← Breaking the Rules: A Clinician's Guide to Treating OCD
Breaking the Rules: A Clinician's Guide to Treating OCD
The value of self-awareness, trust, and non-accommodating support
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- [00:04]
A
This is Breaking the Rules, a show for mental health professionals designed to help you build confidence in treating obsessive compulsive disorder. I'm Dr. Celine Galgett and I'm a clinical psychologist who works extensively with OCD.
- [00:17]
B
And I'm Dr. Victoria Miller, but you can call me Tori. And I'm a clinical psychologist who works with young people, including those with ocd.
- [00:25]
C
Through our shared professional experience, we've found.
- [00:27]
B
That effective treatment of OCD requires commitment, commitment, creativity and the recognition that things can sometimes get a little messy.
- [00:34]
A
They sure can. We want to empower clinicians to be able to work with their patients in new ways to treat OCD with confidence. Welcome back to the second part of our interview with the lovely Emily and Lindsay Stetzer. If you haven't heard the first part of our interview, we highly recommend that you go back and listen to that first part. Our guests share share very personal insights into their journeys with OCD and the development of their jewellery brand presently, which is well worth listening to. In case you missed the first part of this series, Lindsay is a senior interior designer at Gensler in New York City and has always been passionate about sharing her OCD experiences with others.
- [01:13]
B
In this second part of our interview, you'll hear Emily and Lindsay talk about the dynamics of living with ocd, the importance of non accommodating support and the role of exposure, therapy and self awareness techniques in their recovery process. Emily and Lindsay also offer some great advice to clinicians working with clients with ocd, including avoiding providing reassurance, encouraging client self trust and experiential learning. You'll also notice as you listen that I disappear from this second part of the interview completely. Unfortunately, things didn't go according to plan and tech issues meant that I had to leave the interview. Thankfully, however, our guests were in the great hands of Celine. And I swear to you, she didn't just take over the interview.
- [01:56]
A
Let's get started. What was it like managing those dynamics? As you know, you've described a little bit about your trajectories in terms of like you know, Lindsay or diagnosed earlier, a little bit later and not really recognizing it as ocd. Managing those dynamics for your parents, for yourselves, like, because we, we do get a lot of siblings coming through our clinic for OCD treatment.
- [02:24]
D
Just, it's very, very interesting because I never thought about that our mom and our, and our dad, but our dad was like denying he had OCD when clearly we were struggling with it. I don't think Emily, what Emily was experiencing he could relate to but the checking and touching of things he could see, he had that in common with me. My mom, she. I don't know how she came to realize that this was ocd, and, like, she took it upon herself to, like, research it, go find help, go find a group. But there wasn't that many groups at the time. You know, like, there wasn't, like, support groups or. It was really hard. But I think in our house, we always managed to figure out how to make each other feel okay with whatever we were going through, because I think whether it was myself or my mom, I feel like we just helped each other kind of thing.
- [03:23]
A
It sounds like support is what you guys use the most to help you through.
- [03:27]
D
Yeah.
- [03:28]
C
Yeah, for sure. I think. I'm sure the dynamic in our household was very chaotic at the time because, you know, on the one hand, Lindsey's dealing with asking our parents to repeat things. And I think, like, it was. It was a struggle for all of us because we knew it was ocd, but, like, we didn't have that empathy and understanding yet. So we were just like, Lindsay, go.
- [03:50]
A
To sleep out of frustration.
- [03:52]
C
Like, stop asking me these questions. And so, like.
- [03:55]
D
But then my mom would be like, you can't do that. Like, she's going through that now. I'm remembering my brother, my sister, like, Emily, and my dad would get frustrated, which I totally understand why. It was annoying. I was annoying.
- [04:08]
A
OCD was annoying.
- [04:10]
C
Yes, correct. The OCD was very annoying. Not you.
- [04:13]
D
Right. But, like, I. I knew it, and that bothered me so much also, I think I felt so bad about how I spun everyone's worlds around.
- [04:25]
C
Yeah. But it wasn't just you, because I also was dealing with some weird shit. And I feel like this was happening at a very similar time, if not maybe a little bit after.
- [04:35]
D
A lot of stuff was going. Was going on, and, like, we all figured out how to manage to figure out how to move forward, you know, like. And I think that's what's gotten me through all of this. And, like, I wouldn't be here today if I didn't have the support, which is really awesome.
