B (3:21)

Sure. So I think we definitely have a shortage of providers who really specialize in kids. And I'm not really sure what the reason is, because kids can be really fun, but it seems like a lot of people might feel intimidated or might struggle with the language or how to make things developmentally appropriate. And I think sometimes parents can feel intimidating. It can just feel complex. So I just thought that there was a bit of a void in terms of the available books out there, in terms of the middle childhood range. So we have a lot of books for younger kids and some newer books for older teens and certainly adults. But I felt that we needed a resource that more comprehensively passed on the information that we want kids to know and parents to know in terms of how to treat ocd. Understanding the nature of it all, the different ways that it can pick on people. And I just felt that it was honestly enjoyable. It was a fun project. I enjoy the creative aspects of it, just coming up with different ways to explore, explain things. And I thought it would be a great way to. To disseminate information on treatment to a wider audience through the book. So that was kind of the main priority there is just getting. Getting the. The science to people so that they could improve and. And know how to address ocd and then also just helping kids relate to a lot of what's discussed in the book so that they felt more understood.

A (5:07)

It's got a fun title too.

B (5:08)

Yeah. Yeah. So the title, something. I just. I appreciate that because I like it myself. It was just always something that I thought was a little bit catchy. And I honestly had it in my. In my brain for years, even before I had the. It was able to carve out, rewrite it. But the title, what to do when you have a tricky, sticky, picky brain. Cognitive behavioral strategies for kids with obsessive impulsive disorder. It really just tries to focus on the nature of how OCD presents for people. So the tricky part is that, you know, we know OCD is something that tends to try to trick people into believing that certain things are true and those things aren't. So lies, you know, catastrophic things, thinking patterns. And it tries to be very convincing and tricky so that it can stay in control. The term sticky references just the nature of repetitive, intrusive thoughts and urges. So these thoughts tend to get stuck in someone's mind and it's hard to get them to stop being bothersome. And then the, the picky aspect of it has to do with how particular OCD can be with what it wants. So it tells, you know, it convinces someone to do a compulsion to make them feel better. And then it says, you know, hey, I don't think you did that exactly right. Or maybe you need to do it once more just to be sure. And so it's very specific and picky in terms of what it wants in order for kids to feel that they can move on. Well, adults as well. So I thought tricky, sticky picky was a way that just kind of broadly captured how OCD can manifest for lots of people.

A (6:55)

Yeah. And with this idea that, you know, it's for this, this kind of middle range kid there, there's an interesting mix in there. Right. To be able to write a book that kids will relate to, but also that parents can get something out of, because obviously you can't just do therapy with a kid that age and hope things will change if the family system isn't also involved in some of the work. Right.

B (7:24)

Yeah. So the book is, it's written with a focus on children, adolescents and teens, but really it's the same tools, techniques that we use for everybody. So it can be applied to adults and certainly with parents and family members. I think it helps give a better understanding of all the different components of treatment. And when we do work with kids, as you said, parents have a big role. Because if I'm working with a family, let's say an hour a week or maybe a little bit more, but the family or parents or caregivers are with them for so many more hours in a day. They need to know how to best support children so that they can progress in treatment and learn to overcome this. A lot of times, well intentioned parents, they think that they're doing things that are helping their children feel better and, you know, manage these tough moments. But we've actually seen that a lot of that strengthens OCD and reinforces it. And so a big part of treatment is teaching parents how to handle OCD triggers, how to best support their children so that the children feel that the parents are a support, not just a trigger. And so it really is a family based treatment in order to get the best outcomes.

A (8:46)

I wonder if, obviously you go over that in the book, but maybe we could talk a little bit more in depth because one of the things we haven't talked a lot on here on the podcast really is that interaction of the family and The OCD and how OCD could move in and try to take over the households and be the one that runs everything and sets all the rules and regulations. And I wonder if you might speak to that for a bit for families that might be listening, because I'll get calls from people who just feel like they're the only family this has ever happened to. And it's devastating. And yet we hear these stories all the time. So in your work, especially because you do focus so much more on children than adolescents, how do you see OCD try to take a home over and rule the roost in, shall we say?

