to allow others to walk me through this.”

Pivotal Moments

I watched as Blake’s therapist, a longtime specialist and pioneer in OCD treatment, dug in himself. I could see the struggle in him as he could see the road my son is headed down. He pointed out the direction Blake might be going in his quest to continue to do it Blake’s way.

“Blake, my sister’s mental health issue was destroying her life. We begged her to get treatment, to do it another way. But she continued to choose to do it her way…and it killed her.” I could sense the anguish in the therapist’s voice as he shared his personal story of losing a family member to refusing to get proper help. It’s kind of amazing when you reflect that the professional in front of you is a human being.

He continued, “It’s clear that coming to therapy once a week isn’t getting you to where you’d like to be. It might be time to think of doing something more. It might be time to think about residential treatment for OCD.”

“How would that help?” Blake asked. “They’d just be doing it for me.”

“It would help to have therapists and counselors and staff around 24 hours a day to help you learn to live differently.”

“It wouldn’t work. They’d just be forcing me.”

“You’re right. It wouldn’t work if you went into it with the same attitude you have. It wouldn’t work if you continued to see it as something others were pushing you to do. It might work if you were to recognize that doing it your way isn’t working and if you surrendered yourself to something new. You’d have to see yourself as worth it.”

“I’d feel like a freak,” Blake said quietly. “If I was so desperate as to go live in a hospital, I’d feel like a freak.”

“Blake,” I broke in, “if J were to check into a residential program for what he’s going through, would you think he was a desperate freak, or would you be proud of him for getting the treatment you know he needs?” I asked this in reference to someone close to us Blake worries about.

Without a pause Blake noted that he would be proud – and he made the connections.

“I guess I have some thinking to do,” Blake acknowledged.

An OCD Program?

You may have noticed above that Blake’s therapist did not suggest Blake consider going into a residential program for depression. He suggested a residential program for OCD. He suggested it at least twice (I didn’t include all the dialog). Why an OCD program? We never got to talk about it, but I think I know why. I believe the therapist thinks that much of what is going on with Blake can be traced to his OCD. Blake has an extremely low tolerance for uncertainty or discomfort of any kind. He actually shuts down and becomes unmovable when faced with an anxious moment. He prefers to live in a comfort zone according to rules he has determined are acceptable to live by (but that are actually dictated by OCD). He’s been living a life of religious rules for over six years that has been driven mostly by fear rather than joy and meaning.

Blake has something to think about. How much thinking he is doing, I do not know. I know he got himself out of bed for four days in a row – and he felt proud. And then he sunk into three days running of not getting up on his own and falling asleep for large chunks of time. He is mere weeks from leaving our home to finally beginning college in another state and living in an apartment with three roommates he will not know. If he elects to go to a residential treatment program, what would become of that?  For now, I don’t know. I don’t know what happens if he goes to college, can’t get out of bed to go to school, and returns home. I don’t know what happens if he falls backward enough not to be able to leave home. Like all things that are in the future, I am waiting to see. I’m hoping for the best, but not deceiving myself in acknowledging that this just might not go well.

 

Sharing – About Me

Recently, a patient came to session struggling more than usual. Depression had settled in on top of her Obsessive-Compulsive Disorder (OCD), which is not at all uncommon. It just happened on the heels of the deaths by suicide of Kate Spade and Anthony Bourdain, and it sparked her to act.

“I can understand how someone could do it,” she told me. “I can understand what it’s like to have it seem like it just doesn’t matter if you are here anymore.”

She went on to talk about what she felt like at the present time, and then it happened. Maybe I nodded with too much agreement. Maybe I empathized in such a way that sparked the recognition.

“You, too?” she asked.

“I once spent two weeks in bed. Only got out to do the essentials.”

It just seemed to spill out of me, my admission that I, too, have struggled at times with major depression. I didn’t share it for her sympathy or to make me feel better. It just seemed like the right moment to say, “Hey, you’re not alone, and this beast can be bested.”

“I’m sorry,” she said.

“It was before I knew much about how to deal with depression. I’ve learned a lot since then.” And then we had an in depth conversation about how to deal with her depression.

