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The OCD Stories
Sheva Rajaee: Relationship OCD Couples Therapy (#492)
00:51:51
In episode 492 I chat with Sheva Rajaee. Sheva is a psychotherapist who specialises in the treatment of Obsessive Compulsive Disorder and other related anxiety disorders. She is the founder of the Center for Anxiety and OCD (CAOCD). Sheva authored the...
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- [00:00]
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 for interviewing inspired therapists, psychologists and people who have experienced OCD. Welcome to the OCD stories and welcome to episode 492 of the podcast. And in this one I got back on Shiva Rajai. Shiva is a psychotherapist who specializes in ocd. She is also the director and founder of the center for Anxiety and ocd. Shiva offered the book Relationship ocd, a CBT based guide to move beyond obsessive doubt, anxiety and fear of commitment in romantic relationships. So it's great to have Shiva back on and in this one we talk about her center's new protocol for working with couples in relationship ocd. So she'll work with the person with relationship OCD but then also see the partner at the same time. So it's sort of couples work for relationship ocd. So she breaks this protocol down and what that looks like. We also talk about treating the system within our OCD attachment theory, attachment insecurities, emotion focused therapy, having healing couples conversations, helping the partner navigate the OCD and relationship self compassion in the context of the couple, sex and intimacy, values based sex and much more. 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 get started within seven days on average. No hassle, just real science backed help and support between sessions. Begin your journey@nocd.com or the link will be in the episode description. So thank you to Shiva for her time and expertise. I appreciate her as always and of course thank you to you guys for listening. I appreciate you too. It means a lot. Without further ado, here is Shiva. Welcome back to the podcast, Shiva.
- [02:23]
B
Thank you so much for having me, Stu. It's a pleasure.
- [02:26]
A
Yeah, it's good to have you back on and we have just been catching up, but I guess for my listeners, what's new with you or your center? Anything you want to share?
- [02:34]
B
Continuing to do what we do and you know, spend time growing together clinically, I think just sort of developing this couples protocol has been a really exciting thing that we've been up to. In addition to just thinking about the ways in which we can expand our treatment of sort of what works for the treatment of ocd. For our clients. So being a little bit creative, I think, in the past few months as to can we bring in interventions from different backgrounds, different orientations? Can we sort of expand past an idea of, you know, there's only one way to treat OCD and really just kind of expand our horizons there? That's been interesting. Creative and effective too.
- [03:18]
A
Yeah, yeah, I like that. And I'm looking forward to getting into that. And that's a big mission of the podcast, is not leaving the old, still using it because it works, but also filling in the gaps, finding other ways and ideas. So obviously people, hopefully, I mean, a lot of people listening probably would have heard your other episodes where we talked about relationship ocd and you have a book out on relationship ocd, which I'll link to, and the other episodes we've done before. But you're here today to talk about maybe a slight variation on working with ocd. So how do you want to start?
- [03:54]
B
Yeah, that's right. I think what was so interesting for us, and I wonder if many of your listeners will relate to this, is that in working with ROCD and seeing, you know, just thousands and thousands of people come in with rocd, yes, you're working with the individual, but always we're talking about the impact on the system, on the partner. The same way when you're working with a child, you're always talking about the system, which is the family. And so for years we've been specializing in the relationship OCD work and, you know, inviting the partner to come in to have conversations with us and finding that the couple is typically wanting more. So they're wanting referrals for a couple couples therapist who has an OCD understanding. And we just couldn't find it. And we have tried, you know, we were trying, we were looking, we were really hoping to find a good referral where we could send these couples. And after kind of striking out, quite frankly, we decided to develop a protocol ourselves based off of what we found was coming up time and time again in our individual therapy, but also in these kind of one off sessions we were having with the couples. And that turned into our couples ROCD couples therapy protocol, which I would, you know, I'm so excited to share with you here.
- [05:19]
A
Yeah, no, that, that's awesome. And how often. I don't expect exact numbers, but like, how often were you seeing traditional sort of OCD work, really helping people with rocd? And then is it just the same amount you'd see in other themes? Or did you find sometimes it was harder in ROCD because there was more of a system involved.