B (9:43)

Yeah. So, you know, first and foremost, we know that OCD impacts about 95% of families in some ways. So in about 95% of families of a child with OCD, parents are involved in some capacity. And the way that that usually presents is oftentimes by directly being involved in rituals. So a parent could be part of, let's say, a nightly routine where a parent is facilitating or there's questions and answers that are going on at bedtime and the parent has to respond to the child in a very specific or particular way. So it could be directly involved, being directly involved in rituals. It could be by providing items for rituals. So maybe a child with concerns about contamination is requesting that a parent buys a new bottle of soap or new towels. It could be by helping the child avoid different things. So maybe if the child is afraid to pass by something while driving on the road, a parent is, you know, willingly going a different route. And so there's lots of these different ways that parents participate. Reassurance is a big part. Participation in rituals where kids are asking questions to parents, you know, is this horrible thing going to happen? Do I need to go see a doctor? Am I a bad person? You know, did I do something horribly wrong? And so that's a big aspect. But, you know, we have a. We have long lists, there's family accommodation scales that describe these symptoms. So we use the term family accommodation when family members accommodate the ocd. And accommodate is really just another word for like, maintains OCD or enables ocd.

A (11:37)

Give in, maintain.

B (11:38)

Yeah, yeah, there are accommodations in this capacity really refers to when parents make changes or modifications to how they do things because of the ocd. And so these things are super, super common. And again, parents do them with good intentions in the moment because they help their child avoid or minimize distress. And, you know, parents feel like they need to. There's a lot of survival that happens with ocd. How can we get through the day, how can we get our kid to school? How can we get them to bed? And so in the moment, sometimes parents are giving in, but we've learned that ultimately it just keeps the OCD strong. So treatment should involve ways to decrease those accommodations gradually so that the kid is no longer, you know, dependent on those types of things and can learn to overcome OCD and have the confidence that they can handle these triggers without the involvement of parents.

A (12:40)

That isn't just scary for the kids, that can be scary for the parents, too. Right. To let go and then watch their child be uncomfortable. Because I. I never believe a parent will do accommodations in. In any kind of malicious way.

B (12:57)

They.

A (12:57)

They do it because they believe that this is going to be the most helpful thing, even though we know that very often it turns out to not be the most helpful thing in terms of the fact that it maintains OCD and it keeps it in the home. And how do you. How do you make that explanation to families? Because sometimes I've seen people feel so guilty when they find out that, wait, all this stuff I've been doing has actually contributed to the ocd when I thought it was helping my child be calmer and everything of that nature. Right. That's a tough conversation sometimes to navigate.

B (13:32)

Yeah. So, interestingly, I would say that working with parents and caregivers is one of my favorite things to do, because I really feel, well, like they're coming and they're looking for the tools, you know, how can I help my kid? And so when we're able to describe to them specific steps that they can take to help them help their children get on a better path, I think they're very appreciative of it and hopeful. I think the key is really just giving them a good information and explaining how what they're doing is actually feeding into the ocd. And the goal here is never to blame or make them feel guilt. I think that an important part of this is normalizing. Like I said, 95% of parents do this. It makes sense that in the moment, you're trying to help your child minimize distress. So it's really important as a clinician that you're giving that normalization to the family so they don't leave feeling like they caused the problem, because that's certainly not it, and then explaining how and why it works. So I'm big on drawing things out visually so parents can see the OCD cycle and how enabling or participating in rituals is just making it stronger. So it really just starts with good education, validating that it's hard. And then instilling hope and confidence that they can do it. And, you know, all this stuff, we start with small steps that are really manageable for people to incorporate into their life. And then as they see progress and their confidence builds, we make things even. You know, we kind of ramp it up. And then over time, that momentum builds and people see bigger and bigger changes and bigger improvements. So I think as long as we clearly lay out the plan and everybody is on board. So when we're making changes to accommodations, we're. We have a discussion. I talk with the children, I talk with the parents. Okay, this is how we're going to do it. This is what's going to happen. This is how I want you to respond if your child tries to negotiate with you. Or sometimes kids are genuinely struggling and they kind of pull on our emotional heartstrings as parents. So I really like to almost preemptively go through all of these different things that could be thrown out there so parents feel super prepared. Um, and then kids are also on board with these goals.

