I have no mouth and I must perform maintenance on my brain
November 11, 2010 9:12 AM   Subscribe

Fellow communication-challenged mefites: how do you work around your communication problems to participate effectively in therapy? Often I find that regardless of whether I have my thoughts lined up or not, I cannot. get. words. out, as though someone cut the circuit between my brain and my mouth. So far I've had no luck circumventing the issue by writing things down; same problem. It's inhibiting my ability to (a) convey the severity of the problems I'm experiencing and (b) address them adequately if we happen to hit upon relevant topics by chance. TL;DR details inside, but that's the gist -- any suggestions for other work-arounds?

As background, I'm back in therapy again after some years away because, inter alia, the OCD that I had been managing well with CBT techniques got away from me. My therapist is assigned through my university health system and is new to me. I'm not on any medication (I had kind of a crappy experience with the university's prescribing psychiatrist a few years ago when my last therapist suggested a consult).

Inasmuch as I can trust anything in my head right now, I think I genuinely want to speak. I can have a sentence all lined up, open my mouth to say it, and then ... nothing happens. Like getting a car all revved up, but driving straight into a mud pit. Occasionally I can get through by distracting myself from the fact that I want to talk, then blurting something out, but more often it's just driving into the mud pit faster. Last time my therapist asked if I could try writing it down instead and the thought of trying to do it made me nauseated. I'm trying to make progress by gently acknowledging the situation rather than struggling and thrashing against it, but I haven't managed to get it to stick.

As long as we don't come near topics that get my mouth locked up, I'm pretty fluent and high-functioning. Problematic topics turn therapy into <2 sentences per hour and/or a hellish, demoralizing game of 20 questions. I need some suggestions for how to get around/over/through this so I can make progress---any ideas?

I know the little voice that says that if I can't participate adequately in my own therapy, I don't deserve to get better is a complete lie, but it's a pretty loud lie right now.
posted by dorque to Health & Fitness (13 answers total) 2 users marked this as a favorite
Make sure that your therapist is not pressuring you in any way; there's nothing like an added stress to make you close up even more. I had a therapist who was too enthusiastic about trying to help me, and when I had trouble verbalizing he'd take what few words I did say and spin them off on a tangent that was not helpful at all. For example, I'd be trying to figure out what my problem was (shyness) and say something like "My father and I, um, er, one day went to the playground, and...". In those several seconds when I was trying to figure out to verbalize the fact that I was afraid of that particular playground, the therapist would say "oh, you want to talk about your father! Tell me about him. Why don't you want to talk about him? Was he mean to you?" And I'd get flustered and shut up even more.

tl;dr: Make sure it's not the therapist who's the problem.
posted by Melismata at 9:35 AM on November 11, 2010

Best answer: I was like that for a long time in therapy, and then I started writing lists to bring in every time, because i'm just a list kind of person, and also he could go through the list items one by one and we could talk about them, rather than the conversation going wherever.

I've heard this about other therapists as well, but mine got so excited about the lists, it was actually touching. They want to keep them. Good therapists really want to help you. So if you write lists and get the info out that way, eventually you'll be able to use words as well because the trust you build with your therapist will help counteract the anxiety, which I guess is the root of the communication problem.
posted by sweetkid at 9:38 AM on November 11, 2010 [2 favorites]

When you're getting your thoughts lines up, how would it feel if you said those same sentances out loud in your empty apartment? If writing things down in notes to your therapist is terrifying, what about keeping a journal? These aren't things you have to share with anybody (and reminding yourself that no-one will ever see/hear this is important), but techniques to help you bridge the feelings/thoughts/words divide.
posted by aimedwander at 10:36 AM on November 11, 2010

Are you sure you don't have a specific expressive language disorder? Maybe it's not all due to the OCD?
posted by tel3path at 10:54 AM on November 11, 2010 [1 favorite]

I have this issue which I have always attributed to ADHD combined with hating therapists.

Try scribbling, drawing, building LEGOs, knitting, or otherwise engaging your body or hands.

I am 100% serious--find something that pleases you, like, hell, scented markers, colored pencils, those shiny glitter pens, coloring books, and go wild.

It works for little kids, it works for me. I scribble, doodle, or destruct and reconstruct my writing implements vigorously the entire time I'm in therapy, or it's pointless for the same reason you describe.
posted by the young rope-rider at 12:02 PM on November 11, 2010 [2 favorites]

Best answer: Sounds like it might be part of your OCD, though you don't say that explicitly, so I don't know what you think about it. What is the consequence you fear may happen if you speak about these things? (If you don't know, maybe your therapist can help you figure that out.) Is there a compulsion associated with the fears you have? (One possibility is that you compulsively silence yourself -- again, I don't know your case, so that's just a guess.)

Your tactic of "gently acknowledging" sounds like a great start, and before anything else I'd advise you to be patient and stick with it.

Consider working with your CBT therapist to figure out what topics are relatively easy to talk about (or write down). Start with those. Work up to the really hard ones. This technique is called an "exposure hierarchy" sometimes. Basically you generate a list of difficult things, rate how difficult each one is on a 0-100 scale, rank order them, and go from there. You could plug this into a simple exposure or exposure/response prevention technique (if this has an OCD flavor and has compulsions associated with it, which might not be the case).

Alternately (or in combination with a hierarchy technique) look at different communication channels. Can you talk about these topics when you're alone? Can you talk about them into a recorder or camera? Can you talk on the phone? You could practice in one modality and work upward from there.

Also -- it sounds like you're not fond of meds, but perhaps you could work with a prescriber to find you the right kind and dose to just get you wound down a little bit. Just enough to get you started. Of course, that would be completely up to you.

Just a few random thoughts from a clin. psych. grad student. Best of luck and strength to you.
posted by PsychoTherapist at 12:11 PM on November 11, 2010

P.S.: Obviously the 20 Questions game needs to stop. It doesn't really sound like that's getting you anywhere at all.
posted by PsychoTherapist at 12:13 PM on November 11, 2010

P.P.S.: That comment was for your therapist -- not about you. I don't know why your therapist would stick with something that seems like an obvious dead end. Of course, it might be hard for you to bring that up! So I feel a lot of sympathy for your situation.
posted by PsychoTherapist at 12:14 PM on November 11, 2010

Print out your question, take it to your next session, and ask your therapist to read it.
posted by Carol Anne at 6:25 AM on November 12, 2010

Best answer: I wonder if patience would help, and starting with easier things.

You may sense that what you really want and need to talk about is X, but you just can't talk about X. You can't even bring yourself to write it down.

But maybe if you picked a few really small topics - things you might not even bring up to a friend, they're so small and seemingly unimportant - and talked with your therapist about those, you'd build up a greater ability to talk about bigger, more difficult things.

Is it possible you're trying to run, when what you really need right now is to get a lot better at walking?
posted by kristi at 9:47 AM on November 12, 2010

My therapy became more effective when I got comfortable not looking at my doc while I talk. Much easier to say stuff while looking at the ceiling.
posted by longtime_lurker at 10:42 AM on November 12, 2010

I used to write things down that were too painful to say out loud. And then I'd just hand it to my therapist. Many times we'd play 20 questions after that, only because I was still so locked up. But I could nod or shake my head and sometimes get out one word answers. Art therapy and writing poetry that I took into sessions helped too.
posted by kathrynm at 4:21 AM on November 13, 2010

Response by poster: Thanks all. We're working on less intense topics for a while, but I'll keep this all in mind if/when we swing back around to the really unpleasant stuff.
posted by dorque at 8:53 AM on December 16, 2010

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