A (2:06)

But make sure you stick around till

B (2:08)

the end because not only do I always wrap each interview with a helpful application you can take with you, but

A (2:16)

I'm also going to have some of

B (2:17)

the jokes that I didn't use. And if you're curious or maybe just

A (2:23)

nautical by nature, get it. Naughty by nature. Nautical.

B (2:27)

Yeah, yeah, you may want to hear those. Okay, so with that, I'm back and sharing interviews. The last couple pods have been somewhat of a pause and acknowledgement of space taken and hopefully some encouragement if you have found yourself in a similar season where you're like, I just can't. I can't with things right now. But I am so glad to be

A (2:52)

back because I have seen you fam,

B (2:54)

I've heard you, I see your comments on YouTube, I get emails and form submissions about today's guest, Dr. Michael Greenberg, and I think you're really going to enjoy this episode. He is a licensed psychologist who specializes in the treatment of OCD and he is the director of OCD Associates, a practice focused on rumination focused erp. Now if you're newer to hanging out, you might go what is erp? ERP is exposure and response prevention. It is an evidence based practice for the treatment of OCD. And more specifically, rumination focused ERP is a protocol that Dr. Greenberg himself developed and we discussed in much greater detail during his last visit here with the vam. In the last year, he has expanded his work to help explain psychoanalytic perspectives on OCD with the goal of integrating cognitive behavioral approaches like RF ERP with a deeper understanding of the emotional and relational dynamics that can drive symptoms. And so we are going to be focusing on an article he published last March entitled OCD as a Defense Mechanism. So join us as we explore dynamics that underlie ocd. You can also check out the article for yourself over on ocdfamilypodcast.com I always cite resources publications. We'll link to his previous episode on the podcast as well as his website full of of incredible resources over on OCD Family podcast.com on this episode's blog. And with that, let's welcome back Dr. Michael Greenberg.

A (4:38)

So welcome back to the OCD Family podcast and I am just pleased to have the wonderful Dr. Michael Greenberg with us today. Michael, I was looking and our first podcast is still one of my top five downloaded episodes of all time. So it is so cool and it, I think it really speaks to how you're hitting a tone that people are craving to understand better. Whether we're talking about rumination focused ERP or just there's a number of different articles and work that you've put in over the years and today we're going to be talking about OCD as a defense mechanism. But first I just want to say welcome back to the show. So good to see you.

C (5:19)

Thank you for having me. And should we tell people sort of context for this moment which is we naturally just spend hours talking and the first time we recorded we spent like three or four hours together because we had so much to talk about personally and then only by the way got the podcast done and that this is our third installment of this podcast and we're so it's it's fortunate that we've actually started recording.

A (5:47)

Yes, it is. Because we get Chitty Chatty, which is wonderful. And so I'm not even sorry about it, but I have taken quite a bit of. Michael.

C (5:57)

That's not what I was saying. I was just saying. I was saying it's such a pleasure. That's what I was.

A (6:02)

It is. It is a pleasure. You know, actually, in. In the last podcast episode that I published, I told the fam here about. Because I've been kind of radio silent for about a month, and I was having just such challenges with my Internet and how that was impacting the recording process. So, yes, this is our third time. Not for lack of effort, but it was such a disruptive flow. What I love, though, is even when the flow was disrupted, we're like, okay, so screw the recording, but let's just chat, and we still got to catch up. Yeah, it was very nice to chat with you and nice of you to come back today. And today we are going to talk about an article that, in our last episode, I love. If anybody has heard that first episode, you kind of talked about really wanting to take some dedicated time to sit down and write. And this, really, correct me if I'm wrong, is the byproduct of you really investing that time to really zoom in and look at this particular topic more.

C (7:10)

Yeah, that article took years, and it was trying to, like, integrate all of these different things that I learned into something that would be, first of all, accurate, which is challenging. It's a lot harder when you're writing. You have to get things exactly right. You can't just sort of say this and then qualify with that and answer a question. You have to really get it right. So I was trying to get it right and also trying to make it accessible. Trying to make these sort of various different ideas, like integrate them and make them accessible to somebody who doesn't have a psychoanalytic background. So, yeah, that article took an extremely long time. And when I was listening to our original podcast, because I wanted to see what did I talk about back then, I was shocked that it reminded me that there was this period of time before I had formulated some of those ideas, and those ideas were now so central to how I think about things that it's kind of wild to think that there was a time before them.

A (8:05)

Yeah.

C (8:06)

Now I think about, like, OCD as a displacement all the time. Like, of course it is. But I remember even finding that term even within the world of psychoanalysis. There were so many different things that were used to describe the same thing. And then finding this one thing that really was the most accurate term to capture what was going on.

A (8:25)

Yeah.

C (8:25)

Once you find it, it's like, oh, okay, it's that simple. But until you get to that point, it's, like, a big mess.

A (8:31)

Yeah. It is one of those unique things about doing podcasts, because I know that you've done a number of podcasts or events, like, with OCD change makers, I think, and being able to go back and go, no, that's exactly where I was. And it was, like, groundbreaking at the time. And then. But you can see your trajectory. I. I see it, too. When I go back, if I hear an old episode or something and I'm like, man, my word, I was just a little baby then.

C (8:58)

That makes me think of something that's not directly related but I think is worth sharing. I was talking to a colleague. I was on a listserv, and somebody said something that I was like, is that I'll just. Instead of talking generality, somebody said something homophobic. And. But I. I was like, was that what that was? Was that homophobic, or am I just sort of imagining something? And I knew somebody who just. The background here, honestly doesn't matter at all. The. I'll get to the punchline as quickly as I can.

A (9:28)

Oh, no, you had me. So I was on a list, sir.

C (9:31)

Yeah. So I was just sort of wondering if I had, like, clocked it correctly. And so I asked a friend who had gone to a colleague who had gone to graduate school with them, and she said, I do have a sort of story to share that does shed light on what's going on here. But I first of all want to just emphasize that that was however many years ago in graduate school. And, like, people grow and change. And I was like, that's beautiful and accurate. You know, like, essentially, as somebody who's been in psychoanalysis for, like, I think, like, at least seven and a half years at this point, like, yeah, and listening to things that I recorded five years ago, you know, pre pandemic or during the pandemic, I'm like, yeah, it's not. It's. I was just so much more. I was different. I was much harder hitting much more black and white. And I think it's a relief for me that I've had an opportunity to record things subsequently just so people could hear that in context of, like, the evolution in my thinking and my, like, self. So, yeah, that sort of speaks to what you're talking about.

A (10:39)

I like that a lot. Because people do grow and change. And I think I would be more worried if we went back and there was no change. Right. We want to see some of that flexibility. We want to see how life experience and feedback and data is helping us move and grow. And so I think it is.

B (10:59)

Well said.

A (10:59)

It's. It's beautiful. And for anybody joining us today that is newer to Dr. Michael Greenberg, or maybe just heard before, you were like, of course, this is what O C D is. I'm just going to go ahead and tell y' all that Michael's take and Michael's perspective and his protocol and his treatment is probably going to be different if you've been in the OCD world for a hot minute, than what you're used to. And what I would encourage just in the heart of flexibility and openness, is for you to have an open stance and hear the conversation. Because we're going to be talking about things that are almost, but not. We don't label this way, but it feels like a dirty word to bring up psychoanalysis or psychodynamic therapy. When we think about treating ocd, we hear a lot about how talk therapy can be dangerous. And I think, to be fair, all therapies can be dangerous if used, whether it's in malicious ways or just maybe some aloof ways. But, yeah, I think.

C (12:06)

Or just like unspecialized ways or unspecialized

A (12:09)

ways or even sometimes within the specialty. You know, what I will say is if I ever go like, oh, I don't make mistakes when reflecting on my clinical experience, or, oh, I can improve here or there's. Then I'm kind of worried for myself.

C (12:24)

Yeah.

A (12:24)

Because we're human beings. We need to be able to grow and learn, use our mistakes. Well, that's. That's one of my. My mottos.

