Dr Sam Greenblatt: Unlocking Relationship OCD (ROCD) treatment (#506)

Summary

Podcast Summary: The OCD Stories – Dr Sam Greenblatt: Unlocking Relationship OCD (ROCD) Treatment (#506)

Date: October 5, 2025
Host: Stuart Ralph
Guest: Dr. Sam Greenblatt, Licensed Clinical Psychologist

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Episode Overview

This episode dives deep into the complexities of Relationship OCD (ROCD): its nuances, effective treatment, and Dr. Sam Greenblatt’s personal and professional journey to “unlocking” more successful ROCD therapy approaches. Sam discusses his lived experience with ROCD, why classic approaches sometimes fail, integrating exposure/response prevention (ERP) with internal family systems (IFS) therapy, and the importance of learning to process genuine emotions—rather than compulsively analyzing them.

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Key Discussion Points and Insights

1. Personal Update and Introduction

• Sam shares a life update, underscoring the importance of holistic well-being:
  • He's developed a passion for West Coast Swing dance, which fulfills his need for creativity, connection, and joy.
    • “I’m dancing like 10 to 15 hours a week… It is the epicenter of so many things that I’m really passionate about and need in life.” (02:01)
  • He’s in a happy, healthy relationship and feels grateful for where he is in life.
• Therapeutic insight:
  • Both host and guest note that part of recovery and growth is about discovering who you want to be now—not just symptom management. (04:03)

2. Dr. Greenblatt’s Personal Journey with ROCD

• Unique dual perspective as therapist and sufferer:
  • Dr. Greenblatt describes the frustration and pain of experiencing ROCD intensely, despite being an OCD specialist and receiving high-quality treatment.
  • Standard ERP and ACT approaches provided some relief, but often didn’t address everything, especially in high-stakes, committed relationships.
    • "…the skills were just not enough. There was something that was missing." (11:18)
• Breakthrough moment:
  • He realized that anxiety was masking deeper, authentic feelings (like sadness), and over-reliance on ERP or cognitive approaches could inadvertently suppress true emotions.

3. Transition from Standard Approaches to Deeper Emotional Work

• Classic ERP/ACT:
  • Traditionally, these focus on disengagement from thoughts and on accepting uncertainty.
  • Sam found that sometimes, disengagement was not enough—thoughts persisted, and underlying emotions went unprocessed.
    • “What happens when you disengage and… still the thoughts are coming intensely 24/7?” (12:54)
• Key revelation:
  • In his previous marriage, “the anxiety was really serving to obscure my feelings of sadness.” (16:10)
  • Emotional pain that was being masked by ROCD symptoms actually pointed to clear relational misalignments.
    • “That sadness was authentic and was true. It led to this insight that I have been saddened and dissatisfied in this relationship for a while.” (16:12)

4. Integration of Internal Family Systems (IFS)

• Therapy shift:
  • Working with a non-OCD-specific therapist (using IFS) brought new understanding.
  • IFS allowed him to conceptualize intrusive, compulsive thoughts as protective parts—designed to keep him safe, but also capable of obscuring authentic emotions.
    • “We are made out of multiple selves… OCD as kind of a protector self.” (19:29)
  • Emotional awareness (rather than just analysis) became essential to recovery.

5. The Pitfalls of Emotional Reasoning and Compulsive Analysis

• Automated “analysis” blocks emotional experience:
  • “Whenever I experience even a few seconds of an emotion… that would be such a quick and automatic trigger to my OCD of wanting to immediately understand what that emotion meant.” (25:35)
• Key skill:
  • Learn to “feel emotions without immediately analyzing them,” even though it runs counter to what many with OCD have done for their whole lives. (27:19)
• Host reflection:
  • “When I was going through it… I treated it all like relationship OCD.” (28:42)

6. Actionable Strategies for Clinicians and Sufferers

• Order of Operations in Treatment:
  1. ERP first, to reduce “inflammation”:
     • “Put down the snow globe and let the pieces settle before trying to make big decisions.” (35:56)
     • “Passive insight” works better than “active insight” for most major life decisions. (36:03)
  2. Rational Assessment: Needs vs. Wants (not perfection):
     • “Needs need to be evaluated as a binary, not a spectrum.” (39:06)
     • Note: “Is my partner attractive enough?” is answerable, “Could I be happier with a more attractive partner?” is not productive. (39:17)
  3. Emotional Assessment:
     • Identify authentic emotions versus OCD-driven anxiety or despair.
     • Practice feeling sadness/frustration/etc. without compulsion to interpret or “fix” them.
     • Collect a “sample size” of emotional experiences — not just analyze a single good/bad day.
       • “You need more than a singular point in order to make that pattern.” (46:11)
• Avoid “Compulsive Therapy":
  • “If you’re doing the exposure because you’re hoping to get your answer at the end of it, you’re not doing an exposure, you are compulsing…” (43:59)
  • Search for “clarity in the medium term, but not in the immediate experience.” (43:44)

7. Application in Dr. Greenblatt’s Current Life

• OCD still persists, but is now manageable and less intrusive:
  • “My brain still comes up with intrusive problems, but it is much better managed.” (48:29)
  • More willingness to communicate needs and feelings directly; nuanced understanding of relevance versus irrelevance.
    • “The ability to do so is… such a better lived experience where things are not this binary, but it feels healthier, lighter, and way more effective.” (50:00)

8. Message of Hope and Openness

• OCD is highly treatable.
• Dr. Greenblatt extends an open offer to listeners “to hop on the phone for 15 minutes”—whether they intend to work with him or not.
  • “If you have any questions or want to hop on the phone for 15 minutes… this is an open offer to any listener.” (52:56)
• Encourages listeners: If you’re still stuck after years of therapy, the right approach can make a huge difference, sometimes surprisingly quickly.

