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My Therapist’s Vacation and a New Diagnosis

It’s no joke when your therapist goes on vacation and you are struggling. People always say, “the worst time is when your therapist takes a vacation.” I completely agree. I have always felt anxious when my therapists have been on vacation, especially when I am ill or having a hard time.

For me, it’s no joke, no joke at all. My name may mean “laughter” but I am definitely not laughing right now.

It has been a busy year with ups and downs for me: switching therapists, getting to know my new therapist and vice versa, remembering being sexually assaulted, experiencing a moderate depressive episode (the PTSD I experienced after remembering my sexual assault most likely brought about the depression, which luckily did not become severe as it always has in the past. An increase in my newest medication is helping to alleviate my symptoms, slowly but surely). And now, the intense increase in my symptoms of my now diagnosed OCD.

I never told anyone about my obsessions and compulsions as to me, they were simply “anxiety-related,” and many of them began in childhood, therefore I became accustomed to experiencing them. I never told a family member, friend or therapist/psychiatrist about these behaviors because I was incredibly ashamed and embarrassed. My symptoms dramatically increased over the past 6 weeks and finally came to a point where I knew I simply could not live like this anymore. The battles going on in my head can last for hours at a time:

  • I turn off my iron and unplug it and then stare at the empty outlet and say over and over and over to myself (out loud) that I did unplug it. I can stand there for many minutes and even when I finally walk away, my anxiety is out of control with worry.
  • I check my alarm, once it is set, at least 10-15 times in fear of it not going off at the right time in the morning
  • Whenever I see a digital clock, I have to add up the numbers
  • I wash my hands with scalding hot water numerous times a day for fear of getting sick
  • I act on obsessions of picking at my skin until it bleeds and pick at my lips
  • I have to perform things in a certain order (I can only eat chips on a plate from smallest to largest)
  • I write lists for when I run errands and once I complete one, I cross it off but then need to write the “updated” list all over again
  • Several times a day, I have intense worries that something violent will happen to Ken and/or Iliana
  • I spin my thinking from obsessions to compulsions for hours each day, for example, I will return home from work mid afternoon and feel completely overwhelmed with folding laundry, emptying the dishwasher, making dinner, etc. (all things that are not emergent in the scheme of things). I will state out loud to my empty house the order of doing each task numerous times and change it midway thinking my initial plan won’t work. I will spin all of this while conducting each task and rush due to the intense anxiety I feel. As I perform each act, I figuratively beat up on myself for being caught up in these obsessions and compulsions. These acts also need to be completed before my well-being can be tended to, even if I feel dizzy from hunger. This “spinning” is a key symptom of OCD.
The letters OCD are thrown around a lot to describe people who are particular and like things to be clean and tidy. The reality of OCD for me is experiencing the above symptoms, plus many more, in an intense never-ending, life-interrupting way. It is torture. I am mostly aware of what is happening during the obsessive thoughts and compulsive behaviors. I can’t stop myself. I want to, but I simply can’t. The basic visual descriptor of OCD is circular: 

I don’t follow this. For me, there is never relief after completing the compulsive behaviors. This isn’t simply that I want to keep the germs away so I wash my hands a lot or that I worry that I kept the iron on. It is so much more complex and disturbing. This was made more complicated after having ECT as my short term memory is impaired. This does not help. It is unnerving and never-ending.

I told my therapist a little over 2 weeks ago. She had asked me in the weeks prior about any OCD-like behaviors as she was picking up on some through our conversations but I lied and told her there weren’t any. I was terrified to tell her because of the intense shame I felt. That night I told my husband and, as usual, he was completely supportive. To me, it was just one more thing “wrong” with me and I could not accept the thought of sharing it with those close to me.  I felt more shame and berated myself for having so many “problems.” My therapist said, you are stigmatizing yourself and that is not why you work so hard on behalf of those battling mental illness. You wouldn’t treat anyone else who described his/her OCD the terrible way you treat yourself. Intellectually, I knew she was right, but I can’t escape those negative feelings toward myself.