C (12:33)

Can I add in sort of a psychoanalytic perspective on the warning that you're issuing is people with OCD tend to be very split. You know, this is something that I recognize in myself progressively less, but nonetheless, and in people with OCD in general. So when we. People who obsessive compulsives need to believe that the treatment that they're getting is perfect and if there is something about it that's not perfect, either, for example, that it's not a total treatment or that there is something else that could also be helpful, just anything that means that it's not the be all, end all, psychically or emotionally, it becomes devalued to us, and then we think this thing is totally worthless. And it's wrong. So it's hard for us to. Emotionally, it's hard for us to hold in mind that something is good but not perfect or helpful, but not the be all, end all. And so that's what goes on. And I'm sure anybody, if you're someone who listens to this and hears that there's something to criticize or something missing from traditional ERP or something else that can be helpful. If where you go is, oh, no, I'm in the wrong treatment and this is bad, then I assume that that's something that's challenging for you in general. I assume that that's not limited to how you feel about treatment. And maybe thinking about that or noticing that can help you hold yourself together and just remind yourself, okay, that's what's happening here. So even though it feels, like, totally devalued in this moment, like, maybe that'll pass.

A (14:06)

Yeah. You know, it is interesting because black and white thinking is such a defining characteristic of people with lived experience. Both Michael and I have lived experience of OCD. And if you take 10 out of 10 people that are knowledgeable in treating OCD and say, what do you think about black and white thinking? They're like, yeah, no, no, yeah, we don't. Black and white thinking is so characteristic. And then if you go, okay, so how do you treat it? And they're like, well, there is only one way. And you're like, tell me.

C (14:35)

I'm like, I think there's only one way, too. I'm wondering what their one way is.

A (14:38)

Yeah, exactly. And so what I.

C (14:43)

Wait, what's there? What's their? Only one way. What's their.

A (14:45)

Depends on who you're talking to. I mean, you can have people that ascribe or they get. They get kind of into this tribalism. You can get into this tribalism around a certain treatment approach. We're going to be talking about the idea. Well, I'm going to guess. I don't even know. We'll see where it goes. But we're going to be talking about the idea of being good enough and being able to integrate this balance of nothing is all good or all bad, and where can we take from things and create meaningful treatment, meaningful outcomes, all of that? But, yeah, I mean, I just encourage people, if it feels a little bit triggering or prickly, to be like, oh, my gosh, what is he saying? And why are they talking about psychoanalysis at all? Because this is OCD treatment. Please hang. And you know what? I welcome. Leave a comment. Email me or email Michael, Leave.

C (15:37)

Leave a question and I'll come back when I answer your question.

A (15:40)

Hey, I would love that. Love a Q and A, Michael, because then I can just chitty chat with you more. So we're gonna get into all of that, but first of all, for people that are coming into this, and I love that you put it in an approachable and accessible way, because I think when people are coming to find more about ocd, if they're not treating it themselves, but they have lived experience or someone they love has lived experience, it is hard to sit down and read something and take something away because you are just. Your nervous system is reacting. And so I would love if you could first kind of help people understand even what you mean by psychoanalysis. Because some folks coming in are like, I only know cbt, and I've been told only CBT things. You can't look outside of cbt. And so would love if you could even give the listeners an idea of what you mean, how you operationalize that, what psychoanalysis is.

C (16:37)

Yeah. So this is one of the things in the article. So I'm going to do my condensed version, but anybody who wants my best version of it or my false version of it, it's in the article, you can read it.

B (16:48)

Yes.

A (16:48)

Which will be linked on the blog, but also you can check out drmichaelgreenberg.com and I'm going to have that linked. He has a number of articles there.

C (16:56)

So basically, psychoanalysis is about how people navigate feelings within a relational context. There you go. That, I mean, that's sort of top. What's the term? Like top. Top line.

A (17:12)

That's like the. That's the skimming the surface, the top executive summary.

C (17:17)

Yeah, there you go.

A (17:18)

The common factor that you. Yeah, well, I love that. And ultimately, I am a licensed marriage and family therapist trained in the state of California. But I would imagine this is how most states or wherever you are in the world could code such a thing. We treat interpersonal relationships. That's ultimately the goal. And so sometimes, especially if we're really zooming into behavior or the cognitive process of creating doubt, we're missing sometimes the relationship. And yet the field acknowledges that this impacts relationship, because you'll hear about family accommodation, you'll hear about programs like Space, where they're helping through that relationship through your reaction in the environment, but still

C (18:05)

thinking about it, mostly behaviorally.

A (18:07)

Yes, it is.

C (18:08)

Yes, it is what a person is. Okay, so let me. Let me take a shot at it. I think, I think. I think I'll Just sort of summarize the way I did in the article. So here's the example I give in the article, and none of this is mine. This is sort of an integration of many different psychoanalytic ideas which are all

A (18:24)

cited in the article. So you can. You can expound on them if you want.

C (18:28)

I guess what I want to say is it's not exactly loyal to psychoanalysis, has lots of different theorists and, you know, who don't agree with each other or have slightly different takes. This is in my. My best version of, like, the grand unifying theory of, like, the basic concept that sort of gets at the. The heart of things. So it's like this. It starts with the question of how do we learn to. How do we develop any sense of our feelings? The example I use in the article is that when a baby is hungry, like when an infant is hungry, the infant doesn't know that they're hungry. They don't know what they're feeling. They're not thinking about what they're feeling. And they don't even know that they. They don't have a sense of self. They're not a they. They don't have a. A sense of identity. So when they're experiencing hunger, it's just this painful, distressing feeling directly. It's just a physical experience of. Of pain and distress. And then if all goes well, there's a caregiver who comes along and says, you're hungry, or feeds the baby. And this accomplishes two things over time. Like when this happens over and over again, two things happen. Number one is that the caregiver provides the baby with an idea to go with the feelings. Like, this is hunger. I'm experiencing this thing called hunger, which itself is containing meaning. It helps us to hold ourselves together. So, for example, if when we're hungry, we know, oh, I'm hungry. That's why I feel terrible. And then we can sort of handle that better because we know what's going on, right? Not just in this, like, oh, my God, what's happening kind of state. And then the other thing that it does is the tone of that, oh, you're hungry, you're feeding. The baby communicates that there's nothing wrong with this feeling. This is an acceptable way to feel. It doesn't alienate me. Everything's okay. So over time, the baby develops a sense of, I'm having this experience called hunger. And that is okay to feel with other people. And this is the same thing that happens with any other feeling. If I'm feeling Let's say fussy. Okay. Let's stay in baby terms. Okay. I'm like, oh, this is what fussy is. And let's say that mommy or daddy says, oh, you're so fussy today. You know what that's communicating is? And it's okay to feel fussy, you know?

B (20:40)

Right.

C (20:40)

So over time we have these experiences and it gets reflected back to us in this accepting way and then those things get integrated into ourself.

A (20:51)

Yeah.

C (20:51)

This is part of me. Okay. This is a way that I feel. Sometimes it's continuous with everything else. Meaning it's connected.

A (20:58)

Yeah.

C (20:59)

But on the flip side, when something goes wrong, there can be a breakdown in either of these or both of these processes. So either if we don't have anyone who helps us to understand what it is that we're feeling or misunderstands what we're feeling. Like, let's say we're really sad and somebody tries to feed us.

A (21:18)

Right.

C (21:18)

That misattuned response, mismatch. So we don't understand what it is that we're feeling. Or, and, or there's a bad response to what we're feeling. For example, let's say a kid is jealous. You could have a parent who says like, yeah, you're jealous. As if to say, like, yeah, this, this is this thing called jealousy. And everybody feels it sometimes and it's perfectly okay and you can't take their thing. But it's normal to feel jealous. Right. You're okay.

B (21:46)

Right.

C (21:47)

And then a person can say, oh, I feel jealous. They can manage that feeling within themselves. In contrast, if a parent has a reaction to the kid being jealous, it's like, what's wrong with you? Or this is a disgusting way to be, et cetera.

A (21:57)

Yeah.

C (21:57)

And that they have a feeling, like, to feel jealous alienate people. Wrong. It alienates other people. Okay. So I like to use the metaphor of like a food intolerance. So when we can digest a certain food or a certain ingredient, it's no problem. We don't even know necessarily that we're digesting it. Like, let's say a person is not allergic to soy. They might not even notice that there's a soy lecithin in what they're eating. It just you sort of digest it and move on, no problem. But. And cannot digest. All right. You're a gluten free family, right?

A (22:32)

We are, we are. I have celiac, so I can't have gluten.