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Notable Quotes & Memorable Moments

• On recognizing authentic emotion behind OCD symptoms:

  “That sadness rang as very true and authentic. And the more that I sat with that sadness, the more I noticed—that was my default experience in the relationship.” (16:10)

• On the limitations of classic ERP/ACT when overapplied:

  “I didn’t realize that I was using ERP to suppress my emotions… the way that I was using ERP was preventing insight rather than helping kind of achieve it.” (54:16)

• On new, healthier emotional experience:

  “I could have a whole spectrum… the ability to do so is… such a better lived experience where things are not this binary, but it feels healthier, lighter, and way more effective.” (50:00)

• On the open offer to the audience:

  “Honestly, if you have any questions or want to hop on the phone for 15 minutes… I just want people to have this information… it hurts my heart every time I hear of people not being able to access this…” (52:56)

• Advice to his younger self:

  “To let himself feel. He was trying so hard, but too hard or misdirected. I was brute forcing and white knuckling ERP. Coulda, shoulda would have been more attuned with my emotions and not suppress them by using therapy.” (53:44)

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Timestamps of Important Segments

• 02:01 – Dr. Greenblatt’s life update; importance of community and hobbies
• 06:57–16:10 – Personal story: How Sam’s ROCD developed, classic therapy trials, and crisis point in his marriage
• 16:10–20:18 – Realizing anxiety masked sadness; marital insight; leaving the relationship
• 19:23–22:13 – Introduction to Internal Family Systems (IFS) therapy and seeing ROCD as a “protector”
• 25:34–28:07 – Emotional suppression via compulsive analysis; challenge of feeling emotions rather than analyzing them
• 35:26–41:50 – Dr. Greenblatt’s “order of operations” for treating ROCD
• 43:33–46:29 – Avoiding compulsive therapy and the importance of collecting accurate emotional “data”
• 48:29–51:02 – Experience in new relationship and practical application of lessons learned
• 52:56 – Open offer to listeners & the importance of accessible care
• 53:44 – Advice to his younger self: don’t mistake suppression for skill

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Tone and Language

The episode is personal, candid, warm, and hopeful. Both voices blend clinical expertise with lived experience, using real-world analogies, storytelling, and practical advice while maintaining empathy for anyone currently struggling.

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Key Takeaways

• Authentic emotional attunement is foundational to overcoming ROCD.
• Response prevention (ERP) is the necessary first step, but not sufficient on its own for everyone.
• Therapists and individuals must carefully distinguish between enabling compulsive avoidance and supporting genuine emotional experience.
• Self-compassion, patience, and a willingness to feel—without immediate interpretation—are critical.
• Dr. Greenblatt is open to answering listener questions, reinforcing his drive to make good OCD care more accessible.

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Resources and Contact

Dr. Sam Greenblatt’s website: ocdspecialists.net
Offers a free 15-minute call to anyone with questions about OCD or ROCD treatment.

Transcript

[A]

You're listening to the OCD Stories podcast hosted by me, Stuart Ralph. The OCD Stories is a podcast dedicated to raising awareness and understanding around obsessive compulsive symptoms. I do this through interviewing inspired therapists, psychologists and people who have experienced ocd. Welcome to the OCD Stories and in this one I got on Dr. Sam Greenblatt. Sam is a licensed clinical psychologist and several time guests. So in this we get an update on him relationship OCD using his personal story as a case study, improving ROCD treatment, exposure and response prevention therapy, internal family systems therapy, working with other emotions around rocd, feeling emotions while analyzing them, improving relationships and much more. And thanks to our podcast partners. Nocd. If OCD is interfering with your life, NOCD can help their licensed therapists specialise in exposure and response prevention therapy. The most proven therapy For OCD with NOCD, effective treatment that is 100% virtual is available for children and adults with OCD and most members can get started within seven days on average. No hassle, just real science backed help and support between sessions. Begin your [e-mail] with or I'll put the link in the episode description. So thank you so much to Sam for his time and expertise. It's always a pleasure to catch up with him. And of course, thank you to you guys for listening. As always, it means a lot. And without further ado, here is Sam.

[B]

Welcome back to the podcast, Sam.

[C]

Hi.

[D]

Thanks so much. Great to be back.

[B]

Yeah, it's good to have you on. So, yeah, you're probably gonna have to do a bit most of the talking today because of my voice, but so I guess initially, obviously I did ask you off air, but it'd be good to get an update. What's new with you? How have you been? All of that stuff?

[D]

I've been good. I've been very good.

[C]

Yeah.

[D]

In terms of the life update, I'm very into dance now. I'm dancing like 10 to 15 hours a week, west coast swing. If anyone else dances that style, I'm sure I'll see you. I didn't venture, um, I'm in a great relationship, very lucky and happy with my partner and business is going great as well. So really I'm, I'm in a very good place. I'm, I'm very lucky, very grateful.

[B]

Yeah, no, I'm happy to hear it. And you know, on the whole dance thing, is that something you've always been interested in or is it something you tried for the first time?

[D]

You know, I've been a hobby hopper My whole life. I started. Actually, I started off in undergrad. I was not originally a psychology major. I was a fine arts major. And I started off with some oil paintings, which to photography. And then through my whole life, I've just hopped between different art forms and also some martial arts and Brazilian jiu jitsu and aikido and kickboxing and judo. Um, and then a year and a half ago, I found west coast swing, just through a friend was just like, hey, do you want to check this out? And I kind of. Yes, and a lot in life. And it just clicked in a way that no other hobby has. I think that it is the epicenter of so many things that I'm really passionate about and, like, I really need in my life. You know, there's the creativity and the artistry and the expression, but it's also joyful. It's also very social. The community is so nice. I've made, like, so many connections. It's something that I could, like, strive for and like, if I wanted to compete, I could compete. If I wanted to just be like a more community member, leader, organizer, I could do that. And that's a role that I've started to step into. I DJ a little. So, like, there's so many components to it that I. I really love. I've just been having a great time in that. In that sphere and in that community.