- [05:43]
B
Yes. I have found that, you know, I sort of say to clients all the time, it's like if what you have access to is a OCD specialist, that is always going to be a fantastic choice for treatment. But truly, the holistic work of treating ROCD effectively, it requires attention to other matters. So oftentimes there is an attachment insecurity. There's a trauma background that, you know, it needs to be addressed if we're talking about complete whole recovery. And amidst that, looking at the effects on the partnership. So, for example, someone's coming to us with ROCD, and we're making great strides on reducing their compulsive behavior and on treating them as an individual. And then what ends up coming up is, you know, sessions down the line or months down the line, they're telling us about the. The scars on their relationship, because before they sort of knew what was even going on. Here they are telling their partner content. Here they are sort of, you know, increasing the sense of instability in the relationship. And then the question comes down to, what do I do about this now? So, absolutely, in the treatment of rocd, I have found that having a more integrative or holistic lens is, nine times out of ten, necessary for the kind of recovery that we. People. People want. This kind of lasting recovery that's quite deep. And treating the system, which in this case is the couple, is really a part of that.
- [07:19]
A
Yeah, absolutely. And so something I've been thinking about is general. All relationships, not all. Well, yeah, all. But it's only really problematic in some, which probably is still a large amount of relationships are, as you say, like our attachment styles or our childhood woundings or relationships. Woundings or experiences can get obviously very activated in relationships. You know, our partner does something that is probably not that deep, but then it really cuts us in a deeper way, and then that causes a conflict and there's a rift. And if that keeps happening too much, there's huge problems in the relationship.
- [08:01]
B
So that.
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A
That obviously happens in all relationships, but I just imagine with OCD or relationship ocd, it's just amplified. Like the volumes just turned up on those conflicts.
- [08:12]
B
Yeah, that's absolutely right. You know, when we think about the individual with rocd, we call that the primary. In our work here, when we think about the primary who has the rocd, frequently we're seeing an individual who's coming from either an avoidant attachment background or an anxious and insecurely attached background. And so they're experiencing the proximity of a Relationship, the vulnerability of being in a couple as threaten in some way. Right. So depending on what their experience was like growing up, relationships can feel engulfing for them. They can feel suffocating for them. And there can be a lot of instinct and energy to want to create distance and separateness, which can manifest in so many ways and of course can be incredibly painful to a partner. And then on the other end of things, if you have a person who's coming in with a bit more of an insecure attachment style, this is a person who's going to be sort of consistently concerned about the, okay, sort of the rightness of the relationship, but also, am I safe in this context? Are you going to leave me? Are you cheating on me? And both of those orientations, they're going to make experience of being in a relationship so incredibly triggering. And the fascinating thing is, you know, as you know, Stu, we heal these attachment insecurities by being in relationships. So the idea of earned security developed by Mary Ainsworth and John Belby is this concept that, yes, we have these attachment insecurities through our relationships with our caregivers, our primary caregivers growing up, but they don't need to be some kind of a, you know, a death sentence for our ability to love. We can actually heal, but we must heal in the context of a secure relationship. So now you have people coming in with these attachment insecurities, typically actually partnering with securely attached partners and having the opportunity to really heal. Right. If it's done right. That's incredibly exciting to think of that. It's just also the crucible of a lot of conflict, typically, until we get to that healing.
- [10:28]
A
Yeah, yeah, absolutely. And, and, and for a long time, obviously couples therapy has existed for a long, long time. But here I'm guessing you're saying you integrating couples therapy within traditional sort of ERP or OCD therapy.
- [10:46]
B
That's right. That's right. So we have explored the way, sort of EFT emotion focused therapy, which asks the partners to really get into their emotional experience. You know, we've researched the ways that can be utilized, those kinds of, that kind of container that's created in couples therapy. How can we bring what we know about ROCD and how it uniquely affects this couple, you know, into that kind of framework of having a healing, emotionally attuned couples conversation. And I think that's just so necessary because we have all heard stories of going to a well meaning but uninformed clinician who says the wrong thing or is psychoeducating in the wrong way. And it just felt so important that we had a clinician who understood not just what the couple is needing from an emotional standpoint, but what they're needing to hear through an OCD educated lens.
- [11:48]
A
Yeah, absolutely. And I want to find out all about it in a second. But I guess what's coming to my mind is with ROCD specifically, if we're doing one on one therapy with them, we're kind of saying, you know, your thoughts are irrelevant. You know, we don't. The content, we don't need to pay. Pay any attention. Let's do the ERP act, whatever it is, icbt, whatever, whatever. But actually, if it is, if ROCD is in some way linked or heavily triggered to people's wounding attachment styles, whatever, then just focusing on the symptom reduction, we're also missing this big piece that's probably just going to keep fueling it and maybe triggering relapses. Is that fair to say?
