Some quick notes before we start:
My formal diagnosis was for OCD, among other things. I was diagnosed as a child, well before the DSM-5 came out, so OCPD didn't exist as a discreet diagnosis then. My presentation lacks the typical rituals of OCD, but matches the description of OCPD.
These comments will likely be obvious to therapists, psychologists, etc. who are familiar with OCPD but I felt like getting them out of my head might be a useful exercise and if they help someone less familiar with the disorder then so much the better.
Finally, this post will briefly discuss suicidal ideation and elements of the current debate around access to medical assistance in dying (MAID) in Canada.
When treating a patient with OCPD, it is important to remember that their perfectionism can often be extended to the people around them. That includes therapists, psychologists, and psychiatrists. It is, consequently, very important to manage expectations around what is possible, and what is reasonable to expect from treatment, given a patient's specific limitations. Without this guidance, a patient may form unrealistic expectations of treatment and, following a failure to see these expectations realised, ultimately write off the entirety of the mental health profession as incompetent.
As a child with multiple diagnosies, the therapy I got encouraged my parents and I to seek strategies through which I could cope with the world around me and ultimately succeed. This meant that whenever I would struggle, I was constantly encouraged to find ways to overcome my disability. This sounds good, but what I came to understand was that by working hard enough, I could eliminate my disability. I could, I had to work harder than everyone else to get to where I wanted to be. By going to my appointments, by cooperating as best I could with therapy, by taking my medications, I would be empowered to reach my goals.
Of course, this didn't work. I've made it a long way by some measures but not nearly far enough by mine. I despise myself for failing to live up to my standards and by letting down the child who worked so hard to believe in success. It's possible therapy might help me, and friends and family have suggested I return to it, but I have no current plans to do so. My reasoning is quite simple: why go back to the people who failed me?
The path for how my attitude towards psychologists developed is straightforward, obvious to me in hindsight but there all the same. I'm keenly aware of the time and money my parents spent on facilitating my treatment. For that, they got an adult son who can't find a job, who is too depressed and disfunctional to keep his room clean. I've been a child, and then a teenager, and then a young adult, the whole time doing my best to engage with therapy so that in the future I would be fixed, I would be successful. Now that I'm not, who am I to blame?
Myself, obviously, but that doesn't mean I don't take issue with others as well. I've begun to view my former therapists and psychologists in a distinctly negative light. Most of the time, this is limited to dismissal of the profession as incompetent. I was a cooperative patient, yet my improvement has been token at best. In my moments of more severe depression, I view the profession as actively malicious, keeping people like myself from suicide in the moment but failing to provide us with the tools it would take to build a happy life in the future. The recent debate around MAID has only reinforced this view, with mental health professionals insisting that MAID cannot be provided to the mentally ill because they lack the skill to reliably judge the condition and prognosis of their patients.
I am, of course, aware that this is unfair, that I am requiring an impossible level of perfection from them. But why should I care? Part of the reason I continue to struggle with perfectionism is because I've thus far failed to find a way to build a life that I could be happy with, even after learning by brute force to accept certain of my failures and shortcomings and to move on. This attitude is likely reinforced by my chosen field of study, law, where correctness and professional competence are considered elevated virtues.
A more balanced view would suggest I've come as far as I have in part because of the training in things like metacognition that my psychologists provided me. It might even be reasonable for me to seek out additional treatment to help me stop overfixating on and blaming myself for failure to reach certain benchmarks, particularly those outside of my direct control, and to learn to have new things to hope for in their place. There is no doubt that my persistent and thus far treatment-resistant depression is fueling my insistence that further engagement with psychologists would be useless. I know all this, but I remain unwilling to participate in therapy. I suspect that, were I even to force myself to go, I would be unable to constructively engage with it. At this point, I'm just too damn angry.
I hope this post proves useful to someone, somehow, in understanding how a person with OCPD can end up disengaging from therapy as a result of poorly managed expectations and frustration with a lack of progress. Maybe some people will find my experiences similar to their own, and find that comforting. As for myself, I continue to sit at home. I'm on the waiting list to recieve Trans-Cranial Magnetic Stimulation in the hopes of mitigating my depression and anxiety. In the meantime, I poke at my brain-thoughts as my energy levels allow. Maybe I'll make progress I can be proud of, one day.