There’s Nowhere Else…

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Please be aware, short reference to suicidal ideation below:

I can see her waiting patiently out of the corner of my eye, as I listen to the social worker’s voice on the other end of the line. She can’t see or hear me; my camera is off and my mic is, too. I can see the fuzzy blackness covering the square that would be me in this telehealth call. She looks uncertain about what to do as she waits. The social worker on the phone talks on, giving me updates and directions. I dutifully take notes, painfully aware of the time that has lapsed since I darkened my screen and left this mom, mother of one of my young patients, waiting. I hang up the phone. Six minutes have gone by. I turn my camera and mic back on and she looks at me with concern and with what I imagine is a question that hangs between us.

“Is everything okay?”

It is not like me to abruptly leave a therapy session, and the call came in so early during our meeting I hadn’t yet been able to tell her. This has been a week unlike any other. I’ve told each and every patient or parent that I might be interrupted. I’ve mastered the drill by this point – a family member is having a health crisis; everyone is safe; doctors call me unexpectedly and I have little control over when that happens; if it happens, I’ll turn off my camera and microphone, take the call and return as quickly as I can; please forgive me if it happens. But this time, I had no opportunity to share, the call came so close to the beginning of our session. Then I tell her more than I’ve told any other person I’ve met with this week, pausing only for a millisecond in my head to debate whether it is appropriate.

“My son is in the hospital,” I say. Now it is out there. “I deeply apologize that I didn’t have the chance to tell you that I might get a call.”

“Was it planned?” she asks.

“No,” I answer, “though things are stable. I just get calls from doctors and I don’t have any say when they do that. I’m so sorry that this took from our time. I will make that time up.”

“Are you sure you’re up for being here? We can reschedule.” I see the caring and concern on her face.

“Honestly, there’s really not anything else for me to be doing right now. If I wasn’t working, I’d be sitting around waiting for time to pass,” I tell her. Then I lean in to the monitor, “Right now I’d like to be here with you, if you’d like to be here with me, too.”

She decides to continue and this honestly is exactly where I want to be.

Blake has been in the hospital for eleven days as I write this. For those of you who’ve followed this blog, you’re aware he’s struggled with depression and OCD. At times, it has been confusing which is more pressing. He’s been open, for the first time in a long time, to participating in treatment. He’s been working with a couple therapists and a psychiatrist. While he’s been the driver of his treatment, he’s also felt little hope or joy. He’s found nothing he wants in life. Depression is a thief that way; it robs us of seeing any possibility life might hold for us. Still, he continued on, trying a new antidepressant. Then, OCD’s intrusive thoughts took hold, constantly locking him in a fight against the torment. Simultaneously, his muscles started twitching uncontrollably, making him that much more uncomfortable. It took a while to realize that the twitching was a likely a side effect of his medication. The entire experience led him to hatch a plan to end his life – a plan he luckily shared with my husband and I, and later with his therapist.

Now our journey will take a new direction. Blake is scheduled to begin a Partial Hospitalization Program for OCD and anxiety shortly. He has never had treatment this intense ever in his life, and he is understandably scared. I have never had such brain fog in my life as I have this week, nor have I ever recognized so starkly the incredible beauty and supportiveness of those around me. I’ve had little energy to interact with others beyond what I “must” do, but those interactions have made me appreciate the power that exists in supporting one another.

And so, dear reader, thank you for coming to visit with me today. There’s nowhere else I’d rather be than here with you, if you’d like to be here with me, too.

Three Things I’ve Learned in Suicide Prevention Therapy

*This is not meant to be advice; it is simply something I’m learning as our family navigates having a family member with suicidal ideation. If you are thinking about suicide or have a loved one who is struggling with thoughts of suicide, please call the National Suicide Prevention Lifeline at 1-800-273-8255 (In the United States. In other countries, please reach out to a similar service in your country).

Image by Mabel Amber from Pixabay

The hubby and I began participating in therapy with a specialist from a suicide prevention center just a few weeks ago. Our son, Blake, had been sharing a good deal of suicidal thoughts with us and, since he was not interested in any ongoing treatment, we recognized we needed support ourselves. So far, we’ve done an intake meeting and two sessions. Although I’m a psychologist who specializes in treating anxiety and OCD, it’s a completely different story being a patient. I am learning, for sure, so I thought I’d share three nuggets I’ve gotten so far:

1. It’s not necessarily a bad thing that someone is talking about suicide.

Emphasis here is on “talking.” It was terrifying to me when Blake shared the thoughts that go through his mind, how much he suffers, how much he thinks of dying. I became alarmed at the very presence of these thoughts. However, our therapist (and others) have told me that it is actually a positive thing that Blake is talking about his thoughts. Talking and sharing are attempts to reach out and connect with others. This is a better thing than keeping these thoughts all to oneself – and not connecting with others.

2. It’s important to listen, not try to problem solve.

Many times when Blake has shared his pain with us, the hubby and I have worked to problem solve with him about ways to cope. We’ve also tried to shine a light on the bright side of things that he may be overlooking. What I’ve learned is that the most important thing I can do when my son shares his thoughts and feelings – even though they contain very dark and frightening content – is to listen and accept them as his. It is not my job to problem solve. That’s not where he’s at; he’s in sharing mode and he simply wants to be heard. As far as pointing out the bright side, our therapist noted that, for someone who is not ready for that, it’s kind of like shining a light in the eyes of someone who has been sitting in the dark. It’s going to be jarring and unappreciated. So, I’ve been working on listening and simply hearing.