A (16:10)

Yeah. Sometimes I call it refrigerator therapy. Sometimes you have to write it out and stick it on the refrigerator. So everybody agrees that this is what we're working towards.

B (16:18)

I'm a big proponent of that. I think it minimizes confusion, it helps with follow through. So I'm a big proponent of writing things out very clearly, you know, making sure that I answer any questions before they leave.

A (16:35)

Yeah. When I started my career, I had a. I, I had a few sessions where it's like, that's not what he said. And that is what he said. And I was like, well, we're writing this out.

B (16:43)

Yeah.

A (16:44)

Because there's just way too much that's not what it was said and that is what it was. That kind of stuff goes on. Yeah.

B (16:50)

And it helps me as a therapist, you know, foster that accountability. Right. If it's like, this is what we agreed on and, and this was the plan. So I definitely think that it's important. And this stuff is hard when you're in. When there's emotional moments and triggers and people are anxious, it can be hard to recall exactly what to do. So if it's written out, I think that can help.

A (17:15)

For families who are really entrenched, like OCD has quite moved in and got a bedroom and everything, who might think they don't even know where to start. How does, how does a book like yours help them to take a step back and start to think about where to begin? And then would you Also recommend working with someone along with the book and assisting like with, you know, where's the lines for various things.

B (17:53)

Yeah. So I, I tried my best to have the book be as thorough as possible in terms of presenting all the information that we would try to convey, at least the main ingredients of therapy and the treatment strategies. So I think just at the beginning of the book it explains the nature of ocd. I tried to include a lot of the questions that we get. So, you know what, why do I have this? Where does it come from? Questions about brain functioning. Neds A lot of times kids have these questions and I haven't seen too many books that, that answer them in kid friendly language. So I try to give a really good overview of what is ocd. And then the book really delves into recognizing OCD and the various ways that it can present. So a lot of the books can go into more stereotypical presentations. I wanted to include a lot of the symptoms that we see that haven't really been included in a lot of the books written for children and adolescents, such as Taboo Obsessions, Intrusive Thoughts, Scrupulosity, Morality. And then. So I thought that that was, was really helpful. I, I think the book is, best case scenario could be used in conjunction with a therapist because nothing can replace working with an informed specialist in ocd. But for some people that may not be accessible or harder to access. And so the hope is that a book like this can help fill the gap for the people who might not have access to an individual clinician.

A (19:43)

I think something that's nice too about this kind of book, especially for kids who might be wary of telling anybody else about some of these things and letting it outside the family that when they see in a book like yours that, oh, she mentioned all of the things I have already, it's like I'm that terminal uniqueness that people hold on to that they're the only one in the world that has had this. And then suddenly your book comes out and you know, I'm not the, I'm not the only one who has this kind of thing. Right? So.

B (20:14)

Yeah, exactly. I, that was one of the main goals of the book, is that I wanted all kids with OCD to see themselves in it in some way. And I do that through what I think is a really thorough list of different ways that OCD can pick on people. A lot of those themes that, like I said, are often not written about in books geared towards kids. And I tried to do it in as developmentally appropriate language as possible. So Again, the idea is not to put new thoughts into people's minds with ocd, and we really don't see that. That is a concern that sometimes parents have, but we really don't see that much at all. But it's to have those kids who might think, I can't tell anyone about this. No one has thoughts like me. No one has urges like me. And then they read about it in a list of symptoms, and then they read about it in examples, and then they read about it in the characters. I have about 20 different characters in the book with lots of different assortment of OCD symptoms. So I want them to get the message like, wow, I am not alone, and other people struggle similarly, and I can get this under control. So that's really the. The overarching goal here is to reach a lot of the kids that they feel that way.

A (21:38)

How much inspiration did you get in writing this from the people you were working with? You know, and. And were there. Were there people who. Who were. Sometimes kids get excited, like, put me in your book or something like that, Right? Did you. Did you have any of those kinds of things?