- [04:53]
C
So, yeah, I mean, we've been through a lot as a unit, and it's just interesting now to, like, we all got to a point where we moved out and, you know, Lindsay went to college and I went to college, and so we got through that time, sort of got back to normalcy a little bit, I think. And then after college is when I actually went to therapy for the first time, because all of that, like, sexual orientation OCD themes were really eating at me. And I think that was why I didn't want to go to therapy, because I was afraid to, like, sit these things out loud. But when I finally did, the first day I was there, she told me I had ocd. And I was like, no, I don't think so, because my sister has ocd.
- [05:39]
D
And it looks nothing like this.
- [05:41]
C
Yeah, it looks nothing like this. And so that was just, like, a huge turning point for me because I could start treating what I had and really just got a better understanding of OCD in general and how there's all these different faces and flavors and how there were tons of things I was dealing with in college too. Like, with the drinking. Like, did something happen to me that I didn't remember? Do I have cancer? Because I felt something on the side, like, do I need to get tested for STDs? Like, just, like, all the normal college stuff, but really just eating at me. Like, I don't think it would be eating at a normal college kid, but.
- [06:22]
D
Like, also having to shower because you. Your head tapped a wall. That.
- [06:26]
C
Right. That was another interesting. An interesting way that the OCD manifested where I was. This was, like, senior year. So, like, at this point, I'm, like, really just giving into the ocd. And so I was waiting in line for a bar outside, and my head touched the brick wall in the alleyway where this bar was, and I freaked out. And in my head, I was like, what if someone peed on this wall and my head touched it and now I have stuff in my hair and I need to go home immediately and shower?
- [07:04]
A
Highly likely that there may have been pee on the wall on the side of a bar.
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C
Right. Except for the fact that I was standing.
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A
Yeah, of course. So how the heck was it Bay.
- [07:14]
C
That high, Right, Exactly. It was just so, you know, I kind of was freaking out. I was, like, telling my friends, I gotta go home. And I explained to one person, like, one of my friends, what just happened in my head, and she's like, I don't think you need to go home and shower, but you gotta do what you gotta do. Obviously, no one knew at the time that it was ocd, and that that probably wasn't the best decision, but I went home and I showered. And so it was just, like, cool. Constantly me giving in to the ocd, not knowing it was ocd. And so fast forward to pandemic time, and we're all living in the house again, my sister and I and our parents, and we're pretty in Years and years of therapy. And so it just full circle just shows you that therapy is a life changing thing and that Lindsay could be a little annoying or her OCD could be a little annoying at home. But now our dad understands how to answer. And so little things like that. And just like me and Lindsay helping each other through whatever was happening in our head and making sure that neither of us gave in to what Rocd wanted us to give in to.
- [08:25]
D
Which is funny because now we are so. Because we've been to therapy and we've learned, like, a lot of the tools, we then go to our parents and say, you need to go to therapy. Or like, this is what you're doing and it's not okay.
- [08:41]
C
Like, yeah, we kind of almost turned it on them a little bit, which I don't know if they appreciate, but.
- [08:47]
D
I think they do. But it's just interesting because I feel like we're constantly teaching them also, like, just things that maybe have bothered them that we're trying to use to give them to help them be okay.
- [08:59]
A
I love that you guys are just there to help each other out and support each other so much without accommodating or rescuing each other from each other's feelings. That is a huge difference. Right, right. I love that. So which tool or technique was most helpful in therapy?
- [09:16]
C
For me, I think exposure therapy was huge in helping jumpstart my recovery, I think. And also just like, I think there was a time, it was more towards the beginning of my therapy where my therapist would be like, like, keep track of your thoughts and like, what you want, what your OCD is wanting you to do. So, like, keeping track of your fears and anxieties and the compulsions that you're doing. I think this was even like, before we tried to stop them. Then once we did the exposure therapy, she would be like, rate how you're feeling after the exposure. And so I think it was just like a lot of self awareness that was helpful and just like being in tune with what your brain was trying to tell you, because then you could sort of take a step back from it and know that it's not. Just because it's a thought in your head doesn't mean that it's a fact. And so I think even now, like, I've started to, like, write down a little bit what I'm feeling. For example, when I'm with my boyfriend, I live with him now. And so if we're arguing and we're sort of. We're both not really making sense, I don't really understand what he's trying to say. He's not really understanding what I'm trying to say. So I'll like take a break and pause, which is another thing that my therapist had taught me was delay, delay, delay and take a pause when things are getting like a little heated. And I just sit and I like write down in my journal exactly what I'm thinking. I'm upset that you did this and I'm thinking this, and I think it's because of this and xyz. And so I think that was just one of the tools. Just keeping track of of what you're going through is super, super helpful. Especially now when a lot of my therapy is less OCD related and more so just life lesson type sessions. Because actually for a while, I technically like quote unquote graduated from therapy. My therapist was like, you don't need me anymore. You're good with the ocd. That was the OCD stuff. And then when I moved in with my boyfriend, I. There was a big change. I was living with Lindsay before in the city. I moved out, moved in with him. And so I just needed a little bit of like, support and guidance. So I think it just goes to show that, like, there are things that we learn in therapy, techniques and tools and strategies that we learn in therapy that can spill over into just everyday teachings.
