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Illustration by Brittany England

Health and wellness touch everyone’s life differently. This is one person’s story.

In September 2017, I’d reached an impasse of sorts. After two psychiatric hospitalizations, three outpatient programs, countless medications, and a lot of therapy, I was at a loss. With all this hard work, shouldn’t I be getting better?

It didn’t help that my then-therapist had misdiagnosed me at first. Initially, he was sure I had bipolar disorder. Then it was borderline personality disorder. It wasn’t until I sought out a second opinion at a crisis clinic that I got my correct diagnosis: OCD.

Looking back, my obsessive-compulsive disorder (OCD) should’ve been obvious. One of my most noticeable compulsions — in which I’d knock on wood in multiples of three anytime I thought of something distressing — was happening multiple times per day.

In fact, that September, I was knocking on wood 27 times every time I was triggered. And with so many triggers, my neighbors must have thought I had a lot of visitors coming to my apartment.

In reality, though, I wasn’t throwing some kind of party with friends coming in and out of my place. I was unwell.

And it wasn’t just in my apartment, either. It was everywhere I went. Embarrassed by my compulsions, I started knocking on wood behind my back, hoping no one would notice. Every conversation became a minefield, trying to get through an interaction without tripping the wire in my brain that set off my OCD.

Back when it first started, it didn’t feel like such a big deal. I’d started with the number three, which was discrete enough. But as my anxiety worsened and my compulsion became less soothing, it multiplied as I tried to compensate. Three, to six, to nine — before I knew it, I was approaching 30 knocks.

That’s when I realized something had to give. The idea of knocking on wood 30 times, over and over again throughout my day, was unbearable to me. The problem was, I didn’t know what else to do. Having only been recently diagnosed with OCD, it was still very new to me.

So, I called my therapist at the time, asking him what I should do. In a calm and collected voice, he simply asked, ‘Have you tried meditation?’

The advice felt dismissive, to say the least.

Worse yet, he failed to mention that the more you engage with your compulsions, the worse your obsessions become — and so the cycle goes. I could hear the surprise in his voice when I explained how confused I was. “You need to stop your compulsions,” he instructed me.

At that moment, I could’ve thrown my cellphone at the wall. I knew I needed to stop. The problem was that I didn’t know how.

With little support, not only did my compulsions worsen — as the cycle of OCD continued, my obsessions became increasingly distressing, leading me to become more and more depressed.

What if I left a window open and my cat clawed through the screen and plummeted to his death? What if I lost my mind one night, and smothered my partner to death, or stabbed my cat, or jumped off the roof of our building? What if the reason I liked true crime was because I’m secretly a serial killer in the making? What if my gender identity wasn’t what I thought it was?

What if I was actually in love with my psychiatrist, and our inappropriate relationship meant that I’d no longer be able to see him? What if I lost control and pushed a stranger in front of a train, and wound up in prison for the rest of my life?

A thousand times a day, I’d ask my partner questions that seemed outlandish, hoping it would quell my fears. (I’d later learn that this, too, was a compulsion known as “reassurance-seeking.”)

“Do you think I’d ever kill you?” I asked one night. After being together for seven years, Ray was accustomed to this line of absurd questioning. “Why, are you going to?” they replied with a smirk.

To everyone else, my fears seemed outright absurd. But to me, they felt very, very real.

When you have OCD, obsessions that’re antithetical to everything you are suddenly feel very real. I was 99 percent sure of their absurdity, but that 1 percent of doubt kept me on a hamster wheel of panic that seemed unending. It didn’t seem like me… but what if, deep down, it was actually true?

“What if” is the core of obsessive-compulsive disorder. It’s the mantra of OCD. And, when left to its own devices, it can quickly and swiftly destroy you.

I knew that this state of constant fear wasn’t sustainable. So, I decided to do something brave: I fired my therapist

It was brave for me, at least, as the anxiety of (potentially) offending my therapist held me captive for quite a while. But when I told him I needed to find a different therapist, he understood, encouraging me to do what I felt was best for my mental health.

I didn’t know it at the time, but this decision would change everything for me.

My new therapist, Noah, was in many ways the opposite of my previous therapist. Noah was warm, approachable, friendly, and emotionally engaged.

He told me about his dog, Tulip, and kept up with all my TV show references, no matter how obscure — I’ve always felt a kinship with Chidi from The Good Place, who I’m convinced also has OCD.

Noah also had a refreshing outspokenness — dropping the “F-bomb” on more than one occasion — that made him feel not like a distant and detached advisor, but like a trustworthy friend.

I also learned that he, like me, was transgender, which offered a shared understanding that only strengthened our relationship. I didn’t have to explain who I was, because he moved through the world in much the same way.

It’s not exactly easy to say “I’m afraid I’ll become a serial killer” to someone who is, essentially, a stranger. But somehow, with Noah those conversations didn’t seem so scary. He handled all of my absurdity with grace and a sense of humor, and with genuine humility, too.