C (22:36)

Yeah. So if you, if you are not celiac or not gluten sensitive, then you eat gluten, you might not even know that something has gluten in it. But if you cannot digest gluten, then you get symptoms. So sometimes when there's a food intolerance, the body has to physically get rid of the food that can't be digested. When it comes to feelings, we can't get rid of them, but what we can do is push them out of our conscious experience. So let's say I am feeling jealous. Either I don't know that that's what I'm feeling. Right. Or it alienates me from other people. Like, when I would feel jealous, my parent would say, you're being so disgusting right now. Why you're being ungrateful, whatever it might be. Okay, yeah. So psychoanalysis assumes that how we feel fundamentally is how we feel. Meaning if you hit me and I'm angry with you, I could tell myself, oh, you know, she didn't do it on purpose. Or I come with any story or whatever to sort of make myself feel less angry. But psychoanalysis would assume that fundamentally, on a basic level, I am still angry with you. Or similarly, let's say this kid is jealous. And let's say the parents don't have a bad response, but they don't help the kid to understand what it is that they're feeling. Right. So the kid doesn't understand that they're feeling jealous, but fundamentally they are jealous. So this term, like fundamentally, this is how you're feeling. That's what we mean by unconscious.

A (24:01)

Yeah.

C (24:02)

You not know that that's what you're feeling. You might not accept that that is what you're feeling, but fundamentally that is what you're feeling.

A (24:09)

Can I ask a quick question, Michael? I'm thinking about, and it's all very mushed up together, so it's hard to just not think through this lens. But I'm thinking about our neurodivergent population and the concept of masking. Because I'm thinking of so many times where maybe someone's response to sadness gets miscoded in the allistic world as uncomfortable, or you shouldn't be doing that. This is how sad should look. This is how scared should look. And so even kind of that, that pushing down that repression, I think sometimes. Yet people are learning. My experience is not okay for this situation. And so it just. It popped up in my mind. And would you say those are similar in that.

C (24:56)

So to the extent that it's unconscious, if a person knows that they're sad but is consciously trying to hide it, then that's not a defense. I mean, I mean, it's not really. I mean, maybe on some level it's a defense, but it's still conscious for them. If a person in that situation, because of those pressures, doesn't even realize that they're sad, right. They're confused about what it is that they feel because of this environmental pushback on those feelings or how they're expressing them, then that would be the same thing.

A (25:26)

Yeah, I think that. Yeah, I think it can be both. But I think a lot of people that don't realize, or parents that don't understand that their kids might be autistic, or maybe it could be a number of different manifestations of sensory processing or just different ways our brain operates. But. Yeah. And what I will say, family, I, before I got into the OCD field, I was in 0 to 5. So I am all in for this shit on babies. I am here for it. It was my first love. I still love that area of the field. And people would say, how would you do therapy with a baby? You know what you do? You do therapy with the relationship. That's how you do it with them and their secure, or hopefully secure other, their provider, their caregiver, their parent. And I think it was Winnicott, Donald Winnicott that said, and which I know you cite Donald's work quite a bit like, like we're BFFs, he's long gone. But also, I believe you said it, Donald's work. And I think it was even an example to give people a visual. He would talk about one of his pet peeves being people bouncing a baby on their knee. Now you might go, oh, that might be regulating to them. But also there can be that messaging that if you are getting fussy and upset, you shouldn't be. So change your attitude. I'm bouncing you on my knee. And so what we're saying is not that there is just one way of looking at it, but these, these early childhood experiences that help us develop our sense of self are impactful in the way we digest our world.

C (27:04)

And if you want to make it really intuitive, because I think people who are not used to psychoanalysis are like, why are you talking about babies? That's so long ago. But just think about it. Long ago, if you as a baby learn that your, let's say, needs overwhelm your caregiver. So when you express a need, your caregiver gets like super anxious and falls apart and they don't know what to do. And we're not. Also, I should Say, I say this anytime. I'm talking about this. So I'll say it again here. We're not shitting on the caregivers. We're not vilifying the caregivers. We're saying the caregivers are people and they have their own issues, and we all have our own issues and limitations. And so let's say a caregiver gets really overwhelmed by a child's need. They can't do anything that's not their fault, you know, meaning I hope that they can get help with that and support and grow and be able to manage it. But there's no villain in this story.

A (27:53)

Yeah.

C (27:54)

The parent who has a bad reaction to jealousy. Our example of today, a parent who has a bad reaction to jealousy is probably a parent who themselves was raised by a parent who didn't help them to understand and accept this feeling called jealousy or whatever it is.

A (28:09)

They were cited for wanting something that, you know.

C (28:12)

Right.

A (28:13)

I noticed this especially out of. And this. I don't know if this is a worldwide effect, but I know the baby boomer kind of effect here in the United States. If you had parents that grew up during the Depression and you should not want for shit, and you should be grateful for what you have, and you should. There were a lot of shoulds. Right. And so then that generation raising their kids, but also in very different times, with different access and opportunity, created my generation, really, that had some of those ideals carry over because that's what our parents knew. Yeah. It's not a shit on parents. It's not a shit on kids. It's just what it is that our relationship comes from who we are. And we're messy people and thank God we don't have to be perfect.

C (29:02)

Yeah, exactly. So we're not vilifying the parents who get it wrong. Just as a sort of aside, just everybody knows we're not okay, because again with the splitting. Oh, my God. That means I'm a bad mother and I'm failing my kids and I'm going to ruin them. We're not saying that. We're saying you're a person, you have limitations, you have your personality, and that has some impact on your kids in various different ways. Okay, so let's say you're the baby. And when you have needs, you have a caregiver who gets really overwhelmed and falls apart and it threatens your attachment to them. Right. As a baby, it's scary that the person who's supposed to be there with you, like they're falling apart. They're not There with you, you're afraid you're gonna lose them. So let's say you learn unconsciously, you know, to hide your needs and you manage that. However you manage that. Let's say you become someone who. One example of a defense mechanism is reversal. And reversal is when you basically project your need into someone else and fulfill it for them. So if, let's say I am someone who has a need for XYZ but feel conflicted about having that need met for myself, one way that I might deal with it, one of many ways that I might deal with it, is to, instead of being hungry, I feed other people. I'm sure this is operative for many therapists.

A (30:18)

Well, and thinking about transference and countertransference and things like that, I mean, there's.

C (30:23)

Yes, there's a lot of flip flopping of self and other in the unconscious. Yeah. So someone who doesn't acknowledge need and you hide it, you're going to bring that into your future relationships. As you grow up, you continue to be someone who hides their need. Maybe you also get into relationships that sort of are familiar to you because they're similar to that dynamic. Maybe because you are someone who hides need, you tend to fit with other people who have a lot of need. For all different reasons, this pattern gets repeated. And so it's not a far fetched idea that who you are when you're 40 is traceable to this dynamic. When you were an infant.

A (31:05)

Yeah.

C (31:06)

You learned to hide your need and you continued to hide your need and you got into relationships where it was expected or advantageous or necessary to hide your need and you just, you kept on going that way. So it's not such a crazy idea to say that it's traceable to when you were an infant.

A (31:23)

It makes me think like, ooh, all therapists who are so good at compartmentalizing. A good therapist isn't making a session about themselves.

B (31:31)

Right.

A (31:31)

Where does that come from? And that is to show the point that just because we have some of these experiences, it doesn't make them all good or all bad either.

C (31:41)

Great point. Right. We're not saying, oh, if it's a defense mechanism, you shouldn't be a therapist anymore. Correct. That's a great point. So from a psychoanalytic perspective, defenses aren't inherently bad. In fact, we assume that you need to have defense mechanisms. Those are the ways that you manage your experience of the complexity of the world. And we could talk, I think, caught in the context of schizophrenia, talked about not having enough defenses. In other words, it's not a bad thing. Like you're saying, yeah. So what is psychoanalysis? So basically, to boil it down, the infant need the experiences of mentalization and containment. Mentalization, an idea to go with the feeling you're hungry. And containment, being accepted and held with that feeling, learning that it doesn't alienate you.

A (32:29)

Right.

C (32:29)

There's a breakdown. You either don't understand what you're feeling, or you think that it alienates other people. And in that case, we use defense mechanisms to get rid of the feeling. In other words, we relegate it to the unconscious. So I do fundamentally feel that way, but I don't know that I feel that way. A defense mechanism can either mean that I literally don't feel it. An example of this would be like, I'm thinking of grief experience I've had of grief. And like, there are times when you're like, I don't feel it at all. But then something happens or something shifts, and all of a sudden it comes pouring out of you and you're like, oh, okay, it turns out it's there. I do.

A (33:11)

And then it could be an obvious trigger, or it could be something like a broken Internet connection.

B (33:15)

Right?