[B]

Yeah, yeah, no, I'm happy to hear that. And obviously part of recovery is at least the way I practice therapy. I'm sure you're the same of. Sometimes it is helping people establish who they want to be now and the hobbies they want to do and.

[D]

Absolutely.

[B]

So it's interesting to hear how you. You fell onto this or came across this. So. So we've got this booked in because you. You emailed me saying you are finally cracked rocd. I think that's what you said. So some months ago. Something like that. So, yeah. Where do you want to start with this? How do you want to set this up? Or maybe give the background of your own personal experience?

[D]

Yeah, I. I think that the context is very useful so the listener will let me kind of indulge in kind of for my. My personal life narrative. I think it would really help set up for how I have kind of developed this. I think more. More sophisticated, more useful understanding of how ROCD relationship with the docd works. That has been really helpful because, you know, I. I am somebody who has relationship ocd and who acutely struggled with relationship ocd over the course of my life. So I think that I have had the luck of being in kind of a unique position of having first hand experience and having to work through these things myself and of receiving like the standard OCD treatment for relationship OCD and that helping but not quite getting me to where I needed to be and needing to kind of work through some of that as well. So I think the word, you know, cracked is I never want to promise any clients a rose garden.

[C]

Right.

[D]

With ocd, we're still talking about maintaining symptoms over the course of your life. You know, there's no deleting anything. But I am pretty confident that this approach and I could speak at the very least anecdotally, both from personal experience and through working with many, many clients. I mean, at this point, hundreds of clients with OCD and dozens of clients with relationship ocd. And I'm, I'm, I would be very confident in saying that this is more effective than the standard OCD treatment out there. So where did this come from? I'll be, I'll be somewhat briefer than usual because I know that I've disclosed like parts of bits and pieces of this on past episodes, but I think here I could finally like synthesize everything into a cohesive story.

[C]

So.

[D]

I started off, I wanted to be a fine arts major. I switched to psychology. I, you know, graduated undergrad, went to grad school, got two years into grad school pursuing my doctorate in clinical psychology. And they taught us about OCD in grad school. And even, even in grad school, the way that they teach ocd, at least from my experience, is still so rote and outdated.

[C]

Right.

[D]

Most of the OCD mentioned is still around washing hands and touching things too many times. And all of those, like tropic versions that certainly are ocd, but it's not representative of like the, the way that OCD most frequently manifests being kind of obsessional. Thoughts, themes. I had a friend who suggested a OCD clinical placement at Northwell Health OCD center, supervised by the genius Anthony Pinto. I love him. And I was just interested in it because the treatment sounded cool, right? Exposure and response mention. You're not just sitting on the couch saying, tell me how you feel, but you're actually doing things right. Like, it's a little more active, there's a different energy there. And I was really attracted to the concept because it had a reputation of being super effective. And I'm a little perfectionisty and I really can't tolerate work where I'm not gleaning as much effectiveness as possible out of it. Um, so it was like, okay, so let's, let's learn this super effective treatment. Um, and a few months into the externship, I learned around. I learned about relationship ocd and it immediately clicked.

[C]

Right?

[D]

Relationships was something that my entire life I had been obsessed over. If I was in a relationship, I was obsessing over, oh my God, is this the right or the wrong relationship? And if I wasn't in the relationship I. I was obsessing over, am I going to end up being in the right or wrong relationship? A relationship to me and to my two parts of my brain still, like the automatic parts of my brain presents itself as this concept that is the real, like, make or break quality of life. If I'm in the right relationship, then I'll live happily ever after. If I'm not in the right relationship, then my life will be depressing and meaningless and empty and catastrophic.

[C]

Right.

[D]

So if all I'd always struggled with that, I'd gone to a cognitive therapist who helped me somewhat, but I was still kind of white knuckling through things and it just kind of hit me like a lightning bolt. This is the diagnosis that I've had my whole, my whole life. From there, you know, over the course of the next five to 10 years was the experience of both developing my own skills as an OCD specialist and going to other therapists for help in my, my own experience with my own ocd.

[C]

Right.

[D]

I went to an ACT therapist. And the metaphors and the kind of, yeah, the whole acceptance and commitment therapy approach of being mindful and non judgmental to your thoughts was something that was really useful to me. I ended up going to an ERP specialist. And the real stark, like, like determined, tenacious adherence to response prevention was also something that was really useful to me. I ended up in a relationship which I certainly, I experienced initial kind of amounts of OCD that both of those approaches along with medication were, were sufficient on getting me through. But. And, and a careful listener could kind of trace this narrative through my updates over the course of. You know, I think I've been on this show for maybe close to five years now. Something. Something kind of changed and evolved in terms of the intensity of my ocd.

[C]

Right.

[D]

In, in my past relationship, my previous relationship, it was a long committed relationship that even developed into a marriage. And I found myself in a place where suddenly the skills were just not enough. There was something that was missing. I mean, I could tell you as an OCD expert specialist, you know, that absolute. I was I was diligent and I was adherent to the response prevention protocol as, as well as I think that anybody could be, right? Anyone with, with severe OCD will tell you that there are times like the best that you can do is when you notice that your thoughts are wandering. You know, notice them and, and gently, you know, don't play the game of tug of war. Drop the rope, right? Choose not to respond. And any OCD protocol is going to guide you in that direction. We'll hold ICBT in abeyance, but I would say even that it's using some kind of cognitive techniques to then embolden you to disengage. But whether it's that, whether it's acceptance and commitment therapy, which is, okay, so now view it in a different way so that you could kind of coexist with it or whether it's exposure response prevention of, okay, so notice these thoughts and more simply, just drop it. Everything is around disengaging and just not participating with it.

[C]

Right?

