Inability to make decision

[jballan]

Last week (Tuesday) my therapist gave me an option for our next appointment time, either Thursday or Friday or both days. I spent Tuesday-Friday in utter panic. I just couldn't pick a time... So I missed my appointment. She called me yesterday (Saturday) and said I should come in on Tuesday. She gave me two options 11 or 1:30... I said I didn't have a preference and asked her to decide. She said no, this is exposure therapy. I got mad and said, you know I am not going to be able to decide and I am going to miss another appointment and be really anxious!

She said, that's okay to be anxious. Of course I hate being anxious! So I don't really know what to do...

I don't have this problem (of making decisions) in any other aspect of my life, only therapy. I can't help but think how pointless this is. I'm going to continue to miss sessions because she is certain that she is going to continue to give me choices. This whole thing is making me very anxious and depressed...

Any thoughts?

[snowbear]

I think it's excellent that your therapist is managing to give you exposure therapy in this way, so even if you miss the appointment (as a result of not making a decision) you're still getting 'homework' of a sort.

She's exposing you to choice.

Your compulsion is not to decide (presumably in case you make a 'wrong' choice?) so in asking the therapist to give a set time/date instead of two options you are giving in to your compulsion entirely rather than make a decision and live with the anxiety.

That's useful information for her as it shows you're not making much (any?) effort to resist your compulsions at the present time.

When you begin to make choices you will feel uneasy at first, but as time goes by you'll find they get easier to make.

Right now you're being given baby steps - very small, unimportant decisions such as which day of the week or what time to attend. It really doesn't matter which one you choose - the consequences either way are minimal.

As your exposure therapy intensifies you'll be asked to make bigger decisions, maybe decisions which have bigger consequences, until you're able to make choices without feeling anxious. By grading it this way (starting with something as insignificant as the appointment time) your therapist is easing you in to the behavioural therapy very gently.

Unfortunately, if you don't grasp the opportunity you may waste all the therapy time available and miss the chance to go to the sessions and learn about yourself, why you behave this way, and how to change the behaviour and actually enjoy making decisions worry free!

Getting mad with your therapist doesn't help. She's not doing this to be awkward, she's trying to help you face your fears. You have to take responsibility for yourself and start engaging with the therapy if you want the anxiety to lessen.

Feeling depressed is your brain's way of saying 'Somebody please take this problem off me, fix it for me, I don't want to know.'

But nobody else can fix it for you - only you can do that. Once you start to face your fears (start to make small decisions and then bigger choices) the depression will lift as your brain realises 'Ok, now I'm getting somewhere! I'm not stuck after all.'

[Caramoole]

Ditto to Snowbear

[jballan]

Thanks for the response!

I am just stuck on the fact that this isn't a problem for me in other parts of my life--just with her. I can't quite figure it out. I think I am intimidated by her, making me terrified of making the wrong choice. I also recently stopped taking a couple of medications, which has caused my anxiety to return very strong!

Maybe I'm not making the choice because I know I won't have to go to therapy. Actually, I am making a choice.. The choice is not to choose. I'm not sure what to think of it...

Also, don't you need to give informed consent to exposure therapy. This was never discussed with me.

[snowbear]

Also, don't you need to give informed consent to exposure therapy. This was never discussed with me.

Sounds to me like you're more intimidated by therapy than the therapist, projecting your fears onto her as though she were the cause rather than the potential cure.

Maybe you are making a choice - but it's not about choosing not to choose, you're making the choice not to engage in therapy.

And putting the blame for that bad (wrong) choice onto the therapist by thinking she's the one making you miss your appointments.

Blame thinking is something you'll tackle in cognitive therapy (once you actually turn up at an appointment!) and you'll also learn how your current thinking skews the way you interpret what's actually happening. (Putting your own spin on things, as it were.)

You sound angry about the possibility you didn't give informed consent to therapy, as if to say 'How dare she treat me this way when I haven't consented to it!' :ohmy:

Two things for you to consider before you get upset.

1. By trying to book an appointment you gave implied consent - so she's not done anything wrong.

2. Could your 'angry' reaction to the consent issue be another way of you mentally shifting 'the person in the wrong' away from yourself (for not engaging with therapy) and onto the therapist (for starting therapy when you're not yet ready to engage with it)?

When a person has a deep-rooted need to be 'right', to be blameless... their brain can be very sneaky about interpreting everything so it fits with that perfect self-image. We can project blame, feel anger, imagine unjust acts - anything but accept that its your own behaviour that's creating the problem.