B (21:58)

So I would say all of the. The characters, for instance, that I include. So for those who aren't familiar, I have characters like Magical Thinking, Mila, Taboo, Timmy. Just Right. Juan. Contamination Concern, Charlie. So I moral. Marcus. I have to think I don't know them off the top of my head, but they're all really conglomerations of lots of different symptoms. So there's no one character that, you know, references a specific patient. I saw all the things I included. If it's in there, it means I've seen it multiple times with lots of different people. So it's possible that people I've seen over the years might be like, oh, you know, that relates to me. But it's an interesting thing about ocd, and I'm sure you know this from your own work, is that even if people are in a completely different part of the world, it picks on people in very similar ways. And I find that to be one of the most fascinating and interesting things about OCD is people are convinced that no one else has the same struggle. And I'm sure neither of us at this point are surprised with much of what we see. And I actually find it, if there's anything cool about ocd, which there's certainly not much cool, but the fact that people that live in completely. Completely different continents have such similar symptoms, I just find to be fascinating. So all of the examples and characters were like, I Said a conglomeration of lots of different things I've heard over the last 20 years, and I just tried to pack in as much as I could. However, I do have five kids who share their stories and some of their insights, and those are actual, you know, legitimate people, some that I've worked with and some that others have worked with that were interested in contributing. So I have about five kids, ages 10 to 17, who share a little bit about their experience with OCD, and I feel that that's one of the most awesome contributions. Aspects of the book is that kids can hear from other kids as well. And, yeah, they were pretty excited to share those ones.

A (24:23)

Your work, obviously, has gone beyond the private practice in the book. You've done a lot of work in Florida with the affiliate down there and the International OCD Foundation. What keeps your passion for working in this community with these folks and your colleagues?

B (24:44)

It really is just the people. I think I'm passionate about the treatment for this because it works. And I know that there is still such a lag before people get effective treatment for ocd. And I guess there's my own sense of responsibility where I feel like I want to play some role in helping connect people to resources and services. Services and the community itself is just incredible. We're one of the. You know, Patrick and I get to hang out yearly at the OCD Conference, and I think we're one of the most unique. We're both a mob with the International OCD foundation, which is incredibly special in that we have an annual conference that has people who do research on OCD who have lived experience with ocd, parents of those with ocd, spouses, partners, clinicians, and so everybody's together in one place. And I feel that the uniqueness of the community of just so many people working together, it's just really a positive. A positive part of my life. And I feel like it genuinely makes a difference and I enjoy being a part of it.

A (26:04)

Yeah, I agree. It's a great community and we have some fun at those conferences, that's for sure, too, because it is, like you said, it's such a unique experience to be at the conference and to be not just with colleagues, but to have people who've been treated for OCD or thinking about treatment for OCD be able to mingle with us. And we can. There's forever the stop in the hallway question, by the way, those types of things. So it's always such a great time, that's for sure. What are you looking forward to, you know, now the book's out. Obviously, that's a labor of love for. For the book. But what's next for you and what are you looking forward to from the OCD community moving forward?

B (26:55)

I think it's definitely nice to have the book done and out there. I think just disseminating it and helping it get in hands of people who might need it, I think is certainly a goal. I do enjoy writing. So I have some other things that I'm working on, but too soon to share because I don't want to put any timelines on myself. So, yeah, I think just it. I'm just looking forward to continuing to do a lot of the same. Just being involved, being a resource for people, doing good work, helping people, continuing to help, help train and share what I know with other people, learn from other people. So I think it's just kind of an ongoing process of, you know, sharing what I can and soaking in what I don't know as well. Along the way.

A (28:00)

I left more time for these questions at the end for you because I think this is more unique in terms of the fact that we're dealing with children and with families in these situations. So maybe two parts I'll start it with. I would. I would always want to end these with. What's your message to people? Listening, but with. With the unique aspect of the audience of kids with OCD and then the parents and families and guardians and people in. In the lives of people with ocd. So really, two part. What are your specific messages for those two groups? So let's start with. There's kids with ocd. They may see this, they may be on the fence. Maybe this inspires them to get the book and start reading it. Maybe that inspires them to talk to a therapist or the book gives them the tools that they need to do it. But there's. There's always those people on the fence who just aren't sure if they should do this, want to do this. And we know sometimes the fear also, what if I go and do this and I read this and I still don't think I have ocd? I'm something different than everybody else. Right. So how do you. How do you motivate people to take that step?

