Dear Therapist:

I am 54 years old, the owner of a successful business, and I give a nightly shiur. I grew up in a difficult home and developed OCD and anxiety before my bar mitzvah. In those days, there was no treatment for this. I married a wonderful girl, but our marriage was greatly impacted by my emotional problems. At my wife's insistence I made my rounds to many therapists, but my symptoms never went away. I finally found a professional psychiatrist, who prescribed Prozac.

Many years later, I have made great progress as I am on the highest dose of Prozac. I will admit that I still suffer from anxiety and OCD, but compared to what I was, I am satisfied. My wife is not. She is urging me to go for therapy, but at my age I am burnt out. I feel like if Hashem wants me to suffer with this diagnosis, then this must be my tikkun in this world.

My doctor told me to tell my wife that there is no shleimus in this world, and I am doing amazingly well. She claims he doesn't live with me, so it's easy for him to say. She keeps urging me to see a second opinion, but I have no interest in that. We decided to write to the panelists to hear their take. Thank you.

Response:

It sounds like you’re generally content with how you’re managing your symptoms and aren’t interested in pursuing therapy again. Of course, that’s a personal decision. However, your reluctance to return to therapy seems to stem at least partly from your past experiences. You mention having seen a number of therapists without much progress, which understandably would make you hesitant.

Without the aid of medication, many people find it very difficult to meaningfully address obsessive thoughts and the anxiety that accompanies them. It can be extremely frustrating to do cognitive or emotional work when those very symptoms occupy so much mental space. When the mind has relied on defense mechanisms and automatic thought patterns reinforced since childhood, changing them can be a daunting task.

Medication can sometimes make this work more accessible. By helping to “artificially” reduce symptoms, it can create the mental space needed to work on the underlying issues. In general, medication and therapy together tend to be more effective than either one alone. At times, progress in therapy can even help people to reduce or eliminate their medication.

You and your wife appear to have different perspectives on your symptoms and progress. I wonder whether these differences extend to other areas of your relationship as well. It’s wonderful that you’ve made significant improvement, but your wife’s concerns may not be limited to your OCD and anxiety. They may reflect deeper or broader relational issues.

When one spouse has an identifiable problem, it can easily become the reference point for many frustrations within the marriage. For example, if communication is difficult, it may be attributed to the spouse’s anxiety or OCD rather than to the dynamic between them. This can lead a couple to focus on the “obvious issue” while the relationship itself receives less attention.

Your wife’s comment that “it isn’t easy to live with you” may reflect both her experience of your symptoms and other emotional needs that haven’t been met. Regardless of whether you decide to try individual therapy again, it might be helpful for the two of you to consider marriage counseling. That can provide a neutral space to better understand each other’s perspectives and to identify what each of you needs—both individually and as a couple.

-Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Woodmere, NY

 adjunct professor at Touro University

 Graduate School of Social Work

 author of Self-Esteem: A Primer

 www.ylcsw.com / 516-218-4200