“We
used most of the hour to ‘study’ client’s Obsessive-Compulsive disorder, to
which she added Depersonalization Disorder (she named the diagnosis herself).
Client said that she ‘always’ feels ‘not real,’ as if she is living in a dream.
It is this state that will lead to her panic attacks: She becomes afraid that
she is not real or will never become real.”
An agency email informed me that the mother of my 17-year-old client felt I should
have made greater inroads into her daughter’s problems in five (Intake plus
four) sessions, and that she would be quitting me. I admit I am wondering what
the next therapist will do to throttle the teen’s hours-a-day magical compulsions,
and what will be used to dissolve the intrinsic-seeming cellular numbness of Depersonalization.
I had my ideas, which I was already giving her. There was some Peter Levine’s “somatic
experiencing,” which tries to break a trauma victim’s sensory anesthesia by
interesting body-based techniques. I also know that Depersonalization is one of
many possible results of the perfect deflection of the Real Self’s feeling, and that recalling
of pain and deep bawling or other radical expressions of loss and need might
break through it. Add, though, the constant safe-making escapes of obsessive-compulsive
urges to the agenda of the day, and you have a person who is quite
inaccessible, effectively doing tight somersaults in a thick-walled bunker buried
just beneath the surface.
I have never
studied the behavioral techniques against OCD such as the panacea of CBT and
Exposure and Response Prevention (ERP). I don’t care about them. For one, ERP
sounds absurdly oppressive for a teenager, especially one with a dozen
discrete obsessions and compulsions. That’s a ton of brute-force to push on someone who isn’t at a life stage to be an ascetic. I feel the same about a
cognitive approach – trying to swamp old thoughts with new ones. Exhausting and
dreadful!
I will miss the
young lady, but not – I'll admit – for her personality. Pardon the terrible
humor, but with her depersonalization, she didn’t have one! I will miss the
sense of possible breakthrough to the feeling person beneath her zombieness and
her rituals. In fact, I see all my clients from this perch: When is the deeper,
original person going to come out?
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Comments are welcome, but I'd suggest you first read "Feeling-centered therapy" and "Ocean and boat" for a basic introduction to my kind of theory and therapy.