Because once you accept you are the person with the problematic behaviour (not whoever you projected the fault onto), then you're obliged to try to fix that behaviour. In this case that means engaging with therapy and making those small, insignificant choices on appointment time, turning up at your sessions and learning some home truths about yourself which will make you way more uncomfortable than your current anxiety.

It's like being caught between the devil of therapy and the deep blue sea of anxiety. (I've been there so I know!)

At some point you'll be ready to face up to the changes you need to make in your thinking and your behaviour. When that happens the devil will become the anxiety and therapy will be your lifeboat. Then you'll engage with therapy willingly.

[jballan]

Well... I have been seeing my doctor 2x per week for more than 2 years. All of a sudden she is talking about exposures...

I understand I am the one preventing me from going to sessions. After all, I just need to leave a voicemail saying 11am Tuesday.. It's simple. But part of me is resistant to doing that.

I think I am upset about not being involved in the course of therapy. Not the actual course itself. I know exposure therapy is very productive with OCD. I feel like it got thrown at me with no warning.

She has made many suggests to help me and I have gone along with most of them to have them not help me. In some cases, I felt worse. I think this has led me to have doubts about our dynamic and relationship.

Edited April 4, 2016 by jballan

[snowbear]

She has made many suggests to help me and I have gone along with most of them to have them not help me. In some cases, I felt worse. I think this has led me to have doubts about our dynamic and relationship.

When we start facing our fears and begin resisting compulsions we do feel worse - before we feel better.

It's easy to think, 'I feel worse so the therapist must be doing something wrong'. This assumption can indeed lead to doubts about the therapist's ability to help you.

But again, it's easier to think 'it must be a fault with the relationship dynamic' than to accept 'I'm feeling uncomfortable but it's doing me good.'

Projecting the 'blame' for your discomfort (for feeling worse) onto the relationship dynamic allows you to stay in your comfort zone of' believing deep down, 'It's not me putting up barriers to therapy working, the problem has to lie somewhere else.'

Every time you find yourself projecting blame on something outside of yourself the chances are you're (subconsciously) protecting your self-image and avoiding the greater discomfort you know therapy will bring. Better the devil you know (OCD and anxiety) than the devil you don't know (the discomfort of therapy).

Like I said, our brains can be very sneaky! The brain will try anything to avoid doing what it doesn't want to do. It will find any excuse, blame anyone and anything but it's own behaviour - and make the excuse sound completely plausible and blameless, at least to itself.

[jballan]

I get what you are saying..

My pdoc gave me an ultimatum not long ago. She said I had to go to intensive outpatient treatment in order to continue to see her. So I did, it was all group therapy, It was triggering and I left feeling way worse than I started. I was angry about the ultimatum, but gave it an honest go. My post treatment depression screening was significantly worse than when I started. The therapist at the program was like, this type of therapy obviously wasn't good for you.

I feel like she is kind of indirectly doing that now. Even though her intentions are good and picking a time isn't going to kill me, I feel hurt. I think there is a better way to go about this, in particular, not causing me to miss multiple sessions.

[snowbear]

I was angry about the ultimatum

I feel hurt.

I think there is a better way to go about this, in particular, not causing me to miss multiple sessions.

In those three statements lies a wealth of information.

You don't like to be pushed into things. You like to be the one in charge. Your defence mechanism (when people make decisions you don't like) is anger.

You believe you should be the one calling the shots, pulling the strings. You dislike it when anyone else takes control. You see that as some kind of infringement on your personal rights (the right to always be the one in charge). You respond as though someone else taking control was some kind of personal attack and as a result you feel hurt.

You think you know best. So naturally there 'must' be a better way than the current way, since it is upsetting you.

Ok, so what do you suggest? What is it you want? What do you propose as the solution in place of what has been offered to you so far?

If people with experience in these matters say your solution won't cure your OCD, will you listen and accept they are right? Or will you find fault with their knowledge base, blame it on a relationship incompatibility issue, look to yourself, yet again, for a 'better solution'?

Can you be honest with yourself and admit that by 'better solution' what you mean is 'a solution that doesn't hurt'? A way of getting well that doesn't involve moving out of your comfort zone; perhaps a magical fix that gets you to your desired destination without having to suffer the inconvenience of the journey?

What is it you think you're missing out on in the sessions that you're not getting by being challenged over the appointment times? What are your expectations of therapy once you get there?

Let me give you a head start and tell you what you'll learn in therapy: -

Feeling angry, feeling hurt, wanting to be in control, wanting to avoid leaving your comfort zone - all these things are generated by you, not by outside forces or other people.