Noah became the keeper of all my secrets, but more than that, he was my fiercest advocate in the battle to reclaim my life

OCD was by no means his specialty, but when he was unsure of how to support me, he sought out consultation and became a meticulous researcher. We shared studies and articles with one another, discussed our findings, tried out different coping strategies, and learned about my disorder together.

I’d never seen a therapist go to such lengths to become an expert not just in my disorder, but to understand — inside and out — how it showed up in my life specifically. Rather than positioning himself as an authority, he approached our work together with curiosity and openness.

His willingness to admit what he didn’t know and to passionately investigate every possible option for me restored my faith in therapy.

And as we unraveled these challenges together, with Noah nudging me outside of my comfort zone where needed, my OCD wasn’t the only thing that improved. The trauma and old wounds that I’d learned to disregard came freely to the surface, and we navigated those choppy, uncertain waters, too.

From Noah, I learned that no matter what — even in my worst place, in all of my despair and messiness and vulnerability — I was still worthy of compassion and care. And as Noah modeled what that kind of kindness looks like, I began to view myself in that same light.

At every turn, whether it was heartbreak or relapse or grief, Noah was the lifeline that reminded me that I was so much stronger than I thought I was.

And when I was at the end of my rope, despairing and reeling from the loss of a transgender friend to suicide, Noah was there, too

I told him I wasn’t so sure what I was holding on for anymore. When you’re drowning in your own grief, it’s easy to forget that you have a life that’s worth living.

Noah, though, hadn’t forgotten.

“I’m literally twice your age, and yet? I’m soclear that there’s a fabulous outfit that you’re supposed to wear, with San Francisco fog rolling in, just after sunset, and dance music coming from some club that you’re supposed to stick around for, Sam. Or whatever is the wonderful equivalent for you,” he wrote to me.

“You’ve asked, in a bunch of different ways, why I do this work and why I do this work with you, yeah?” he asked.

“This is why. You’re important. I’m important. We’re important. The little sparkly kids coming up are important, and the little sparkly kids we couldn’t get to stay [were] important.”

The sparkly kids — the queer and transgender kids like me and like Noah, who dazzled in all their uniqueness, but struggled in a world that couldn’t hold them.

“We get told over and over again that [LGBTQ+ people] don’t exist, and that we shouldn’t exist. So, when we find our way through the awfulness of the world that wants to crush us… it’s so preciously important that we do everything we can to remind ourselves and each other that we just need to stay here,” he continued.

His message goes on, and with each word — despite not being able to see Noah’s face — I could feel the deep wells of empathy, warmth, and care he was offering me.

It was after midnight now, and despite having just experienced the loss of my best friend in the worst way possible, I didn’t feel so alone.

“Deep breaths. [And] more cat pets,” he wrote at the end of his message. We both have a deep love of animals, and he knows a lot about my two cats, Pancake and Cannoli.

I have these messages saved as a screenshot on my phone, so I can always remember the night that Noah — in so many ways — saved my life. (Did I mention? He’s an online therapist. So you’ll never convince me that it’s not an effective form of therapy!)

Today, my life looks nothing like it did just a year ago. The main difference? I’m happy and excited to be alive

My OCD is incredibly well managed, to the point where I often forget what it was like when it ruled over my life.

Noah helped me to not only practice self-acceptance, but also to apply different therapeutic techniques — like exposure therapy and cognitive behavioral therapy. Noah helped me access more effective medications and cultivate better routines and support systems that have allowed me to thrive.

I’m still shocked by how much has changed.

I remember when my previous psychiatrist used to ask me to rate my anxiety, and it was never less than an eight (ten being the highest). These days, when I self-report, I struggle to remember the last time I was anxious at all — and as a result, I’ve been able to cut the amount of psychiatric medication I’m on in half.

I now have a full-time job that I absolutely love, I’m completely sober, and I’ve been properly diagnosed with and treated for OCD and ADHD, which has improved my quality of life beyond what I ever thought was possible for me.

And no, if you’re wondering, I haven’t accidentally killed anyone or become a serial killer. That was never going to happen, but OCD is a weird and tricky disorder.

Noah is still my therapist and is probably going to read this article, because in addition to being client and therapist, we’re both incredibly passionate mental health advocates! With each new challenge I encounter, he’s a consistent source of encouragement, laughter, and no-nonsense guidance that keeps me steady.

Too often, it can be tempting to just resign and accept an inadequate level of support. We’ve been taught to never question our clinicians, without realizing that they aren’t always the right fit (or right — period).

With persistence, you can find the kind of therapist you need and are worthy of. If you’re waiting for permission, allow me to be the first to give it to you. You are allowed to “fire” your therapist. And if it could improve your health, there’s no good reason not to.

Take it from someone who knows: You don’t have to settle for anything less than what you deserve.


Sam Dylan Finch is a leading advocate in LGBTQ+ mental health, having gained international recognition for his blog, Let’s Queer Things Up!, which first went viral in 2014. As a journalist and media strategist, Sam has published extensively on topics like mental health, transgender identity, disability, politics and law, and much more. Bringing his combined expertise in public health and digital media, Sam currently works as social editor at Healthline.