To Cancel or Not to Cancel? That is the Question

After a call to my husband, reassuring him (“I’m fine”) and a quick cry, all I could think was ‘how am I going to get to work on time for my intake now?’ Never mind that I’m 16 weeks pregnant with my first child and just had a car accident in a country that is still very new to me. My overcontrolled (OC) leaning brain automatically had the thought ‘if I cancel it will look unprofessional’. I quickly calculated time already lost and time needed to get to work – I would make it 15 minutes late. Then the sinking sensation of guilt set in. ‘Do I start late, then have the trickle effect of running over with all my clients or do I reschedule my first? How do I explain cancelling before I even meet her? Do I tell the truth or is that going to make it seem like I think my problems are more important than hers? Will she think I’m flaky if I cancel?’ I decided to reschedule my intake and told the client the truth about the accident. Though she was understanding, I apologized profusely for needing to cancel. I Googled hand signals to use for turns, since the whole front driver side of my car was smashed, and quickly drove to work. The thought of my car being unsafe to drive through Sydney traffic was not on my radar at all!  After all, the rule is—don’t cancel. Of course, I would get to the office, even if it meant parking in a random neighborhood and Ubering it.

Once I sat down at the office, that’s when I started noticing slight stomach cramps. Another string of worries followed… ‘Is the baby ok? How hard did I get hit? It’s probably in my head. I’m fine. I can’t cancel all of my appointments, I had last Tuesday off for my midwife appointment. Maybe I’m imagining the cramping. Please Rebecca, it isn’t that bad.’ I finished my day not thinking about the accident and went home. At around 11pm my husband (who also leans OC) and I decided to go to the Emergency Department to check on the baby. This was after researching “car accidents while pregnant” and calculating potential risks with my symptoms for the past two hours. When the doctor asked why I waited so long to come in after the accident (fair question) I simply said, “I wasn’t sure if I needed to”. She most likely didn’t have the time for me to go into my OC ruled behaviors of not wanting to cancel my appointments.

The ultrasound showed that the baby was ok. Phew! I calculated the hours of sleep I could get and still be at work in time for my first session. I could do it. Finally, I relaxed. It was then that I was able to retrace the day and noticed how exhausted I was.

If a friend told me this whole story I’d tell her she should have gone to the emergency department immediately, no question. However, for some reason I hold myself to a higher standard. This sense of obligation with keeping my work commitments is not a new experience for me. It’s a pattern that I’ve had all my life, taught both directly and indirectly. I’ve learned to rearrange my schedule accordingly in order to avoid cancelling sessions. I even managed a caseload while my parents were in hospice care and actually went to work the day after my dad’s funeral. At the heart of it all there is the automatic thought ‘if I cancel, I’ll look flighty, unprofessional, selfish, etc’. This thought is paired with the inevitable guilt when I actually do need to cancel because I physically cannot be there. I’ll then extend my hours or offer video sessions to make up for the cancellation. I’ll also do an over the top repair. Let’s just say I’ve been known to make homemade lavender candles for clients as a repair. Oh, you haven’t tried making homemade lavender candles before? It’s simple, just like Pinterest says (cue sarcastic undertone). It all circles around my OC rule (don’t cancel) that is ingrained in me even when I have understanding clients and a supportive team telling me it’s ok to stay home.

As I’ve grown to understand Radically Open Dialectical Behavioral Therapy (RO DBT) and what overcontrolled means, I’ve learned this sense of obligation with work commitments is part of my OC ruled thoughts and behaviors. It’s also a very common theme with people that lean OC. We may overextend, overcommit and over schedule ourselves with work. Yet somehow, we manage to do it all because our brains calculate and plan out exactly what we need to keep our commitments. How much sleep is really required anyways? After all there are 24 hours in a day. We may also get sick in the process, but we’d most likely soldier through that too and only allow ourselves one day of recovery…preferably on the weekend. That one day of recovery would then be spent sitting up in bed answering work emails. I mean let’s be honest.

During my pregnancy, I’ve had several “opportunities for growth” – as my brother so eloquently puts it – to practice being flexible with my rule of not cancelling, such as the accident, getting colds and midwife appointments. I started to practice the RO DBT mindfulness skill ‘awareness of harsh judgments’ as my fixed mind ruminates on the thought ‘If I cancel, I’ll look (fill in the blank)’. As I practice being radically open, I’m increasingly self-aware and using the RO DBT skill of self-enquiry to ask myself “Where did I get the idea that cancelling sessions is unprofessional?” Through this work, I’ve come to realize that pregnancy has definitely been more of a challenge as an OC leaning person. As someone who assesses the environment and relies on evidence to make decisions about work, it’s been difficult to know how my decisions are affecting the baby. I cannot assess what I cannot see. Unfortunately, the GP chuckled when I asked for daily ultrasounds to make sure the baby is ok. I’m realizing with each month that it’s not just me that I’m overextending, it’s the baby as well and with that I’ve opened the door to flexibility and understand this is just the beginning. I’m ready. I think. Wait, is there a way to plan for these changes? (types into Google search ‘How to prepare for baby’s first five years’)

About the author: Rebecca Ciatto, DBT-LBC, AMHSW

Rebecca is an intensively trained RO DBT therapist in Sydney, Australia. She treats clients (ages 7 and up) with disorders of overcontrol and specializes in anxiety disorders, chronic depression, trauma, personality disorders, self harm and suicidality. She is passionate about increasing awareness of childhood mental health disorders and the effectiveness of RO DBT treatment.