Since my therapist’s 2 week vacation was coming up, she wanted to have a consultation with a leading expert in OCD at Yale, whom she knows. She spoke with him and then I scheduled an appointment. I, of course, did my own research before meeting him and was very enticed by his education and experience. I knew though that many people can look good on paper but it is the actual human interaction that is most meaningful. Having an M.D. and Ph.D. is certainly impressive but there is always more to an individual.

I went to my appointment with some apprehension as it is always difficult for me to see someone new and have to relay my past and present life of having mental illness. Driving off of the highway, the same exit that one takes to Yale’s Psychiatric Hospital where I have spent much time, not only as an inpatient but where I also received ECT and ketamine infusions, was traumatic. Parking across the street from the main hospital where my husband brought me to the ER before my hospitalization 4 summers ago was traumatic. Walking into the health center and going through security was traumatic. It was traumatic sitting in front of this sign while waiting for the doctor. I felt like a lab rat.

I met Dr. OCD (I made this up prior to the appointment as I needed some way of getting through this with some sarcasm) and he was very nice. In person, he was polite, kind and obviously brilliant. This is where the positives ended. He listened to me and we went over my precise symptoms (which I brought in list form in order not to forget) and he diagnosed me with OCD. He then went on to say that phrase that no one ever wants to hear from any doctor, “Not to minimize your experience, but…” I can handle a doctor saying this to me once or twice but it was many more times that Dr. OCD said this to me. He basically, completely and utterly, minimized my experience, my hell that I am living in right now because the two options to help me do not make sense for me at this time:

1. I could see a CBT (Cognitive Behavioral Therapist) and practice exposure therapy where I would need to sit with and tolerate my anxiety regarding specific obsessions.

2. I could try a medication that he has used in just 2 other patients with the same complex mix of diagnoses and symptoms. I agreed about not starting either as I am not in a place to fully take part in CBT and I definitely do not want to add another medication to the mix when I am still coming out of my depression. He repeatedly said he understood that “this week” has been bad as it was leading to my therapist’s vacation and I had to correct him a couple of times by reminding him that it has been the past 6 weeks or so that have been worse, not only “this week.”

And that was it. Almost 2 hours telling this stranger very personal and embarrassing obsessions and compulsions I was told, yes, I have OCD, but there’s really nothing else to do right now but continue with my current medications and therapy. After about two hours and a $400 bill (I will submit and be reimbursed for this from my insurance companies), I left feeling completely misunderstood and not heard. I never expected a miracle cure but I expected something concrete I could do to help combat my painful symptoms. All he left me with was to wait a month and see how I am feeling in terms of possibly moving forward with one of the options discussed.

He is a researcher, studying medications and treatments to treat OCD and I walked in feeling like a lab rat and walked out with the same feeling. My sister-in-law said since I didn’t fit his research profile, I was dismissed. I agree with her.

I sobbed as I drove home. I dreaded seeing my therapist the next morning, the last session before her vacation. I told her how it went and she felt so badly and responsible. I told her she did nothing wrong and did everything right. She sent me to an expert for a consultation in order to help me and inform our treatment together. The session went along with me feeling completely understood, validated and taken care of. And then it ended.

My normal schedule of appointments with her are on Mondays, Thursdays and Fridays, with 15 minute phone check-ins on Wednesdays and Sundays. That’s a lot of contact and support, particularly when I have so much happening in my head. It’s a dramatic change in my schedule and life for these 2 weeks.

I can email her over the next 2 weeks and she asked that I do so as she wants to know how I am getting along. She referred me to a colleague to see while she is away and I have an appointment this week. We’ll see if I make another the second week. I simply don’t feel secure left on my own with so much turmoil in my head.

So, yes, the worst time is when your therapist takes a vacation but when I say this now, there is no sarcasm or joke involved. I’m trying to focus on getting through each day, as I did prior to her vacation, and I know she will return refreshed which benefits her and benefits me.

But for now, her vacation is no joke and I am not laughing.

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