Chapter 4: Dr. K

A true story about the worst therapist I've ever had

Welcome to Chapter 3 of my “book” Will There Be Free Food? If you’re new here, you can access all previous chapters (and any future chapters) here!

Having lived with OCD for most of my life, the one piece of advice I hear most often is “Get therapy.” Sometimes it’s said out of empathy, but more often it’s said with annoyance and dismissal: “You’re asking me ten times in a row if our diced pineapple was poisoned by a Nazi lone wolf at Whole Foods, it’s getting annoying. Get therapy so you can be fixed and stop pissing me off.” My family, friends, and of course, strangers on Reddit (prior to my total ban) always seem to want me to get therapy so I can stop annoying them. And, well, fair. But I’ve always resisted. Not because I’m ashamed to seek therapy, but because therapy for OCD is extremely difficult to come by and I’ve had too many failed therapy experiences to have a lot of faith in it.

Behavioral therapy is the most effective treatment for OCD, especially combined with exposure (deliberately exposing yourself to your fears/triggers without performing your safety behaviors to alleviate it–like superstitious rituals, Googling or constantly asking your brother for reassurance that you don’t get mad cow disease from eating cheese–not that I’d know anything about that.) Unfortunately, behavioral therapy (usually CBT, or cognitive behavioral therapy) providers typically don’t take insurance. Medication is another tool that benefits some with OCD, but I’ve tried several and I can say confidently that it does nothing for me. (Well, I don’t know if I can really say “nothing.” It decimated my sex drive and made me dizzy all the time, which is technically something.)

Traditional analysis-style therapy that works for some other anxiety issues can often make OCD worse, by assigning too much value and symbolism to intrusive thoughts that are better off ignored, lest the brain get “stuck” on them–for example, in my case, delving into the specifics of why you’re so worried that you have late-onset mad cow disease, as opposed to just learning to live with the uncertainty of such things. (Apparently I’m supposed to “radically accept” that I’m riddled with mad cow, okay.) 

When I found Dr. Kramer, I was in my late twenties, and married to Nick for a few years. Dr. Kramer was one of many faces that came up on a “Find a therapist in-network” portal through my insurance. I was working at a company with great health insurance benefits, but even then, most CBT providers don’t take any insurance at all and charge hundreds of dollars for each appointment so my only hope was to find a unicorn CBT practitioner who was in-network. After scrolling through numerous therapists who seemed to specialize in literally everything except OCD, who had questionable last names that didn’t include “Stein”, “Klein” or “Gold”, I finally stumbled upon Dr. Kramer. His photo looked like a headshot from the ‘80s, with his chin pensively perched atop his fist. The background was faded cognac, his hair was yellowish-gray. He seemed just old and Jewish enough to potentially work for me.

I met him at his office, which was just as dilapidated and neutral-toned as any good therapist’s office should be, complete with a slightly crusty sofa, a peeling leather chair, a dusty-but-not-unpleasant odor and faded plastic plants that he bought decades ago. I don’t mean to stereotype too much, but having been to numerous therapists since the age of seven, I can verify that therapists who seem like they constantly have a half-eaten roast beef sandwich lying around are the best ones. Dr. Kramer, who was much older in real life than in his photos, also took all co-pays ($10 per appointment) in cash only, so that gave him a little extra therapist-cred with me. He wasn’t too snazzy, clean, or digital, which meant he wasn’t going to be a new-age grifter who tried to sell me on bogus California self-love essential oil nonsense. If he was anything like my expectation, he was going to look at my brain like it was a jigsaw puzzle and figure it out like a good therapist should: mostly detached and totally professional, if not a tiny bit too blunt at times. 

As soon as I sat down I gave Dr. Kramer my whole story as quickly as I could. I had been in and out of therapy for about twenty years at that point, so I was used to this. I gave him a five-minute overview of my current life situation. (I was close with my parents, who were divorced but on good terms. I was married and we wanted kids, but hadn’t started trying yet. I had a job that I liked but I had persistent anxiety about getting fired, which was probably part of my OCD, but also I got fired all the time, so maybe it was real.) I then explained that OCD was the main reason I was there–previously, analysis had exacerbated my OCD symptoms and I really wanted straightforward CBT. I clarified that my obsessions mostly had to do with Nick disappearing somehow, usually via death but also occasionally via leaving me for another woman. 

Dr. Kramer stopped and rubbed his eyes. “Well, I have to tell you,” he said. “Hearing all of this, I think you need far more intensive psychotherapy than you’ve ever had before.”