Once in a while a client comes along who defies all the odds, making incredible progress despite very complicated issues. The issues included depression with suicidal thoughts, severe obsessive compulsive disorder and near complete lack of function. This person was unable to work, to sleep, to eat, to leave his apartment or to care for himself in even the most basic ways. The psychiatrist and I strongly recommended that he be hospitalized for treatment. He declined this option. The second option was to move back home, take medication and begin intensive cognitive behavioral therapy. He took this option.
His OCD symptoms centered on fears of contamination. His compulsions required him to wear 4 pairs of surgical gloves, wash his hands up to 90 times and to clean every single item that entered his house. This is why he had stopped leaving his apartment, stopped sleeping and stopped eating. It was just too exhausting. As a result he was severely depressed and felt hopeless and helpless.
The decision to move home was a very difficult one since he’d been out on his own for very many years. The treatment plan included sessions with the client and his parents to set guidelines and boundaries. The parents were supportive and loving; they were not to be his therapist.
The cognitive behavioral therapy that was utilized was ERP, exposure and ritual prevention. He slowly but surely went from hand washing 90 times to 80 times to 70 times… As his confidence in himself improved he was able to shed a pair of gloves almost every week. He started eating better and sleeping better since he no longer had intricate long cleaning rituals. He even joked that now he had time to catch up on movies and TV. He demonstrated such courage in addressing his overwhelming fears! As Mark Twain once said, “Courage is resistance to fear, master of fear – not absence of fear.” His transformation was nearly miraculous; yet it was due to his determination and commitment to get better. He took his medication as prescribed by the psychiatrist, he set his goals and he did the hard work of treatment. Within 3 months he looked and acted like a different person than the one who had entered treatment. He no longer felt depressed or hopeless. He was able to begin a new life.
I picked a quilt with a pattern called disappearing pinwheels to honor this man’s courage. The pattern begins simply but then requires multiple cuts and twists to achieve the design. Then the task is to sew all those pieces back together. Treatment sometimes looks and sounds simple but the application is often a trial of twists and turns and cutting out behaviors that have felt comforting for years. The effort is worth it; hope and confidence returns.
It’s Not a Race but I Won Anyway: OCD
The first time I went to a quilt camp we were given the option to work on a camp quilt. Those who wanted to participate brought flannel rectangles, exchanged them with others, and made the same quilt. Over the next three days I diligently worked on the quilt and was able to piece it, quilt it and bind the edges. I finished the entire quilt! The other quilters were surprised because most of them worked on other projects throughout the weekend and had no intention of finishing the camp project that weekend. I didn’t know any better. So the next quilt meeting the guild president gave me a blue ribbon entitled “It’s not a race but I won anyway.”
Fast forward years later to a teenager I met one day who came in for therapy for OCD.
This 15 year old had a multitude of compulsive behaviors due to obsessive fears and worries. The list was extensive: unable to leave home without checking the locks 10-20 times, unable to do laundry for fear he had drank the bleach, unable to swallow any pills his entire life for fear he would choke, and many others. This would be a big project because the behaviors weren’t limited to just one area of OCD.
Many people with OCD have symptoms clustered in one area, such as checking, ordering, washing, hoarding, etc. His were severe in several areas. We began working on his list through cognitive behavioral therapy, specifically exposure and ritual prevention techniques (ERP.) He was determined to get better and worked weekly on his goals. One week his goal was to learn to swallow pills. The exposure technique employed was for him to swallow a mini M&M candy each day. He came back the next week and said he’d done it several days without anxiety but then stopped. When I asked why he stopped, he sheepishly admitted he’d eaten the rest of them. His Mom agreed to buy more for that week and then move up the exposure to learning to swallow tic tacs.
He got sick before the next appointment and was prescribed antibiotics and he decided to take pills instead of liquids. By the time I saw him he’d’ accomplished most of the goals on his entire list. He was only checking locks once, he was doing laundry and had learned how and when to use bleach on stains, he even volunteered to do the cosmetology class towels at school! Once he got stared there was no stopping him.
It wasn’t a race but he won anyway!
Tea cups OCD
An older woman entered my office one day and proclaimed she came in ready to work. She said, “I’m getting too old and too tired to keep up all the rituals I have about cleaning.” She admitted she had obsessive fears about germs and washed items excessively in her house. And so therapy began.
She focused her energy on resisting the urges to compulsively clean. When she was unable to resist she had to “undo” her cleaning by deliberately getting the items dirty again. One example of this was that she had to touch the floor with the dish towel and use it the next day to dry dishes. Tolerating anxiety and uncertainty is a cornerstone of treatment. Whenever she faltered I reminded her she was “too old and too tired” to keep doing so much work.
We knew her therapy was successful when her granddaughter came to visit one weekend. The little girl was setting up for a tea party and told her Grandmother that the tea leaves were already in the antique tea cups. What she was seeing was dust in the teacups! Grandmother laughed and enjoyed the party. No more excessive cleaning for her. She had plenty of energy to enjoy her children and grandchildren now.
School Phobia: Fairy Quilt
Kara was an adorable little six year old who had a not so adorable problem; she didn’t want to go to school. She cried, complained of stomach aches and felt so nauseous she threw up sometimes. She was afraid to leave her parents. By the time she finally got to school she was exhausted from all the anxiety. What’s a girl to do? She came into therapy.
Kara and her Mother learned about the causes of anxiety and the three areas to work on in order to get better. They learned physical, behavioral and psychological strategies to help Kara cope with her school phobia. We all need tools to deal with difficult parts of life, Kara put her tools into an imaginary toolbox. Using the “toolbox” was a concrete way to organize her new found skills.