[D]

But what happens when you disengage and not participate with it and still the thoughts are coming intensely 24, 7, right. A lot of times with the OCD experience, the choosing to disengage eventually lets the inflammation die down, so to speak. And if you're not kind of trying to, you know, scratch at your itch in order to relieve it, like, you know, it, it, it kind of fades away. But that wasn't my experience with my relationship ocd. It, it became as intense as OCD becomes, right? I was experiencing panic attacks. I would, I would be walking down the street, have such an intense thought that then I would, I would vomit into, like, you know, I'd have to find like a nearby like, public trash can to, to throw up into. You know, I, I had moments just like, of, of anxious thoughts rattling through me with such intensity that it would be like an electric shock through my body that would just kind of like jolt me up. So intense. And all this time I am trying to be as, as diligent as possible, you know, reading through ACT materials, reading through, reading through more ERP materials. Is there anything that I had missed working with an ERP specialist and, and truly giving it my best. So it was clear to me at that point there, there's something, hopefully there's something missing, right? Like, hopefully this is not the best that treatment can get me. There was, there was a point like, towards the end of that relationship where then I, you know, I, I, I had a little bit of a shift and realized that there was some Some more optimizing that I could do in terms of fully committing to the relationship. And there was this moment where things shifted, where when I fully committed to the relationship, I started to notice other feelings pop up. My, you know, I won't go over the specific things that I was obsessing around my partner, partly because they ended up being true, but I'll go into this in a second and maybe I'll bring up some specifics. But when I started to truly try to work with them and fully commit into the relationship, which was something that I realized partway through that, like, I was maybe like hedging on a little bit, I started to notice feelings like, like sadness pop up. And it was the first time that I had really processed how sad I was underneath the obsessive anxiety. First I, I kind of brute force this part because I hadn't really conceptualized like, what is going on. But that sadness rang as very true and very authentic. And the more that I sat with that sadness, the more that I noticed.

[C]

That.

[D]

That was my default experience in the relationship. There were, there's some real objective challenges in the relationship that were authentically depressing. And when I let myself really feel the impact of those experiences, I realized how sad I've been in this relationship overall and realized that my anxiety was really serving to obscure my feelings of sadness. And I know that I'm. I'm talking about it in kind of confusing terms right now, but it was still a little confusing at the time. But what was not confusing is that that sadness was authentic and it was true. And it led to this insight that I have been saddened and dissatisfied in this relationship for a while. And I'm also very, very clear on that. This is something that is around inherent qualities in my partner that I do not believe can or will be remediated in, in any sort of like near or medium term future. And that my best shot at happiness would be to get divorced, to leave the relationship and to seek something else and also to do some work to figure out why did it take me this long to figure out like, you know, what other emotions I was feeling. So that led to divorce and seeking a therapist who doesn't specialize in ocd. Because I think that at that point I had just been, you know, preaching to the choir and having the choir preach me and preach to me and like working through things all within, like, like a very specific approach. And perhaps I needed somebody who just specialized in relationships, connections with other people that might be able to give me some wisdom from A non OCD approach. So I found a great therapist. You know, I want to, I want to shout her out also. Marissa Alexander, to quote the Travel Road, who also quoted somebody, somebody else, you know, your favorite therapist. Favorite therapist there. But she's great. And she worked through an internal family systems modality, right. And she, she integrated it. She didn't like. I was a little resistant, honestly, to using it so heavily. I started to read through the book itself and there were a lot of concepts that I, that I feel like didn't hold water to me or it didn't connect to me as much. That's beyond the scope of this. But what was really helpful was through working with her, I started to understand.

[C]

That.

[D]

You know, the internal family systems approach is that we are made out of multiple selves.

[C]

Right.

[D]

We could conceptualize ourselves not as one cohesive unit, but a lot of different voices that are advocating for many different things. And through that approach, we could start to look at OCD as kind of a protector self where it's, it's, you know, advocating for our safety, it's looking out for us, and it's trying to protect us, but that could also obscure some other authentic selves. And I, I realized through my work with her that a lot of the approaches that I had done at that point and the way that I had interpreted exposure and response prevention were all really useful. We're all authentically very useful.

[C]

Right.

[D]

I'm still an ERP specialist.

[C]

Right.

[D]

That's, that's still my modality.

[C]

But.

[D]

They were, they were very useful. And the way that I was interpreting and applying them was also maladaptive in a really important way. The first, the first clinician that I'd ever seen was a cognitive, you know, work through a cognitive therapy kind of modality.

[C]

Right.

[D]

And that's about noticing your thoughts and kind of arguing against like the logic of them.

[C]

Right.

[D]

Even within cognitive therapy, there's emotional reasoning. And emotional reasoning is saying, okay, just because you feel something doesn't mean that it's true.

[C]

Right.

[D]

And we could bridge from there to the rest of, you know, from, to act and to erp. That also really doubles down on the emotional reasoning kind of part of cognitive therapy.

[C]

Right.

[D]

Just because you feel something doesn't mean that it's true. And I had had a, a relationship to my emotions that was really, really categorized by that axiom where, especially through like the Happiness Trap by Russ Harris, which I still recommend. I think that's the most useful single self help book that, that I've read. It's still very much your brain generates contents and you get to choose which content is relevant or irrelevant.

[C]

Right.

[D]

You ultimately get to make that choice. And at least implied to me through that was a lot of your emotional experience you might want to ascribe a relevance to.

[C]

Right.

[D]

The very premise the title of the happiness trap is. Oh, pursuing like certain emotions, you know, trying to feel happy all the time is a trap that will lead to unhappiness.

[C]

Right.

[D]

And then again to me, and I'm sure that the author would disagree and say that I misinterpreted it, which is. Which is possibly very fair.

[C]

Right.

[D]

Because again, still big fan. But to me, when reading it, the flip side of that of like don't pursue happiness all the time is really work on accepting unhappiness and dissatisfaction.

[C]

Right.

