Re: First Psychologist Visit

[Guest guest]

Hi, Kathy. Our son, Josh, also has OCD and GAD. And when it was out

of control, he had a few panic attacks. Because I knew what they

were, I was able to talk him through them, getting him to breath

through them. Awful things. The twitches could possibly be due to

the anxiety being so high. Tics are not uncommon with OCD. Our son

seems to rarely not have them, and they switch around from one thing

to another.

With CBT, you should expect that first they will make a hierarchy

list. It will consist of all the rituals that your daughter can think

of that is bothering her. Then they are rated from least to worst.

They start working on the easiest, confronting the OCD. Our son chose

which one he felt was easiest, and chose the pace to work on it. He

chose when to move on, based on rating his feelings attached to it.

Rather than having anxiety attached to many of his rituals, he had the

feeling that things needed to feel " just right " . As the feelings

diminished, or disappeared, he and therapist would talk about when to

move on, and to what. It really helped that he had a say and some

control in it.

His anxiety was caused more so by the " intrusive thoughts " he had with

his OCD, and some GAD thoughts. Eventually, he was having nondescript

anxiety. I suspect at that point, he was just so stressed out, and it

had been going on for some time (taking time for the meds to work),

that the anxiety was feeding on itself. It can get to a point that it

can perpetuate itself.

Concerning the actual ERP: As an example. . .He was constantly

checking drawers throughout the house to make sure they were shut. He

couldn't only look, he had to run his hands down them to make

" absolutely sure - 100% " that they were shut. Typical OCD, needing a

100% guarantee.. . Checking, checking and rechecking. The exposure

exercise consisted of him purposely leaving drawers ajar throughout

the house. Drove me sort of nuts. I kept closing them in the

kitchen, without really thinking. Then I would have to open them back

up. <grin> Creature of habit. He rated how it made him feel, on a

scale from 1-10. As the numbers came down, it was the key to figuring

out when it was time to move on. At one point, because the numbers

were not coming down, he had to sit for 5 minutes and look at a drawer

that was ajar. It is a matter of desensitizing yourself to it.

A key thing is, if it's an OCD thing. . . And if you do it without

really thinking (like if he had shut the drawer, rather than me), undo

it (whatever it is). In that case, open the drawer back up.

Another example: He also dealt with things needing to be at a 90

degree angle. He would go throughout the house straightening things

perpendicular to each other. His exposure homework was to purposely

put things at a different angle (other than 90 degrees). Typically, .

.. The OCD switched and started wanting a new angle, so then his

homework switched to him purposely having a different angle every

time. Eventually, he was instructed to just let things be at whatever

angle they were laid down at. Once again, it is a matter of

desensitizing yourself to it, to the point of either completely

getting rid of the " need " , or lowering it to a point that they can

ignore it.

They work up the list to eventually get to the toughest stuff. They

gain confidence as they gain victory over one thing after another, so

they are prepared to take on the hard stuff when they get there. If

they start on something too hard to begin with, they will be

overwhelmed and get discouraged. It can cause some anxiety or

uncomfortable feelings when they first start confronting stuff, that

is normal, but it shouldn't be out of control. If it is, it might be

something that is too hard at that time.

The CBT part of it, is the talking back to it, in your head (sometimes

out loud), to combat the thoughts. It's often referred to as " bossing

it back " . At 16, our son felt that was a bit silly, so his therapist

had him take a bit of a different approach that also works. He was

told to think of the thoughts as something like " junk mail " like you

get in email. The OCD thoughts are the spam you would delete. When

you have a thought, and recognize it as OCD, you choose to disregard

it as OCD, knowing it has no real meaning. Choose not to give it

importance.

As far as the SSRIs, it can take some time to find the right dosage.

The first time our son took it, we noticed improvement in the first

week. Things just started to slowly calm down for him, as they got

better and better. The second time he took them, it took longer, but

he was in crisis mode. The doctor typically upped his dosage every

two to four weeks, watching to see when it helped enough to get the

anxiety under control. You should see improvement, but it can take

time. The second time our son took them, it took months to find the

right dosage.

In our case, the med did not make it all magically disappear, but it

made it less intense. And he was able to get the anxiety under

control. Many of the rituals were still there, but therapy is taking

care of them.

I've often helped our son (over the years) by going in with him and

breaking the ice concerning the tough subjects. Once I bring it up,

it helps him to discuss it. Even now, at 16, he occasionally needs

help. He's much better then when he was younger though.