- [11:47]
D
For me, I don't even see therapy as like therapy for my ocd. It's almost just like therapy for me. And like, whatever Emily was just saying is the same how I feel. A lot of the tools and techniques that I use is exposure therapy. But also sitting with and checking in on your feelings when you're having those anxious thoughts or your mind's kind of racing, it's like, where do you feel it in your body taking yourself out of your mind and taking it into what physically you feel like and like getting back in touch with your other senses, I think has been helpful to do that. Another thing is if you are afraid.
- [12:27]
C
That this chip is poisoned, like a potato chip is poisoned, could you bet your left arm that it was poisoned?
- [12:36]
D
Yeah, I constantly use that. Like the other night, like I was trying to not check the stove before I go to sleep every night. And my therapist was like, first of all, she always tells me, check the facts. Go over the facts in your mind. Did you use the oven today? No, no, you don't need to check it. Like, that's one of the things. And then like, what I'll do then is also I'll check the facts. But Then that becomes kind of a little bit of a compulsion because you're checking to see if it's so warm. So it's that balance. Yeah.
- [13:05]
A
You can check the facts once, but don't go back for more.
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D
Right. But also, like, another thing is, is trusting myself.
- [13:12]
A
Yes. Which OCD takes away from, like, the doubt can be so strong you lose trust in your own judgment in things.
- [13:19]
B
Right.
- [13:19]
D
Yeah. And that's. That's something that's like, kind of been a big thing for me. Maybe this week specifically is like trusting myself, trusting what I know and what I see. And the fact that we're all walking across the street. I don't have to check the sign to say you can walk was on because I know I could see it. I'm aware, and I could see the people around me. So I'm going to just keep going and continue on with my day. Right. And allowing myself distance also from it. I think kind of taking a step back, like Emily was saying with the delay, delay, delay. It's like looking at it in front of you almost as a way to, like, see it for what it is and like to see that it is the ocd. And I constantly am telling myself, like, the delay fear that you're having, it sounds like ocd. And I've done things like this before and I've gotten through harder things, so I should be able to get through it, you know, And I constantly use that as, like, motivation for myself.
- [14:19]
A
So it sounds like you coach yourself through it. Like you're your. You are your own personal trainer. If we were to kind of put it that way, when it comes to ocd.
- [14:27]
D
Yeah, for sure.
- [14:28]
A
That's really cool. I also, you know, it also sounds like you use a lot of what we call, like, grounding techniques. Like, you orient yourself to your body and break the circuit in your mind and come back to the world around you and your own values as a person. Like, what's important to me, what do I want to do right now? I want to cross the street. Okay, I can do that. I've done this before. I've sat with worse. Keep going. Like all those things. Hey, Tori.
- [14:55]
C
Hi, Celine.
- [14:57]
A
Did you know that we run our own courses here at Melbourne Wellbeing Group?
- [15:01]
B
I did know that. In fact, it's one of my favourite things we do here because it's a great way to help psychologists and other clinicians learn more about ocd, which means.
- [15:10]
A
We get to help more people. So if you're a clinician who works in mental health and you're interested in learning from us, then get in touch.
- [15:18]
B
For more information, head to www.melbournewellbeinggroup.com and click on the webinars and Books tab.
- [15:26]
A
Alrighty, back to the show. If you could give therapists some advice in terms of, like, something they need to hold in mind, what would that be?
- [15:38]
C
I actually think there's one thing that my therapist does, and I'm sure a lot of other therapists do, but I find it really helpful. Well, I find it frustrating, but, like, in the best way possible. Yeah, good.
