“I’m always fine.” I gave her a grin, and slid into the old beater. “See you on Friday.”
She watched me through the windshield for several seconds, like she wanted to say more, and then turned and strolled back to the shop. I watched her go, a sinking feeling in my chest. When she made it back to the shop, I pulled out my cell and powered it up.
Ignoring Hank’s twenty or so messages, I left the shop and drove a few minutes until I reached a pull off. Sitting idle but mostly hidden on the side of the road, I navigated to my phone’s browser and spent the next ten minutes reading about exposure therapy.
And then I drove home, certain that the best use of my time on Thursday—which was my day off—would be researching and learning everything I could about the topic. And then I’d call Dr. West.
I wanted to be prepared to help Shelly.
* * *
I reached out to Dr. West Thursday morning and she called me back that afternoon.
“Sorry for the delay in calling.” I didn’t want to say that Shelly’s reluctance to give me the informational paper—and Dr. West’s phone number—had been the reason for my tardiness.
It had been, but I wasn’t going to throw Shelly under the bus.
“It’s perfectly fine. And know that you are under no obligation to come tomorrow if you’d rather not.”
“No. I definitely want to come.”
“May I suggest you withhold your commitment until after we speak?” I heard the doctor take a deep breath. “You might change your mind.”
I shook my head even though she couldn’t see me. “I’ve been researching Exposure Response Prevention Therapy all morning. I know it can be difficult to watch. On the other hand, it also seems like it’s been proven to help a lot of people. I do have concerns, but first I wanted to ask you about Shelly’s fear of touch.”
“Go ahead. I’ll answer what I can.”
“It doesn’t seem consistent. Sometimes, if I’m already touching her, then it’s like she doesn’t have any fear about touching me anywhere. And sometimes, even if I’m already touching her, it’s like she can’t reach for me.”
“The only answer I can give you is that the patterns and rules for some obsessions make more logical sense than others. Sometimes they don’t seem to make any sense at all. They don’t have to, they’re all irrational. One person’s experience with OCD can be night and day different from another person’s. The rules for what triggers anxiety can change daily, or it might never change over the course of a person’s life. The finer details and patterns surrounding Shelly’s aversion to touching being somewhat unevenly applied—based on whether you’re already touching—doesn’t surprise me.”
“Hmm . . .”
I hadn’t delved too deeply into the different types of OCD, but I did read everything I could find on Exposure Response Prevention Therapy as a treatment for the disorder. The gist of the procedure was to expose the patient—Shelly—to what she feared, and then prevent her from ritualizing her response, as the scholarly papers described it.
One of the examples I found was about a woman who was afraid of germs. She was forced to stick her hands in a toilet and then keep them there for hours. She’d screamed and pleaded. And then, after a time, she’d calmed down. And then she had to follow a plan for months where she was exposed to her fear and had to work through it. When it was over, and in her interviews over the next few months, she talked about how it had changed her life for the better. That it had saved her life.
The sites I read described the therapy as a way for a person to face their fear in a safe environment, realize the fear was irrational, and stop the person from engaging in the compulsion as a way to avoid the fear.
It made sense. But it also made me worry for Shelly. She’d clearly been struggling with initiating touch for years, and now we were going to be able to fix that? It didn’t seem likely.
But that wasn’t my biggest concern.
“How are you going to make sure she doesn’t self-harm later? At home when she’s alone?”
“That’s not Shelly’s pattern. When she was cutting, she had to do it immediately after touching a person. She’d excuse herself to the bathroom. She carried packets of razors on her. She had to do it right away.”
“But didn’t you just say that the compulsion can change?”
“No, I said the aversion—the fear, the obsessive thought—which is usually the most irrational part of the equation, it can change and is difficult to nail down. But the compulsion, the part that provides relief, most of the time has to be followed precisely. But again, each case of OCD is different. I won’t ever speak in absolutes about this disorder.”
“Okay. I think I get it.”
“Good. Let’s see, the session tomorrow will be several hours long and she’ll have no opportunity to self-harm. I’ll have a male nurse present."
What the?
“What?” I asked sharply, unable to keep the spike of alarm from my voice. “No, no, no. She doesn’t like it when people touch her, but she trusts me.”
The doctor didn’t respond right away and I got the sense she was going to argue, so I added, “Take it or leave it. I’m not coming if you bring in a stranger.”
Just the idea of someone else’s hands on her against her will, it made me want to break something. A lot of somethings.
“What if I have him wait outside? And if you’re unable—for whatever reason—to keep her from injuring herself, we’ll ask him to come in.”
“Okay. That’s fair.” But I’ll keep her safe.
“Let’s get to the details. There are five conditions that must be met.”
Dr. West went through the next several minutes explaining about the mandatory conditions of the therapy: graded, prolonged, repeated, without distraction, and without compulsion. Then she went over the meaning of each, how they would be applied in the initial attempt, and guidelines for how they should be followed over the next week.
“From your perspective tomorrow, your role in this will be to sit quietly while she touches you. She may not succeed this time, and that means we’ll have several weeks of sessions ahead of us. And if she does make an unexpected breakthrough, then it’ll need to be constantly reinforced. She has a plan, which she and I drafted together over a month ago, specifically for her aversion to touch. She’s done one plan before, for a different obsession, and it worked well for her. She has confidence, but I need you to understand this is only the first step.”
“Yes.” I closed my eyes, rubbing my forehead. “I understand.”
“Also, Shelly will become extremely agitated. She might scream, or cry, or try to run. It will be very difficult to watch.”