'Nine, Ten , Do it Again.'

The Caregiver

"Nine, Ten , Do it Again." A book for those with OCD and their families.

We're constantly searching the world for excellent books which may not be readily available through your usual outlets. We're very pleased to present Kathryn I'Anson's most recent book on Obsessive-Compulsive Disorder (OCD).

Rather than describing the book, the author has allowed us to place the chapter on caregiving those with OCD on our site. I'm sure you'll agree it is written in the clear and straightforward style of a person familiar with OCD who does not have to constantly fall back on technical terms to provide the help and understanding the book offers.

This book is now available through Amazon. Click on the title to order.

Highly Recommended: Nine, Ten , Do it Again: A Guide to Obsessive Compulsive Disorder: An excellent clearly written book for both those with OCD and the families of those living with it.
Kathryn I'Anson. $12.00

Table of Contents

• Introduction
• What is Obsessive Compulsive Disorder?
• 'Life Begins at 47! A Sufferer's Story
• What Causes OCD?
• Assessment of OCD
• Treatment of OCD
• Self-Help Strategies
• For Families and Carers
• Other Books Which Will Help

The following section is based on extracts from: Nine, Ten , Do it Again: A Guide to Obsessive Compulsive Disorder 2nd edition, 1997. 91 pages

From the Cover: The author, Kathryn I'Anson is the Director of the Obsessive Compulsive & Anxiety Disorders Foundations of Victoria (Australia) . The material has been reproduced by kind permission of the author. The British and Australian term for "support person" is "carer".

This is one of the most informative and easy to read books I have come across on OCD. The author's style is such that you feel she is talking to you on a one to one basis explaining OCD both from the feelings of the sufferer and from those of the caregiver.

Extract from the Chapter for the Family and other Support People

Helping the Carer

If you are a spouse, sibling, mother, father, child or friend of a person who has OCD, then it is quite possible that you have been suffering too. Carers of people with OCD have to deal with many emotions that arise as a consequence of living with and caring for a sufferer. You are likely to feel worried, frustrated and confused, and sometimes despairing. These difficult feelings arise from the impact of the OCD on your relationship and environment and because it is so hard to see someone close to you either battling or in despair over thoughts and behaviours that seem to make to sense. Maybe insidious guilt thoughts creep into your mind. "Is it my fault?", "What have I done wrong?", Should I have loved and cared for him/her more?" Maybe you feel angry and confused - simply can't understand how it is possible that this person, who seems quite rations in all other respects, just can't stop these ridiculous behaviours. Have you secretly wondered, "Is it attention seeking, laziness, naughtiness?'" On top of all these conflicting feelings, there is the feeling of helplessness you just don't know what to do.

The Following ideas and strategies may help:

Do not condemn yourself for having negative feelings. They are natural reactions to a difficult and confusing illness. You cannot be expected to understand behaviours and emotions which you have not experienced yourself - at least initially. You will develop greater understanding if you spend time reading relevant material and listening to your family member and other sufferers at support groups. However, negative feelings will continue to arise - occasionally or often, and self-condemnation and guilt over these feelings will only make them more difficult to let go. Accept your feelings, and actively find a way of releasing them on a daily basis - for example, talk them through with a friend, cry, go for a long walk or drive, do an activity such as gardening, painting or craft which enables the creative expression of feeling.

Obtain support and care for yourself.

Maybe you have a great circle of family and friends who provide an empathic listening ear and practical help when you need it. If not, you might consider joining your local OCD Support Group where you will find some people to care for you, and you can talk to and learn from other carers who have been in similar situations. If your own state of mental and emotional health is suffering, it may be helpful for you to see a therapist. This will be a positive act of affirmation that your health and needs are important, and will put you in a better position to help the sufferer effectively.

Obtain and read information and books about OCD so that the disorder can put into a proper perspective.

As you learn more, you will be able to make some new choices about your feeling and reactions to the OCD. For example, you will learn that your family member's strange and excessive behaviours are not caused by a lack of willpower, and that pleading, threatening or cajoling them to stop will not help. You will learn to accept that the OCD impulsive urge, anxiety and intrusive thoughts are the compelling force behind the repetitive behaviours, the slowness, the constant questions or requests for reassurance. You will also learn that you didn't cause it. You will recognize the important part you can play in your family member's recovery and discover many ways that you can help. The recovery journey will not e easy and you will still feel frustrated and despairing sometimes. However, now you know why you are feeling this way, and that your feelings are a reaction to the OCD, not the sufferer.

Take Some Time Our for Yourself

Every week - or every day if possible, spend some time doing something that you really enjoy and where you cannot be interrupted. We all need some time to ourselves, and we all need time to relax, have fun, and to pursue those goals that interest us. If you are able to look after you own mental and emotional well-being, you will cope better with the stresses that the OCD brings into you life.

Helping The Sufferer

If you have been living with a family member who has had severe OCD for along period of time, it is likely that the disorder has caused significant disruption and distress to your home life, relationships and social life. Possibly you have been involved in the sufferer's rituals or avoidance behaviours, trying to ease her distress, or just to keep the peace.

