Advice please - concerns about my current treatment (IAPT)

[cashewnutsandraisins]

Hi everyone,

I've literally just finished a session with my CBT therapist who I am working with after self-referring to IAPT.

My expectation was that we would be working more on ERP today and sitting actively with thoughts. I feel bad posting here as my therapist is lovely and very supportive, however after the session today I do have some concerns about how effective and potentially damaging this therapy could be.

I feel that this context is important - he hasn't go so far as to give me an official diagnosis, but has heavily suggested a number of times that this is OCD and GAD. 

My biggest red flag is that we spent a lot of time today discussing the trigger that first started my theme around homosexuality. This led into a long discussion in which he said all of the evidence would indicate that I am not gay - up to 99.9999999999 recurring etc percent. He did say that he wasn't having this conversation to give me reassurance and that a big part of getting over this is being able to tolerate the un-certainty, but ultimately that my history doesn't match up to the OCD theme I have.

Needless to say, despite hearing this, my brain is still fixating on the 'evidence I am gay'. He also said that he didn't think doing ERP around this theme would be helpful as he thinks with all of the interrogation my brain has done over the last year that I have already performed ERP on myself enough. He thinks the more important ERP that we need to try and do is to shift my attention away from a worry and allow myself to sit with the unncertainty. 

I also thought we would spend more time on my relationship theme as this is currently what is troubling me most. I feel in a way he has opened up a can of worms with the other stuff by inadvertently offering me reassurance, or trying to. 

The homework he has set me has also somewhat triggered me. He's also me to do this exercise on my relationship; we went through it together on sexuality stuff. I have to write a list called 'I should not worry about this unless one of these things becomes more apparent' - and then fill it in. Some of the things are making me concerned that they are evidence that I am gay already - e.g. having sensations down below, which until today I was working to understand that these are groinal responses.

I should say that these exercises might have been set more to help with my problems with worry than OCD. I did make a point at the start of the session of saying 'how do you know if thoughts are legimate concerns' and he said he would help me to create a framework, so this might be why we have done this.

I'm in a bit of tiz from it all and feeling very unsure about whether or not this therapy is going to end up causing me bigger problems with enabling my thoughts to spiral and spiral. I had fully prepared myself for ERP and then spending today focusing on not doing compulsions - instead I'm now really worried about what has happened in therapy today and if there is a problem with what has happened.

I'd appreciate any advice others may have on similar issues with CBT from IAPT

Edited April 28, 2021 by cashewnutsandraisins

[Gemma@OCDUK]

Hi cashewnutsandraisins

I haven't personally experienced CBT through IAPT but I hear from many service-users who have or currently are. It's difficult to say if what your therapist is doing is going to help you in the long term, how many sessions have you had so far?

I'm confused by them saying they don't think you need to do ERP because you've done lots of ERP already, but because they said you need to accept uncertainty, it's possible they are helping you to get on the right track. Have they helped you understand what compulsions you're doing day to day that's keeping this problem going? I would say this is a good step to understand why a lot of these worries are still bothering you.

I think the most important thing is to not worry too much right now and look to address some of your concerns in your next therapy session. If for any reason you feel a different therapist would be better, you can ask to see a different one within the same team.

Gemma

[Ashley]

I am not sure on this to be honest. I will be interested to see what others think.   

2 hours ago, cashewnutsandraisins said:

Needless to say, despite hearing this, my brain is still fixating on the 'evidence I am gay'. He also said that he didn't think doing ERP around this theme would be helpful as he thinks with all of the interrogation my brain has done over the last year that I have already performed ERP on myself enough. He thinks the more important ERP that we need to try and do is to shift my attention away from a worry and allow myself to sit with the unncertainty.

 

Part of me thinks he is right about looking at the uncertainty but at the same time we know with OCD we have to focus on not the nature of thoughts specifically, but what those thoughts might mean to your OCD.   That's where CBT comes in.  So doing some ERP work is needed, but so is cognitive work too.

 

2 hours ago, cashewnutsandraisins said:

I'm in a bit of tiz from it all and feeling very unsure about whether or not this therapy is going to end up causing me bigger problems with enabling my thoughts to spiral and spiral. I had fully prepared myself for ERP and then spending today focusing on not doing compulsions - instead I'm now really worried about what has happened in therapy today and if there is a problem with what has happened.

 

Recovery from IOCD is not just dealing with the compulsions, and you may still need to do that but facing and understanding the obsessions' and meanings we attach to the thoughts an equal part of treatment too.  So part of therapy and recovery will be taking the risk that the thoughts might spiral and being ok with that.

 

[Ashley]

Sorry just seen Gemma replied, I had started typing my response before hopping on a zoom meeting.

[cashewnutsandraisins]

Hi @Ashley and @Gemma@OCDUK

Please accept my apology for replying so slowly. To be honest, I was in a bit of a state after that session and it took me a while to get myself back together.

I think my biggest concern after that session was it just seemed like a big dose of trying to give me reassurance which I’m thinking is the worst thing to do and that the way he was trying to treat me was along the lines of ‘not really understand how OCD works’ and therefore I started to really panic about how much he could help or if this would be totally ineffective treatment because of his ‘lack of understanding’.

I’m on appointment six so far and have since had a much better session. I would say that at the moment I feel like a lot of the CBT side has been useful and I feel like there is sone improvement. I still have my concerns about his ability to overall successfully treat OCD - which he said I fit - and whether I might need to find myself seeking out an OCD specialist after this treatment ends. That’s definitely not to say that I’m in a place where I feel like I’m not getting any benefit/progress from these sessions - just seriously concerned by the reassurance that was offered previously and my uncertainty (no pun intended) around his employment or ability to carry out effective ERP.

[Caramoole]

I deliberately didn't reply to you the first time around because I didn't want to put you (or anyone else) off.  My experience of the IAPT service was that I found it very poor in terms of the Well Being Practitioners knowledge, experience or ability to offer beneficial treatment for OCD.  I also found much of it was completely contrary to what I know as good treatment.  The practitioners had a fairly "packaged", set treatment that was not applicable to me or OCD.  Much of it was quite gimmicky.  I think some of it could be helpful for certain aspects of anxiety so it's worth you giving it a go.  The idea of IAPT is a good one in that it allows people to self-refer and takes a bit of pressure off GP's who can point you towards this self-referral.  However, if you don't think it's helped tell your GP and ask that you'd like to be referred to Primary care for some more specific CBT from a Clinical Psychologist of OCD therapist.

[Ashley]

12 hours ago, cashewnutsandraisins said:

and whether I might need to find myself seeking out an OCD specialist after this treatment ends.

Sadly many people find themselves in this situation, and is not what was meant to happen with IAPT.  IAPT is meant to deliver evidence based treatment to help a person to recovery.  This is not happening all too frequently, in part because of the IAPT therapists lack of OCD treatment knowledge (sometimes lack of OCD knowledge!).

That said, it is a postcode lottery, some IAPT services do a very good job, others as yours and Caramooles experience demonstrates, less so!

Fingers crossed the remaining sessions do continue to help.   If at the end you do feel you still need help, there are some NHS options still open to you which we can advise :).