Preparing to Start Therapy (and some reasons why you might not)
Getting started, keeping going, getting started again … it seems to me that this is the essential rhythm not only of achievements, but of survival, the ground of convinced action, the basis of self-esteem.… Calling a spade a spade may be a bit reductive, but calling a wooden spoon a wooden spoon is the beginning of wisdom.
- Seamus Heaney
At its core, the therapeutic process is a pretty straightforward treatment model: analyze symptoms, identify a condition, select the best solutions, and apply them. Of course, real life is rarely that simple. There are numerous factors that keep people from getting started, and many are deeply personal. I’m not suggesting all people have an inner desire to stay ill, or that they don’t have other legitimate demands for their time and energy. Still, I do think the biggest obstacle to health can sometimes be people themselves, so I’d like to talk about why someone might avoid treatment, and why those reasons shouldn’t be left unchallenged.
I Don’t Have the Time
This is one of the most common reasons people use for turning down lots of different commitments, parents or otherwise. Those of the preachy persuasion might retort with vague soapbox statements like ‘if you really want it, you’ll find the time’ or ‘don’t find the time, make the time’. Personally, I scoff at those ideas. They’re pompous and impractical. Instead, my suggestion is to explore the idea that you don’t have time to work on yourself. In my experience, there are a few unintentional blind spots that tend to stall progress.
I was worried that therapy would be an all-encompassing drain on my time, but that was an untested assumption. It’s not as if it only took a few minutes per week, but it wasn’t overwhelming either. Here are some specific numbers that might help: for the first two months, I went to Kevin once every two or three weeks for one hour. I was fortunate to be able to schedule appointments outside of my work hours, but for those who can’t do that, many therapy services now work online, and at odd hours. For the time required to journal and complete my therapy exercises at home, my time commitments looked like this:
- First three months: thirty to forty-five minutes per day, five to six days per week
- Three months to six months: thirty minutes per day, four to five days per week
- Six months to one year: thirty minutes per day, three to four days per week
- One year onward: journaling two to three times per week, and therapy exercises as needed
Remember, those are my numbers, not yours. Some people might need more time, others will need less. I should also note that the gradual tapering of my therapy was due, in part, to Kevin’s recommendation. Therapy is a process, not a lifestyle. At some point, it’s important to take what you’ve learned and get back out into the world to give it a try. As Kevin used to say, don’t get stuck in analysis paralysis. The human brain processes thousands of thoughts per day. Some of them have to be let go, and some aren’t worthy of introspection. Everybody’s process looks a bit different, but the common step for everyone who makes progress is the decision to get started.
Of course, my mental health time had to be balanced with work and other personal commitments, and that meant certain parts of my schedule had to change, at least for a while. There was no getting around it – some sacrifices had to be made. Honestly, though, it wasn’t as bad as I thought. Schedule changes didn’t have to be drastic, they just had to be reasonable. I couldn’t do my therapy exercises when I was at work, or when my boys were awake, so I cut my evening TV time down and woke up half an hour early on days when I was too tired to do anything the night before. I had always kept a busy exercise routine, but I also needed time and energy for therapy, so for a while I switched to workouts that were less frequent, shorter and less draining. I also snuck in journaling and therapy exercises on longer road trips (my wife and I would swap driving duties at regular intervals) and at odd down times, like when I was waiting for an appointment (phones and laptops are a great tool for that). The combination of regularly scheduled sessions and occasional spontaneity worked well for me. I’m not sure a more rigid approach would’ve been sustainable.
Again, I’m not saying you should allocate your time exactly as I did. That’s not practical, and it takes a few things for granted: first, by the time I started therapy, I had already decided that my treatment was going to be a priority. It’s an important decision, and one that needs to be made consciously. I knew I was going to have less time for leisure, but I wanted a healthy mind more than I wanted free time.
I also never thought about how much time I was losing by not starting therapy, and when I did, I was shocked. When my symptoms were at their worst, I was spending unhealthily large amounts of time – literally hours per day – doing nothing but thinking about my obsessions. As soon as I realized there was a way to get that time back and spend it with my boys, the decision to commit to therapy was easy.
Bottom line, the decision about therapy and time commitments should be made from an informed place. Here are some guiding questions that, in retrospect, I wish I had asked myself sooner:
1. Information: Do you have a specific understanding of how much time you’ll need for your treatment (day-to-day, weekly, long-term) and has that prediction been verified by a credible source?
2. Mindset: Do you have a clear idea of what you want from therapy, and what adjustments you’re willing to make to get it? I answered this question using some helpful phrases from the book Self-Esteem: A Proven Program of Cognitive Techniques for Assessing, Improving, and Maintaining Your Self-Esteem by Dr. Matthew McKay and Patrick Fanning (listed in the Resources section). This one is my favourite: in order to________________, I’m willing to _________________. The first blank is where you talk about your desired goal (it could be something tangible, or something abstract like an emotional state), and the second blank is where you declare a feeling you’re willing to have in order to achieve your goal, or a specific action you’re willing to take. It’s a simple phrase, but I found it surprisingly effective.
