If you have experience with cancer treatment, you may already know what is meant when I say, “cut out the margin.” Margin is the edge or border of tissue that is being removed through surgery. Why can’t you just cut out the “bad” part? Why must you go further? Simply, it is only deemed clean when all cancer cells are removed; if you don’t remove the margin, you run the risk for recurrence. Treatment for OCD is not so different. To strengthen your outcomes and run a lower risk of relapse, you’ve ‘gotta catch ‘em all’ (compulsions). Let’s take a look at a therapy insider tip that you might not have gotten elsewhere: cut out the margin.
Why Clients Come To Me
Clients come to me ready to get unstuck. Ready to get their lives back. Ready to leave their house without a ridiculous layer of requirements they must adhere to until their anxiety lets them off the hook. To kiss their spouse without second thoughts of contamination or checking. To wash hands like their peers. To not be tormented by intrusive thoughts. To be less anxious. To be free. And many, many more reasons.
Part of the education process in my delivery of CBT [link when you have an article] from Day One looks at how you can gain as much victory as possible over your OCD- and this naturally involves looking towards the end of treatment- today. It’s important for you to know up front what you’re committing to. Though a client is often ready to move forward with their lives as soon as they see “good enough” progress, don’t settle for that.
Encouragement to Keep Going
It is important that we don’t just stop treatment once you get symptom relief. In fact, it’s important to remember what brought you to therapy in the first place. If you are treating a chronic and/or episodic condition like OCD, research is very clear on the need to take it to the endzone:
“Leaving untreated areas in OCD is problematic because it makes relapse more likely” (Gillihan et al., 2012).
I promise- this is not the same as perfectionism. I promise- this is not to hold you in therapy longer (I’ve got way too much important work to waste either your or my time). I will always try to balance celebrating your wins and working with your real-world limitations (cost, time, motivation, etc.). But I want to be very clear here: your long-term outcomes are directly connected to whether you get rid of all your compulsions or not (when possible). If you leave behind some untreated area of OCD, you are leaving room for the “whack-a-mole” presentation of OCD to grow. Fear always generalizes as it grows; unfortunately, you won’t be able over time to stick with one manifestation without it growing. One door knob you avoid becomes two. One social situation you avoid becomes more. Obsessively mentally checking your moral intentions with one intrusive thought becomes one thousand.
Cut out the margin.
Just as in cancer treatment, get the margin. Go for it. It may seem daunting and scary. Especially if you’ve been trying on your own and/or if you haven’t gained a specialized lens for one of the most debilitating conditions on the face of the planet (medical and mental- a top 10 every year). Your long-term well-being will be better for it.
This post is intended for Christians looking to deepen their faith and mental health and may not apply to my entire reader base.
A vaccine for Sars-CoV-2 is just beginning to be administered to the public as 2020 is coming to a close, and a palpable ‘shot in the arm’ brings hope for the ravages of COVID-19 for many.
Consider with me what life was like prior to 2020? What was going well? What made you long for change? My guess is that there was aplenty wrong with the world in 2019.
“So we do not lose heart. Though our outer self is wasting away, our inner self is being renewed day by day. For this light momentary affliction is preparing for us an eternal weight of glory beyond all comparison, as we look not to the things that are seen but to the things that are unseen. For the things that are seen are transient, but the things that are unseen are eternal” (2 Corinthians 4:16-18 [emphasis mine]).
Hope is always counterbalanced with another weight- fear, suffering, pain, injustice. Even a “perfect” rollout of a vaccine will leave us with a still broken world. Where is God in suffering?
The Apostle Paul had opponents who claimed that because he was suffering, this clearly meant he wasn’t in God’s will (2 Corinthians 11:24-29). Paul gave about a thousand reasons why this was not true in his entire letter. In fact, the mere existence of hope as a concept will be unnecessary, because God promises us all our hope and faith will be realized in time (1 Corinthians 13:3, then 12-13). So we wait patiently (Romans 8:25).