C (33:17)

I could be right. But it. It shows the experiences like that really show us that we have an unconscious and really show us that there can be something that is totally. If. If we didn't know that there was an unconscious, we would think. We just don't care. We would think. We just are not. It's not operative for us. But then you have these moments that remind you, oh, wow, this really is a big deal. This really is affecting me. I'm just not. Just in some moments, just not experiencing it. So OCD is a specific constellation of defense mechanisms, specifically displacement and undoing. And I'll explain what that is. So let's say I. I'll just use the main example I use in the article. But there are infinite examples of this, because literally every obsession is an example of this. Let's say that I am someone who, for the reasons described, does not know when I'm angry at a family member. It's not acceptable to be angry at someone I love, or it's too threatening to be angry at someone I love. So I don't experience myself as angry at someone I love. When I am angry, there's a reason that I'm angry. Like, fundamentally, unconsciously, I am angry, but consciously I have no sense of that. I'm not experiencing that. Okay. So in ocd, that feeling might get displayed, placed onto. Let's say, an obsession that I've left the stove on and that there's going to be this fire that's going to burn down the house and destroy all of my loved ones, and I'm going to be left all alone. Okay. So that preoccupation is where those feelings have gone. So I'm not aware that I am angry and that I'm afraid that it will have this destructive effect on my relationships and my family. Right. I'm not aware of that at all. But I become fixated on the feeling that I've left the stove on, that there's a fire that's burning that's going to burn down the house. Okay. So it's this metaphor that captures this feeling, but puts it at a safe distance in a disguised context so that I can then deal with it over there without having any sense of this feeling within myself about being angry.

A (35:29)

Michael, would it be fair to say, and I don't want to make it too confusing, because it is a fire analogy that we're using, but that it's almost like the fuel. Right. So you have maybe some unconscious fuel that is going to really make this situation ignite, and then it's igniting here. What I would ask you is, for folks with ocd, why is it then igniting in these ways with certain themes and not in other ways? Do you have thoughts on that?

C (36:04)

I do. So, first of all, psychoanalysis does leave a lot of room for temperament and predisposition. So just because we're saying that, oh, it's this emotional dynamic and this relational dynamic, it doesn't mean that we're not also open to, like, a hereditary loading. So we have twin studies, and we know there's definitely a hereditary loading to ocd. And I think it accounts for. You probably know better than I do. What is it like, 40% of. There's like, a good chunk.

A (36:30)

It's a large. I feel like it's a moving needle.

C (36:33)

But.

A (36:33)

But I feel like in terms of. Yes. In terms of the contributing factors, it's one of the main kind of three things that we understand.

C (36:42)

Ocd.

A (36:43)

Yeah. I think sometimes people overemphasize.

C (36:47)

That's what I'm saying. So in other words, you could say. Let's say. Let's say the number is 30%. And I'm making that up. Okay. Kim might be.

A (36:53)

Well, the stats are made up. We're good. No, I'm kidding.

C (36:57)

That's funny. Let's say it's 30%. Okay. This big chunk of heritability that's only 30%. Right. That means that environmental factors, emotional, relational, are coming to bear on whether this person actually has ocd. So I think one, there is a predisposition not just towards OCD but towards a personality in general. But then also there are all of these other factors that lead a person to be someone who uses certain defenses. So, for example, we see a lot of patterns in like obsessive compulsive families, around control and around anger and around splitting, meaning, like a lot of people, those seed come from families where there were good guys and bad guys. So I think all of those things are gonna come to bear on somebody having specifically OCD symptoms. And I think I should add that from a psychoanalytic perspective, your psychological symptoms, whatever they may be, whether it's O, C D or depression or whatever, they're not separable from your personality. They're part of your personality. Like your personality from a psychoanalytic perspective is what defenses you use. Are you someone who tends to be very intellectualized? You know, you sort of disconnect from your feelings and just think, are you someone who, I don't know, Are you someone who martyrs themselves and tries to connect to people through showing them how much you're suffering? Are you someone who defends through grandiosity, you know, and disavowing bad things in the self and projecting them on them onto others, like whatever? Meaning all this is your personality, your symptoms are part and parcel of that personality.

A (38:35)

Let me ask this. Would you then distinguish. I. I know I would, and I think most people would. But I do think sometimes people define them synonymously. So it's important to kind of look at that. The temperament that you're describing from attachment, would you differentiate that you might have a certain kind of temperament or personality, and then you also are going to have this attachment that gets developed. Whether or not these feelings can exist between you and your caregiver at a very young age and may get suppressed or repressed over time.

C (39:14)

Saying that is, you can be a healthy obsessive compulsive. Nancy McWilliams emphasizes this in her book Psychoanalytic Diagnosis, which basically any therapist read in graduate school. So she says, what kind of personality you have? Are you an obsessive compulsive? Are you a depressive? Are you narcissistic? Are you whatever. It doesn't mean good or bad, healthy or unhealthy. That's sort of like, what's the nature? What's the tone of your personality? Or what character type are you? And then within any of Those types, you can be a really healthy person or a really unhealthy person. And a really unhealthy obsessive compulsive might be someone who is totally fixated and preoccupied with their obsessions, whereas a really unhealthy narcissist might be someone who, you know, is. We know what that looks like. Yeah, well.

A (40:02)

And sometimes we go through all of those different stages in our normal developmental maturation. If you think about, like, Melanie Klein's work, you would go, look at. I'm getting smiles from.

C (40:12)

He's like, oh, smiling. Because we're taking my practice. We do psychoanalytic coursework within the practice, and the practice is currently doing a course on Melanie Klein.

A (40:22)

Oh, okay. So you could.

C (40:23)

Really excited about Melanie Klein right now.

A (40:24)

You could really zoom into that. Well, then you tell me, because it's been a hot minute since I brushed up on Melanie Klein. Tell me if I get it kind of out of whack. But there's the different developmental stages, like maybe early infancy, you're going to have more of that paranoid schizoid presentation. That's gonna. Then really, if you think about it as an infant not understanding your other. You feel like you're an extension of your caregiver. Then you're understanding and you're looking to caregiver for, are things all good, are things all bad? And you're understanding, you're taking your cues that way. And then it goes into more of a depressive stage where you're like, shit, some things aren't as simple as that.

C (41:03)

So let's actually just explain it in terms of our earlier conversation.

A (41:07)

Yeah.

C (41:08)

Paranoid schizoid means. Schizoid means splitting. It doesn't mean schizophrenia, it means splitting. And paranoid means projecting. So it means you split and you project. Instead of being able to acknowledge this thing within myself, I split things and I split it off and I project it onto somebody else. Or it means that everything is divided into good and bad. Instead of being able to recognize this bad thing in you, I want you to be all good. So I split it off and I project it. Either it's myself or into somebody else. But basically, we all start off, not initially, but very early on, in this state of splitting, seeing things as all good or all bad. And that's normal developmentally and important. Developmentally, we need to start off splitting. Then over time, if we have caregivers who can handle our aggressive, ambivalent feelings towards them, it becomes safe enough to recognize that, to bring these things together and to recognize that the people we love also have limitations or that the people we love, there are also things about them that we hate. And the people that we hate are not all bad. We can have ambivalent feelings towards them also. So basically, we start off needing to split things into all good or all bad because the world is too overwhelming, right? And over time, if we have an environment that facilitates it, we can dare to recognize that it's not all good and all bad. Everything is good and bad. Everything is integrated. And that requires us to be able to manage ambivalent feelings within ourself. And ambivalent just means having loving and hateful feelings towards the same thing. So everybody starts off with like, mommy is perfect. And that if we have a healthy environment, we can get to a point where we feel like, mommy's great, and I love Mommy. And there are also some things about mommy that I really don't like. Yeah, I love you, Mommy, and I hate you right now. Those are ambivalent feelings. And a lot of people with OCD struggle in that department.

A (43:05)

You know, I have an example. I was putting one of my sons to bed last night. I was saying good night, and he was just putzing and kind of pushing buttons because he was like, ooh, this is getting a response. And I was tired and a little. Probably a little more fussy, as we described earlier. And so I. I was like, it is time to go to bed. It's time to go to bed. About nine times in. I was like, it is time to go to bed. And he was like, mom, why did you use that voice? And he was like, you sounded mad. And I said, you know what? I am. I'm getting mad. Getting mad. That's true. And then he was like, oh, I kind of like it when you're mad. And he didn't mean it in a way of like, ha, ha, screw you. I made you mad. It was kind of like, but it's kind of a funny voice that you made. But what was interesting is, while I wanted to be, like, prickly about that, I also was like, I love that he can say that to me.