B (29:16)

Well, I think one thing I'll say is I see that so much in our work, those types of doubts and questions and concerns and feelings that someone's different or they're not going to be able to benefit. And so I actually wrote down all those things that I've gotten over the years, those questions the skepticism. And I incorporate that into the book in a couple of different areas. So there is a chapter on doubts and barriers that might come up, and there's a chapter on how to build motivation. And so I, I think similarly to how we talked about how OCD symptoms can be similar with people across the world. The doubts and the barriers are also very similar for lots of people. So if I write those out and I present that to someone and then they're reading about their own doubts and barriers again, it's adds credibility to what I'm sharing with them because I'm speaking to the concerns that they have. And so it really, the message is, I would say it's simple. We know how to treat ocd. We have very effective treatment for ocd. It's manageable. It's something that you need to connect with someone who is specialized and very experienced in it. Because OCD treatment is nuanced, we don't have a cure, but we have really effective strategies to get it to a place where it doesn't have to interfere or stop you from anything. And so if people are willing to do the work, they can get better. I always say that severity almost is somewhat irrelevant to me. It's, are you motivated and are you willing to follow through and do the work? And we can go at whatever pace works for somebody. It can be super small steps, it can be fast, but if there is motivation and there's a willingness to follow through, then people can get so much better. To a point that OCD is more of just a nuisance or an annoyance or something that they're not even thinking about very often at all. And so, yeah, we know how to treat it. And if you're willing to try, you have a lot to gain. So that would be the message, and it would be a similar message to parents, family members, partners of adults, spouses. Sure, we know how to treat it, and there's hope, and I know that there's fear. When you're a parent of a child who's struggling with this, there's worries about will they be able to live a happy, healthy life, will they be able to reach their goals? And all that is absolutely possible. You just have to do the treatment that we know works.

A (32:22)

A second part on that parent piece, because as we introduce erp, when we're removing coping strategies and removing reassurance and the soothing behaviors, it means parents are with somebody who's uncomfortable without providing them the immediate relief that OCD demands, and instead having their children learn that they can handle whatever Those obsessions are. That can really pull on the heartstrings of parents, though, right, to watch your child be uncomfortable. How do you help people through those moments to be able to see more into the future that even though it's uncomfortable now, it's the best choice for treatment?

B (33:02)

Yeah. So if. If they understand the rationale and the why we're doing this, I think it makes sense. You know, we want your child to learn that they don't need reassurance from you in order to go to sleep at night. And the reason for that is because it's going to build their confidence, it's going to make them feel stronger, and it's going to help them learn that their feared outcome doesn't come true or that they can manage the distress. And so I think it really stems with just having an honest conversation with parents about the rationale for this. It's temporary discomfort and distress for significant improvement on the other side. And again, we meet families where they're at. The goal is never to do things that trigger panic attacks or horrible escalations of anxiety. If it's a situation where that occurs, that's okay. We can still work through it. We don't need to be afraid of that. But our goal is to do things gradually so that we build momentum and confidence bit by bit. And so parents are making small changes, kids are making small changes, and then there's learning there, huh? You know, that went okay. My fear didn't come true, or I handled that better than I thought, or that was really hard. But I got through it, and eventually I felt less anxious. So all those things that they learn, we then build on, and hopefully it generalizes to the next, you know, goal in treatment and then the next one. And then after not too long, we're seeing a lot of improvement and progress. And kids are seeing, like, that they're functioning better. So I think it really just is about validating that it can be hard. But if you tailor it to the individual, I think that people tend to really do very well. They've, you know, we've. Any treatment can be done, you know, haphazardly or effectively. It's just like any surgery can be done that way. And so a really experienced clinician is going to tailor it to the individual, keep them on board, have things be at a manageable level to progress. And so that's really what it's about. And then we just keep them focused on their, what a lot of us say, like, their why. Why are we doing this if we don't do this, this is what the path could look like. The path looks like, you know, continued anxiety for many years. OCD doesn't remit on its own. We just don't see that tend to happen. So would we rather have years of distress and anxiety where we're pretty much guaranteeing that we're going to experience that or some temporary short term distress so that we can get a handle on the anxiety and it doesn't have to be so disruptive? So I think the choice is obvious. Sometimes it takes a little convincing for us to do as therapists, but I mean, I feel confident that I can convince people in the benefits of doing this. And so I'm happy to do that if, if it helps them get on board.

