Yes, I'm putting on my own oxygen mask. Now help me help others.
September 14, 2011 6:14 PM   Subscribe

Yes, I'm putting on my own oxygen mask. Now help me help others.

Therapists, OCD/anxiety sufferers, family members of same: how should I (or shouldn't I) respond when listening to someone I care about describe irrational thoughts?

My S.O. was was recently diagnosed with OCD - no compulsions, but a wide streak of thought-action fusion and anxiety issues. He's a wonderful, sensitive, and otherwise highly logical individual who's apparently walked around for 20+ years convinced that he's secretly a terrible person who, if he didn't check his thoughts and actions, would be an arrogant raging asshole hated by everyone.

We've lived together for years, so you'd think I'd be more prepared for this, but right now there's plenty that still takes me by surprise. I'm not sure how to react to his descriptions of irrational thoughts, or worse, completely skewed assumptions about how people perceive him. The content and level of intensity he brings to conversations like these were one of the reasons I encouraged him to start therapy. Now that he'd done so, the number and disturbingness of crazy mental hijinks he's willing to discuss has increased substantially. This is probably good, but I feel like it's putting some strain on our interactions.

I may need some coping mechanisms or strategies to be a better spouse here. We aren't even talking about *absurd* levels of out of touch with reality - he's not hearing voices, after all - but I still catch myself needing to weigh in on any opinion or assumption he makes that relates to his issues. If these conversations were a book, they'd have chapter titles like "The World Is Not Your Middle School Cafeteria," "You Haven't Turned Into A Drug-Addicted Nazi Pedophile Yet Because You're Not Going To," "The Algorithm That Sorts Through Job Applications Is Not Secretly Laughing At Your Resume," and "Maybe You Should Talk To Your Doctor About SSRIs, But In The Meantime, What Would You Like For Dinner?"

Anyhow. That's all kind of amusing to write out, but part of me is afraid that I'm becoming overly negative, sarcastic, or worse, actively unhelpful in my own attempts to process this as a part of our - and my - life. So I'm turning to MeFi for advice. What's the best way to be supportive when someone you love is openly acknowledging more of the crazy fucked up shit that goes on in their head? What should I (or shouldn't I) say? And if you do have to trot out that overused saying about the oxygen masks, please counter your generality with some specific questions you think I should be asking a therapist.
posted by anonymous to Human Relations (10 answers total) 18 users marked this as a favorite
Part of me wonders if he's actually thinking what he's saying...or if he's just kind of putting some of that out there to see how the world (you) reacts. Which isn't at all to suggest he's faking or exaggerating.

But I know when I've been the full flush of anxiety crazytalk, the stuff that came out of my mouth was about 1-2 standard deviations more nuts than my general thoughtstream. I think I was feeling like, "Well, I'm kinda crazy....but what would happen if I was THIS crazy...let's see if the world implodes around me."

Reacting as calm and naturally as you can, but not really engaging seems like the right "reaction" -- at least that's what seemed the most helpful to me.

But as for you coping....

Anyhow. That's all kind of amusing to write out....

This. Lather, rinse, repeat.

I'm sure the therapist can tell you much more specific things, but finding a place to write, or people to talk with who get it, and a place to be as full-bore sarcastic as you need to be seems crucial. You seem awfully smart, funny, and compassionate. Remember that you are.
posted by pantarei70 at 6:51 PM on September 14, 2011 [1 favorite]

I think there are a few tacks to take here:

1. It might be helpful for you and your partner to start thinking about those irrational thoughts as their own entity, separate from your SO. Giving it a name and setting it outside of one person makes it easier to talk about sometimes (e.g. "Are we running into the "mean reds/inflexible thoughts/ now?"). It makes it less frustrating for both of you if it's an enemy you can unite against together.

2. Ask your partner about what's most helpful to them in those moments. Do they appreciate you being able to joke about it? Do they want you to challenge the irrational stuff in those thoughts? Do they want you to ignore it? If you're not working at cross purposes, you can each support each other more.