C (44:06)

Yes.

A (44:07)

I love that I can leave room for him to be like, you're mad. And it wasn't always that way. Especially all my kids are autistic. And so sometimes the tone itself is just hard metabolize, for lack of a better word. But I was like, I love that we can both have these experiences. I am still annoyed. I'm still.

C (44:27)

And if you. You can be annoyed, it's kind of nice that you can be annoyed and still love me. It's okay to be annoyed. It's okay to be angry. I can be angry and annoyed at you and still love you. Like, that's what we're going for. And then to be able to move on from that, okay, we were angry at each other, and that was okay. And the next second, we're reading a bedtime story like, that's. That's what we're going for. That's what Winnicott calls going on being like, if you can digest gluten, you eat the gluten, you move on to the next thing in your life. If you can digest somebody being angry at me, me being angry with someone, then you can feel that, and it's totally fine, and you move on to the next thing. Obsessive compulsives often say, well, what do I do about this feeling? What do I do about it? And that speaks to the fact that it doesn't feel okay to just have this feeling, and it's okay. And we move on to the next thing because they can't digest it.

A (45:20)

Yeah.

B (45:21)

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A (45:31)

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B (45:35)

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C (45:49)

So we were talking about, like, displacement. Yeah. So displacement and undoing. So basically, we have all these sort of unconscious, unformulated feelings floating around, and then there's some topic that in some way, like, fits with those feelings, and so our feelings find a home in that new context. It's sort of like, if it's a good analogy on social media, like the algorithm, there's something that, for some reason, captures your attention. Right. You might not know why it is that it captures your attention, but you become focused on that thing. So I think an obsession is sort of functioning the same way. You have these unformulated feelings. And I'll give another general example. A general example might be just because it's so sort of literal, somebody becomes preoccupied with, like, having a parasite, that they have parasites. Okay. And I'm thinking of a case from many years ago where somebody was preoccupied with having a parasite. And, like, what emerged very quickly is that what they were really dealing with was a lot of guilt about taking too much from their parents, their dependency on their parents, but that was unformulated. They weren't thinking about that. What they were thinking about was, oh, my God, I have a tapeworm. And they were, like, focused on getting rid of the tapeworm and figuring out whatever. Whatever in that department. Does that make sense? So. So unconsciously, fundamentally, what's really bothering them is they're feeling like a parasite towards their parents, but they're not aware of that. And instead, they're totally fixated on this obsession that they have a literal, concrete parasite and that they need to do something to get this out of themselves. As an example.

A (47:24)

Yeah, yeah, yeah, yeah.

C (47:26)

So. And then you could think of lots of other symptoms as also displacement, like, whatever, eating disorders, maybe substance. You can think of lots of things in terms of displacement. The real hallmark of OCD is the undoing. It's a displacement plus an undoing. It's not just that I become fixated on the stove being on. It's that I then go and turn it off, turn it off, turn it off, turn it off. It's trying to undo the displaced feeling in its new displaced context, which is why the compulsion never works and never feels satisfactory, because you're not really turning off your unconscious anger or whatever it might be.

A (48:04)

Well, and what I was gonna say is, and again, I encourage everybody to go over and read Michael's article, But if you're listening to this, and especially if you're, you know, practicing or have been in treatment using something like exposure and response prevention or erp, Michael's not saying this is the sole thing for ocd, but he's also saying, yes, we're

C (48:29)

adding, we're adding, we're adding.

A (48:30)

Right. It's not just about erp. We have to look at some of the underlying emotional conflict as well. And so he is pairing the two. He's not just going to shit with erp. He's saying there's.

C (48:45)

Do your ERP practice not checking the stove. But now let's also understand what this is really about and why you feel compelled to check the stove. And that way, another metaphor would be like. Like a sailboat on very turbulent waters.

A (49:00)

And we've used this one. We used it in our last episode.

C (49:03)

He came up with it in the last episode. Right. This is. Okay. This is an OCD family podcast, original metaphor. It is very important to learn how to manage the sales and learn what? Whatever. But wouldn't it be better if we could calm these waters down and we didn't have to be fighting against these forces our whole lives. So erp, even rf erp, even learning how to stop ruminating. Very, very important for managing turbulent waters. But a psychoanalytic perspective is trying to attenuate, calm down the forces that are making you feel so emotionally compelled in the first place. And so if we can put the two together, there's nothing mutually exclusive about them. Like, you can do your exposures and you can still try to understand and work through the feelings that are driving them in the first place.

A (49:49)

Yeah, yeah, it's a both and it's a both and correct.

C (49:53)

Yeah, I think it's a both hand, especially for ocd.

A (49:56)

Well, and even if you. Because I think where you were gonna go, and you. You can tell me if my instinct is off, but where you were gonna go is you could just direct this. But then. And it's like, well, whether you're just directing the sails doesn't mean that the turbulence or the seismic effects of the water and how that's go. I don't even know the right word, but it's still happening, whether you ignore it or not. And what you're saying is, wouldn't a more helpful approach be both? And I can understand how to behaviorally navigate this. It's going to be really important. Can be life saving, but I'm also going to understand what led to this. And it could be life saving. And if I choose to not go on a sailing trip when there's a tsunami coming, then that might be really helpful too, or help kind of resolve some of the things and understand it better. So I think, like, even if we do, one, the other is still happening. It's whether we're integrating it or not.

C (50:50)

Yes. And I want to just highlight, because you use the word understanding, which. Which gets to a piece I wanted to add in, which is what psychoanalysis is really aiming to do is provide the experience with a certain feeling that we didn't get as a baby. So, for example, it's not just about understanding what we're feeling. It's about having the experience of mentalization and containment. Like, oh, you're feeling. Let's go back to our feeling of the day, which is apparently jealousy. Okay, so let's say you're someone who does not recognize when you're feeling jealous because growing up, nobody helped you to understand that or that wasn't acceptable. And let's say. Let's say you have symptoms actually, I mean, easy. Let's say you're someone who struggles with retroactive jealousy. What A psychoanalytic perspective treatment would try to do is help you to become aware of that feeling, to experience that feeling in the context of a relationship with someone who is not alienated by that feeling. Yeah, it's okay for you to feel jealous. So it's sort of giving you the experience of mentalization and containment that you didn't get around that feeling as a baby. And you might say, well, that sounds very simple. What makes it complicated is that it's not so simple to understand what the feeling is underneath the defense mechanism. So I'm giving these sort of very simplistic examples. But the truth is that symptoms are not just one feeling going through two folds of defense mechanism to yield one very clean symptom. It's not so simple. It's all sorts of additional defense mechanisms coming into play in terms of forming the symptom. And you need to have psychoanalytic theory and methodology to help you access the underlying feeling.

A (52:38)

Yeah, because our brains ultimately, and there is kind of just an innate instinctual drive to want to feel some comfort, some security, some certainty is a word that we throw around a lot when it comes to O C D. But I'm thinking, and maybe you tell me if this is too much of an offshoot, but I'm thinking even you're. I'm sure you're familiar with Harlow's work with. There was a wire monkey study. I'm just going to reference these poor monkeys. They were like taken from their caregivers and we're doing all sorts of different experiments. What is a bigger drive for people that need for nourishment and food, that need for comfort. And so they replaced the caregiver for these baby monkeys with wire monkeys. One which would have kind of a cloth covering on it that was the identified comforting monkey. And the other one, devoid of any of those comforts actually is who had the food. And though the monkeys would drive towards a need for sustainable maturation to eat, they learned very quickly, I need to go for this comfort. This is where I feel security. I don't. Even though food and sustenance is coming from the non cloth wire monkey, My drive is to feel some comfort and some resolution even in an unideal circumstance where it's still just a wire monkey with a cloth on it. And so there is an instinctual drive that is like I'm wanting. I need to be able to kind of resolve these feelings. I need to be able to feel some sense of safety. Even if what I'm dealing with is wire with cloth wrapped around it. And so when we think about an OCD person that may have a lot of emotional conflict that is suppressed, which I was just like, I don't know that I've ever met somebody that doesn't have some emotional conflict.

B (54:33)

Surprise.

C (54:35)

Right.

A (54:35)

But you're describing this process of how the feelings then that didn't get digested are manifested. And it just kind of reminds me of that drive of ultimately wanting and striving for comfort and the compulsions. The. The ruse is that if you just know, if you just double check again, this lock, if you just resolve this, and you'll be okay. The problem is it's never okay enough

B (55:01)

when it comes to ocd, because there's

C (55:04)

this feeling that you can't digest that isn't going away.