Avoidance Behaviours:

People with OCD avoid many situations or objects that trigger their compulsions. Your involvement in avoidance behaviours may take many forms - for example, you may do all the shopping because the sufferer's compulsions are triggered by contamination and decision making fears involved with buying food, or you may always have to cook the meals, clean the house, or answer the home telephone or the front door because of similar triggers of compulsions and the sufferer becomes too distressed if pressed to to these things. There are several things that you can do to help ease the daily stresses as is the sufferer in their recovery.

Share your knowledge and new understanding of the disorder with the sufferer.

The isolation that four family member has been feeling has been an enormous burden, and she has been feeling distressed and guilty about the affect of the disorder on you. Now, hopefully, you will both be able to talk about the disorder, and express your feelings about it, openly and honestly. This will be a great beginning to the healing process for both of you, and any other family members of friends that are involved.

Encourage the sufferer to talk to you about her disorder.

This will help you to understand exactly how her obsessions and compulsions, have been interwoven into the daily fabric of her life, an yours. This may be very difficult for as it is often very embarrassing and to explain, so ask, but don't push and let her tell you in her own time. When your family member does decide to confide in you, listen attentively, encourage her to get it all out , and thank her for trusting you. Return this trust by accepting what she tells you as an hones and accurate account of what she feels and experiences. Ask questions, if you need to, to clarify what the anxiety or compulsion or obsession in and when it occurs, but don't start trying to engage the sufferer in discussion about the logic of her behaviours. The sufferer will immediately catch on to the fact that you do not understand, and it may be a long time before she will confide in you again.

Encourage the sufferer to obtain professional help.

Your role here will be to provide support and encouragement, and if she agrees, to offer some practical help in locating an experienced therapist. If the sufferer decided to try behaviour therapy, and if you have been extensively involved in the rituals or avoidance behaviours, it will be important that you join in the therapy at some stage. The sufferer will need your help as she begins doing the work with exposure and response prevention, and so you will need to know what to do, what not to do, and the best ways to support her. If you and other members of the family are involved in the sufferer's rituals or avoidance behaviours it is important that you begin to reduce your involvement and find ways of normalising the family routines. Firstly, discuss this with the sufferer - don't just abruptly stop your involvement as this may cause her a great deal of agonising distress. Tell her that you want to reduce your part in the rituals or avoidance behaviours to help her get better, and decide with her which ones you and other family members will no longer participate in. Set some realistic goals together, and make sure that the whole family agrees to abide by the plan. Once you begin to work cooperatively together in this way, your situation will gradually change and the sufferer will no longer take your involvement for granted. When the sufferer undertakes behaviour therapy or a self-help programme, the work you have done together will give her a great head start. Once therapy begins - whether pharmacotherapy" [medication] " or behaviour therapy, your involvement in the sufferer's rituals and avoidance behaviours should be reduced to zero - if at all possible. The doctor or therapist will need to be informed if y our involvement continues, so that they can work on this aspect with the sufferer.

Create a Supportive Home Environment:

The home is often the primary setting of compulsions, and is also generally the 'haven of avoidance' for the anxiety sufferer. The less tension that in 'in the air' the better. If there are significant conflicts in some the family relationships, it would be very helpful to the sufferer if these conflicts are worked through and resolved - including those conflicts that include the sufferer.

Ask your family member to tell you when she is having a particularly hard day.

Your family member's symptoms may flare up when her anxiety is high, she is depress, or when she is stressed about something. Offer what support you can, and be flexible in terms of what you are expecting from the sufferer on that day.

If you notice improvements, however small, acknowledge them, and encourage the sufferer to reward themselves for the progress. Fro example cutting down a hand washing routine by 5 minutes, or reducing a checking ritual from 50 checks to 40 checks may seem insignificant, but represents a great step forward by the sufferer. Your recognition and praise will encourage her to keep trying.

Try to maintain a non-judgemental and accepting attitude toward the sufferer. A non-judgemental attitude from you and all the family, to sufferer, and avoidance or personal criticism, will enable the sufferer to focus her efforts at coping and getting well, rather than expending her efforts in dealing with anger and resentment.

Laugher is good medicine.

When the sufferer is doing well, and having a good day, a bit of humour and laughter - offered with sensitivity, is great balm to soothe away some of the painful feelings and thought which arise.

Be patient.

None of the treatments or self-help programmes that are available for sufferers provide quick 'cures' - or even immediate relief. Recovery is a slow and gradual process. Be prepared to support the sufferer on a long-term recovery programme, and don't make day-to-day comparisons. Recovery always includes slips and set-backs - the important thing is that the set-back isn't interpreted as failure. The guilt and stress that will arise from thoughts and feeling of failure could make the set-back much more difficult to overcome, than if it is viewed as an opportunity to learn.

There can be no simple, straight-forward plan that will smooth away every rock on the road to recovery. Every person who has OCD, and every family who has a sufferer as a member, has a different set of symptoms and circumstances to deal with, different relationships, different personalities and a whole complex array of different influences, Try these ideas and strategies, and draw upon all the resources and support that you have. Slowly, but surely, you and sufferer will discover the treatments and self-help strategies and ideas that will work for you."

order book

next: Panic Attacks: Why Do They Feel This Way?
~ all anxiety disorders caregiver articles
~ anxiety-panic library articles
~ all anxiety disorders articles