With his therapist now, we both go in at the beginning and discuss how

things are going for the first 10 minutes. Then I leave, and return

for the last 10 minutes to discuss what he is going to be working on.

Explain to the therapist how you feel about being involved, and why,

just like you did to us. . That your daughter sometimes has trouble

talking about it all, except with you. They should be receptive to

that, and understand. Your daughter is so young, I expect it is not

unusual to need your help.

Explain to your daughter that the medication helps to calm things

down, making the worry feelings become less or even go away, so she

can do the homework the therapist needs her to do to get better.

Therapy should be the first line of treatment, but medication can be a

very useful tool. In some cases it is needed for the child to

function enough to do the therapy. For others, if the OCD is more

severe, they may always need meds. I realize with our son that might

be a possibility. If it is, it is. I've become resigned to that. I

would not deny him meds if he had a heart condition, or diabetes. .

So, I don't stress over it like I used to.

Generally, the psychiatrist takes care of the meds, and the therapist

does the therapy. They usually stay in touch and keep each other updated.

Hope I didn't wear you out before you reached the end of this. lol I

was trying to make sure I answered any of your concerns. It's

overwhelming at first, when everything is new. I don't think you are

being dramatic, you are being a good, caring Mom, who wants to see her

child get better. There is hope. Hang in there.

BJ

>

> I guess things went well. lol I have no clue what was supposed to

happen. The therapist talked to both of us, then each of us alone,

then both of us again. Joei (pronounced ) has OCD, GAD and Panic.

OCD is prevalent right now. She is also developing tics/twitches.

>

> She gave Joei some breathing exercises to practice nightly. We go

back in 2 weeks then the CBT will start. She told me that she will

mostly see Joei alone then give her assignments to work on. I will get

a copy of the assignment so I can make sure she does them. She said

she will see her about every 2 weeks to start with.

>

> What should I expect with CBT?

>

> The Prozac should start showing some effects soon if it is going

to work, she's been taking it since 8/8. How do I know if it is

working? That sounds silly I know!! I am thinking though that it

doesn't just magically make this all disappear.

>

> My main concern with Joei is that though she trusts me and is able

to talk to me about things she feels shameful of, she isn't willing to

do that with others. She spends a lot of time with my parents and she

hides her symptoms until I get there to pick her up. She just holds

stuff in until I am available.

>

> I've talked to her about the importance of being open and honest

with the therapist but I wonder how realistic it is to expect her to

do that. I know the treatment has to be hers, but I wonder how

involved I will be in it?

>

> I understand that I am supposed to make any accomplishments about

her and her work and keep it off of the medicines being what makes

things better. How do I explain this to her while telling her at the

same time that she has to take her meds every night?

>

> We have an appt with the psychiatrist next week to talk about the

meds, probably adjusting the dosage, etc. How involved is the

psychiatrist in the treatment? Is it just for medications?

>

> I was grateful to find she starts work very early. We will have a

7:30 a.m. standing appointment which will allow Joei to only miss

about 20 minutes of school. I will just adjust my work hours that day

to 9-5 so I won't have to use those precious comp hours that seem to

be dwindling the last few weeks due to this stuff.

>

> This is what I feel like today though: I feel like though the

last 2 months seem like forever and they have been awful at times (to

say the least) that I am in the midst of a major life change and that

I am going to be surprised at where that change takes me.

>

> I'm not trying to be dramatic at all, I know this will be a lot of

work and ups and downs but I have a lot of hope to. I have learned the

last few years though to trust that inner voice and ride the ride with it.

>

>

>

>

> ~~Kathy

>

> gkathy40@...

> http://www.myspace.com/clearingachannel

>

> Courage is not living without fear.

> Courage is being scared to death and doing the right thing anyway.

>

> -Chae

>

>

>

>

[Guest guest]

Hi Kathy, well it looks like you're off to a good start with

therapy!! BJ gave such a good reply explaining it all.

The tics/twitches might be due to the medication; ask the prescribing

doctor about that.

I think as Joei gets more comfortable with the therapist, she'll open

up more. As to the medication each day, well, it'll help therapy to

go better. And with all the " tools " she'll learn about in therapy to

conquer OCD, better chance of not needing medication for the long-

term. That's how I think I would explain it if she questions having

to do both.