- [15:51]
A
Frustrating.
- [15:52]
C
It's when I'm sort of, like, explaining a story and there's something in there that she thinks might be an OCD thing, and she purposefully doesn't give me any reassurance towards that. Like, I think she's very good at figuring out which stuff she can reassure me on and which stuff she can't. And in the moment, I'm like, oh, this is so annoying. Like, now I'm even more anxious.
- [16:21]
A
Yes.
- [16:21]
C
But it's, like, so helpful. And I think as much as you might want to give your client or your patient reassurance or make them feel better, like, in the long run, it's probably more helpful. It's way more helpful just to let us feel discomfort. And I'm sure, like, a lot of people listening do that, especially if they're experienced with dealing with ocd. People with ocd. But, like, that's just, like, one thing that I don't think every therapist that doesn't have experience with OCD would do.
- [16:56]
A
Yeah.
- [16:57]
D
So my therapist, what she does, it has helped me so much because I'm always. I always think that I'm not hearing everything. Like, I'm making sure that I, like, make sure I hear everything she's saying. Make sure I'm really understanding it. And if I question her, like, what did you just say? She says to me, what do you think I just said? Like, what would I tell you? Tell me in your own words. So then I repeat it back to her. Then I kind of know that all I really wanted was, like, for her to repeat it. Not necessarily for me to know exactly what she was saying, but it helps me because then I. It's like just trusting yourself that you know what she's trying to say. Like, you have the idea and you have it.
- [17:38]
A
And you know her well enough through the rapport that you have together to have hazard a guess.
- [17:44]
D
So she kind of challenges me back to say, like, what. What do you think I would say? And then I would have to Say it. And then if I'm not right, then she would explain what she was trying to say.
- [17:54]
A
I love that because a lot of the time when supervising like, or case consulting with other psychologists who work within this area, one of the things that we can often kind of get pulled into is the anxiety of reassurance seeking, too. So I love that you guys are like, trust that. We can handle it. We can handle this. Push the buttons.
- [18:15]
C
Yeah.
- [18:15]
A
I once. It reminded me of a session I had with one of my clients. They were, like, chatting away, and I was like, are you asking me for reassurance? And he was like, fuck you, Celine. Just answer. Come on. Like, just once. Just, like, let me have this reassurance. And, like, he stuck his finger up at me, and I was like, no, it was all playful and whatnot, and we giggled about it, but I was like, like, every time, he's like, nothing gets past you. And I'm like, I wouldn't be helping you if we fed this.
- [18:49]
C
Exactly. And I'm sure after the session, he really appreciated it.
- [18:53]
A
He did, yeah. The following. He was like, thanks for doing that.
- [18:57]
C
I guess it was nice.
- [19:01]
A
I think that's something that in our clinic, especially, like, we're encouraging our team to be like, trust your clients. You know, trust that they can do hard things. That's the thing that we're learning. And I think the message that's coming more and more, not just, like, even outside of ocd, just in terms of being a person. I think we really need to move towards this level of acceptance of our job isn't to get rid of our feelings or our thoughts. Our job is to get good at feeling them. Right. And that's what we're doing as. And it can happen in anything, whether it's OCD or anxiety disorders or dealing with grief or something else that might be coming up. All right, so what is something you guys know now that you wish you knew a little bit earlier in your treatment journey?
- [19:55]
D
The first thing that came to mind was, like, the more you give in to the ocd, the more control it has over you.
- [20:02]
A
We do a lot of education at the beginning for our clients so that they know just what. I'm sure your therapist would have done the same, like, what you're dealing with. And knowledge is power. Right. So do you think there are different stages of how you feel about treatment, like the terror coming in and OCD being really loud and that sort of stuff? Do the messages hit differently at different times in your recovery journey? So perhaps, like, hearing the message Again, a little bit later. Is something that would land differently based on where you're at.
- [20:38]
C
Absolutely. Yeah. I think in the beginning, everything was scary. Just thinking about how far I've come, personally. Like, I remember walking around. One of the exposures we did in session was walking around a gallery. And I don't even remember why there was a gallery in the therapist's office. I think that they were like, pictures of women, of models, I think. And she had me, like, walk around and not engage. Like, listen to what I would. My thoughts were telling me, but, like, not negating what they were saying. And I'm just like, now that I'm thinking about that, I was so uncomfortable at that point.