Indeed, “we do not lose heart” (4:1) though we are broken vessels walking around (4:7), afflicted in every way (4:8). But….BUT, “so that the life of Jesus also may be manifested in our mortal flesh” (4:11). God keeps extending grace to us in the midst of suffering- not in the absence of it- which leads to us being more thankful and God being more glorified (4:15). So we do not lose heart (4:1).
Jesus is the suffering servant, who shocked a watching world that God’s promise of salvation would come to give up his power, suffer, and wash our dirty feet (John 13:1-17).
Lest we only consider O Little Town of Bethlehem a cute ballad of Nat King Cole, let’s remember the tension of fear and hope. Phillips Brooks, in 1877, wrote it. Did you know that though he lived in the “Gilded Age” after the Civil War- that largely saw growth and prosperity in the United States- he also wrote this song smack in the middle of “The Long Depression” of 1873-1879. Furthermore, the Reconstruction Era was in full swing, with the highs of officially abolishing slavery and the lows of deep political shifts and divides, violence, and disenfranchisement of many, not the least of which was continued oppression.
O little town of Bethlehem,
how still we see thee lie!
Above thy deep and dreamless sleep
the silent stars go by.
Yet in thy dark streets shineth
the everlasting light;
the hopes and fears of all the years
are met in thee tonight. [emphasis mine]
For Christ is born of Mary,
and gathered all above,
while mortals sleep, the angels keep
their watch of wond’ring love.
O morning stars, together
proclaim the holy birth!
And praises sing—let “Glory!” ring
with peace to all on earth!
How silently, how silently,
the wondrous gift is giv’n!
So God imparts to human hearts
the blessings of the heav’ns.
No ear may hear his coming,
but in this world of sin,
where meek souls will receive him still
the dear Christ enters in.
O holy Child of Bethlehem,
descend to us, we pray,
cast out our sin, and enter in,
be born in us today!
We hear the Christmas angels
the great glad tidings tell.
O come to us, abide with us,
our Lord Emmanuel.
God is with us in suffering as He always has entered into our world- simultaneously a world of suffering and one with hope. Let us sit in this mystery and proclaim with the Psalmist, “It is good for me that I was afflicted, that I might learn your statutes” (Psalm 119:71). A bigger hope can- and does- transcend suffering. “The hopes and fears of all the years are met in Thee tonight.”
Despite how great food at Chick-fil-A is, there is a significant correlation between consuming chicken and oil being imported to the U.S. Does this mean anything? Probably not.
If you have ever dug into statistics- in the news, in school, or even through your own research- you may have learned an important principle: "Correlation does not equal causation;" in other words, just because two things are associated doesn’t mean they are related to each other. I discovered a fun little website that features "Spurious Correlations." Check out the connection between chicken and crude oil:
So there you have it, ladies and gentlemen. Eat Mor Chikin, or don't. Obviously, it’s probably ridiculous to put any significance on this. Frankly, you and I may hold some correlations that are just as absurd. Here's an example of one I did today.
I woke up with the same irritation in my left eye that I had from my contacts last night. My thoughts jumped to a torn cornea, eye irritation, my brand new 1 year supply of expensive contacts being a bad choice, to some generalized unknown disease. I don't have Health Anxiety Disorder (the disorder formerly known as hypochondriasis), but my very human brain seems to generate all sorts of interesting thoughts and hypotheses. As of this writing, they're all correlations I'VE come up with in my "I clearly know more than an eye doctor" experience.
What I'm practicing at this moment is something I teach my clients: Observe. Pause. Engage in what you know to be good and meaningful in the moment. Face obsessional trash talk. Restructure actual harmful beliefs that are believed to be true. And wait. Wait. WAIT. Sit with it in absence of an emergency or clear decision that must be made (or disordered expectation that it should be clear and you must act now).
