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Back when I began writing my first book (OCDad: Learning to Be a Parent with a Mental Health Disorder – read about it here!). I had a mantra that I kept repeating throughout the project: practical, not profound…practical, not profound. 

The reason for that mantra was simple: I knew my situation as a parent with a mental health disorder wasn’t unique.  I’m not saying my situation was insignificant. But I knew I couldn’t be the only one out there looking for practical ways to manage my mental health. And be a good, reliable parent at the same time.  I personally, only wanted to engage with posts and resources that gave me relatable, practical advice. The advice I could use in my real life.

My desire to help other people

To that end, I wanted to take a bit of time to share some key points from my notes and experiences. This information is for those who either can’t engage with a full-length book at the moment (no judgment, honestly…I’ve been there, too). Or who are just looking for some supplemental information along with their parenting and mental health journeys?  This being the case, here are some thoughts on the practicalities of managing mental health treatment and parenting in tandem.

Some Practicalities of Accessing Therapy When You’re a Parent

I always say parenting and therapy are difficult to manage together because they demand the same resources: time, money, emotional energy, and meaningful attention.  Parenthood is also a challenging time to put oneself first. After all, you have at least one tiny human in your life who is utterly dependent on you for survival. And, later, for playtimes, questions, discussions, and fort-building.  It’s a tough balance, and it needs to be approached with intention whenever possible. 

With that goal in mind, let’s turn first to some of the obstacles to accessing therapy as a parent, and then to a few starting ideas about what you can do to help yourself, and your loved ones:

Time

This is one of the most common reasons people use for turning down lots of different commitments, parents or otherwise.  I was worried therapy would be an all-encompassing drain on my time, but that was an untested assumption.  It’s not as if it only took a few minutes per week, but it wasn’t overwhelming either. 

Here are some specific numbers that might help. For the first two months, I went to therapy once every two or three weeks for one hour.  I was fortunate to be able to schedule appointments outside of my work hours. But for those who can’t do that, many therapy services now work online, and at odd hours.  For the time required to journal and complete my therapy exercises at home, my time commitments looked like this:

• First three months: thirty to forty-five minutes per day, five to six days per week
• Three months to six months: thirty minutes per day, four to five days per week
• Six months to one year: thirty minutes per day, three to four days per week
• One year onward: journaling two to three times per week, and therapy exercises as needed

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Your journey could be different – read on for more tips

Remember, those are my numbers, not yours.  Some people might need more time, others will need less.  I should also note that the gradual tapering of my therapy was due, in part, to my therapist’s recommendation.  Therapy is a process, not a lifestyle.  At some point, it’s important to take what you’ve learned and get back out into the world to give it a try.

In terms of the time at home for journaling and exercises, I’ll admit, it was a struggle sometimes.  There were plenty of days where time for therapy simply went out the window, but there were also some strategies that helped.  Here is a list of my top five:

1. Keep the right mindset from the start. For a time, therapy will likely have to replace something in your life.  In my case, I modified the frequency and intensity of my workout schedule and readjusted my down time in the evenings.  I also allocated funds for my therapy knowing that it was a necessary investment.  Honestly, I didn’t want to do any of those things, but I wanted to heal more than I wanted money and down time.
2. Trade off driving responsibilities on long road trips and complete some journaling or written CBT exercises.
3. Watch less TV.  Yes, sorry, it’s true.  Even one less episode of something per night can really add up.  I cut out TV a few nights per week for therapy exercises for the first year of my treatment.  It helped.  A lot.
4. Take advantage of any family support and babysitting you can access.  It’s OK if you don’t want to disclose your therapy journey to other people, but you can always spend a bit of your release time in a cafe with a workbook, or on the phone with a therapist.  Every bit of time helps.
5. Trade off on rest and chore times with your partner.  For example, maybe your partner can manage evening clean-up while you do your therapy exercises in exchange for a bit of sleep in time the next morning.

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Why therapy is worth it

As I’m sure you can see, I viewed (and still view) therapy as work; important, life-altering work, but still work.  I don’t think it’s wrong to admit that.  The fact is, therapy takes time and effort.  With time and effort comes results, but also some inevitable sacrifices.  I don’t mention that to be pessimistic, or to deter anyone in their therapy journey.  I say it so that you can have a realistic idea of what you’re signing up for when you start therapy as a parent.  There are drawbacks, but there are so many benefits.  In the next section, we’re going to look at an example of each of those.

Exposure Response with Prevention therapy (ERP)

Exposure Response with Prevention therapy (ERP) is the process of gradually exposing yourself to things that trigger your obsessions. To lessen the intensity of your reactions and reconceptualize the source and function of your intrusive thoughts.  It sounds swell and helpful, and for the most part, it is. 

Here’s something I learned the hard way, though: not all exposures work for parents and families.  That was one of my biggest frustrations with every resource I read when I first started my treatment.  I remember thinking, ‘Great, this exposure stuff is going to work brilliantly for my obsession about heights and suicidal OCD, but what about my obsessions about my kids?’  There was no way I was going to expose my sons to gradually increasing levels of contaminants, greater heights, or more dangerous water settings. Just so I could prove to myself that I could feel more comfortable with them being at risk.  Luckily, I found a solution that worked well: imaginal exposures.