B (55:07)

Right.

C (55:07)

So what we're trying to do from a psychoanalytic perspective is get to what the underlying feeling is and being able to hold that within the self and not have to get rid of it by displacing it into an obsession. The. The idea of holding, I think this having explained everything that we've said about psychoanalysis, I think that the simplest version I've come up with to explain psychoanalysis is that we become able to hold the people. Obsessive compulsives think that mental health is feeling one way all the time, feeling good all the time, feeling loving all the time, feeling whatever it is all the time. And really, mental health is being able to hold all of the different feelings that come with being a person. Being able to hold them within the self and manage them and contain them.

A (55:52)

Yeah.

C (55:53)

So if mental health, being able to hold a feeling within the self, we develop the capacity to hold that feeling within ourselves. When we have a caregiver, it's gonna sound very flowery, but I think it's an accurate description when we have a caregiver who can hold us while we're holding that feeling.

A (56:11)

Yeah. Process. Yeah.

C (56:14)

They can hold me and say, you're like. They can say emotionally attuned and say, you're feeling jealous. I can say, oh, I'm feeling jealous. And now I can hold that within myself because they could hold me while I was holding that feeling. And you can only do that for someone. You can only hold someone who is holding a feeling. If you can hold that feeling within yourself, if that feeling is acceptable to you, that's something that's part of you and it's okay, then it can be part of this other person and be okay there also. So I think that psychoanalysis fundamentally, on the simplest Level is about someone holding us while we hold our feelings.

A (56:51)

Yeah. I used to supervise in child parent psychotherapy, which was a trauma model and evidence based trauma model that came out of ucsf University of California, San Francisco. And again you say, how do you do this trauma work or this therapy? We would do a lot of holding of that. And one of the techniques we would use in kind of helping processes through this trauma and help do some repairs in the attachment between caregiver and child was what we would call scooping. So they would have this experience in the relationship and then we would scoop the caregiver in that experience and help them process it so they could scoop the baby or the child and then help them metabolize that process. But yeah, it's what it made me think of when you were. We're describing that curling. Yeah. And it's, it, it makes a lot of sense because if there's room for

C (57:53)

me in case it's not obvious to everyone, we mean emotionally, not physically.

A (57:57)

Yes, we're not.

C (57:59)

No holding or scooping is happening. Yes.

B (58:02)

Yeah.

A (58:02)

Oh my gosh, that's so funny that it. Yes, yes. This is not a physical containment, it's an emotional containment and connection. There's. And, and yeah, when I was doing that work, this was through Department of Mental Health in Los Angeles. I was the Birth to Five program coordinator and program manager for a Birth to Five program. And we would absolutely talk about how it is so important to build this trust. Because when you're working in a population, a community mental health population in a very populated millions of people in the city and surrounding areas of la, there's a shit ton of trauma, there's a shit ton of ways that people's trust has been broken. And so again, it's what you're speaking to that it's not shitting on the parents at all. But these parents were once that little baby that didn't have someone there to help scoop their feelings and help them understand what they were going through. And so you can see how intergenerationally this practice, though it changes. You might be like, damn, this happened in my dynamic growing up. So I'm going to do the opposite. And you go out there and you try and overcorrect, but you can see how those early experiences played such a dynamic role.

C (59:22)

And that's an example of why you need help. Because somebody who says, I experienced this, so I'm going to go change it, they don't necessarily know how to deal with it. They're like, they don't really Know what it was unconsciously meaning. Yeah, by definition. I'm trying to think of a good example of this. Let's say somebody's parents got divorced, okay. And their narrative that they were raised with or that they formulated for themselves of their parents got divorced because. Fill in the blank. Let's say their parents got divorced because they didn't have any shared interests. Let's say that was the narrative. Right. That's the conscious idea of why this thing happened. And let's say. So then when they're dating, let's say they don't want to get divorced, they want to have a happy marriage. So they're going with their conscious narrative of what happened. So the most important thing when they're dating is shared interests. Gotta be shared interests. Okay, totally making up this example. But the truth is far more complex than that and might not be conscious to them. Let's say their parents got divorced for a whole bunch of unformulated emotional like. But let's say. I'm making. Let's say their parents were very sort of split in their perspective of other people. Let's say the parents. Neither of them could handle being criticized or being told that something they did bother the other person. Let's say there are all these sort of emotional relational factors that happen. Our patient that we're talking about, who's now looking for shared interests. If they're not cognizant of all of those dynamics, they're probably perpetuating them.

A (60:52)

Yeah.

C (60:53)

They're probably within that way of relating. They're probably within that way of seeing other people, et cetera. So they're probably gonna end up doing the same thing as their parents did, while consciously they're trying to counteract it. Unconsciously, they're doing the same thing again.

A (61:08)

Yeah.

C (61:09)

So that's why we need. Who said this? Margaret Little. I quoted this in both of the articles I've written about this topic because I love the quote. She says, trying to see your own unconscious is like trying to see the back of your own head. You don't know what the feeling is that you struggle with. You don't know what you're having. You can't do your own psychoanalytic therapy. By definition, the whole point is that it's unconscious. I mean, the obsessive compulsive obviously thinks, no, no, I'm going to figure it out. I'm going to somehow analyze the situation and read the books and figure out what it is. You won't, because the whole point is that you have defense mechanisms in place to keep this out of your conscious experience. So that's why you need somebody who's trained to figure out what it is that's going on unconsciously.

A (61:51)

And I would imagine for whether it's people that are very focused on the fidelity of say, ERP or other evidence based practices, or maybe you're a person or your loved one is a person struggling with OCD that's like, well, okay, if you have unconscious stuff like how do you know what's what?

C (62:11)

And the answer is you don't and you need help. And this is, I think, to another barrier, another reason that people with OCD don't like psychoanalysis. Unconsciously, not their stated reason, but emotionally, people with OCD have real issues around dependency. We have real issues around needing help from other people. We want to do it all ourselves, want to be able to solve our own problems. And an ERP model of like, we're going to do 12 sessions and you're better. You know, it really appeals to us because we don't need to depend on someone else. We can just get in and get out. There's no sort of ongoing dependency. And there's sort of this idea that I'm going to give you the skills and then you can go work on it yourself. And so that also really appeals to the omnipotency of the obsessive compulsive who wants to believe that I can just do this myself. In a psychoanalytic approach, it says you're going to need help and you're going to need help on an ongoing basis. That doesn't mean forever, but it means we're not going to be out of here in 12 weeks.

A (63:08)

Yeah.

C (63:09)

You know, I'm not saying, I mean, maybe I scare people by saying I've been in analysis for seven and a half years. This looks different for everybody. And you know, I'm not, we're not, we're not stipulating a certain number, but it's not going to be a psychoanalytic treatment or a psychodynamic treatment is not going to be 12 weeks. You could do something in 12 weeks, but that's not the nature of, of the treatment.

A (63:29)

And can I just say, for people that are hearing the 12 weeks too, that are like, shit, I've been in this more than 12 weeks or whatever, am I, am I broken? No. What we're talking about is research is going to have like, you know, if we lived in a petri dish and could isolate down just certain variables, could the navigation of the sales change in 12 weeks, sure. It's not so much about the amount of time, but like, you're saying, we're so individual and our experience of OCD is so individualized. So how treatment support is going to impact us is also going to look different. We're different people. Right.

C (64:04)

Yeah. Thank you for flagging that and clarifying, because that. That's important. Definitely. People are going to wonder about that. What I'm saying is that obsessive compulsives don't like needing help. We want to do it for ourselves. We want to figure it out for ourselves. The whole setup of a psychoanalytic treatment where you really need to depend on someone else to help you is unappealing to our personalities. And I think it's one of the things that somebody with OCD getting into a treatment really has to contend with is, like, the resistance to trusting someone and believing that someone else can help you.

B (64:36)

What would you say to the fact

A (64:37)

that no matter where the lived experience, person lands on this and me going to a therapist, and they're like, content doesn't matter, bruh. You gotta, like, not focus on the content. Because ultimately, behaviorally, that's true. Behaviorally, it is true. But what do we say to that? If you are having. Well, again, whether you're acknowledging it or not, underlying emotional conflict. And, you know, as. As a therapist community, we've been drilled to not focus on content, whether it's of the obsessions or even underlying jealousy or other feelings that that may be.