Stepping away from the heat of the moment, I have more clarity (as we all gain perspective when we’re not entrenched in strong emotions about a topic). It's likely just some irritation. But maybe not. I'll sit with it longer. I'll work hard in delivering therapy today. I will stop ruminating on it. I can face this. I’ll use some eye drops. I can tolerate this distress. I'll likely learn this is nothing big, but even if I don't, I bet I can learn what to do and face it regardless.
These are core components of the CBT treatment of Anxiety and Fear:
So if you correlate chicken with oil imports or discomfort with disease, you might just give CBT a try so you can live a little more in the truth of reality. You might just find some more clarity, less anxiety, and/or you can handle it. I have.
[Post update 4 days later: turned out I had a stray eyelash that had lodged itself in one the pores at the bottom of my eye. Once removed, it was fine! If I had rubbed my eyes trying to make it go away out of fear, it would have made it worse- and increased the risk of harm to my eye. If I resolutely minimized it and called it ‘nothing’, I wouldn’t have calmly scheduled an eye doctor appointment where the lash was easily plucked out.]So there you have it, ladies and gentlemen. Eat Mor Chikin, or don't. Obviously, it’s probably ridiculous to put any significance on this. Frankly, you and I may hold some correlations that are just as absurd. I did today.
This post is intended for Christians looking to deepen their faith and mental health and may not apply to my entire reader base.
One of the things that is very grounding about the Christian faith is that there is not only truth/Truth we follow, but hopefully a willingness to pursue disciplines that either a) aren't comfortable, or b), may not necessarily make sense immediately. This is very helpful in therapy when clients don’t throw up resistance to the concept of a greater good through suffering- and the need to persevere in it. If you haven’t yet accepted the tenet of persevering through suffering- and not having an answer- we must first do some preliminary work. Therefore, when asking clients to consider, for example, the hard work of facing fears of certain illnesses, social rejection, or harm, there is already an excellent platform in place. However, I also see that Christians can be remarkably inflexible- myself included. I think it’s often the backside weakness of a frontside strength: commitment to truth. But a commitment to truth is not incongruous to flexibility- the practice of humility is at the heart of the Christian walk- along with acceptance of mystery and uncertainty.
A massive University of Rochester study (meta-analysis) examined over 44 THOUSAND people and found that in relationships, psychological flexibility was a unifying key to positive outcomes. Some of these positive outcomes were:
Examples of inflexibility I often hear in Christians:
In therapy and in life, we must call out seemingly true things that are actually false, or at least not the full picture (Ephesians 4:25; 2 Corinthians 10:5; Matthew 4:1-11). I'm game if you're game. Not only is humility one of the marks of the Christian life, so is living in mystery, tolerating uncertainty with patience and joy, and simply not being a ‘know-it-all.’
Examples of hardcore acceptance, flexibility, and uncertainty in the Bible:
When feeling pervasive doubt, uncertainty, and indecision, I've got to shoot straight with you: I think we Christians tend to be a bit more annoying in learning to sit with uncomfortable feelings. 🙂 There, I said it. We’re supposed to have the answers, right? Well, yes and no. We have some incredible answers and access to the living God of the universe (Hebrews 4:14-16)!! But we are not perfected, yet. Simply put, we are not God.
Want to be flexible? Be circumspect, fellow Christians, so that you don’t fall into a trap of needing to know- being unable to tolerate uncertainty. When you demand certainty and are inflexible in enduring discomfort, you’re not only missing out on some cool benefits, you’re also missing some parts of Christian virtue- and as soon as you start living in fear, you’re clearly outside of God’s desire for you. No shame, but God wants you to experience freedom! (Galatians 5:1). There are many ways to grow in flexibility. It starts with the humility to say: “I don’t know it all.” The pursuit of the “perfect” in ourselves is often the enemy of the good. Rather, pursue The Perfect One. God is patient with His children and provides wisdom to those who ask.
A Psychotherapists' thoughts on healthy living.
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