3. You can just empathize with the feelings your partner is having, but not get involved with how rational/irrational their thought is at all (e.g., "Wow, I would feel so anxious if I were thinking that." "That's a really painful thing to believe about yourself.").

At the same time, you are well within your rights to set your own boundaries too. If there is something that's driving you nuts, it's ok to say that. Pick a time when emotions aren't running so high, explain that you love your SO, but that you are going a little nuts hearing about how other people are judging him, so the next time it comes up you're going to have to take a time out (or whatever) until the talk can turn to something else.

There are a few decent books about how to support a partner with OCD. Maybe one of these will also point you in finding some additional support for yourself.

Good luck to you both. I have all the faith in the world that this will get better.

posted by goggie at 6:57 PM on September 14, 2011 [3 favorites]

Agree with goggie!!!! Why am I even writing?

As to #2 ask him if he'd like reflective listening ("Gee, that must feel really bad.") or talk-back to his irrationality (Yes, I know you're feeling that way but we both know it isn't true. Here's why...) and teach him to tell you what he'd like. For example, he can tell you "I'm having thoughts and I need help countering them" in which case you'd launch into logical mode.

He needs to learn self-talk. This entails "talking back" to his irrational thoughts and proclaiming them to be as irrational and absurd as he knows they are. This will probably only help a little bit. Some people with OCD seem to have anxiety that "attaches" to an issue. Not only does the person know the thoughts are irrational but once the thoughts are countered the anxiety often persists. Still, this should help.

You need a pitch-hitter. Really. This is key. You both need to have someone he can call if he needs moral support and you're not physically/emotionally available. Being on-call 24/7 is exhausting even if nothing happens. It's enough to give you anxiety.

Ask him what makes him feel better when he feels bad. Maybe he has a favorite movie or needs a firm hug. Suggest these when he feels bad. Tell him how he can care for you too so you don't feel like it's just you giving.

I hope this helps.
posted by ticketmaster10 at 7:11 PM on September 14, 2011 [7 favorites]

Sounds like my ex-boyfriend, if you just added clinical depression. We found a great psychologist as well as a psychiatrist and my ex starting going to weekly (and sometimes biweekly) one-on-one therapy sessions with the psychologist, as well as starting a drug regime with the psychologist's recommended psychiatrist, and after 6-8 months, my ex was much MUCH MUCH happier, healthier, and far more functional in his daily life.

However, the first few months were HARD. My ex had alot of stuff to work through and a ton of stuff to share that I was entirely unprepared for, and he was much needier than I expected. It gets better though. :)

Question for the therapist from you: "How can I take care of myself and how can we both make sure that my SO's needs don't take over our relationship?"

What seemed to work for us:

- I acted as a reality-barometer. "Boyfriend, you're so kind and very smart and wonderful, but you ARE NOT BEING RATIONAL regarding this. I am not going to go into the numerous reasons why you don't become a drug-addicted nazi pedophile because you are presently NOT BEING RATIONAL and any argument I present will be defeated by irrationality."

- I did a lot of active listening without contributing opinion, if that makes sense. "Oh you think about blah blah blah," or "Repeating whatever: that made you feel..." or the old, "Uh huh".

- I asked about what his psych said. "What did Dr. Whatever say about that?"

- I told him that I sometimes felt overwhelmed by everything he had to share, and that I thought it would be helpful for him to talk to others about it- friends, a support group, etc. (At the time, I was the only person who knew about his thoughts/that he was going through therapy.) He starting talking to his closest friends, and joined a support group- thank god.

Also, talk to someone. I didn't share about how much I was struggling with my ex's difficulties, and I think it have been so much healthier for me if I had. Good luck!

PS: Upon checking preview- hell yeah to the self-talk recommendation.
posted by ckk88 at 7:26 PM on September 14, 2011 [1 favorite]

From a MeFite who would prefer to remain anonymous:
Hi OP,

First I want to preface all this with the following: these type of issues are not easily dealt with on the internet, and you should consider seeking assistance from a mental health professional about how to best deal with this situation. That being said:

I am very familiar with these types of problems. I suffer from OCD, and specifically, I deal with the same types of thoughts and issues that your SO does. It sounds to me like you may be dealing with an OCD-specific issue: reassurance seeking.