- [12:32]
B
Absolutely. Absolutely true. And you have your partner's attachment style at play as well. So when you're thinking about the couple, of course it's not just the person who's coming to your office for the OCD treatment, but also their partner's attachment styles as well.
- [12:46]
A
Okay, interesting, interesting. I think I'll chat with my wife before I publish this. But we, we did couples therapy a few years ago to work through some, some issues. And, and you know, I had RACD for many years before I met her. And when I met her, it was. It was. The RSD really flared up and, and I got the symptoms under control. And then after getting married, not long after that, my symptoms really went. And ocd, I was working on it in a big way anyway, but it went more on other things. And then now I've got that down as well most of the time, but with where am I going with this? So I did manage to get the symptoms down, however, then things still kept coming up for both of us, actually. But certain things would then trigger stuff in me and I would feel big emotions, but it wasn't activating OCD anymore. So I feel the traditional work did help get my symptoms under control. So OCD wasn't popping up in this area, but then there was still stuff that remained that I had to deal with that no longer look like ocd. And I did work on that in couples therapy with her and a bit on my own, my own therapy and understanding my own attachment stuff, and that really helped. And I get way less activated now in relationship with her or anyone. If I was in a relationship with someone else. And it was just understanding all of that.
- [14:13]
B
Yeah, absolutely. And that is a way that we see it go sometimes. I mean, that's a nice combination of things, is that you sort of the individuals doing the OCD work and they get things to a place where it feels manageable enough, and then you have the couple's work as well. The way you're describing it is, you know, somewhat that went in a. Those things were not needing to be combined. And, you know, I'm not sure, Stu, if the impact of your ROCD on the relationship felt significant enough to have warranted, you know, a treatment specifically for that. But, you know, as somebody who's gone through it, that it can be incredibly painful for the partner. They can be very confused about what's going on about, you know, what's true and what's not. And not that that's a place for a therapist to say what's true and what's not, but the power of the psycho education, you know, for someone outside of the OCD world, you know, that you're in with your client to come in and really understand, hey, this is what it means. This is what this diagnosis looks like. Here's what you can expect. Right. We have partners who are coming in wanting to understand what the trajectory could look like for their relationship. And I think these are really. It's an important space for a partner to be able to ask these questions that we want to offer them.
- [15:32]
A
Yeah, yeah, absolutely. And, yeah, mine was very spread out, and that worked for me, thankfully. But, yeah, if I could have, in the depths of rocd, targeted all of it at the same time, I'm sure that would have saved me a lot of time.
- [15:49]
B
Yeah.
- [15:50]
A
And maybe money, who knows? Definitely a lot of arguments. So, yeah. So I guess, yeah. Tell us about the protocol. Like, what does it look like?
- [16:02]
B
Yeah, absolutely. I think I'll share with you ways in which it might feel different than sort of the typical OCD treatment that many of your listeners are going to be familiar with. They're going through it. They, you know, they're kind of familiar with the sort of gold standard protocol. So it's okay with you? I'd love to sort of highlight maybe what feels a little bit different about what we're going to be doing in here. So one of the things I think sort of one of the pieces that I think is really interesting is, you know, aside from psychoeducating, the partner is really helping them understand the reassurance cycle, which we know, of course, when we're Engaging in reassurance with ourselves, that's problematic. But when we're talking about accommodations, which of course the partner is accommodating, the statistic is, you know, 99% of family members engage in an accommodation with an. With their OCD loved one. So partners fall into this as well. It's like the most natural thing to do when you love someone is to try to alleviate their suffering. So if the person with OCD is asking, you know, I'm feeling so overwhelmed, are we the right match? You know, do we, are we going to make it? Or they're needing reassurance that, you know, they are loved enough or whatever it is. And we're not, of course, talking about the first time this question's been asked. But of course, this is now falling into a sessional and compulsive cycle. We're going to want that partner to begin getting really educated on the right ways to respond. So we know that if they respond with reassurance, they're going to be, oh, no, don't worry, we're fantastic together. Here's why you've always loved me, you know, or even monitoring their behaviors. For example, not engaging in intimacy because it could be triggering to the individual with rocd. So sometimes it's verbal, sometimes it's non verbal. Essentially, they begin to. The partner begins to sort of walk on eggshells in the relationship. And what they're doing is, is they're walking on eggshells around the rocd. And we sort of have an imbalance, right? So we have like a. It's like a twisted menage a trois. We have three members in this relationship. When we want the balance to resume back to the two. And so we're going to be really working with that partner on, you know, in those moments, how can we respond in a way that is not reassuring but is still supportive? Because I think it's really important to note, you know, we're not going to be abandoning our loved ones in those moments. We are really going to be responding in a way that shows them, we trust them to be able to cope with distress. Right. It's a very. It's a very trusting way that we would respond something to the effect of, you know, I know it's hard to know right now, can we sit in this discomfort together, you know, or, I don't know, maybe we'll work out, maybe we won't work out. You know, I'm willing to take that chance. But sort of training the partner not to get caught in these moments with their Loved one.