3. Perspective: How much time could you get back from investing in therapy, and how would you use that time if you had it?
It’s possible that some of these questions might seem confusing or just plain out of reach at first. That was certainly the case for me, but I found that getting my answers out of my head, even if it just meant articulating what I didn’t know, was a helpful step forward. To do that, you can use a journal or talk to a friend, a partner, an OCD-specific organization, or a therapist. I started off by talking to my wife, which eventually led to my first session with Kevin. As confusing and imperfect as they were, those first conversations were a huge step forward.
Therapy demands time, but so do obsessions and compulsions. It took me two months to realize it, but fighting your own mind is a waste of precious family hours, and if the quality of the time I now spend with my boys is any indication, my therapy was worth every second. Of course, treatment demands more than just time.
I Don’t Have the Money
Money is a sensitive topic. I make no assumptions about anyone’s finances, nor would I ever presume to tell you how to spend your money, but here’s something I know to be true: some form of help with OCD is accessible to everyone. When I sat down to figure out how much therapy was going to cost and what I could spend, I found it helpful to think of my financial budget along the same lines as my time budget.
First, a question about information: do you know what your treatment options are and what they cost? Here are some ideas to help get you started, listed from least expensive to most expensive:
1. Books and multimedia in public libraries
2. Online reading and videos
3. Online support groups
5. Books from public libraries
6. Books from bookstores
7. Community groups and organizations
8. Government-funded therapy (individual or group)
9. Private therapy with a social worker
10. Private therapy with a psychologist
With the exception of community groups, I have tried all of these options, and I’ve benefited from each one in different ways. Talking to Kevin was helpful because I had a private audience and could go into certain thoughts in great depth, but talking to other people with OCD in a group therapy setting was motivating because it reaffirmed the normalcy of what I was going through. Guidebooks were great for learning about CBT exercises and ERP procedures, and memoirs offered unique first-hand perspectives on OCD.
Researching the types of help available to you is a great way to start the conversation about your therapy budget. Depending on where you live, several of the options on the list above are likely free, or potentially eligible for subsidy. If you’re struggling financially but you want to access a paid option, you might consider investigating these sources:
1. Workplace benefits and employee assistance programs
2. University research centres and clinics (some offer grants or pro bono services – you’ll never know unless you ask!)
3. Your insurance provider
4. Your local hospital and family doctor
In my experience, spending money on treatments and therapies is just like any other big purchase: if possible, it’s helpful to hold off on big decisions until you have an idea of what you’ll need to spend, based on the options you want. Remember, as well, that the cost of therapy is based on more than just the type of service you choose. The predicted timeline for that expense matters as well.
Speaking of which, here’s another important information question: if you’re looking at a paid option, how long do you expect to be paying for it? Mental health treatment is like any other form of health care – intensive treatment only lasts for as long as it’s necessary, and people respond at different speeds. When I first started therapy, I went for one hour every two to three weeks. These days, I check in with Kevin on an as-needed basis, and my therapy bills have shrunk accordingly. I’m not telling you how to allocate your finances; I’m just saying that treatment isn’t necessarily a fixed, permanent expense.
Last, a point about perspective: I found it helpful to think of my therapy as a long-term investment. I had some coverage through my work, but I also had to pay for some of my sessions out of pocket. That meant less money was available for savings goals and personal wants, but it also gave me what I needed to be a better parent, a better professional, and a better version of myself. It’s an investment I would make again without hesitation.
I Want to Change, Don’t I?
One of the more surprising problems I had to solve during my treatment was a sense of inner conflict about how much I actually wanted to change. Part of me liked who I was, and I even felt protective of my obsessive tendencies because, in my mind, they had also been helpful in my life. I’ve always worked jobs that demand analytical thinking and attention to detail, and I was generally good at them because of my vivid imagination, keen eye for risk assessment, and ability to concentrate. I was worried that changing my thinking too much might mean dulling down those abilities. I also remember feeling stuck between a rock and a hard place about my ‘identity’ – if I couldn’t keep the version of myself that I had always known, who was I going to be?
The other reason I resisted change is because change isn’t easy. There’s endless research out there about how long it takes to build new habits, but those demands are doubled with OCD treatment because you also have to confront powerful thoughts and feelings about the things that matter to you the most. That’s hard enough, but there’s yet another problem: to an obsessive-compulsive, change can be a threat. If things can change, then they’re not entirely predictable, and if something isn’t predictable, then there’s a chance it could be harmful. OCD’s need for certainty can be so strong that it can make you prefer negative outcomes over positive change, because at least the negative outcomes confirm that your gut was right. More than once, I doubted my commitment to therapy because something just didn’t ‘feel right’. I felt tempted to stick to the thought patterns I had always known, because with them I at least knew what to expect. It felt easier to get by with suboptimal functioning than to bring my obsessions to light and risk losing who I was and what I thought to be true.