The consequences- being upset, feeling wronged, fearful of losing control, anxiety at engaging with therapy - these are your behaviours, your interpretation of why you feel as you do, leading to your suffering.

Nobody else is making you suffer here. And the only person you're making suffer is yourself.

Once you can see that (and accept it) you'll be well on your way to learning how to think differently about situations, how to choose more appropriate behavioural responses, and as a result you'll experience a different outcome - a happier, anxiety-free future.

Edited April 4, 2016 by snowbear

[jballan]

I don't like being pushed into things that aren't going to help me. I don't like being told I have to do something or else. Therapy is a collaborative process - of course I want to be part of it! If I know something isn't going to help me, of course I'm going to contest.

The therapeutic relationship should be one build on trust. If I am certain about an approach that won't work for me given previous experiences - the therapist should respect that and work with the patient to think of a more appropriate plan.

I saw a great analyst who never made me feel the way I feel with my current doctor. He was in control, I respected his opinion, I trusted his approach. He make inferences and decisions I didn't always agree with, but I didn't get angry. He took the time to explain things to me and I always felt "in the loop." I felt hurt because she didn't listen to me. She made a choice that disregarded my feelings and experiences. Even though I disagreed with her choice, I continued therapy with a positive attitude and an open mind.

I think she should have talked to me about exposure therapy, explained it to me and introduced a plan to include it into therapy. That way I would be involved in the process. This is my therapy - I should be informed of the process. I would have gotten the chance to ask questions, raise worries, and she could have explained things to me thoughtfully.

Feeling angry, hurt, etc., do come from within. However, people do influence these feelings. I've gone through alot with this therapist and she has flat out told me she does not know what to do at times. She admitted that the system is flawed and the things I have gone through weren't always the greatest options. Due to those crapy options I got stuck with - I have great reservations toward treatment.

Unfortunately, I've had my share of bad doctors who have led me to feel angry and hurt due to their lack of compassion, and understanding of my case. I have good reason to hold up reservation, and want to be included in my therapy plan. In some cases, I do know what works best for me, and I expect my doctor to trust me. Other times, I don't know and I have to trust my doctor to make the right choice for me. That's what collaboration is all about.

[snowbear]

I agree, in an ideal world therapy is always a collaborative process. I think, despite any shortcomings it has in reality (or how it is perceived as having shortcomings), the intention is always to make it collaborative. When it feels as though you're not central to the process sometimes that's because you've not engaged sufficiently with the process to enable you to become central to it. It's not necessarily a failure of the therapists to meet you half-way. Ask yourself if your own behaviour/choices could be contributing to the sense you are being excluded. Just a thought to bear in mind as a possibility.

But I suppose it comes down to the age old question: which is more important to you, being right or being happy?

You might be lucky enough to get another doctor/therapist like the analyst you got on well with, someone who is 100% on your wavelength and able to tailor his words and therapies to keep you feeling in control and comfortable.

But in the meantime you're being offered the same treatment, just presented slightly differently. And it's the presentation - the sense you aren't fully in control and being fully involved in the decision making - which seems to be causing you most concern.

Is being unhappy with how it's been presented sufficient reason not to engage with the therapy? Would you rather continue with your current state of anxiety and OCD than be flexible over feeling strongly you have the right to be informed, the right to be fully involved in decisions, the right to be in control?

This isn't a question with a right or wrong answer - it's a choice. Your choice. Whichever is most important to you will win out in the end.

I know for me the choice (for 40 years!) was I'd rather be right than be happy. Fair enough - that was my choice.

So I didn't engage with therapy offered from people who I felt hadn't gone about it the right way, who weren't on my wavelength, who were pushing me out of my comfort zone without asking, or were making me uncomfortable due to the kind of therapy they offered. The many therapists and therapies I rejected, or claimed made me worse, or believed were wrong for me - all this was just me not being ready to make the necessary changes to overcome my OCD and framing the problem in a way that made it seem like the fault lay elsewhere - anywhere but with me.

Some of the therapies I felt I was forced into did make me worse, and sometimes the result of therapy was I got depressed. But looking back I now see this was me digging my heels in, demonstrating to them they were wrong and I had been right. Unconsciously I made myself worse to prove a point, made myself depressed by believing things weren't going well for me - all the while blaming it on bad therapists and their faulty methods.

Now in my 50s I look back at all those wasted years and wonder why it took me so long to see the problem was as much my attitude and my way of thinking as my OCD. That actually my OCD problems arose because of my attitudes and beliefs and thinking patterns.