[D]

So I viewed negative quote unquote emotions all in the same way of if I am feeling unhappy, if I'm feeling sad about something, you know, and angry, frustrated. But my goal and my value is to commit to this relationship and to be like a non judgmental supporting partner, then the application of the skills would entail that I should ascribe a relevance to those thoughts and those feelings and then just act according to my values, which is to commit to the relationship which say, oh, don't worry about it, which is to kind of change my life to accommodate for other people's challenges or you know, lack of ability in different areas, etc. Etc. Stop me if I'm, I mean, yapping too long, but I mean, I could keep going, but I'm also trying to save you your. Your throat a little bit, but how am I doing?

[B]

Yeah, you're doing great. I mean, I could jump in there quickly. So I did just fact check myself a minute ago. You didn't say crack the code on rocd. You said unlock. I've unlocked ROCD treatment. So I just wanted to fact check that for you. So, yeah, on the rust thing, because I think what I'm kind of picking up from your story is in your previous marriage, there was, it sounds like there were some, I don't want to say red flags, but some things that were clearly not in alignment. I think from Russ's perspective, he might say, or when working with rocd, you would sense check that stuff to make sure. Are you generally quote unquote happy with this person? Forget anxiety. When anxiety is not there, do you get on with them? Do you have a good time? Do your values align up somewhat? Because it's never going to be perfect. Is there any red Flags, which makes me think maybe that was missed for you at that time because you're committing too hard or you're.

[D]

You're totally on the point, right? And that links to the next point, right? Like, I'm sure that he would say that. But then when you go to sense check it out, right? If you. If you have a patient that comes in and they're saying, you know, my brain will not stop upset, or, you know, I'll bring it to myself rather than even the, you know, hypothetical patient, because I landed in a place and perhaps if I was sentence checking earlier, before, like, my OCD was, you know, so intense, I would have had this option. But a lot of the experience with, um, you know, practically speaking, when clients come into our. Our offices for the first time, they're already in a place where that sense checking is really difficult because the only sense that they're experiencing is unbridled anxiety.

[C]

Right?

[D]

I was not. It was really, really hard for me to understand that I was experiencing other emotions because my anxiety was so high and so consistent that it was difficult for me to experience other emotions. That. That's one. But two, what I later learned is that whenever I experience even a few seconds of an emotion in either direction, happiness or sadness or, you know, any. Anything in between, that would be such a quick and automatic trigger to my OCD of wanting to immediately understand what that emotion meant. So I was trying. I was compulsively trying to sense check, right? I would experience, like, a blip of frustration or sadness, and immediately my brain would go to, oh, my God, does that mean I'm in the wrong relationship? It would start creating obsessions. And then the only thing that I would really notice, because that was such a quick process, was, oh, I'm obsessing again. I need to ascribe irrelevance. I need to do my response prevention, drop the rope and not engage with this, right? So, so then I throw the whole thing out. Same with happiness. I experience happy moment, and my brain would say, oh, is this finally the evidence I'm in the right relationship?

[C]

And.

[D]

And then it would just go to anxiety, and then it'd be like, okay, it's OCD again, I need to, you know, drop the rope and come back to the present. So because my anxiety would immediately attack any emotion, I was not able for a very long time to gain a sense of the ratio of emotions that I would normally be feeling.

[C]

Right.

[D]

I would only experience them a second at a time, and it was only when. Yes. So it took quite some Time to realize that process, to be able to notice how quickly I was like attacking these emotions and then to build up an ability to notice and feel emotions without immediately analyzing them, which I had realized was something that I'd never done in all of my, you know, 30 something years of, of living. I, I had always had this experience with my emotions of like, these, these are threatening, or I need to analyze it or something like that. And that's, that's the piece that I was missing.

[B]

Yeah, fair enough. I hear that. Yeah. I mean, when I work with relationship ocd, I will explore the relationship with the person and to try and see if I'm picking up on anything as the therapist, that maybe this does need work or maybe this is just a complete clash. You, you know, because then I think you can help the client. Pause for a second. Let's process this part. Because otherwise, like you're saying they can't. I couldn't think. But like you're saying, back in the day, when I was going through it.

[D]

Yeah.

[B]

Or I treated it all like relationship ocd. And I think sometimes there are not in your case, because it sounds like there are obvious things that meant he was probably better off separate. But, you know, definitely in my, you know, I'm married to my partner and that there are definitely things that have come up over the years that my, originally my, my rocd latched onto, but it was latching onto real things, but they weren't do or die. They were just things I needed to work on. And then there were other things it latched onto that were complete nonsense.

[C]

Yeah.

[B]

You know, but sometimes I think because of our own, I don't know, attachment histories, interpersonal histories, whatever, if there is a slight real issue, it gets dramatically amplified tenfold. And then the anxiety kicks in. Whereas most people, it might be annoying to them, for us, it's catastrophic.

[D]

Absolutely. And I think that this kind of identification with emotions can be a cure to some of the intense of OCD in those moments and in those experiences. Because what, what I've experienced at least is that. Because my brain wants to go to this black and white perspective of, you know, this, this narrative that is always developed. If I'm in the right relationship, things are perfect. And if I'm in the wrong relationship, then that's when, like, there's. There's problems to, to your description of, I guess, I guess both scenarios.

[C]

Right.

[D]

In both scenarios, there's, there's some potential legitimacy towards feeling a little off.

[C]

Right.

[D]

In, in the first one that you described. Okay. So there's, there's something that needs to be addressed and there's some action that needs to be taken. But I would also guess in that second one where you're saying like, it's, it's, you know, it really is, is far better, just like ascribing a relevance to it, the relevant part of it is that there's some characteristic within your partner that's, that's maybe like a little annoying or something like that, or like to, to some part of your brain, you know, suboptimal in, in some way or another causes, causes minor, mild kind of elements of a frustration or sadness or disappointment or things like that that is totally normal and healthy in any relationship.

[C]

Right.

