Monday, February 21, 2011

15 Minutes at a Time: The FlyLady and Exposure Therapy for OCD

15 Minutes

In January, faced with increased difficulty finding things in my house, and general chaos, I remembered reading about the FlyLady, and went to her site. Just going there was an exposure for me, since my perfectionism starting raring up, but what I like about the FlyLady is an explicit acknowledgment of how much of the home clutter chaos stems from this very perfectionism. The fear that you have to do it "right" and all at once, and rip apart every closet and scrub every surface.

She advocates doing 15 minutes at a time, and then stopping. That's the hardest part for me. My perfectionism OCD gets entangled in this, and once I start a task, I feel anxiety at the thought of stopping before the task is done, even if there's no clear ending point, and so I keep going until I exhaust myself and it seems preferable to avoid cleaning at all. For someone with contamination OCD the feared consequence may be that nothing is clean enough after only 15 minutes.

The FlyLady is practicing a form of Exposure Therapy. She dares her readers to do housework imperfectly, incompletely, incorrectly. The irony of OCD is that it's all about the anxiety not about reality. Avoiding cleaning altogether is not more "perfect" than doing 15 minutes at a time. A refrain on the FlyLady forums is "I've got so much to clean up that 15 minutes isn't enough time." This kind of thinking is part of why I didn't start actually doing exposures right away when I finally found an Exposure Therapist.

I saw the enormity of my compulsions and anxiety, and I wanted to be better immediately because I was in pain, but also because my perfectionist OCD made it seem dangerous to have a learning curve, to proceed slowly, by trial and error, imperfectly, haltingly, erratically. I needed to do things instantly, the first time, or my feared consequence was that I was a worthless failure. Again, the reality is that avoiding learning or taking small steps serves to give a relief from the anxiety of facing the fear, and yet paradoxically, set me even further behind in getting better from my OCD.

What I have learned in therapy is that anything above zero is good. 30 seconds of resisting compulsions is good. 1 minute. 5 minutes. 15 minutes. It's all good. Exposing myself to something I fear, even if it is the least of my fears, is good. Perfectionism says that you either get better all at once, or you don't get better. This doesn't give me my life back. It keeps me trapped in my compulsions. In 15 minute increments I have cleared through the chaos of my house. The FlyLady motto is that you can do anything for 15 minutes, but for 2011 she's challenging us with a new motto: Let's Go for Seven in 2011

Seven minutes on the timer, because 15 minutes can still be too daunting. The FlyLady says that housework done incorrectly still blesses your family, and in the case of debilitating rituals, this is a powerful statement.

Thursday, February 10, 2011

Finding OCD Support Groups

The International OCD Foundation's new list of support groups is now live! I had started a list of OCD support groups for adults in the US and Canada when the IOCDF's page was under construction. I am going to leave it up for now, but I encourage readers to go to the IOCDF's support group page. You can search by location or alphabetically.

If there isn't a group in your area, there is a link to a manual by Dr. Jonathan Grayson on how to start your own GOAL group. The support group I've attended is modeled on the GOAL group structure of having a time of sharing followed by making a concrete goal for an exposure to do before the next group meeting. It was very helpful to have accountability and support from other people who understood what it's like to have OCD.

Sunday, February 6, 2011

A Shout Out to OCD Reflections: Things I Have Learned The Hard Way

Imperfectly perfect

None of my progress in Exposure Therapy has come through being perfect. None of it was perfect. My therapist said this last week, and it has been on my mind. Perfection was not required in order to do my exposures, live my life, get better from OCD. In fact perfection is the enemy of ever getting started. Then I read Fellow OCD Sufferer's latest post, Things I Have Learned the Hard Way. I encourage you to go read it if you haven't already. She's getting at the heart of some really important stuff for those of us who suffer with perfectionism OCD. I especially resonated with this:
The thing that I kind of overlooked was that whole middle part - you know, the part where you have to do the work and you don't like it and you feel like it's "too soon" or "too much" or "not time yet." Yeah, I kind of forgot about that part. . .
Waiting for the day when I feel like being "better" to take action, waiting for a time when I'm 100% sure I want to be well and want to do exposure, isn't exactly a sure-fire strategy. In fact, in retrospect, it's almost doomed to fail. It is unlikely that there will come a day when suddenly getting "better" seems easy or completely "right." If that day does come, it probably means that I'm doing something wrong...
I overlooked the middle part too. Like Fellow OCD Sufferer, I am an "OCD Nerd" and had read a thesis' worth of information about OCD, and wanted to do my Exposure Therapy perfectly, which delayed me actually doing much in the way of exposures for my perfectionism for almost a year. In spite of muddling along, I am getting better. My therapist would say there is no other way, that perfection is never an option. This is both liberating and scary. The perfectionism chimes in with "Well, if you can get better, then you will REALLY have to be perfect." I am getting better at recognizing all the guises of my perfectionism, and how rickety the arguments are, and how stifling. I am heartened to read posts where a fellow sufferer gets to the heart of the matter, the moment where you move forward, in the midst of all the "not ready" "not yet" "not right" moments.

Tuesday, February 1, 2011

The Purpose of Therapy for OCD vs. the Goal of Therapy for OCD

Motivation Mind Map
I remembered something the leader of my OCD support group said, "The goal of treatment is to live with uncertainty. The purpose of treatment is to reclaim your life." Sometimes in the short term all I can see is the goal of Exposure Therapy, which is to tolerate uncertainty until the anxiety recedes, or to use the fancy word, until you "habituate" to the anxiety. And often I read comments on the OCD Support Group that reflect a fear that the goal of Exposure Therapy is to suffer, "learn to live with the anxiety" or give up the possibility of any peace.

It helped me to connect the pain of doing Exposures with the purpose of doing them. My therapist didn't ask me to do Exposures just for the sake of doing them, or because it was "correct treatment"--he asked me to do them so I could reclaim my life. The first time I met with him, he listened to my history of having OCD, and said that OCD was a disrespecter of my person. I was struck by this. Much of what is important to me was lost inside the OCD. Connecting with what I value, love, am passionate about, gives me motivation to do my Exposures. I love making art, and this often gives me the fuel to defy the OCD pull toward compulsing, and therefore losing many hours in my day to rituals.

Jeff Bell, IOCDF Spokesman, in his new book When in Doubt, Make Belief: An OCD-Inspired Approach to Living with Uncertainty, argues that human beings are motivated by what they value, by making a difference, and doing things for the greater good:
As seen through the distorted lens of unhealthy doubt, "good"
choices are those that reduce our anxiety, while "bad" choices are
those that increase our fear and introduce uncertainty.
Some of the choices that I want to make, cause me anxiety, and my OCD tendency would be to label them bad, and this crashes directly into an essential part of my soul that knows I want to make these choices, that there are things I want in this life, things I desire to accomplish and experience. With OCD it's hard to inhabit your own life. When I think about all I've lost to compulsions, I feel a deep grief, but every Exposure I do allows me to move back into my own life.

What are some good choices that you've made that *increased* your anxiety, but which you chose anyway, because they were in the service of something important to you?

Jeff Bell's Memoir Rewind, Replay, Repeat
What do you want your life to be about? Action and Commitment Therapy for OCD