Psychiatrists generally only prescribe the medication. Then you

return, say once a month, as he's checking to see how things are

going and increasing dose (monitoring the medication). Then when

Joei has reached the target dose or things are going well, the visits

will probably drop to around every 3 months. At least around here

they write prescriptions for a 3 month period and then you go back

for that " med monitoring " and get a new prescription. Visits end up

about 15 minutes.

Hope your's and Joei's day went well!

>

> I guess things went well. lol I have no clue what was supposed to

happen. The therapist talked to both of us, then each of us alone,

then both of us again. Joei (pronounced ) has OCD, GAD and

Panic. OCD is prevalent right now. She is also developing

tics/twitches.

>

> She gave Joei some breathing exercises to practice nightly. We go

back in 2 weeks then the CBT will start. She told me that she will

[Guest guest]

Lots of great information!! Thanks!

svdbyhislove wrote: Hi, Kathy. Our son, Josh,

also has OCD and GAD. And when it was out

of control, he had a few panic attacks. Because I knew what they

were, I was able to talk him through them, getting him to breath

through them. Awful things. The twitches could possibly be due to

the anxiety being so high. Tics are not uncommon with OCD. Our son

seems to rarely not have them, and they switch around from one thing

to another.

With CBT, you should expect that first they will make a hierarchy

list. It will consist of all the rituals that your daughter can think

of that is bothering her. Then they are rated from least to worst.

They start working on the easiest, confronting the OCD. Our son chose

which one he felt was easiest, and chose the pace to work on it. He

chose when to move on, based on rating his feelings attached to it.

Rather than having anxiety attached to many of his rituals, he had the

feeling that things needed to feel " just right " . As the feelings

diminished, or disappeared, he and therapist would talk about when to

move on, and to what. It really helped that he had a say and some

control in it.

His anxiety was caused more so by the " intrusive thoughts " he had with

his OCD, and some GAD thoughts. Eventually, he was having nondescript

anxiety. I suspect at that point, he was just so stressed out, and it

had been going on for some time (taking time for the meds to work),

that the anxiety was feeding on itself. It can get to a point that it

can perpetuate itself.

Concerning the actual ERP: As an example. . .He was constantly

checking drawers throughout the house to make sure they were shut. He

couldn't only look, he had to run his hands down them to make

" absolutely sure - 100% " that they were shut. Typical OCD, needing a

100% guarantee.. . Checking, checking and rechecking. The exposure

exercise consisted of him purposely leaving drawers ajar throughout

the house. Drove me sort of nuts. I kept closing them in the

kitchen, without really thinking. Then I would have to open them back

up. <grin> Creature of habit. He rated how it made him feel, on a

scale from 1-10. As the numbers came down, it was the key to figuring

out when it was time to move on. At one point, because the numbers

were not coming down, he had to sit for 5 minutes and look at a drawer

that was ajar. It is a matter of desensitizing yourself to it.

A key thing is, if it's an OCD thing. . . And if you do it without

really thinking (like if he had shut the drawer, rather than me), undo

it (whatever it is). In that case, open the drawer back up.

Another example: He also dealt with things needing to be at a 90

degree angle. He would go throughout the house straightening things

perpendicular to each other. His exposure homework was to purposely

put things at a different angle (other than 90 degrees). Typically, .

.. The OCD switched and started wanting a new angle, so then his

homework switched to him purposely having a different angle every

time. Eventually, he was instructed to just let things be at whatever

angle they were laid down at. Once again, it is a matter of

desensitizing yourself to it, to the point of either completely

getting rid of the " need " , or lowering it to a point that they can

ignore it.

They work up the list to eventually get to the toughest stuff. They

gain confidence as they gain victory over one thing after another, so

they are prepared to take on the hard stuff when they get there. If

they start on something too hard to begin with, they will be

overwhelmed and get discouraged. It can cause some anxiety or

uncomfortable feelings when they first start confronting stuff, that

is normal, but it shouldn't be out of control. If it is, it might be

something that is too hard at that time.

The CBT part of it, is the talking back to it, in your head (sometimes

out loud), to combat the thoughts. It's often referred to as " bossing

it back " . At 16, our son felt that was a bit silly, so his therapist

had him take a bit of a different approach that also works. He was

told to think of the thoughts as something like " junk mail " like you

get in email. The OCD thoughts are the spam you would delete. When

you have a thought, and recognize it as OCD, you choose to disregard

it as OCD, knowing it has no real meaning. Choose not to give it

importance.