[D]

And I found that, you know, making space for those feelings of. All right, I, like, I'm noticing this intense anxiety because of this like, you know, perceived flaw in my partner, but can I access like the authentic feeling underneath it? Okay, so I feel a little annoyed right now. Can, can I let myself feel this annoyance without going to, oh my God, what does this annoyance mean? But can I let my body send a signal of, you know, this moment, this experience right now is, is one that is evoking, you know, a, an unwanted or unpleasant emotion and allowing for, that prevents the experience where all of these distressing emotions get immediately converted into anxiety and amplified.

[C]

Right.

[D]

Because we're not, we're not suppressing them. We're not saying like, oh, like, you know, this, this flaw is, is a threat or I can't experience it. And a lot of times that, that's a very soothing thing to experience it, to process through.

[B]

Yeah, no, I, I agree with that. And if we view sometimes that the, our alarm system, amygdala, ocd, whatever is, is signaling or signposting to something. Not always, but when it does, like you're saying, yeah, if you can work through and feel the feeling, it may then potentially prevent the alarm going off and. Right, yeah.

[C]

Right.

[D]

So that's, that's, that's the kind of narrative piece. But I, I also want to give a shout out to like, you know, any clinicians that are listening and like, how to fold this into like a structure. Like what is the order of operations that I have found therefore most useful when a client is coming into your office or for any like, you know, self identified patients. I think it's still useful too. And I think it really depends on like an order of operations because relationship ocd. We talk about how like all themes are created equal. And for the most part, I absolutely believe that Right. If like someone with contamination OCD will say, oh, this is the worst theme and if only I had like moral scrupulosity, that would be so much easier. And then someone with moral scoop would say, oh my God, this is the worst theme.

[C]

Right.

[D]

I, I wish that I had existential ocd. And OCD is just an intolerance of uncertainty and it's looking for, you know, broken alarm system, looking for justification. And, and it's all treated the same way, I would say, with one or two exceptions. And the biggest exception in my mind is relationship ocd. And the reason for that is that you can't make these cut and dry rules that you can use to like cheat a little bit, quote unquote with other themes.

[C]

Right.

[D]

If I have a fear of contracting hiv, right. I could set a rule in my brain that unless I've engaged in some risky behaviors as, as would be agreed upon by, you know, you know, most medical practitioners, shared needles, had unprotected sex, then I'm just going to make a rule of, I'm going to ascribe irrelevant to all of my other thoughts and I'm going to just get my annual checkup and my STD test like you know, once a year.

[C]

Right.

[D]

I'm not saying the experience is easier, but conceptually that's an easier kind of rule that you can make with relationships. Every, almost everybody is going to be in a relationship in which they're going to choose to end the relationship.

[C]

Right.

[D]

So obsessing over is this the right or wrong one is something that we, we do have to, at different points in our lives, really consider whether that's a relevant thing or not to a much greater ratio than the other OCT themes and fears in general. So when somebody comes in and they've been obsessing around whether or not they're in the right relationship, I think that things need to be approached in a certain order of operations.

[C]

Right.

[D]

I'd say still, we're still starting with the first like bread and butter, right. I, I love exposure response prevention. And that is a kind of a necessary first step in terms of bringing down like the, the inflammation. Right. I like to use the metaphor that you have a snow globe in your hand and you're trying to see what's in it by feverishly shaking it up. And it's only by putting it down on the desk, taking a step back, that you can start to gain some insight and things could get clearer.

[C]

Right.

[D]

I, I also describe this differences like the difference between passive insight and active insight.

[C]

Right.

[D]

For most major decisions in our lives of like, where do we want to live, what job do we want to have? A lot of those things aren't done by actively combing over the pros and cons in an obsessive, myopic kind of way. We kind of just live our life and we're open to our brain sending kind of different thoughts and signals. And over time it starts to send thoughts and signals that are weighted in one direction versus another and then we choose it, right? That's we passively achieve that insight, even on those most important things. But with the ocd, there's often this perception that our passive insight is going to fail and that we need to supplement it with active insight.

[C]

Right?

[D]

I'm sure that I have said in, in like one of my first episodes on this podcast, because this is the theory that I started off with of like, you can't trust your gut when it comes to ocd. Big mistake of mine to say so. Big apologies for anyone misinformed by an earlier episode. You know, you can't trust your gut. You can't trust your instinct. Like with, with ocd, it's, it's a false gut and it's a false instinct and you just need to make your quick rational best guess, right? My conceptualization, my conceptualization has changed dramatically, right? I would say that we absolutely have functioning guts and instincts as people with ocd. It's just that we also have a false gut. We also do have that false instinct that can scream a little louder and could sometimes be the first voice that we have. But underneath that, we absolutely have not just an ability to make cognitive rational decisions, but if we are open to it, to notice just these gut feelings and these instinctive feelings just like anybody else, that signal without like an exhaustive logical defense what is right or what is wrong for us. So response prevention is that first step that needs to happen so that we can start to bring down all of the ancillary noise that obsessing brings about and starts to kind of like help that snow globe settle and make things clearer.

[C]

Right?

[D]

Then we could start to do a rational assessment. And that's still part and parcel with a lot of like the standard treatments of it, right? The way that I define the rational assessment to separating things into needs versus wants, a relationship. Need is like a non negotiable element that you can't imagine being satisfied in the without it. And a want is something that, you know, it's a preference that would enhance the relationship, but it's not essential to the relationship satisfaction, Right. I think with folks with ROCD that also tend to be very perfectionisty. The needs need to be evaluated as a binary. Like it's a met or an unmet need rather than a spectrum.

[C]

Right?

[D]

So the question is like, is my partner attractive enough? Is something that is answerable versus oh, would I be happier with a partner who is more attractive?

[C]

Right.

[D]

I need a partner to be, you know, to be able to engage in, you know, deep conversations. Oh, but could this conversation have been deeper? Now it's a binary, you know, is, is my partner deep enough, frequently enough? Again, the brain's going to attack that with obsessional thinking. But hopefully if you're doing response prevention, you can make a quick, rational best guess and a gut instinct guess around this.

