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Staying engaged with therapy


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Hi guys,

I have been seeing a therapist for about a while now, he is really good and things have gotten so much better. The issue is that the therapy is becoming unaffordable for me, so we've decided to spread out my sessions to make it more feasible. So, we initially had appointments once a week, then spread it out to every two weeks and have now agreed to meet once a month. I realised after the discussion that the biggest thing I felt was relief, not just for financial reasons but because I've been finding the therapy and exposures very challenging and this gives me breathing room so that I don't have to do this stuff so often. I'm now thinking that this is probably wrong and not how I should be thinking. So I've made a decision to try and stay as engaged as I can in what I've been learning and to try and challenge myself on my own between sessions. Isn't that ultimately the goal anyway?

I just wondered if anyone had any suggestions for how to do this? I'm worried that I'm just going to become complacent and comfortable and fall back into old patterns. So my fear is self harm, mainly with knives. I am doing the best I can not to avoid them. Tonight I had intrusive thoughts about this and forced myself to chop up some broccoli with the sharpest knife I own. I also struggle with being at home alone so I've been trying to stay at home more when my partner is out. He is going to be away for one week in February and my goal is to spend 1-2 nights on my own, which is much more than I have been able to do in the last year. 

So these are some ideas, I realise that they aren't really extreme and I'd like to leave some things for therapy as there as some exposures I can't handle on my own just yet. 

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Hi malina,

Trying to stay engaged with therapy once one stops seeing a therapist, (or stops very focused work on a book in my case), remains to be my main issue as well. Being motivated because one's ocd is really interfering with normal life is one thing, but when we move beyond that, it is, as you know, important to keep up the progress...

Staying accountable to somebody really helps. It's like taking music lessons from a teacher vs learning on our own. Knowing you have to show up at a lesson and demonstrate what you've been told to practice can work really well. But when we have no option but to continue on our own, we must really stay vigilant to stay on top of things. 

This is my ongoing challenge.

I find coming here somewhat helpful. But honestly I'm not doing much to stay engaged.

Sometimes I try to get out my OCD book to keep me focussed but that doesn't last long either! But i would imagine that would be a good idea. To sit down at a scheduled time each week with a self-help book for OCD, set goals for the coming week, and check off each day you complete them...Ok having written that, I will try to do that myself!

It's good that you'll at least be continuing to see your therapist once a month. Maybe you can set goals together for the month ahead and at least you know you'll have to report back once a month on how you did.

20 hours ago, malina said:

Tonight I had intrusive thoughts about this and forced myself to chop up some broccoli with the sharpest knife I own. I also struggle with being at home alone so I've been trying to stay at home more when my partner is out. He is going to be away for one week in February and my goal is to spend 1-2 nights on my own, which is much more than I have been able to do in the last year.

That sounds like a great goal. I find using the SMART goal idea really good too. Keeping the goals very specific--so instead of:

"trying to stay home more when my partner is out" having it more set like " I will stay home one evening each week on my own" or whatever would be a reasonable goal.

Anyways, again, something I'm not doing great at myself but it has helped in the past.

You've been doing really well with all this. Keep at it!

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On 21/01/2020 at 05:21, malina said:

I realised after the discussion that the biggest thing I felt was relief, not just for financial reasons but because I've been finding the therapy and exposures very challenging and this gives me breathing room so that I don't have to do this stuff so often. I'm now thinking that this is probably wrong and not how I should be thinking.

I think its a totally relatable feeling to have!  Also, when its a long term challenge its even more important to find the right balance between time to breathe and time to push yourself.  While OCD recovery can be quicker if you are more aggressive, if you are TOO aggressive you'll burn out and it'll become worse.  It sounds like you are doing good work to find that balance.  So don't feel bad about feeling relieved at being able to have a little more of a breather.  
 

On 21/01/2020 at 05:21, malina said:

So I've made a decision to try and stay as engaged as I can in what I've been learning and to try and challenge myself on my own between sessions. Isn't that ultimately the goal anyway?

This is a good attitude and the examples you give are great ideas on how you can keep doing that.  I agree with Leif that setting clear goals is a good strategy.  (BTW SMART if you aren't familiar with it usually stands for Specific, Measurable, Achievable, Relevant, and Time Bound, though you sometimes find variations on the wording, the idea is to avoid vague goals that are easy to manipulate and ignore).  I also agree that working with your therapist to set goals and have it as part of your checkins each month is a good idea.  Accountability is a good motivator for a lot of people.  Another technique that you can combine with this that helps a lot of people is checklists.  Set up your goals with things you can check off, create a digital or physical checklist (erasable whiteboards are good for this) so when you do these things you can mark them off.  It feels good to check things off and it helps you have a clear visual guide to what you need to do.  It can also be helpful to keep track of key goals and achievements in some kind of record.  Think how good you'll feel when you can look back and see that over 2020 you were able to increase your nights spent alone at home from 2 a month to 8 for example (or whatever number matters).  That gets back to the Measurable aspect of SMART goals.  Being able to see this kind of progress can be a real strong motivator and reminder when you hit a rough patch or are feeling doubt over your progress.  If you can actually SEE the changes its a big deal.  Anyway hope that helps, good advice from Leif above I definitely second all of it.

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Thanks a lot for the advice @leif and @dksea. I really agree with your point about making specific goals, I'm going to work on that. I've been facing a few other issues that I'm not sure how to deal with. Firstly, I'm not getting intrusive thoughts about self harm as much and when I do, they feel less intense. But the OCD has jumped, I'm now going through a big phase of guilt. I understand that this is common, the guilt was hard to deal with at first but I'm trying to apply the same strategies to it and treat it as part of the same problem. It's just that some days it really gets to me. But that is okay, this is a work in progress and, while I haven't figured out how to overcome it just yet, I will.

The other issue is that my feelings of anxiety seem to have been replaced by apathy and I really hate that. When I was really anxious, all of my feelings felt amplified and feeling the positive emotions really helped me overcome the bad ones. I felt strong a connection with my partner and my family and I felt engaged. I am so grateful that I'm less anxious, but a lot of the time I feel distant from others, I find myself feeling like things are pointless. One thing I hate is that I'm not even enjoying listening to music as much. I do see how this is another aspect of anxiety, my mind disengaging so that it doesn't feel all the anxiety again, but I'd really love to have all the happy feelings without having to deal with the really bad ones all the time. 

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You may benefit from a little love kindness thinking. 

You can build up those positive emotions. 

Look at yourself in the place you are now. See how much better you can start to feel now the intrusions are beginning to fade and the negative emotional response to them is falling away. 

Then look around you with new eyes. Take in what you see hear feel touch smell and marvel in the experience, and the joy simple things like that can bring. 

Try a couple of new artists with your music. 

Maybe a new hobby. 

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8 hours ago, taurean said:

You may benefit from a little love kindness thinking. 

You can build up those positive emotions. 

Look at yourself in the place you are now. See how much better you can start to feel now the intrusions are beginning to fade and the negative emotional response to them is falling away. 

Then look around you with new eyes. Take in what you see hear feel touch smell and marvel in the experience, and the joy simple things like that can bring. 

Try a couple of new artists with your music. 

Maybe a new hobby. 

Thanks Roy! You're absolutely right. I think that I've been in this cycle of feeling either anxious or detached for so long now that I've forgotten how else to feel. I need to learn to appreciate everything that is around me, because there is so much to enjoy! 

I hope you're doing well!

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