A (36:36)

And it's quite a message of hope then, isn't it? To families who, who when we meet them very often feel like they are so far down the well that there's no way out and there's not a ladder long enough to get them out of this situation. And I know, I've heard this, and no doubt you've heard it too, that people will even say things like, I don't even know who this child is anymore, right? This, this doesn't even feel like my kid. What is, what is going on? So to meet somebody who specializes in this, who understands this and who can give that encouragement, that message of hope to them is just, I've seen, so uplifting to families who finally feel like, okay, maybe there's a path forward here and we're not stuck in this for the rest of our lives.

B (37:23)

No, you nailed it. I think that's a big part of what keeps me doing it. So many of the people we see before they get to us, they worked with providers who are not well versed in ocd, who might not do the gold standard treatment for ocd. And that is incredibly discouraging and frustrating when you are seeking out a help helping professional and then you are kind of, you know, go through the ringer on the hamster wheel of trying to get help. And then a lot of times kids internalize that like, oh, is there something wrong with me that I can't get better? You know, and so a huge part of it is instilling confidence, instilling hope. And families do really feel appreciative. And it's just so amazing when they make comments like what you just referenced where like, I finally feel like someone gets it or that's exactly it. You know, one of my favorite things to do is almost like preemptively tell people what they're thinking because I've just seen the same, you know, and again it adds that credibility, ability to having someone who finally understands it. But I get it. Like in the book I talk about barriers like I've tried treatment and it didn't work. You know, and then we sometimes see people who've, who feel that they've tried the evidence based treatment and it hasn't worked. And that can feel discouraging. But there's just so many factors that play a role in improvement and it's about tailoring treatment, making sure somebody is a good fit as a therapist, addressing any of the, the family factors or other things that could be getting in the way. But I really believe that we can help pretty much anyone if they're willing to do the work and figure it out to benefit.

A (39:20)

So yeah, I, I remember being on postdoc in about a week in thinking, I think this is what I'm going to do the rest of my life. And I have. 26 years later, here we are, we're still.

B (39:34)

Yeah, it's super reinforcing. You see, you see people improve and it's in a relatively short period of time. Right. So correct. A lot of my background is on treatment studies where we had like 10 to 12 sessions to help people see clinically significant progress. And so I became probably a little competitive with it. But, but people shouldn't be in treatment for this for years and years and years just barely making progress. This is a treatment that's very effective on a more short term basis. Some people like to stay in treatment to maintain their gains and you know, spread things out and that's totally cool. But you should see progress within a matter of months for ocd and I think that can be really encouraging for a lot of people who may have struggled for many years with this.

A (40:26)

All right, where can people find you in the book and all those things? Give us, give us your deets, shall we say?

B (40:31)

Where can they find me? I might not share, but I'm just kidding.

A (40:35)

Home address, Social Security number, bank account information.

B (40:39)

Yes. So the, the book is available wherever books are sold. Amazon the directly through the publisher, which is Pessy Publishing. But you can pretty much get it anywhere books are sold. If you want to connect with me, my information is on my website, which is www.jacobscenterfore.com and yeah, happy to connect with people. And if people read the book and have any feedback, I'd love to hear it. And I do hope it helps a lot of people.

A (41:16)

People and that's Jacob. No, everyone wants to put an S on your name.

B (41:20)

Everyone wants just Jacob. No S. Thank you, Patrick, sir.

A (41:24)

Yes, I'm, I'm all about the Jacob. Right. There you go. Awesome. Well, Marnie, thank you so much for being here today. Always fun to have friends on the show.

B (41:33)

Yes, thank you very much for having me. Nice to see you and chat about

A (41:37)

all this fun and thank all of you for watching the get to Know OCD podcast. If you're looking for help for OCD, check us out@nocd.com that's n o c d dot com. If you like the podcast, you can subscribe to our NOCD YouTube channel where you can watch other episodes and webinars that we've recorded along with lots of other educational material. We're here to help. Reach out anytime. And remember, be better to yourself than your OCD ever would be. We'll see you again soon.