Imaginal Exposures

Imaginal exposures are exactly what they sound like. Exposing yourself to a distressing situation by imagining it and writing it out.  That might sound like a strange process, but I think it has a lot of advantages.  For one thing, you can confront any intrusive thought you want with no actual risk to you or your loved ones.  Second, you can control when and how the exposure takes place.  There are no concerns about making noise, leaving the house, spending money, or any other logistical demand you can think of, other than time and attention.

A warning when working through exposures

That’s not to say, of course, that imaginal exposures are easy.  The first time I tried one, I broke down crying because I went straight to imagining my most difficult kid-based obsessions. Such as seeing my sons fall from a high balcony.  I didn’t realize that imaginal exposures work just like real-world exposures. They need to be conducted slowly, regularly, and in progressive steps. 

It would’ve made far more sense to start by writing out an exposure about my son falling from the couch, then maybe a couple of stairs, then maybe a small park climber.  If you’ve never done an exposure with the help of a qualified therapist, MAKE SURE you read about how to create an exposure hierarchy first.  This page and this page will help get you started.  DON’T go any further without reading both those pages (seriously, don’t). 

With that caution in mind, here are the instructions I used for my imaginal exposures:

Imaginal Exposure Instructions

1. Select a trigger from your exposure ladder that you either can’t or don’t want to try in real life.
2. Choose a scenario where this trigger plays out most often.
3. Write out the scenario as vividly and powerfully as you can.  If possible, include a description from all five senses.
4. Re-read your imaginal exposure often, and read it out loud.

Next, a couple of reflection points from my experience with imaginal exposures:

I did my best to limit my imaginal exposures to one page of writing.  The point of this exercise is to confront a scenario that you repeatedly see in your mind. Not to imagine all kinds of other bizarre and irrational ways the situation could play out. I also found I had to be cautious about not letting my mind wander too much.  I also found my exposures had to be repeated until they became easy or boring, and that often took several repetitions.

Say it out loud

Also, step 4 in the instructions is worth repeating. Read your written exposures out loud, if possible.  Seriously.  Reading my imaginal exposures out loud helped me process them in a completely different way.  It took away so much of their influence over my mind and emotions. More so than writing alone, and infinitely more than keeping the exposure in my head.

Now, let me be clear about something – it was an immensely uncomfortable exercise at first.  I didn’t even want to write out an imaginal exposure, let alone read it out loud. And I was always worried that someone else was going to hear me and think I was crazy.  Eventually, I decided to give it a try. 

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Starting exposures

I waited until my boys were out on a walk with my wife and her friend, and then I locked myself in my room, opened the imaginal exposure, and read it; quietly, but out loud.  Have you ever had one of those moments where you explain an idea to someone and then realize that the idea made a lot more sense in your head than it does out loud?  It was a lot like that.  To this day, I’m so glad I took that uncomfortable leap, and I have therapy to thank for the push.

Drawback: CBT and ERP Don’t Always Work in the Moment (at least not right away)

Sometimes, even with all the progress I’ve made, my symptoms still get the better of me.  Whether it’s a compulsion that slips through my net or an anxious reaction to an unexpected trigger, sudden flare-ups just happen. 

I remember one incident, about a year into my treatment, when my wife and I took the boys to a park near our house.  The park was lined with oak trees, and acorns were strewn all over the ground.  I had just worked through an exaggerated threat exercise about fears of my boys choking at mealtime, and I was feeling good about my progress.  

Then, all of a sudden, one of my sons picked up an acorn and put it in his mouth.  I lost it.  I ran over to him, took the acorn out of his mouth, put him in the stroller, and insisted to my wife that we relocate our playtime to somewhere with no acorns.  She and the boys were understandably stressed and confused.  Mealtimes were no longer a trigger for obsessions about choking, but evidently, park time was, at least when there were acorns around.

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After that incident, I did the only thing I could do. Apologized to my wife, forgave myself for the lapse, and completed more exercises to help process my obsession in that situation.  Over time, I started using a specific set of questions to reflect on these kinds of incidents:

Momentary Lapse Reflection

1. What happened?
2. How did I react?
3. Why did I react that way?
4. What were the pros and cons of my reaction?
5. How should I change my reaction if this situation comes up again?

Taking some intentional reflection time after momentary lapses was helpful and productive.  I didn’t have time to debrief every disagreeable situation. But it was great to have a resource available for when I needed it.  The next time we went to the park, I mentally prepared myself to manage the trigger of the acorns. And I had a much more balanced reaction when my boys tried to pick them up.  Sometimes, the best you can do is reflect on a moment that didn’t go well and prepare for next time.

Summary

So, there you have it.  A very brief glimpse into the practicalities of managing therapy and parenting.  If you would like to know more, please visit my website – http://www.theocdad.ca – and get in touch.  This conversation is a long and personal one, and there are so many ways therapy and OCD challenge each of us.  The key, in my opinion, is the same key that brings change and results in any other setting: consistent effort.  If you ever feel your efforts waning, just know that you’re not alone.  Ever.

Fighting forward.

Jason Adams

Final thoughts from me

I want to thank Jason for writing this post and highlighting these important issues. I know how difficult it is to discuss such personal topics. However, we must do. To help other people, we must speak out.

Please head over and check out Jason’s website and social media accounts.

Thank you all for taking the time to read and comment on these posts. Part one can be found here if you missed it.