- [19:10]
A
Yeah, yeah. So you're like I would with parents. Right. Doing that early psycho education around accommodation and how you do it because you care. But ultimately in ocd, it's just making it worse.
- [19:22]
B
Exactly, absolutely. And how often that is kind of a light bulb moment for family members because the most natural thing on earth is to try to alleviate suffering. So I. It's always so cool to give that education, whether it's to parents or partners or children of people with ocd and have them kind of realize they don't have to be part of this cycle. That's ineffective. It's not as if we give in and it makes the OCD better.
- [19:47]
A
True, true. And just one other question, Shiva, before you continue. You may have already said it and I may have missed it, but are you doing one on one therapy with the primary, as you call them, as well, or is this a sole intervention?
- [20:04]
B
That's a great question. We do ask that the primary has either had OCD treatment in the recent years. I think we have sort of like a loose three to five year span there. Or if they have. Not that they are concurrently in their individual therapy. Because we really don't want the couple's work to be about the partner without OCD just sort of witnessing their process. And likewise it might compromise the confidentiality of the. Of the primary. So we do ask that is either has been completed or is being completed concurrently with a different clinician.
- [20:39]
A
Cool, thank you.
- [20:42]
B
So another piece that I think is so unique to sort of the couple's work and I love is the empowerment of the partner. Right. Again, whereas clinicians, we're so used to working with a person with OCD and thinking that a. And it is. It's a huge part of recovery is about recovery for the couple, even is about getting the individual's symptoms under control. That's a large part of the. It's imperative. But helping the partner understand, the partner of the individual understand that they have the right to protect themselves from, quite frankly, sometimes abusive behavior. Right. By the primary is really important as well. I want to be really clear to anyone who's listening because I think this is a moment where like, shame can really enter in the conversation. But anyone with ocd. Right. And especially, you know, if you're sort of in a relational setting with ocd, there's behaviors that we engage in. I'm someone with OCD as well. There's behaviors that we engage in or have engaged in that we can look back on and regret.
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A
Yeah.
- [21:51]
B
And it comes from a place of Us being very afraid and oftentimes ill equipped. And you know, in those moments we. We can sort of act out in a way in our partnerships and in our relationships, relational relationships with parents, whatever it may be, that can be very hurtful. And I really think it's important to give that partner the empowerment to protect themselves. So if a conversation is getting really unhealthy for the partner or if the reassurance has been addressed, like, hey, this feels like reassurance. I'm not really trying to give in to this right now. I don't think this is helpful. And the individual with OCD is sort of continuing to badger or their name calling or their voice is raising. We really want to empower the partner to take care of themselves because we need that partner to understand that boundary setting is really healthy for the relationship, but also for the individual's recovery, for their loved one's recovery. So that empowerment is a big piece as well. That's critical to, I think, the work and the reframing that we do about how to manage in a couple.
- [23:06]
A
And do you find in certain partners, regardless of gender, what I try to say either certain attachment styles, certain personalities, where they may be accommodating more than others?
- [23:27]
B
That's an interesting question. It's a good one. I do find that the majority of our ROCD clients find themselves paired with securely attached people. I think that's interesting. I suppose it makes sense. It's quite difficult to manage a big anxiety around vulnerability and connection with someone who also has that anxiety. There's just too. There's sort of too much instability or avoidance, I think, to typically fall into a more committed relationship. So I do think we typically see someone who the ROCD partner is working through what they're working through, and you have their partner who's typically a bit more securely attached. And that's actually a fantastic choice for somebody with rocd because we want to be learning from that kind of security. We want to have that safe space in which to earn our own healing, that earned security concept. But yeah, I don't know if I would say there's one personality type. Not necessarily. It's more so an attachment type that I see.
- [24:36]
A
Yeah. Yeah, interesting. And I don't know if I'm going to get whipped for saying this, but like with parents, I find generally speaking, not always the dads are typically better at not accommodating. And that might be because men can shut down emotions better. And that's not necessarily a good thing because obviously that leads to the mental Health crisis in men. But.