- [21:23]
D
And it's a good exposure.
- [21:25]
C
Yeah, I'm pretty sure that's what happened otherwise.
- [21:28]
D
Yeah.
- [21:29]
C
But, like, we did things like that and where I would feel like, so intensely uncomfortable. And it was just really hard. I remember the work being really hard. And now thinking about it, we've gotten to a point where we can, like, do this to ourselves. Like, we don't need to have our handheld walking around a gallery or being, like, pushed to do something. Like, we know that that is going to be the most helpful thing for us and that's going to make us feel better in the long run, is to make ourselves feel uncomfortable now. And so that is definitely something I wish I knew earlier, but I don't think I would have been able to know it earlier. Like, I think.
- [22:05]
D
Or been able to handle it.
- [22:06]
C
Right. I think that's something that you learn as you.
- [22:09]
D
You get comfortable and you see that you've done this before pretty much. And you're okay.
- [22:14]
C
Right. So you can't get there until you've felt the discomfort. Until you've felt. Felt like, I can't get through this discomfort. And then you get out the other end and you're like, wow, I got through that discomfort. And that's when it all kind of transitions.
- [22:27]
A
Yeah. So what you're describing is something I think at times don't always have the language, but hearing you speak and share that, what came to my mind was ERP is very experiential. You need to experience it in order for the lessons to land and the messages to hit home and to feel comfortable and safe and to make sense. And we can't rush the process. It needs to happen at your pace.
- [22:56]
C
Exactly. Yeah. I think that's really important. It's like, it's not just with the snap that it goes away or even gets better. It takes a lot of time and energy.
- [23:05]
D
And I think it also different for every person. Every person. You can't give them the same subscription and, like, prescription, whatever. Yeah, yeah, yeah. Prescription. Yeah.
- [23:17]
A
The same treatment protocol or prescription or whatever.
- [23:20]
D
Right. Everyone's gonna have a different. They're gonna take to things differently. It's gonna upset someone or it's gonna make someone feel better, actually. But, like, those are things that kind of have to happen naturally and part of the process, I think.
- [23:35]
C
And I think even, like me and Lindsay, there are times where I get frustrated, and I'm like, you've been through this before. Like, why is this still so hard for you? Like, I remember there was one point where I was like, I was getting a little mean, but then I realized, like, just because I got over something faster or just because maybe I didn't need as much therapy as Lindsey does, it doesn't, like, mean anything. Like, we all have different ways of processing and different timelines. And so that's definitely something even just, like, from me and Lindsey's experience that I've definitely. There's definitely truth to that.
- [24:12]
A
Yeah. Amazing. Thank you guys so much for joining us. Do you want to tell us where we can get the Presently jewelry from?
- [24:20]
C
Yeah. So you can find us@presently bracelets.com and pretty much, I think all of our handles are at Presently Bracelets.
- [24:30]
A
So socials.
- [24:31]
C
If you type in Presently bracelets into Google, you'll get us. So find us there. For every bracelet that's purchased, we donate 5% of that to different mental health nonprofits. So currently we have four different options. You can choose them when you're adding the bracelet to Cart. And I think we share a lot of personal stuff on Instagram, on TikTok, on our blogs. On our blogs. Yeah. So lots of good content coming from the two of us.
- [24:59]
A
Amazing. Thank you guys so much for your time.
- [25:03]
C
Thank you.
- [25:04]
D
Thank you for having us.
- [25:06]
A
Thanks, everyone, for listening. You've been listening to Breaking the Rules, a show for mental health professionals designed to help you build confidence in treating obsessive compulsive disorder.
- [25:19]
B
This podcast is brought to you by Melbourne Wellbeing Group, a psychology practice based in Melbourne with a special focus on treating OCD. To find out more, head to our website, MelbourneWellBeingGroup.com all one word. That's MelbourneWellBeingGroup.com this podcast was made with.
- [25:37]
A
Strategy and production support from Wavelength Creative. To make sure you don't miss an episode of Breaking the Rules, be sure to subscribe to or follow the show in your podcast app. And while you're there. Leave us a five star review. It really helps others find the show. I'm Celine Galgett.
- [25:54]
B
And I'm Tori Miller.
- [25:56]
A
And we'll be back next episode with more reasons to convince you to get messy, have fun and break the rules.