3. An increasing number of conversations about suicidal ideation does not necessarily mean the person is about to act.

In our last session, I noted to our therapist that the freqency of conversations seemed to be going up. Our son was having more conversations with us about his pain and his thoughts of death. He wasn’t sharing intent to act, he was just sharing more often. It was emotionally exhausting, at times, and I was concerned what it meant. The therapist reminded me that we’ve shifted our conversations from problem-solving and pointing out the bright side to actually just listening and accepting. She noted that the increased frequency may simply mean it’s become more safe to share and that, when a person feels like they will be heard, they’ll take the opportunity to talk more often about what may be going on in their head. So, although it feels scary to me to be hearing my son’s thoughts more, it may just be that he feels more accepted in voicing them now than he did in the past.

We still have a way to go on this journey, and we have to listen to our son to ensure we are not missing signs of intent to harm himself. On the way, I am learning, and I hope our experience can help others.

OCD and the Importance of Specialists

Image courtesy of lekkyjustdoit at FreeDigitalPhotos.net

The voice on the other end of the line is searching for an answer. She knows there is another way. There has to be. I’m speaking to a woman. I don’t know her age. I only know that she’s self-diagnosed with OCD and she is looking for help. Her plea to me draws me in; this is what I’m passionate about: helping people with OCD find help and get better. At the same time, the call leaves me furious. Something inside of me demands, “Something must be done about this!

A little background. I am the parent of a young adult with OCD. I am also a clinical psychologist. Several years after my son’s OCD diagnosis and successful treatment, I sought out training and began to specialize in the treatment of OCD. I did not want other families to go through what we did. Heck, I was a psychologist and I had had no clue about OCD. I’d been lucky to find help through my psychology connections. How were people without a psychology background to know the “what’s,” “why’s,” and “how’s” of OCD?

The Woman on the Line

The woman I’m speaking to is resourceful. She’s figured out that there’s a name for the disturbing thoughts that go through her mind, and for the anxiety and discomfort created by them. It’s called Obsessive-Compulsive Disorder. She is troubled by fears that she will harm herself in some way. She does not wish to harm herself. The thoughts terrify her. She wants to learn to deal with them in a better way, rather than spending great amounts of time ruminating. What she describes to me sounds a great deal like a theme that the OCD community has dubbed “Harm OCD.” It’s a fairly common OCD theme.

“I wanted to use my health insurance,” she tells me. “I went to see a therapist who wasn’t an OCD specialist, but he seemed professional enough.”

What followed was anything but a pleasant experience. When she told the therapist that she believed she had OCD and that her obsessions centered around thoughts of harming herself, the therapist told her that there was no such thing as the disorder she was talking about. His reasoning? He had never heard of it.

He told me I was suicidal and that the thoughts were just fragmented pieces of myself that I’d disowned,” she lamented.

“Let me guess,” I said. “The thoughts and the anxiety only got worse then.”

“Yes!” she responded with fervor.

“This is a frequent problem we see in the OCD community when people see therapists who are not specialists in treating OCD.”

Our talk continued with me providing resources, referrals, and information on finding a specialist to work with her. I trust that she will get into proper treatment and get the help she needs.

The Uninformed Psychology Community

Being immersed in the OCD community, I sometimes forget that the psychology and psychiatry community as a whole can be misinformed about OCD. Although I have never met this woman to be able to diagnose her, nor was I present to witness what happened in the consultation room, what she describes matches what many with OCD describe on their road to finding diagnosis and treatment. Not all mental health professionals are trained to diagnose or treat OCD. When a person has OCD, it is a specialist they must see.

People trust therapists and psychiatrists to be able to identify what is wrong and to be able to treat them. If their diagnosis is OCD, and if it manifests in a way that does not reflect what tends to be shown in the media, the diagnosis can be missed. What’s more, the treatment provided can end up making things even worse, as this woman shared. When she noted that she thought she had harm OCD and was told that that did not exist, it made her doubt and despair even greater.

What frustrates me is when mental health professionals do not admit that OCD is not their specialty, or when they are not willing to listen to the person in the room with them. A quick search on Google for “harm OCD” led me to over 700,000 results in less than a second. A search for “OCD suicidal obsessions” leads to nearly 300,000 results (my friend, Janet, at OCDtalk wrote an article on the subject last year).

Getting Help

The woman I spoke with was informed. She had done her research and she knew what she likely had. It was her reluctance to go outside of her insurance (or, perhaps better, to stand up to her insurance provider and ask that they approve her seeing an OCD specialist since there are none on her panel nearby) that led her to not getting the appropriate treatment. It’s not that the therapist she saw is not a talented professional; they just were not likely informed about OCD.

If you believe that you, or a loved one, have OCD, seek out a specialist. The International OCD Foundation has published a great article called, “How to Find the Right Therapist.” Both the International OCD Foundation and the Anxiety and Depression Association of America have features to help consumers find therapists. Starting with a specialist can help an OCD sufferer avoid wasted time spent in treatment that does not help. If there are no specialists in your area who take your insurance, you still have options. Perhaps there is a therapist on your insurance who is out of your immediate area, but provides therapy via secure video (they must be licensed in your state and your insurance company may or may not authorize this kind of treatment). Perhaps your insurance company can make an exception and authorize treatment outside of network. Additionally, if finances are an issue, do not be afraid to ask providers if they can provide you therapy at a reduced fee you can afford. There are many who will.

Above all, this is your health and your life. Getting the appropriate treatment is important. Do not stay in a treatment situation that feels inappropriate, or with a mental health professional who does not understand OCD, or who will not look at valid articles you point them to on the subject. OCD is treatable – and getting the right treatment is key to recovery.