Sharing Personal Information

There’s a bit of a rule in the world of mental health professionals that we don’t share much about ourselves. The treatment session is for our patients, not the place for us to get our needs met. We have therapy and our own relationships outside of the therapy room for that. I actually came from a training experience that encouraged us to be “blank slates” to our patients. We were to answer questions about ourselves with, “How will the answer to that help your situation?” or “What makes you ask that question now?” It always felt strange to me to answer that way, but I did it figuring that I’d get used to it. I didn’t.

When I began treating individuals with OCD, it was already out there in the world that I was a parent of a child with OCD. I’d written articles about it and I shared about it with most of my patients if it seemed appropriate. Working with other parents, it seemed to give credence to what I was asking them to do. To many, it made it seem that I understood, on a deep level, what they were going through. For me, it felt more genuine.

I don’t know if it was the right thing to do, letting my patient know I’d experienced depression myself. I’m not going to try to justify it, and I’m going to have to continue to look at why, when, and how I share personal information with my patients. I do know that being more real feels like a better approach than being a mystery or a “blank slate.” I do things in session like share about the panic attack I had at forty feet below the surface of the ocean while scuba diving. I share about the intense fear I had of public speaking when I was younger – so great that it nearly prevented me from pursuing a career as a psychologist (we had to take an oral exam). And I share how I learned not to have these things rule my experience.

On the day my patient came in struggling with depression, I took the session outside. It’s not something a lot of therapists do, but it’s not so unusual. I took it outside because we uncovered the fact that my patient had stopped her daily walking routine a few months ago, and because we talked about the importance of exercise as one component in dealing with depression. And so we walked. She in her athletic shoes and me in my dress sandals. Together we sought out slight inclines in the neighborhood and we climbed them. I got blisters…and a note from her the next morning showing the miles she’d walked and describing how the fog was beginning to lift.

 

I’m Still Here

Image courtesy of Bill Longshaw at FreeDigitalPhotos.net

Just a quick post to let my readers know that I’m still here. Life has been a bit busy with Michael returning home from college for the summer and Blake wrapping up his class for the semester. Friends’ kids are graduating from high school and college. My practice has been busy with more adults and children with OCD than I can humanly work with (I suppose that it’s a good thing that my practice is busy, but I always feel sad when I have to say, “No.”).

I’m working on my next post. In the meantime, if you’re looking for me, you might find me helping prepare one 18-year-old to go off to school in the fall, or helping a hubby prepare for a trip, or teaching a 21-year-old how to meal plan so he doesn’t eat out every day again in the next school year. Of course, you might also find me in a public restroom, coaxing a patient to touch a door handle; or crawling around in the outdoor planter with a child at work; or I might be in a home encouraging a frightened young patient to eat a challenge food or prompting an adult to put her things away “just wrong.”

No matter what I’m doing, it won’t be boring. Have a good week!

These Spring Evenings

Spring has finally arrived in our area. The plants are blooming and blossoming. The days are warmer and the nights are still cool. The hubby recently completed a project of changing over our landscaping to a more water efficient and drought tolerant one. Consequently, our backyard is a joy to be in right now. Every evening that I get home later than the hubby, I find him sitting in a cozy chair on the back patio just enjoying. Frequently he is flanked by a dog on either side, and both of these appear equally as content as their owner.

Along with spending more time on the patio, the hubby has suggested we move several of our evening meals in the last couple of weeks outdoors. I’ve obliged him, and therein lies the issue for Blake. I’ve shared before that Blake’s Obsessive-Compulsive Disorder (OCD) has played a back seat role to his depression of late, but it is at times like this when it shows itself more.

“Are we eating outside again?” he asks.

“We are.”

“I’m guessing you’d like me to join you…”

“We’d love you to join us.”

I can feel the hesitation, the thinking, the rationalizing, the many things that must be going through his head. When we first realized Blake had OCD it showed itself in fear of contamination. Although it has had many incarnations, his OCD has never quite abandoned attacking him on the issue of things being contaminated. Our patio table is contaminated (it sits outdoors all the time). The chairs are contaminated (ditto). There are bugs out there (they might land on you or, heaven forbid, your food). I think even the outside air feels a little contaminated, but I’m not quite certain about that. It’s no wonder Blake is hesitating.

