[From Tim Carey (980819.2250)]
Hi Bill,
The chap I saw tonight is a young man who has had various labels piled on
him at different times (OCD - obsessive compulsive disorder, Asperges,
Schizoid traits, etc., etc.). He is 20 but has currently returned to school
to complete what he did not finish when he was there as a student. As a 14
year old he refused to go to school and there seemed to be quite a deal of
anxiety associated with this and subsequent decisions.
A therapist had been seeing him before me and had been treating him for OCD
with not much luck. In the first session he had with me he spoke about
wanting to do lots of things like get an education, exercise, get a part
time job, etc., but he finds he procrastinates a lot.
During this session I spent some time talking to him about how he went
about making decisions and just generally asking him lots of questions
about that. I eventually drew a bit of a graph on the whiteboard to try
and map out what he found easy to decide on and what he found difficult. He
really liked this and said that he had never thought about his decision
making like this before.
An interesting feature of my interview with this man was the extent to
which he spoke in dualities. He says that he wants to study philosophy at
university and that he likes to consider everything before deciding. He
would frequently present both sides of a perspective when he was talking.
Things like: the world could be a better place ... but it probably never
will; damn this seems to make so much sense ... but tomorrow it will
probably all be just the same.
On quite a few occasions it seemed like he'd made a shift, only for him to
pause a couple of seconds and then give the other perspective e.g., Things
aren't just going to happen, I've got to get out there and make them happen
.. but then maybe I shouldn't rock the boat.
During the week I had wondered whether "thinking/deciding/procrastinating"
might have become his way of reducing anxiety. He may have learned to avoid
situations where he felt anxious by saying that he was just "thinking". In
other words, thinking could be his way of controlling level of anxiety. To
investigate this I got together 18 little scenarios that he was required to
only answer yes or no to. The scenarios were things like: Your friend has
bad breath, do you tell him? You don't get charged for the drinks at a
restaurant, do you correct the error?
When I read out the first 9 cards, he found it really difficult to answer
with out giving an explanation.In fact he gave an explanation on every one
of the first 9 despite my instructions. He would say things like: I'd say
yes ... of course that's in an ideal world, in the actual world I'd say
.... To make it a bit more pressurised I told him he only had 5 seconds to
answer. For the next 9 I read a bit faster and he actually just answered
yes or no, but then at the end he spent some time explaining his decisions.
I don't know how much this tells me but it was an interesting activity.
What are your thoughts?
Regards
Tim