We came up with a great tool to help with her physical symptoms. Kara loved to dance and twirl around. We decided that when she started to worry she’d fly those worries away. Her mother or father would lift her up and twirl her around like an airplane. She also could turn on some party music and dance. She loved it! She got really good at challenging her worrisome and scary thoughts.
Her comment one day was priceless and I remember it years later. “Sometimes I go too far with my imagination!” Wow, such wise words from a six year old! Another gem was her remark when she told me about getting upset at school one day. “I cried a little but got over it.” Several weeks later she came in and announced, “I’m all better now,” and she was indeed.
The fairy quilt I made reminds me of that brave little girl who learned to fly away her troubles.
All That Glitters
Obsessive Compulsive Disorder (OCD) Perfectionism
Do you ever want some project to be absolutely perfect? You spend a lot of time on it, but never quite finish it? You are not alone, most of us have unfinished projects lurking in our closets or garages. But sometimes the desire to have things “perfect” interferes so drastically with the process, that people lose their jobs, their friends and their self-confidence. They overly obsess about minutiae and compulsively try to achieve perfection and life becomes overwhelming. This person is experiencing OCD.
Today’s quilt was started in a class which required extremely accurate piecing because each block had 24 pieces. When I worked on it at home, I had to calm myself if each seam wasn’t exactly 1/4 inch, because if the seam was just two threads short, the pieces wouldn’t fit together. The quilt I made is called “All That Glitters” and it represents the disorder I am sharing here today. “All that glitters is not gold,” so goes the saying. Sometimes life is about working hard, accepting the imperfect and learning limits.
Larry was a historian and worked at a library researching and cataloging data about Civil War engagements. He was so obsessed about accuracy that he checked and checked and checked his work. He worried so much about his accuracy, second guessing his every move, that he was always late for his deadlines, though he stayed at work 10-12 hours each day! He’d come home fatigued at night but couldn’t sleep because the “what ifs” got him. The “what ifs” are a symptom of OCD in which the brain is constantly questioning if something was done correctly. It was only after we worked on addressing the “what ifs” that he was able to tolerate letting go of the unattainable goal of absolute certainty and accept that his conscientious work was sufficient for the task assigned. He learned to build confidence in himself and trust himself more. Achieving perfection was no longer his goal. Working hard, prioritizing work and completing his assignments on time were his current goals.
By the way, I did work long and hard on this quilt, it is not perfect, but I’m still pleased with it.
Stack and Whack Quilt
This quilt was quite a challenge. The directions involved lining up repeats of fabric exactly one on top of another and then cutting them all up. The excitement was seeing the kaleidoscopic designs that were then revealed. Yet the work was not done; now I had to sew all those pieces back together. Yikes!
Building self-confidence is a lot like the process of making this quilt. There are many steps to the process and you don’t know the result until the end.
One year I was working with a wonderful teacher who came into my office suffering from anxiety and depression. Mary felt her work was never good enough. She criticized herself for not developing more exciting lesson plans, not being more active in school activities and not offering more individual help to her students. The reality was that her classes were sought after by the students, we’re always full and she had been nominated for teacher of the year!
After many sessions challenging her thoughts about herself in cognitive behavioral therapy, I asked her why I had more confidence in her than she had in herself. “That’s easy to explain, “she said, “You are basing your confidence on facts.” Amazing! The facts about her achievements were not enough for her. She wanted to know the outcome of her career before she finished it, we discovered. So we went back to the facts, lining them up exactly so she could see and feel them and begin to believe them. Then we had to sew them together to build a strong bond of self-confidence based on reality not fear.
Life is a journey and the final results are not revealed until the end. Be pleased with all the phases of your life and take pride in all your accomplishments. Believe In yourself and remember, it never hurts to believe in the facts!
I’m posting this entry at the beach so the picture was taken in Wildwood NJ.
Along came a spider: Simple Phobia
This little quilt, 12″ square, was part of a challenge to make a quilt inspired by the word falling. I used an unfinished block that looks like a spider web and added spiders. Spiders and fear are the theme of this story.
Phobias are irrational fears that cause the body to trigger a fight flight response. The person with a phobia usually has many uncomfortable symptoms, both physical and mental, that makes them want to escape. Yet escape will only reinforce the fear. The goal is to approach not avoid. People only come in for therapy when a phobia significantly interferes with their life.
So how could something as small as a spider prevent a person from functioning?
Let’s look at Sam. Due to his fear he was unable to leave his home if he saw a spider web near his house. This did not bode well for his work schedule. He’d also have to check his car before any trip and drive with the windows up. This all took an inordinate amount of time. He’d never eat outside. So yes, it seriously interfered with his life!
He learned deep breathing exercises, relaxation and desensitization techniques. Then the fun began. I’d bring in spiders to the session and we’d practice calming techniques. Eventually the spider was left out of the jar and he’d have to catch it and take it outside.
Through this exposure to spiders he was able to desensitize himself to their presence. Through cognitive reframing he was able to check the irrationality of his fears. Sam also learned to use the appropriate technique to calm his symptoms. He never did like spiders but he was no longer afraid of them.
He didn’t allow those arachnoids to spin him in a web of fear!
I’m new to this blog thing so in the previous blog I failed to identify the name of the quilt, which is Storm at Sea, and the quilter who made it, my friend Bonnie Anderson, and the title of the story, Childhood Bipolar Disorder. Hopefully I’ll improve as I continue this journey!