As far as the SSRIs, it can take some time to find the right dosage.

The first time our son took it, we noticed improvement in the first

week. Things just started to slowly calm down for him, as they got

better and better. The second time he took them, it took longer, but

he was in crisis mode. The doctor typically upped his dosage every

two to four weeks, watching to see when it helped enough to get the

anxiety under control. You should see improvement, but it can take

time. The second time our son took them, it took months to find the

right dosage.

In our case, the med did not make it all magically disappear, but it

made it less intense. And he was able to get the anxiety under

control. Many of the rituals were still there, but therapy is taking

care of them.

I've often helped our son (over the years) by going in with him and

breaking the ice concerning the tough subjects. Once I bring it up,

it helps him to discuss it. Even now, at 16, he occasionally needs

help. He's much better then when he was younger though.

With his therapist now, we both go in at the beginning and discuss how

things are going for the first 10 minutes. Then I leave, and return

for the last 10 minutes to discuss what he is going to be working on.

Explain to the therapist how you feel about being involved, and why,

just like you did to us. . That your daughter sometimes has trouble

talking about it all, except with you. They should be receptive to

that, and understand. Your daughter is so young, I expect it is not

unusual to need your help.

Explain to your daughter that the medication helps to calm things

down, making the worry feelings become less or even go away, so she

can do the homework the therapist needs her to do to get better.

Therapy should be the first line of treatment, but medication can be a

very useful tool. In some cases it is needed for the child to

function enough to do the therapy. For others, if the OCD is more

severe, they may always need meds. I realize with our son that might

be a possibility. If it is, it is. I've become resigned to that. I

would not deny him meds if he had a heart condition, or diabetes. .

So, I don't stress over it like I used to.

Generally, the psychiatrist takes care of the meds, and the therapist

does the therapy. They usually stay in touch and keep each other updated.

Hope I didn't wear you out before you reached the end of this. lol I

was trying to make sure I answered any of your concerns. It's

overwhelming at first, when everything is new. I don't think you are

being dramatic, you are being a good, caring Mom, who wants to see her

child get better. There is hope. Hang in there.

BJ

>

> I guess things went well. lol I have no clue what was supposed to

happen. The therapist talked to both of us, then each of us alone,

then both of us again. Joei (pronounced ) has OCD, GAD and Panic.

OCD is prevalent right now. She is also developing tics/twitches.

>

> She gave Joei some breathing exercises to practice nightly. We go

back in 2 weeks then the CBT will start. She told me that she will

mostly see Joei alone then give her assignments to work on. I will get

a copy of the assignment so I can make sure she does them. She said

she will see her about every 2 weeks to start with.

>

> What should I expect with CBT?

>

> The Prozac should start showing some effects soon if it is going

to work, she's been taking it since 8/8. How do I know if it is

working? That sounds silly I know!! I am thinking though that it

doesn't just magically make this all disappear.

>

> My main concern with Joei is that though she trusts me and is able

to talk to me about things she feels shameful of, she isn't willing to

do that with others. She spends a lot of time with my parents and she

hides her symptoms until I get there to pick her up. She just holds

stuff in until I am available.

>

> I've talked to her about the importance of being open and honest

with the therapist but I wonder how realistic it is to expect her to

do that. I know the treatment has to be hers, but I wonder how

involved I will be in it?

>

> I understand that I am supposed to make any accomplishments about

her and her work and keep it off of the medicines being what makes

things better. How do I explain this to her while telling her at the

same time that she has to take her meds every night?

>

> We have an appt with the psychiatrist next week to talk about the

meds, probably adjusting the dosage, etc. How involved is the

psychiatrist in the treatment? Is it just for medications?

>

> I was grateful to find she starts work very early. We will have a

7:30 a.m. standing appointment which will allow Joei to only miss

about 20 minutes of school. I will just adjust my work hours that day

to 9-5 so I won't have to use those precious comp hours that seem to

be dwindling the last few weeks due to this stuff.

>

> This is what I feel like today though: I feel like though the

last 2 months seem like forever and they have been awful at times (to

say the least) that I am in the midst of a major life change and that

I am going to be surprised at where that change takes me.

>

> I'm not trying to be dramatic at all, I know this will be a lot of

work and ups and downs but I have a lot of hope to. I have learned the

last few years though to trust that inner voice and ride the ride with it.

>

>

>

>

> ~~Kathy

>

> gkathy40@...