Here’s what I’ve learned since: OCD only helps you think creatively when it comes to your obsessions. In all other areas of your life, it makes you a more rigid thinker. I’m not a creative person because of my OCD. If anything, my OCD was likely made worse because I’m a creative thinker. I haven’t lost any of my creative abilities by getting my OCD under control. I actually find the creative process easier because I can let my thoughts flow freely, without judgment or worry that they’re going to come true. It’s a welcome relief, and it gives me a sense of confidence and agency about choosing who I want to be.
I can also tell you that all those fears about losing my personal identity because of therapy didn’t come true. I’m still a creative and analytical thinker with plenty of ability to concentrate. The only difference between ‘current me’ and ‘pre-therapy me’ is that I don’t fight the ebbs and flows of my moods and thoughts because I’m no longer worried about what they mean. If anything, that’s the biggest impact of therapy, and one that I would invite you to consider: it doesn’t erase anything in your head; it just shows you what’s going on in there and helps you choose what you want to focus on.
This Is Just Too Hard (and other forms of doubt)
Doubt comes in many forms. As a parent, and as someone with OCD, my doubt always focused on one question: can I do this? Am I strong enough to be a good parent? Can I really take all this scary stuff swirling around in my head and fix it? I doubt those thoughts are unique to me, but over time I’ve learned that they can be subtle, insidious, and very hard to articulate. Here are some snippets of my inner dialogue surrounding doubt and therapy:
1. Guilt – how can you possibly think this is a big deal when you have kids and a wife to worry about?
2. Toxic positivity – other people have it way worse than you, either with their OCD, their life situation in general, or both. Get over yourself.
3. Despair – this is just too hard. It feels uncomfortable to even talk about it. I’m getting by, so let’s just leave this alone and cope.
4. Shame – you’re just lazy. If you exercised more and got more sleep, this wouldn’t be a problem. Toughen up and get to work, already.
5. Fear – what happens if I start talking about all this and people suddenly think I’m crazy? What if my wife thinks less of me? What if I lose my job?
6. Thought-action fusion – you’re not happy right now, so you must not be happy about having kids. If you were really a dedicated father, your love for your family would be enough to fix this.
Different concepts, same theme – what if I’m not enough, as a parent, and as a person? It’s doubt; toxic, parasitic doubt. I never realized how much doubt played into my reluctance to come forward about my OCD, and I think it’s because it presented as other emotions. As I’ve already discussed, ‘toughing it out’ for my family seemed valiant, and staying in my suffering because I knew someone was suffering worse than me seemed honourable. It had never occurred to me that fear might masquerade as a positive quality, but it did.
The answers that I found for my fear and doubt were fairly straight-forward: first, whenever I felt worried that I wasn’t enough, I tried to define what I thought I couldn’t handle. The question and response pattern looked like this:
- I’m worried I can’t handle therapy.
Well, what does ‘handle therapy’ mean to you? Talking to a therapist? Reading a workbook?
- This is just too hard.
What’s too hard? Reading about mental health symptoms? Talking to a therapist? Admitting that something is wrong?
- What will other people think?
Who are you planning on telling, and how do you think they’ll react? Are those thoughts based on facts or feelings? Have you given that person a chance to verify your thought?
The key with the follow-up questions was that they forced me take specific actions, and to remember that some kind of step forward was always possible. If talking to a therapist was out of the question, maybe a workbook was in order. If telling someone about my symptoms was too hard, I could always start by typing them out and reading them back to myself in private. I also noticed that some parts of therapy felt great from start to finish, whereas others were terrible at the beginning, but amazing at the end. I loved sitting down to journal, even when my thoughts and ideas weren’t flowing, but I hated getting started with certain kinds of exposure and response prevention exercises. The thing is, somehow, the hard and uncomfortable stuff was always worth it in the end. Even if I didn’t like an exercise, it was better to sit with that reaction than to stay stuck with my same old obsessions and compulsions.
There doesn’t have to be a distinction when it comes to how you feel about therapy work; sometimes, it feels good and bad at the same time. That’s the thing about doubt, though – it’s completely black and white. Things are either possible, or they’re not. Mental health treatment isn’t like that. People’s goals are often similar, but their pathways are different, and everyone works in different ways. The answer to doubt is one action, no matter how small. Any step you take is a step forward.
What If I Still Don’t Want This?
At this point, if you’re still worried that you’re not feeling motivated enough to help yourself, don’t despair – just make sure you get to the bottom of why you feel that way. If you’ve searched for motivation and you still can’t find any, even after trying lots of different strategies, consider talking to a professional. Don’t take a persistent lack of motivation lightly. Depression can be a real consequence of OCD. I’m not saying that resisting treatment means you’re depressed, but if you’re actively choosing to stay in your suffering, or feeling like you can’t escape from it, you might be in a situation where you need more help than friends, family members, or even you can offer. Challenging your thoughts and changing yourself is a risk, but so is inaction. If you’re worried something is wrong, choose to change, or at least choose to find someone who can show you how.