C (65:13)

I think. I think. I think broadly speaking, you know, I'll be nicer in a second, but broadly speaking, I think it's totally misguided and totally wrong. And the idea that your obsession doesn't have. That there. Doesn't have meaning. And let's be very clear, let's issue the usual warning. You're not saying that your obsession is true. We are nowhere near at all saying that your obsession is true. We are saying the opposite. In fact, we are saying that the thing that's really bothering you is a normal, healthy feeling that you personally have trouble with because of your early emotional experiences. But it's nothing bad. It is getting displaced and disguised into this obsession that is bothering you. But that is a defense. So nothing in what we're saying at any point in this podcast says that your obsession is true.

A (66:04)

Would it be better to say that with that analogy from before, that the fuel and the distress is. Is real? Right.

C (66:11)

You know, we're saying your. Your obsession that you, I don't know, have committed a murder, that you Forgot about or hit somebody with your car or whatever it is. If you're taking any of what we're saying and turning it into, oh, my gosh, are you saying that's true? No, that didn't happen. The person who is obsessed with whether they have a parasite, okay, it is significant and meaningful that they're obsessed with having a parasite. It points us, among other things, it points us to what might really be going on for them emotionally, for example, that they feel really guilty about how much they're taking, et cetera, et cetera. So it's meaningful and it's important to understand what the obsession is. That doesn't mean they have a parasite.

A (66:50)

Right. That doesn't mean the content is true. But yes, it's meaningful why they're upset and it's meaningful.

C (66:57)

It's symbolic.

A (66:58)

Yes, yes.

C (66:59)

Not in the sense that you should now go again, the other proviso or warning that we already said, but let's say it again. This doesn't mean that you should now go try to figure out what your obsession stands for and what the metaphor is, because, number one, you cannot do that for yourself. It's like trying to see the back of your own head. It will not work because the feelings that you're trying to understand are feelings that you have trouble understanding. They are unconscious for you. So you can't know something that you can't know. But also, it's not as simple as they've made it sound. It's not like, oh, so it's a metaphor and then you know exactly what it is, and, oh, very. Everything gets cleaned up. That's not how it works. It's much more complicated than that. I'm just trying to provide a sort of simplified understanding. So you said the behaviorists say it's not important, et cetera. So I would say like this, the content of your obsessions is not important to learning how to manage the sales. It is enormously important to trying to understand the turbulence in the waters.

A (67:55)

Yeah, yeah, yeah, yeah. So it's a. It's a nuance and distinguished difference. It's not the. The content, the fact that it's about, did you keep the door unlocked or did you hit somebody? Or whatever. The theme, the intrusive thought, the obsessional doubt may be, but the underlying unresolved emotion bank that is kind of help fueling this and creating the choppy waters, turbulent waters in the first place.

C (68:22)

I love the term emotion bank. That's the unconscious. Perfect. That's the unconscious is this underlying emotion bank where every feeling you've ever had, and everything you feel about everything gets stored away, even if you're not. Yeah, I love that. To say that you don't need to understand the meaning of the symptoms or that it's not useful to do that in order to treat them behaviorally is valid, but it's not valid to take one step further and say that they don't have meaning or that, that the. That they're random. That's not true. They're not random, and they do have meaning. That might not be important to the type of work that you are doing if you're working purely strictly behaviorally. But if you take one step further and you say they don't have meaning or they're random, then you're incorrect.

A (69:08)

Okay, so what advice do you have for people that whether they're in treatment or providers that may be a bit prickled by kind of thinking about some of this stuff? Because if we're recognizing it's both and. But maybe our provider or maybe we're just in the process of trying to find a provider and potential prospects are like, nope, it's only the sales or it's only the water. What advice would you have for them?

C (69:38)

I would say that if you can find somebody who can do both, that would be great. In a world where you can't find somebody who can do both, and you have to separate behavioral from psychodynamic, psychoanalytic, I would say, by all means, start with the behaviorist, like, start with your ERP but you have to keep in mind that that is not the I I. One of my big complaints against people who are strictly behaviorist is not that they are only working behaviorally, that's totally valid. To be a behaviorist and to say, to stay in your lane and to say, this is the part that I'm doing, it's when those people think that there's nothing else, that we have a problem. In other words, if you say I do this part and then we refer for other parts or there are limitations to what I can do with this, that's fine. But if your behaviorist who thinks that you have the total treatment and you devalue everything else and tell the patient that there's nothing beyond what you're offering, and if that translates into keeping somebody in treatment with you, even though you don't actually have anything to offer beyond the exposures that you did at the beginning, but you're sort of rationalizing to yourself that there's nothing else out there for them. So this is the best they can have. And so they should just stay in a strictly behavioral treatment. I would say that's really wrong. So I think behaviorists need to recognize that this is what I do and I don't do this other thing, but not sort of convince themselves that what they're offering is the be all, end all treatment. So if you're the patient, if you have to separate and see a behaviorist and a psychoanalytic or psychodynamic therapist separately, by all means, see the behaviorist first. Let's clean up as much of these symptoms as possible and get as many skills under our belts as possible. But don't stay there for that long. Get in, get out, get in. Do as much as you can in a few months until you feel like you've gotten what you can for that treatment. And the second you feel like you're stagnating or this isn't really going further. Instead of saying, oh, there's something wrong with me, or oh, there's something wrong with the therapist, say, no, no, that is what behaviorism can do. It can help you to a degree get it. Get what it can give you, and then it's time for something else. Yeah, don't stay in that treatment forever. A few months, as much as you can, and then go for your psychodynamic treatment. Two things. If the behaviorist says, like, oh, that's garbage. Don't listen to them. And number two is behaviorists peeing their pants right now, by all means. See, I'm saying see the behaviorist first. That we.

A (72:08)

I know you are. Yeah, I know what you're saying, Michael.

C (72:11)

Yeah. And, and then also keep in mind not all psychodynamic, psychoanalytic therapists are created equal. It's not like somebody who says, I'm psychoanalytic. They might, they might not be good. They might not have a lot of training. They might not know what OCD is. So we're not saying that anybody who says, I practice psychodynamic therapy is a magical unicorn.

A (72:29)

Same for erp. Just because you took a training doesn't mean. Yeah, you've got to, you've got to continuously be growing and honing in on

C (72:37)

that and really want a strong. Like with everything else, you want a strong word of mouth referral to someone who has experience working this way with ocd. So it's not, it's not like you do your behaviorist and then you go find any psychodynamic therapist. You go see your behaviorist, and then you find a strong psychoanalytically Trained therapist with a lot of experience with ocd. Ideally, yeah.

A (72:58)

Which usually there's big warning signs when psychoanalysts or psychodynamic people are like, I treat OCD like the, the. Yeah. Cause our, our treatment community would be like, this is doing harm. And that's how they'll say it. You're going to be doing harm. And can it. Sure. If somebody doesn't really understand OCD and is out there just maybe compulsing for a couple hundred dollars an hour. But that's not everybody. And we really gotta. Guys, if we could. If you hear one thing from this podcast, we really gotta fight that urge to make it all good, all bad. Right. It's not that all behaviorists are this way and all psychoanalysts are this way.

B (73:45)

And there are plenty of people.

A (73:46)

I remember when I first started treating O C D because I'm coming from the background, I am. People are like, well, you know, us behaviorists. And I, I felt like I. Because I don't think of myself as a behaviorist, but I also don't necessarily at this point think of myself. Yeah, I'm both.

C (74:05)

And I'm both too. I'm here talking about psychoanalysis today. But I also do the other stuff.

A (74:10)

Yes, yes, yes. So if you're listening to this and you're like, okay, I think the message that I'm hearing from what you were just sharing about Michael is if you're in that plateau, it's not that you've peaked or the plateau is as good as it can get, both from the provider standpoint and from the patient standpoint. There are other options to try. And sometimes it's not one thing, but it's that both. And it's the multiple things and. And there's room for more than just one ideology on how things are done. You know, actually, I think a great comparison to this is just kind of thinking about being cross cultural. You know, we might have a tradition of how we raise kids and, you know, whether co sleeping is a thing. And another culture might go, oh, no, this is a huge part of our culture. And of course we do this. Now. Which one's right? Both.