You see, your SO does have compulsions. They aren't physical. They're mental. They involve this "checking" that you describe, and they also involve your SO's incessant description of his fears/anxieties/worries/bad thoughts. He very well may be looking for you to quell his fears. He seems like he needs you to tell him, yet again "You're not a nazi-pedophile honey. I promise." Do you feel, sometimes, like a broken record?

I did the same thing your SO is doing now. I sought reassurance from my parents, and from my partner. I needed to know I wasn't, as you say, a drug addicted Nazi-pedophile, and I needed to know it on a regular basis by having those close to me tell me so. The "crazy fucked up shit...inside [my] head" could vary in its iterations; maybe one day it wasn't drug addiction, but rather alcoholism or insanity. Another day it wasn't Nazism, but Maoism. The specifics can and do change, but the general theme remains. Fear of being crazy/raging/asshole/drugaddict/nazi/inadequate/psychokiller/pedophile/blasphemer etc. is really kind of the same thing, when you think about it. It is fear of being "not actually a decent human being, but [the worst thing I can imagine at this particular moment]". And because of this fear, your SO turns to you for assurance.

The reassurance seeking ultimately wasn't good for me. It's ultimately not good for your man. For me, itt caused a lot of tension with my SO, and we almost broke up. It was hard on my parents. And perhaps most importantly, it helped perpetuate the cycle of anxiety I was caught in and made recovery more difficult. Ultimately, before I was able to make a solid recovery, I needed to learn to stop seeking reassurance from others and be effectively able to reassure myself.

You should try to move away from the reassurance seeking pattern. It can be a hard line to draw, and I'm not suggesting it needs to be hard and fast. It can be gentle. Obviously, you can strike a balance between being a supportive spouse- and reassuring your partner from time to time when he is in real distress - and being mindful of the cyclical nature of reassurance seeking generally, by trying to wean your SO off this method of coping with his anxiety. OCD treatment doesn't work quickly. I've heard the phrase "it takes a big ship a long time to turn around" in various circumstances before, and I've been struck about how good that metaphor is for OCD management. It's a process that's ultimately going to take years to perfect, and it's ultimately got to come from your SO.

Learning to deal with that much anxiety takes time. Seriously. The amount of anxiety your SO experiences when he is in a bad state is incomprehensibly overwhelming to you. I don't mean that in an insulting way. I just mean that this disease is capable of sustaining for hours and hours a level of utter panic and fear that you, perhaps, have experienced only very briefly, like at that surprise moment in a horror movie. I just mean that it's a level of sustained intensity that I simply don't see present in people lacking a serious anxiety disorder.

For me, it took about 1.5 years, from when I started seeking treatment until when I felt really in control of my life again, although I had significant and noticeable improvement over only a few months. Part of getting better was learning to stop relying on others' reassurance. Your SO will (eventually) have to learn to be mindful of how much he is leaning on people close to him. But it's going to be hard, especially at first, and you're going to have to accept the fact that it may be a rough few months.

And it never disappears. I still have OCD, and every so often it becomes disabling. (For me it happens a lot when I travel or have a lot of time to do nothing). But I'm able to work at a very demanding job, maintain a relationship and a large group of friends, and for the most part be able to dismiss my crazy thoughts when they appear. A few times a year, I may end up asking my SO for reassurance. So I think there is real hope for you that what you are dealing with right now is temporary.

Anyway, I suggest talking to a Cognitive Behavioral Therapist. Why not schedule a session or two? They will likely understand what your SO is dealing with, and help you formulate an effective strategy for helping both him, and yourself, with this disease. I also suggest reading up on OCD literature to get a better picture of this. Dr. Edna Foa and Dr. Lee Baer are two experts who have written extensively on OCD.
posted by jessamyn at 9:17 PM on September 14, 2011 [4 favorites]

You're funny as hell, great writing. You could start a blog about this, or probably anything else, and people would show up and read it. Hell, some people could check for new posts obsessively, and compulsively, and like that, and then feel bad about it, and tell you; it'd be swell!