[C]

Right.

[D]

And then the step three is like the emotional assessment of it, right. Is being able to distinguish between authentic emotions, what I call like authentic emotions, and the OCD driven anxiety or despair.

[C]

Right.

[D]

Learning how to separate when something is a gut feeling or an instinctive feeling or genuine emotion, happiness, sadness, etc. Etc. Learning how to, and I'll coach clients to do so. Like we might do some exposures where we think about something that generates some, some sadness in the relationship and then instead of practicing sitting with the anxiety, going right to what does this mean? Like turning that into exposure. Maybe I'm sad because I'm in the wrong relationship. Practicing sitting with that sadness without analyzing it. Can you feel that sadness in your body? You know, can we notice the urge to analyze that sadness but instead sit with that? Starting to identify, like, what do different feelings feel like? Sometimes we need to start like really early on. I had gone 20, you know, 30 years without really learning how to like identify and sit with emotions without trying to like, you know, piece them apart.

[C]

So.

[D]

Once we're able to do so, once we, we engage in the response prevention so we're not obsessing, so things clear up and we learn not to obsessively analyze and therefore suppress or repress our emotional experience. If you're able to do that for a few weeks, then you're able to collect a sample size over. Okay, so when I'm not obsessing and compulsing and I'm, and I'm really opening up all of my sluice gates and allowing for my full range of emotional experience, what is the actual lived experience of being with this partner?

[C]

Right.

[D]

Like, sure, on paper, even when I'm not with them, I can analyze if they meet my needs versus wants.

[C]

Right?

[D]

But that missing component was even if on paper, because I would have justified that on paper. My, my last partner met my needs. I realize now that like my paper was off and stuff like that. But if you asked me then and we were just working through the rational lens, I would have said on paper that, that they would have met things.

[C]

Right.

[D]

What I was missing was that attunement to my general emotional experience. And when you're able to be in tuned with both your rational and needs and your typical representative emotional experience in the relationship, that is when you're able to gain clarity and then ultimately make a decision as to whether or not you're in the right relationship.

[B]

Yeah, yeah, I agree. I agree. It's like, yeah, once the symptoms or anxiety comes down, it's like the clouds part and you can see the truth. But what you said a few minutes ago was like, it almost. I guess my question was, how do you get people to make it not compulsive? Where it's like, let me get all these symptoms down so I can see the truth. It's almost like, because I've said that to people before in all walks of ocd, but with that, that's not the goal. We're not trying to do it for that. But eventually the dust will settle and you'll see that you're not a pedophile, you're not, you know, whatever. So, yeah, yeah, you know what I'm trying to say?

[D]

Yes. And I think that even in your description of how you respond to them lies the answer.

[C]

Right.

[D]

We're looking for an achievement of clarity in the medium term, but not in the immediate experience.

[C]

Right.

[D]

If you are doing response prevention in the moment in order to gain clarity in the moment, you're compulsing, you're not, you're not doing response prevention. And that's something that so many clinicians miss, that the treatment itself can become compulsive.

[C]

Right.

[D]

If you're doing the exposure, because you're saying at the end of this exposure, I'm hoping to get my answer, you're not doing an exposure, you are compulsing, you know, under, under the guise of an exposure.

[C]

Right.

[D]

And exposure is really practicing ascribing irrelevance. But it'll take a second for the snow globe to settle.

[C]

Right?

[D]

You can't shake the snow globe up and put it down and immediately look at it and say, okay, so what's it look like now? It's not going to look any different. Or I guess to that metaphor, it would be putting it down for a second so you can lift it back up and shake it and look at it again.

[C]

Right.

[D]

It's also why I say that, like, you probably need a couple weeks.

[C]

Right.

[D]

I do think that there's, there's a few ways that I, that I. Few kind of like temporal metrics that I use. A client will achieve greater clarity over if something is an imminent emergency. If they're able to do adhering to response prevention for 24 hours.

[C]

Right.

[D]

If they're able to really not try to answer a question and, and really kind of hold in abeyance all of that uncertainty, then I'm, I'm pretty confident that within 24 hours they're going to have increased clarity as to, you know, is this an immediate emergency?

[C]

Right.

[D]

But with the emotional experience, we need to collect like a good sample size.

[C]

Right.

[D]

Let's say we say, okay, so today's going to be your day to tune into your emotions and decide on the rest of your life if it's a good relationship. That's. That's bad data.

[C]

Right.

[D]

It could just be a good day or it could just be a bad day. It's not necessarily representative.

[C]

Right.

[D]

I would want clients to at least, you know, at the very, very minimum, you know, collect two weeks of, of data and to be able to come back and say, okay, so like, in general, do you think that those are two kind of representative weeks of, of your lived experience? And then if so, what was the ratio of, you know, what, what did you generally feel?

[C]

Right.

[D]

So we could see it as collecting like, little data points, but you need more than a singular point in order to kind of make that pattern. So a client really needs to understand the spirit of the law instead of just doing the letter.

[B]

Okay, that makes sense. Yeah. So it sounds like doing the internal family systems therapy did help you think in this way and bring some of this in, like, understanding. Obviously they talk about firefighters, managers, all of that stuff, but seeing the. What do they call it? I'm blanking now, but like the emotion that's behind wherever the defenses are.

[D]

Right. And just, just honestly, like the, the broader concept that the nuance of ifs, I don't think that I ever, like, went through, but almost like ifs as a vessel of introducing, at least to me personally, just, just the concept of experience, of being able to ascribe validity to parts and bits and pieces of different emotions rather than trying to gain this, like, profound larger insight from each one.

[C]

Right.