> http://www.myspace.com/clearingachannel

>

> Courage is not living without fear.

> Courage is being scared to death and doing the right thing anyway.

>

> -Chae

>

>

>

>

[Guest guest]

Very helpful. Thanks!

wrote: Hi Kathy, well it looks

like you're off to a good start with

therapy!! BJ gave such a good reply explaining it all.

The tics/twitches might be due to the medication; ask the prescribing

doctor about that.

I think as Joei gets more comfortable with the therapist, she'll open

up more. As to the medication each day, well, it'll help therapy to

go better. And with all the " tools " she'll learn about in therapy to

conquer OCD, better chance of not needing medication for the long-

term. That's how I think I would explain it if she questions having

to do both.

Psychiatrists generally only prescribe the medication. Then you

return, say once a month, as he's checking to see how things are

going and increasing dose (monitoring the medication). Then when

Joei has reached the target dose or things are going well, the visits

will probably drop to around every 3 months. At least around here

they write prescriptions for a 3 month period and then you go back

for that " med monitoring " and get a new prescription. Visits end up

about 15 minutes.

Hope your's and Joei's day went well!

>

> I guess things went well. lol I have no clue what was supposed to

happen. The therapist talked to both of us, then each of us alone,

then both of us again. Joei (pronounced ) has OCD, GAD and

Panic. OCD is prevalent right now. She is also developing

tics/twitches.

>

> She gave Joei some breathing exercises to practice nightly. We go

back in 2 weeks then the CBT will start. She told me that she will

~~Kathy

gkathy40@...

http://www.myspace.com/clearingachannel

Courage is not living without fear.

Courage is being scared to death and doing the right thing anyway.

-Chae

[Guest guest]

Very welcome, Kathy. Glad you are here.

BJ

> >

> > I guess things went well. lol I have no clue what was supposed to

> happen. The therapist talked to both of us, then each of us alone,

> then both of us again. Joei (pronounced ) has OCD, GAD and Panic.

> OCD is prevalent right now. She is also developing tics/twitches.

> >

> > She gave Joei some breathing exercises to practice nightly. We go

> back in 2 weeks then the CBT will start. She told me that she will

> mostly see Joei alone then give her assignments to work on. I will get

> a copy of the assignment so I can make sure she does them. She said

> she will see her about every 2 weeks to start with.

> >

> > What should I expect with CBT?

> >

> > The Prozac should start showing some effects soon if it is going

> to work, she's been taking it since 8/8. How do I know if it is

> working? That sounds silly I know!! I am thinking though that it

> doesn't just magically make this all disappear.

> >

> > My main concern with Joei is that though she trusts me and is able

> to talk to me about things she feels shameful of, she isn't willing to

> do that with others. She spends a lot of time with my parents and she

> hides her symptoms until I get there to pick her up. She just holds

> stuff in until I am available.

> >

> > I've talked to her about the importance of being open and honest

> with the therapist but I wonder how realistic it is to expect her to

> do that. I know the treatment has to be hers, but I wonder how

> involved I will be in it?

> >

> > I understand that I am supposed to make any accomplishments about

> her and her work and keep it off of the medicines being what makes

> things better. How do I explain this to her while telling her at the

> same time that she has to take her meds every night?

> >

> > We have an appt with the psychiatrist next week to talk about the

> meds, probably adjusting the dosage, etc. How involved is the

> psychiatrist in the treatment? Is it just for medications?

> >

> > I was grateful to find she starts work very early. We will have a

> 7:30 a.m. standing appointment which will allow Joei to only miss

> about 20 minutes of school. I will just adjust my work hours that day

> to 9-5 so I won't have to use those precious comp hours that seem to

> be dwindling the last few weeks due to this stuff.

> >

> > This is what I feel like today though: I feel like though the

> last 2 months seem like forever and they have been awful at times (to

> say the least) that I am in the midst of a major life change and that

> I am going to be surprised at where that change takes me.

> >

> > I'm not trying to be dramatic at all, I know this will be a lot of

> work and ups and downs but I have a lot of hope to. I have learned the

> last few years though to trust that inner voice and ride the ride

with it.

> >

> >

> >

> >

> > ~~Kathy

> >

> > gkathy40@

> > http://www.myspace.com/clearingachannel

> >

> > Courage is not living without fear.

> > Courage is being scared to death and doing the right thing anyway.

> >

> > -Chae

> >

> >

> >

> >