He's breaking boundaries, in a big way. He's like a toilet overflowing, truth be told, and that's usually not my idea of a fun time, nor yours I'm sure. You have a right to tell him "Hey punkin-seed sugar-pie sweety-kins, I sure do love you all to pieces but you're going to have to take this to your therapist. You've mistaken me for a therapist, but no, that's incorrect, I'm your funny-writing sweetie, who's fixin' to bust your chops if you don't knock this jive off pronto."

My mentor and his wife have this beautiful thing they do -- at any time, if one or the other feels threatened or put upon or anything else, they reach out and put their hand on the others arm. That's it. They've agreed -- ahead of time, it's part of their love -- they've agreed to shelve anything they are doing, to just stop the show, and talk about it later, if at all. I'm thinking you can get something like this with your sweetie; he starts in with "Hey Darlin', I'm a big lump of sweaty, greazy oafish pig fat" and you just reach out and touch his arm, or have a safe word or phrase that you use, and no, I'm not suggesting you use a phrase like "Hey, knock it off you jerkoff!" but rather something like "I love and trust you." or maybe even just a meaningful look.

And if he can't stop -- won't stop, really; even though it'd be hard, he'd stop if Abraham Lincoln was there, and he wanted to talk to him about the Louisiana purchase or something -- if he can't/won't stop laying this on you, um... I dunno. You don't want to abandon him, but to allow yourself to get dumped on all the time is abandoning your own needs; not a good plan.

Overall, love him, but not at the expense of putting you second, at least not often, and not for long. It's part of love to care for one another, and help one another, and all of that's just swell, but we're to carry the love, and not the person. You can't let him down unless he's leaning all over you, and, hard as it is to stand up, or even if he can't stand up for a while, and staggers around and falls out some as he goes through his process, I think we're supposed to try to stand side by side, not wrapping around one another, choking off the sunlight to each other.

If you write, plz let me know somehow, I'd follow you.
posted by dancestoblue at 1:56 AM on September 15, 2011 [2 favorites]

My ex has OCD; our teenage son also has it. My son got treated with amazing CBT and he barely has signs of it on a daily basis. But when he was full-blown or he gets a seasonal trigger it was really hard to figure out how to help him.

My life became running interference for his OCD. After he'd ask me five times if he wrote his name in his math right, I wasn't certain if I was supposed to answer him, ignore it, or say "This is the OCD talking; not you."

What helped the most for me was a little bit of family therapy. It gave me tools to better help him but also, it gave me tools to help myself because while he's my son and I love him, I didn't really want his OCD running my life. So with some help I discovered appropriate responses to his worrying (I most definitely didn't realize that I had actually been fueling it for years by answering all of his questions).

So I would ask if you could have a few couples sessions to better understand how you can help him but how you can also have a sane life.
posted by kinetic at 3:30 AM on September 15, 2011

...I should say that my son has a "toolbox" of strategies that he uses when he's having thoughts. Now, when he comes to me to confess or wants to talk about the intrusive thoughts, I just tell him that he has a toolbox of strategies to use and that he has to go pick one and use it. And he does.

I learned that all those times I sat with him and listened to his worries and tried to reassure him with, "You're not going to turn into a monster (or whatever)," I was actually feeding the OCD monster.

A good therapist will tell you the same, but will also tell him the same, so he doesn't think you're unsupportive and the OCD is truly his to manage and every time you get into reassurance mode you're actually making it worse.
posted by kinetic at 3:45 AM on September 15, 2011

What's the best way to be supportive when someone you love is openly acknowledging more of the crazy fucked up shit that goes on in their head?

Point them in the direction of people who do that for a living.
posted by flabdablet at 6:57 AM on September 15, 2011

Possibly a better example.
posted by flabdablet at 7:14 AM on September 15, 2011

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