Maybe I just took a long time to grow up. Where I am now is the mental and emotional maturity of an adult, with the mental and emotional resilience that accompanies that blissful state. We're supposed to reach that developmental stage between the aes of 21-25, but I guess better late than never.

Now when I see young people on the forum thinking as I thought, reacting as I did, behaving as I did - and creating the same delay in getting well that I created for myself, I try to help them see the light a bit quicker than I did.

You're 100% right. It's your choice, and so it should be. Just be clear about what you are choosing in reality. Not what you tell yourself the choice is about, but that you're actually choosing between being right and being happy.

There is one thing you definitely do control absolutely. You alone get to say when you're ready to change. Nobody can force that mental change upon you.

Until you're ready doctors, therapists, analysts, friends and family can only offer their well-intended support and provide repeated opportunities for you to choose to change.

Good luck!

Edited April 4, 2016 by snowbear

[navalshukla]

Dont make any decision by your self right now. Take help of your loved one including family memeber. We lost decisions ability

[jballan]

I appreciate you responses snow bear. This has really opened my mind.

I can't imagine a future of continuing to live in my head - I don't think I could do it. I do want help, but it's scary. To think that I have to get more anxious to get better is terrifying. I can't even imagine that. However, I don't have much choice right now. It's necessary for me to face my faults - wanting to be right, needing control - in order to gain happiness.

The problem is I don't always know when my behavior is a result of my wanting to be right, or fearful of losing control. Thankfully you pointed this out to me and I now have a clue that I have a problem.

I don't really know where to go from here. I don't want to be the person that has to be right. I don't want to be the person that needs to be in charge. Somehow I developed these habits - probably as a defense mechanism.

I don't know how to undo that or relearn better behaviors. When it comes down to it - my biggest obsessions are pure in nature. I don't know how to do an exposure to obsessing about obsessing, or thinking about thinking, or being depressed about being depressed. I have to justify everything I think, even when I'm not talking. How in the world do I fix that?

[snowbear]

As you say, they are learned habits, a defense mechanism. Anything that's been learned can be re-learned differently.

Just being aware there may be a problem means that from here on you'll increasingly recognise when you're reacting in a controlling way/wanting to be right. Sometimes it's a case of 'Oops, oh well, what's done is done, I'll do better next time.' Sometimes you catch yourself early enough to stop and change direction mid-response - that takes courage, just like exposure therapy, but it gets a lot easier with practise.

I think the idea that anxiety will always rise before it improves is sometimes a bit overdone. It can happen, for sure, but the more cognitive work you do the less the rebound anxiety when you face a new challenge/ exposure. And in the end facing your fears and dealing with the problem is far FAR less than the misery of having a head knotted up in OCD and its related anxieties. As with OCD itself, the anxiety which comes from anticipating fear can be more crippling than just getting on with it.

The simple answer to fixing thinking about thinking or obsessing about obsessing is the same as for any unwanted thought - stop reacting to it, note its presence and ignore it, get on with other things. The problem fades away once you aren't giving it your attention.

Like everything else it's just a matter of practise and once you start trying you 'learn on the job' and it gets increasingly easy.

First step is to bite the bullet, choose an appointment time and go. Then you can discuss what we've touched on here with your therapist and ask for her advice/ideas on how to proceed. Take it from there. I think she'll be rather impressed by the new insights you've gained!

Wanting to change (rather than just 'wanting to be well') is 80% of the battle in my opinion.

Edited April 5, 2016 by snowbear

[jballan]

Ignoring thoughts about obsessing. That sounds impossible. It's so automatic I don't even realize I'm doing it most of the time. I guess the more I can be aware of it, I could more so ignore it. I don't really know how to ignore my curiosities towards wanting to know the meaning behind it - reality is I'm obsessing and need to figure things out.

I obsess about therapy – analyzing everything I said, what was said to me. I wonder if I should have said something differently. I wonder where my resistance stems from, I question if I am sabotaging a chance of getting better. I wonder where my anger comes from – I wonder what’s going on in my subconscious that is causing havoc in my projections, interpretations, and emotional being. MY doctor thinks I don’t think about sessions outside of therapy, in reality I can’t stop thinking about it. Trying to figure out the threads of my thoughts, values, beliefs, is exhausting. I’ve accepted I have faults – desire control; don’t allow myself to think certain things; avoidant, etc. I have a need to understand where these fears and faults are derived from – I wonder how I can overcome my fears that have such thick neural pathways, I wonder how patterns of thinking could possibly be reconstructed.