C (75:11)

Can I share the thing that I ended the article with? I think really captures what you're saying, which is the behaviorist could say to the analyst, you know, you've been treating this patient for a year and they're still checking the stove, so have you really addressed their problem? And the analyst could say to the behaviorist, you know, the patient has stopped checking the stove. But they still cannot tolerate being angry with someone they love. So have you really solved their problem? And I think both of them are right. And I think ideally, I mean, what, what I wish for, my, my fantasy is that the behaviorist learn more about psychoanalysis, learn more about psychoanalytic perspectives on ocd so that they can keep doing what they're doing, but enhance it and enrich it and add to it and be able to offer people something beyond the initial ERP RF ERP exposures and skills.

A (76:15)

Yeah.

C (76:15)

So I think it would be great if we sort of broke down the wall around ERP and said that it's permissible to think outside the box. I mean, I have a friend who wanted to consult with me on a case, this was a few years ago, and she was talking about this kid who basically everything related to one parent was contaminated. And she said to me, like, okay, but like, where do I start? She's not an OCD therapist. She's working in a hospital where you see all types of cases. So where do I start with this in terms of what's going on, how do I understand this? And I know that this person is a really smart, well trained therapist. So I said, what if you were just thinking about this, like any case, what would you think is going on? And she gave me this very rich formulation about the relational dynamics in the family, et cetera, et cetera. So I said like, yeah, exactly. That's what's going on. Right. So she, in other words, had internalized this taboo against thinking about what's going on in O C D. Like people have been taught that when it's O C D, we turn off. We don't think, we don't interpret, we don't try to understand what's going on. We just put on blinders and do exposure.

A (77:18)

Yeah.

C (77:19)

And want to give people permission to do. Do the exposure. But you're allowed to also think about what's really going on here and also think about the meaning of the symptoms, et cetera. And I will say I don't mean that everybody should just, without any training, shoot from the hip and just spontaneously from their own creativity. Some people think somebody posted some, something about encouraging people to work dynamically. Somebody posted something in an OCD group encouraging therapists to work dynamically and interpret symptoms. And I thought that was really misguided because it devalues psychoanalytic work. As if somebody without any psychoanalytic training could just make up a psychoanalytic interpretation. That's not true. Like you need training theory to Understand what's going on here, and that informs your ability to formulate an interpretation. So I'm hoping that people can be open to. To training and to learning more and to enriching their perspective. And I just wish there weren't this taboo around thinking emotionally about what's going on in ocd.

A (78:26)

Yeah.

B (78:26)

Cause then people learn.

A (78:28)

It's not that that disappears, but they learn. I can't talk about it, I can't bring it. And it's kind of, again, a parallel process of what's happening. I can't have this feeling. So I'm going to hide it or I'm going to push it down.

C (78:40)

Yeah. And it's also like the idea that, let's say somebody has this childhood where X, Y, Z happens, okay. And then they have OCD and they're being told that this has nothing to do with that. Like, on what planet?

B (78:54)

Right.

A (78:54)

Talk about splitting, right?

C (78:56)

Yeah, a different kind of splitting.

A (78:58)

Well, you know, I really value the conversation. And you guys, if you have any questions, leave me a comment, shoot me an email. And, you know, you heard Michael. I will take you up on that at the beginning of the class.

C (79:11)

We'll come back, we'll answer any questions people have.

A (79:14)

We can do a Q and A. And I think that could be really helpful because making sense of this, like, if this is your first blush, first hearing about psychoanalytic theory at all, let alone how this could work and does work in OCD treatment, then you might be like, what? You might feel like you have a little whiplash here. And so bring the questions back. This is a safe space to have dialogue and conversation and we don't have to suppress it. Bring it out. We'll have a conversation. And thank you, Michael. Third time was the charm.

C (79:45)

It worked for us. We have. We just have, you know, too much chemistry.

A (79:51)

Thank you. I appreciate you.

C (79:53)

Very mutual. Thank you for having me. And I'll see you next time for the Q and A. Also, if anybody's confused by how I formulated anything, my best version is the article. So check it out.

B (80:03)

Yes, check it out.

A (80:04)

It's linked over on this episode's blog. And there is a lot of really helpful resources over there. So dive in. Enjoy learning. Remember to have an open stance and bring your questions. We're here for it.

C (80:15)

Thanks for having me.

A (80:16)

Yeah.

B (80:18)

Intrusive thoughts.

A (80:21)

Alrighty, fam. How good was that?

B (80:25)

Thank you again, Michael, for your time and your patience and your thorough explanations. And I know this content is going to be a lot to digest. No pun intended. And that Brings us then into my intrusive thought segment, which, for Newer Family is my application segment of the show. It's where we apply what we talked about today, so it can be as helpful for you as possible. And one of the big takeaways from our conversation with Michael, at least for me, is that OCD symptoms don't just appear out of nowhere. And as Michael discussed, they can function like a defense mechanism where feelings can get displaced into those obsessions and compulsions. So while the behavioral work is important, the emotion, the turbulence in the water, that choppiness the storm, it's important, too. So, like we discussed, and hopefully we were really clear, this doesn't mean that your intrusive thoughts or obsessions are true, not even a little bit. What it may mean, though, is that your brain is trying to cope with emotional tension or discomfort. So here is the gentle reflection and application I'm going to propose for this week. Instead of asking, how do I get rid of this thought? What does this mean about me or for our loved one that we see suffering there? Maybe our client, might we ask, what feeling am I struggling to hold right now?

A (81:56)

Hmm.

B (81:57)

Maybe it's anger. Maybe it's guilt. Maybe it's jealousy or sadness or fear. It can be really uncomfortable to feel those feelings. But sometimes it's just a matter of simply recognizing that feelings can exist without meaning. Something is wrong with you. In fact, I bet Michael and I would both argue it's not wrong to have feelings. And when we can do that, even if we're not solving that feeling, we're just recognizing, validating, holding it. That, too, can help soften the grip OCD has. So that's our application segment for the day.

A (82:36)

And I told you you were in

B (82:38)

for some additional sailing jokes, so here are a few that I found to be interesting. Okay, why is it that sailors are so good at keeping secrets? Any guesses, Pam? Because they know how to stay anchored.

A (82:55)

If you're anything like me, you're like,

B (82:57)

what does being anchored have to do with secrets? But you know what? It's okay. Oh, I liked this one, though. I love sailing jokes, but sometimes they just drift. Why did the sailor bring a ladder on the boat? Because he heard the sea level was rising.

A (83:15)

Oh, here's a good one.

B (83:17)

Again here with the theme of the episode. I asked a sailor how he stays so calm during storms. He said, I just go with the flow and I'll end on this one. I liked this one.

A (83:30)

The dad joke.

B (83:32)

To end it all, why did the sailor refuse to play cards on the ship because you see the captain was standing on the deck.

A (83:43)

Yeah, that one's actually pretty good, I think.

B (83:46)

Okay, that's gonna be a wrap for today. I'm going to just take one more

A (83:51)

moment to thank Dr. Michael Greenberg.

B (83:55)

I've referenced it to an extent, but

A (83:58)

it took quite a few attempts for

B (84:00)

us to actually record this episode. And honestly, even more months than I'd like to admit to finally get it posted. Because life happens, technology happens, storms happen. And through it all, Michael remained incredibly supportive and generous with his time. So Michael, thank you not only for your work and everything you do for the OCD field, but also for being willing to sit with me through my choppy waters. For being a friend and then still showing up with such thoughtfulness and care for this community. It really means a lot and I'm grateful that you were in the boat with me for this one. Thanks and family, I'll see you again next week. Thank you for joining me and our OCD Family Community. If you enjoyed what you heard today, please like and subscribe to the OCD Family Podcast wherever you enjoy your podcasts. Did you find this content helpful? Please consider leaving a review. The more people that know they're not alone alone the better. For more information regarding today's podcast, please visit ocdfamilypodcast.com and remember to join the email list while you're there. It will provide you with the most up to date information, resources and the down low on the family chatter. Oh yeah, nothing says family like Michael and me discussing all things ocd. That's right, I went there and you can too@ocdfamilypodcast.com. Hey practitioners, if you're looking to deepen your understanding of obsessive compulsive related disorders, check out the OCD Training School's amazing course catalog on emetophobia, what to do when you have co occurring eating disorders and OCD and process based therapy for BFRBs. Plus tons of OCD trainings and self help courses. Add that many of the trainings are apa, ASWB and NBCC CE eligible with both live and on demand options. I mean say less. So head on over to ocdfamilypodcast.com courses to learn more because when you use my special link you will be supporting the POD at no extra cost to you. So let's get to learning family because

A (86:20)

we are better together.