Ok, today’s IOP went really well. Dr. Coco and Ashley were fantastic. We were able to openly talk and learn from the last session, make additional progress, and hit some milestones, and I have some very specific takeaways from the session.
The first thing that really helped to put me at ease (aside from the friendly and gentle demeanor of my visitors) was a little get-to-know-you conversation. After all, this was not only the first time having them in my house, but also the first time I had actually met both of them. Both Dr. Coco and Ashley gave me a bit of personal history, which I really appreciated. It helped me to see them as real people rather than just clinicians here to run me through exercises. Ashley and I bonded over experiences traveling to India. Then I was able to tell them a bit of my story.
They then summarized their understanding of how my OCD operates, which was on point, and the work that I have done so far. They summarized their understanding of what happened in the last session and then we planned together what to do today to move forward. We decided it was a good idea to repeat some of the exercises from last session to reinforce the safety learning.
One of the exercises involved simply walking by and being in a space in my apartment that OCD had made off limits. As I did this we listened to uncertainty scripts. Almost immediately there were two small-to-medium triggers. The first was that Ashley set my phone down on my table in a spot that was “contaminated” and I asked her if she could not put the phone there. Dr. Coco did an excellent job of seizing that opportunity to dig a little deeper and we were able to, in that moment, change course and do immediate exposure to that trigger. We were able to take address it rather quickly and it diverted us for less than five minutes. When I went back to the other exercise, there was another trigger where I stepped on a crumb on the carpet unexpectedly. I think Dr. Coco’s response to the first trigger gave me permission to talk about the second one and work through it in real time. I was able to verbalize my fears in the moment and analyze and talk through my choices for responding to the trigger and the reasons for responding in different ways. I noticed that when I have an OCD response to a trigger that pushing through and taking the next step is often the most difficult part. Stepping on the crumb set off my OCD alarms, and literally taking that next step without doing anything about it was the hardest part. As I slowly began to take baby steps it really did get progressively easier and OCD slowly relinquished. It was slow and it still hasn’t totally gone away. But it happened. So that’s takeaway number one: the first step is often the most difficult.
Takeaway number two was that social interaction and laughter really help to ease the tension. Throughout the session we were chatting and laughing and it helped me to tolerate the discomfort of the exposure. I think the ultimate goal of exposure is to experience the discomfort that comes with uncertainty, but laughter in this case helped to sweeten and ease the experience (thinking of Hannah Gadsby’s Nanette special right now). It’s also helpful as a tool to help break through into new territory.
Takeaway number three was to harness the emotions that will empower me to fight back against OCD. Dr. Coco again did an excellent job of coaching me through this. In the moments of exposure where my impulse was to ritualize, she would ask me what reasons there were for not ritualizing. The main reasons of course are because OCD has taken over my life and to fight back against OCD and reclaim what OCD has taken away. “What reason do you have not to engage in ritual?” Dr. Coco would ask. “Because, screw you OCD.” Dr. Coco mentioned another client who says that both OCD and exposure therapy suck, but that you might as well do the kind of sucking that is productive. So, I will try to do the productive kind of sucking.
Dr. Coco had to leave, but Ashley was able to stick around for an extra 90 minutes. We used that time to achieve another milestone: cooking a meal in my kitchen. We cooked ravioli with marinara, a meal that didn’t actually require me to touch the food with my hands (that will be future exposure). Then we ate the raviolis out of my bowls using real utensils, and then cleaned all the dishes and loaded them into the dishwasher. It’s been five or six months since I cooked a meal and used my dishes. So… win!
So, I wrapped up today with a boost in confidence and feeling like we accomplished a lot.