I have a client who is a New York Yankees fan. Not your everyday fan, but a huge, die-hard fanatic. She bases her daily schedule around theirs. She’s stood-up dates, canceled doctor’s appointments and skipped out on jury duty if there was an afternoon game on the slate so that she didn’t miss an inning. It’s part of her family’s pride and identity. “My dad was hard-core, as was his dad and his granddad. That’s the way our family does it.” As a fellow New Yorker and a fan of the team I can appreciate the fervor.

One morning, looking at my upcoming schedule for the day, I saw that this client was due at 4 P.M. With my coffee cup in hand that said “Psychologists do it for 45 minutes,” I sat down to channel surf for a few minutes. I stopped on Sportscenter and noted that the Yankees were playing at 1 P.M.

Why is there a day game early in the week? I’m going to miss that because of work. And it’s a big game, too. Damnit! Why does life have to be so hard??

After my PMS (Poor Me Syndrome) moment, I thought about my client.

_____ is due at 4:00. That’s right around the end of the game. If it’s not over, will she just cancel at the last minute ? That would be annoying. And yet, I could watch the end of the game…
I had to guess that she would choose the game, especially a critical one, over our appointment. She’s put her Yankees before “less important” matters, such as an uncle’s funeral, a friend’s hip replacement surgery, and dialysis. And while I would love to think that therapy is each person’s most important priority in life, that’s just not reality.

And yet, there she was, standing in front of me, exactly at four o’clock.

“I’m not going to lie to you,” I said. “When I realized that the game might still be going on, I figured you were going to cancel.”

“I’m working on re-prioritizing my life,” she said. “I’ve got to get things into better order and stop indulging my every whim. That includes not blowing off anything and everything for the Yankees.”
We started our session, and she began talking about this new goal of practicing better impulse control and focusing on what is really important in her life, which was work and family. Yet her eyes kept trailing to the wall to the right of me where the clock is located.

“Why do you keep staring at the clock?” I asked.

“No reason.”

“No reason at all?”

“I just like to know what time it is.”

“_____, I’ve known you for a long time now,” I said. “You’re focused on the Yankees game, aren’t you?”

“What? Of course not. That’s no longer a priority. In fact when I left the house the game was just going into extra innings and I’m completely okay with it.”

Extra innings? Shit!

“Even if the game was still on after our session ended I’m going to dinner with a friend, so I won’t know the score until tonight.”

“Level with me: you want to know the score of the game, don’t you?” I asked.

“Desperately” she admitted.

Me too.

“Well, either one of us could simply punch a few keys on our phones and have that score or I could go over to the computer and look it up.”

Her eyes beamed with pleasure at these ideas.

“But, given that you want to work on better impulse control, why don’t we start practicing that right now and put the game on the back burner until the session is over.”

Please say no. You take out that phone RIGHT now and pull up that score!

“That’s a good idea.”

Yes. Unfortunately, it is.

We then stared at each other for about 30 seconds.

“This is hard for you, isn’t it?” I asked.

“Very. I’m anxious to know the score.”

This is a form of Exposure/Response Prevention (EX/RP), a commonly used treatment for Obsessive-Compulsive Disorder (OCD) and, in this case, impulse control and prioritizing. When a patient is exposed to a situation, such as dirt and germs, that might induce a compulsion, such as excessive hand washing (or looking up scores of baseball games), the patient is required to essentially do nothing. In other words, don’t wash, refuse to take out the cell phone, etc. At that moment of non-action a patient’s anxiety will skyrocket, but if she can tolerate it long enough it often will diminish. Ideally, this intervention will make it easier for the patient to resist these urges in the future.

Unfortunately at this point we were both anxious about the game.

“Are you a baseball fan, Rob?”

“I am.”

“Do you like the Yankees?”

“I don’t think anyone could like them as much as you, but yes, I’m definitely a fan.”

“Do you want to know the score also?”

Very much. “I do, very much so, but the reality is that I’m working right now, as are you on a particular psychological issue, and I therefore sacrifices must be made.”

So we continued to sit and talk about her new priorities, which probably served as somewhat of a distraction for her. She fidgeted a bit in her seat, smiled awkwardly, confessed to still aching to know what the score was. Sometimes patients are given medication and/or taught relaxation procedures to help reduce the anxiety, but I sensed that this client could get through the session just through talk. Sure enough by the end of our time her anxiety had gone down, at least somewhat.

“That helped a bit,” she said. “It’s interesting how not doing anything can be of benefit.”

“Do you want to look up the score now?” I asked.

“I do, but I can wait until I get outside.”

“That’s a really good start. Congratulations.”

She left and I immediately dove for the keyboard, not nearly as controlled as she was. 5-3, Yankees win.

A sense of relief moved through me, not so much about the victory, but more that I had indulged the urge. And then I realized that very feeling of relief serves as reinforcement and will make me more likely to look up the score the next time something like this happens. Impulse control isn’t normally something I grapple with, at least not more than the average person, but the experience served as yet another example of therapist imperfection both in and out of the office. I told her what to do, knowing it was right, but either couldn’t or didn’t apply it myself. Fortunately it’s just baseball but I either need to address this issue or simply stop watching sports altogether. Or at least take days off from work when the game is on.

This entry was posted on Tuesday, August 26th, 2008 at 2:29 pm and is filed under Blog. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.