On one particular night, we have relatives over. We barbecue. I prepare the meal. The hubby prepares the table outside. Blake, as he has for several years now, prepares his own meal. I head outside with my full dinner plate and notice Blake at the indoor dinner table. He’s putting together his plate. One by one, my hubby and our guests all settle in for our meal. I’m guessing Blake will not be there, but I’ve guessed wrong.

Moments later, Blake has a full plate and he carves out space for himself. The rest of us reposition ourselves. He sets his plate down and leaves. He comes back with a can of soda in hand. I know what this is. Soda for Blake is liquid courage; it’s motivation and reward for doing something that is difficult. He joins us at the table. He eats his food. He actually participates in the conversation. At some point everyone except Blake and I have left the table for seconds or for dessert.

“I’m so glad you joined us,” I note. “How are you doing?”

“I’m glad to be here,” he says, and then he answers, “I’m uncomfortable. I’m definitely uncomfortable.”

I ponder this for just a second or two.

“Uncomfortable is good,” I respond – and it is.

A Different Kind of Obsession and Compulsion

Providing further evidence that Obsessive-Compulsive Disorder (OCD) is not always what we tend to think it is, I submit the following experience from Blake’s recent therapy session:

I don’t frequently participate in Blake’s therapy anymore. In fact, if I do come in for something, he’s taken to asking me to leave at some point now. It’s a far cry from when he began therapy a year ago, or should I say refused therapy one year ago.  But that’s another story one can dig into the archives to read. Let’s suffice it to say that Blake choosing to go into a therapy session and talk with his therapist alone is major progress. Recently, though, I asked to come in for clarification on how the therapist had requested that the hubby and I handle something.

The basic issue was this: Blake had returned to his habit of getting back in to bed or falling asleep on the sofa in the morning. I was growing tired of repeatedly waking him and wondered if our plan needed to be modified. Blake’s therapist was looking to understand what gets in Blake’s way of staying awake. That’s when he shared this interesting anecdote.

Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net

“I work with a woman who cannot begin work in the morning if she has a certain body ache. So, she’s taken to checking herself every morning to see if she has that body ache, and most of the time, she finds it. So, she can’t start working and she keeps monitoring herself until it is gone. Actually, it’s OCD.”

Do you get it? Do you see the OCD? If you don’t that’s okay; I’ll explain it shortly. First, here’s Blake’s response:

“Oh my gosh. I get that,” Blake says. “I wake up feeling miserable in the morning. I’m so tired and I feel sick. I know if I start on anything that it’ll be terrible and I won’t like my work. So, I won’t work if I feel that way.”

“Then what we need to teach you is to work even though you might have that feeling. We have to teach you to work through that feeling,” replied his therapist.

Wait, did my son just admit to some OCD in his life? I don’t know if he realized it, but his therapist just implied that his issue with getting up in the morning had to do with OCD – and he agreed…

Where’s the OCD?

If all that escaped you, or if you just can barely make out the OCD, let me help. Think of obsessions as something that brings anxiety or discomfort up. Think of compulsions as bringing anxiety or discomfort down. It’s that simple. Now, let’s look at the patient the therapist mentioned.

The woman who works from home believes she cannot work if she has a certain ache. The concern she will have that ache is the obsession. That brings her anxiety up. The checking her body for the ache is the compulsion, as are the monitoring and refusing to work. They bring her discomfort down.

Blake holds the belief that he will turn out what he calls “trash work” if he feels tired or sick. That’s the obsession; it brings his discomfort up. His compulsion? Returning to bed or lying down anywhere and just checking out. He’ll only work if he feels “just right.” And that brings his discomfort down.

Is it a stretch? Could an OCD pattern be part of what is holding Blake back right now? Maybe. Maybe not. It’s interesting how he jumped on the therapist’s comparison. So, I wonder in my mind. Is it OCD? Is it depression? The therapist’s notion that Blake needs to work right through his discomfort fits for both – at least that’s what I think. Now, let’s see if Blake starts to do it…