[D]

Like we were talking about before, of, of being able to experience. Okay. Sometimes I experience annoyance, sometimes I experience sadness and to not immediately convert those to anxiety so that therefore I couldn't collect data on like, you know, how. How frequently they are. And again, this is passively collected data too. Like in my head, in my relationship now. It's not like I'm. I'm coming up with any sort of chart or anything like that. I just noticed that, like, you know, I'm. I'm. I'm more open to experiencing a broader range of emotions and therefore I have a better read on, like, what my subjective experience is relationship. So ifs is a conduit to introducing just emotional identification and a healthier relationship with. It was really what was fundamental for me.

[B]

And in your current relationship, obviously it sounds like it's good. Has your OCD latched onto this at all? Or anxiety?

[D]

Absolutely. Yeah. I still have ocd, right.

[C]

My brain.

[D]

My brain still comes up with intrusive problems, but it is much better managed.

[C]

Right.

[D]

My relationship with it is much more gentle, I think, also because, like, there, there are less authentically, like, I mean, there's. There's no red flags, whereas in the other relationship, there were flags that I was ignoring. Right. So I've always been decent, like the response prevention piece. But I think here, like, allowing for a wider range of emotions, even has. Has even also led me to an increased amount of times where I ascribe relevance to what my brain is obsessing over. But metered relevance.

[C]

Right.

[D]

I think in this relationship, I have more conversations over, hey, like, you know, this made me feel this way, or this made me feel that way, or, you know, couldn't, can we work on this? It's not the end of the world. But like, you know, something like X or Y could make me feel like, you know, even happier and even more satisfied.

[C]

Right.

[D]

And I'm not as afraid of those conversations because my brain doesn't tag it as, oh, you obsessed over it, therefore it's corruptive. It needs to be thrown out.

[C]

Right.

[D]

I could have a whole spectrum of. There are certainly some things that my brain obsesses over that I ascribe total irrelevance to. And I'm like, this is on me. This is not even something that I, I want to bring up or I think, like, would even benefit from a casual conversation. I just totally want to ascribe a relevance to this. And then there are other things that, that are. Yeah, I, I think that this, this is something that, like, would make me happier, like, if we kind of talked through it and something that I process and so we'll have, like a little quick conversation around it, but the ability to do so is. It's just great. Honestly. Like, it's. It's such a better lived experience where things are not this binary, but it's. It's more sophisticated and it's more nuanced and it just feels healthier and lighter and way more effective.

[B]

Yeah. Nice. Thank you. And is there anything else you wanted to say on this topic before we moved on?

[D]

Not off the top of my head. I mean, OCD is treatable, right? Like, if you're stuck. If you're stuck in your relationship. Supposed to be. I hope that this could be helpful. I also just want to offer at this point because I was talking earlier around, like, moving to dance and stuff like that. Like my career, the business is. It's in a great place where I'm training, you know, great externs and stuff like that. And I have. I have, you know, a decent amount of time in my life to, like, indulge in things. And one of the most heartbreaking things to me around, like working in this field and being able to achieve a lot of success with clients is just the myriad of stories where clients come in and they talk about, like, the years of therapy that they've done before for meeting with me or one of my externs. And so often there's some grief work almost that needs to be done over how fast results can be achieved, like in the right place and in the right treatment. And I know that, you know, we're in New York, we're not accessible to everybody, but honestly, if you have any questions or you want to hop on the phone for. For 15 minutes, this is an open offer to. To any listener, whether. Whether or not you ever intend to work with me or not, I'll always try to make time for you. You could contact me through the website ocdspecialists.net specialists like plural, with an S at the end of it. And, like, submit a form, submit to question. Like, schedule block for 15 for free.

[C]

Right. Like.

[D]

Like, I just want people to have this information and like it. You know, it hurts my heart every time I hear of people not being able to access this, and I think it should be way more accessible. So hit me up if you have any other questions from this episode or anything in OCD in general, and I'll probably have the time and I'd be happy to answer.

[B]

Cool. Yeah, thanks, Sam. Appreciate that. And let's do. You could pick up the phone and call the version of you that was in that haze three, four years ago. What would you tell him.

[D]

To let himself feel right. He was trying so hard, but too hard or misdirected. I was brute forcing and white knuckling. Exposure and response prevention. And I didn't know what I didn't know, but like, coulda, shoulda would have been more attuned with. With my emotions and not suppress them by using therapy.

[C]

Right, right.

[D]

To your point of, like we were talking about five minutes ago, how you could use the therapy in a compulsive way. I didn't realize that I was using ERP to suppress my emotions, but yeah, the way that I was using ERP was preventing insight rather than helping kind of achieve it.

[B]

Yeah, I like that they're saying if all you've got is a hammer, everything looks like a nail.

[C]

Yep.

[D]

Absolutely.

[B]

Yes. Yeah, we, yeah, a lot to learn, so. And then you got a billboard in New York. What do you want written on that billboard?

[D]

Just to hit me up. You got any questions, I'm here. You know, it would just be my website and just ask me ama. Honestly, like, I just, I, I hate how it's not, it's not intentionally gate kept. I think there's a lot of people that want to put this information out there, but there's so many clinicians that say that there are and just don't do the right treatments and like, God, it irritates me so much. So if you are stuck, if you're not receiving like the help that you're looking for. Yeah, ask me anything. I just want to help.

[C]

Cool.

[B]

Nice. I like it. Well, thank you so much for your time, as always and unlocking RACD for us. Yeah, no, I appreciate it.

[C]

Appreciate you.

[D]

Thanks so much.

[A]

Thank you for listening to this week's.

[B]

Podcast and thank you to our patrons who help make this episode possible. And if you would like to find out more about Patreon and the rewards and benefits, then there will be a.

[A]

Link in the episode description. If you enjoy the OCD Stories podcast and would like to support us, please subscribe and rate the show wherever you listen to the podcast and thank you to NOCD for supporting our work. And you want to find out more about nocd, you can click the link in the episode description and quick disclaimer. Guys, this podcast is not therapy. It is not a replacement for therapy. Please seek treatment from a trained professional and until we speak, take care.