BEING BAD (AT THERAPY)

Here are two things you should know about me: 1) I am a huge proponent of going to therapy and recommend it to everyone both personally and professionally and 2) I am not a good therapy client. I am often resistant, defensive and convinced that I “know better.” Recently, I have started paying more than $200 a session to combat my OCD with Exposure and Response Prevention (ERP) therapy and more than half the time I don’t do my assigned homework. Over the last few months, I’ve had to expend as much effort trying to find my “willingness for change” as I have actually changing. And do you know what? I’m still getting better. But I’m doing so on a timeline that’s realistic for me.

Therapy--and addressing your mental health in general--is as much an artform as it is a science. You are going to have moments of breakthrough followed by weeks of feeling stuck. You will make progress on something specific only to backslide in an infuriatingly specific way. While this reality is frustrating, learning to accept it is a huge and helpful part of the process. I didn’t start ERP with the expectation of being the perfect client and walking away without OCD. I started it filled with dread and a bit of hope that I would make some progress. Approaching it this way is an example of treating myself with kindness. It is much harder to let yourself down when you have reasonable expectations that not only allow for, but anticipate, bad days.

Although I have been going to therapy on and off for most of my life, I haven’t been in exposure therapy since I was a kid. And this type of regimented therapy has ironically opened up my eyes to how important it is to work with your therapist to find the right treatment for you at the right time. In ERP, you create a fear hierarchy where you list and rank various exposures based on how much discomfort they cause you. You then start to systematically work through the list from least discomfort to most discomfort, increasing your distress tolerance and lowering the control your OCD has over you along the way. My current therapist attempted to do this with me, but I wasn’t very good at it. In fact, I was downright bad at it.

I found that the bigger fears on my list kept getting in my way by increasing my anticipation anxiety and I was having a hard time trying to find motivation to do things that didn’t bring any inherent value to my life. For example, I understood the benefit of sitting on the floor of my apartment because it allowed me to be more comfortable as I played with my dogs, but I couldn’t wrap my head around throwing my trash down the shoot and then not washing my hands after. To me, that was just gross with no added benefit and a clear cost. To my therapist, that was a clear-cut (and research based) way to loosen the control my contamination OCD had over me by not giving into a clear compulsion (hand washing). While I intellectually understood her point, I didn’t have “buy-in,” which is crucial if you want therapy to be successful. To put it more simply, it’s really freakin’ hard to change if you don’t even want to in the first place. So I’ve been working with my therapist to find a route that does work for me, even if it requires us to go off book* (*treatment manual). So instead of having clear cut homework each week where I tackle a different exposure on the list, I have been trying to have two moments a day where I push past the discomfort and do something I don’t want to do but will make my life easier. (For example, not wiping my car seat down when I’m already exhausted.) This helps me fight certain compulsions in the moment without me being afraid about having to do it all day.

In the past, I would have beaten myself up for “breaking the rules” and not being an excellent client. I would have obsessed over the money I was wasting and felt like a failure for not following the ERP guidelines exactly. I would have declared myself a fraud as a mental health advocate because I wasn’t doing the right work every single day to be my best self. But I’ve learned that I don’t flourish under tough love. I do my best when I’m smothered in compassion, understanding and encouragement—all of which I am able to offer myself. Starting ERP was a brave thing to do. Have I been as brave as I would have liked since starting it? No. But that doesn’t mean that bravery won’t come with time. It is a difficult balance to figure out the right amount to push myself and just because I haven’t stumbled on the best combination yet, doesn’t mean I won’t in the future.

Another huge component of your therapy process and progress that we don’t talk about enough is the context of your current life. I’ve learned to acknowledge that sometimes it’s easier to do the work than other times. And right now, I’m in an “other time.” In the past few weeks, I’ve moved out of my apartment, moved into a house with a myriad of problems, officially started cohabitating with my boyfriend and had major knee surgery. Now is probably not the time to force exposure therapy on top of everything else. But that doesn’t mean I can’t use the tools I’ve been building since starting ERP. The only reason I’ve been able to mentally handle the disarray of my new place is because of my increased tolerance for discomfort and my brand-new mantra, “It’s okay to be disgusting.” When I saw my hired handyman put his tools and building equipment all over my clean bedding last week I didn’t freak out and rush to change the sheets. My brain had enough built-up tolerance to focus on other priorities like my impending surgery. I’m not sure if I would have been able to do that without the (admittedly disjointed) work I’ve been doing in ERP.

Sometimes we start seeing a therapist to work on our attachment issues, but end up spending multiple sessions talking about our confusing career path. Sometimes we start ERP to specifically work on contamination OCD and end up talking about using self-care to get through a hard time. While it’s important to have clear goals when it comes to therapy and our mental health, it’s equally important to give ourselves what we need as we need it. It can be a disservice to be too strict about what to expect from ourselves in this complicated journey. It’s not about hitting the milestones on time and showing up each day with the same exacting motivation to put in the work and make our therapists proud. It’s much more about showing up in the first place. And remembering that even on the days we don’t want to show up, we did it anyway and we will do it again.

xoxo,

Allison