- [24:57]
B
Right.
- [24:58]
A
I think that maybe men can just, you know, tune it out for whatever reason, whereas mums, again, stereotypically, are seen as more empathic, compassionate, loving, nurturing mothering, and then find it harder to not accommodate.
- [25:13]
B
Yeah, it's a great question. We absolutely see that when we're working with parents as well and through the space framework. So I so get that question.
- [25:21]
A
Yeah. Yeah. I don't want that to come across as sexist. I'm caveating. That's just what I see.
- [25:27]
B
Likewise.
- [25:27]
A
Yeah.
- [25:31]
B
So I'll share with you a little bit more about what we're seeing as, again, sort of unique to the work here, I think another piece that we. We actually. This. This is a piece that sort of. We love this concept and it's borrowed from space work as well, but addressing sort of the. We call them target knots. So the treatment is sort of focused on, you know, we're not going to go through a hierarchy, but we're really going to talk to the partner and figure out what is the most distressing behaviors or accommodations for you. So that as we're working through this kind of protocol with couples, we are able to target something that would be very impactful for that partner. So it could be that, you know, while your individual therapist is working with the primary on rumination and the things that are going on in that person's internal world, the compulsions that they're, you know, in charge of when they're sort of outside of the couple dynamic, we want to make sure that the things that we're working on in treatment, the exposures that we're targeting, it's going to be very impactful for the couple and for the partner. So similarly to space treatment, where we're looking at what is most impactful on the family system, we're going to be asking the partner that as well. And I think there's a real. I think there's a real, again, stance of kind of empowerment and agency. There's a real respect to the partner's position and impact when we give them that sort of. We give them that responsibility and an opportunity to tell us, hey, what bothers you the most? What is it that really gets to you the most? That's something that we're going to be looking at in this treatment as well. And we really only target about 3 to 4. So it's in our. In our limited time. Right. It's. We're looking at what is most impactful for this system.
- [27:25]
A
That's interesting. And is it sort of Empowering them that after the protocol programs finish, they continue, you know, their own sort of hierarchy?
- [27:35]
B
I guess they certainly can. Or they can then go into more traditional couples therapy. But now they're going to be informed enough to not get sort of caught in, you know, in that clinician's lack of expertise, essentially. So they're now coming in as sort of the educated couple on ocd and they can benefit from the absolute expertise of the couples therapist, you know, which we don't claim to be. We're very particular about our timeline being about you know, 10 to 15 sessions max, because we do not want to encroach into the world of couples therapists. That's absolutely a specialization in its own right.
- [28:16]
A
Hmm. Do you have. I'm more asking for my own center at curiosity. Do you have, like couples therapists you trust that aren't OCD specific, but you know, they get ocd, they know not to accommodate or reassure in the therapy and that sort of thing.
- [28:31]
B
You know, we do stu, and we've also consulted with a lot of those individuals, so we've had great relationships with, especially in our community, sort of our people that we go to that will be consulting on the phone about a case and they kindly will sort of educate us on things that we're less specialized in and we'll share the OCD background as well. And I'm so grateful for those relationships and the conversations. I so admire when a clinician has the beginner mindset enough to be like, I don't get this. I would love to know more about this. It's so thrilling to see. But as you know, the nuances and intricacies are they're quite niche in treating ocd. And so really, unless you are getting trained in and seeing clients with ocd, it's tough, it's tough to catch. Especially the sort of tricky pieces that the tricky little ways OCD sneaks in and tries to get buy in.
- [29:35]
A
Yeah, good point. Good point. Cool. So what's next in the program?
- [29:41]
B
This piece is something I want to talk about that is actually it's about the primary and it's a piece that you've had so many fantastic speakers come on and talk about self compassion for ocd. And so I want to take another minute and kind of talk about that within the context of the couple and how much guilt and shame a primary a person with ROCD can hold on to well into recovery. Well into recovery. So you'll have a person who's gone through their own ROCD treatment. Maybe they've even gone through the couples course or they're going through the couples course. What they come to is this moment of. And I'd be so curious too, if you kind of recognize this as you see people work through OCD as well. I don't know if you see it slightly less in the younger set, but it's just this, like, you know, they just go, wow, I am better. And in that space of recovery, I'm able to reflect on the real impact that this illness has had on my life and my partner, you know, and there can be a such a significant amount of shame and guilt and sadness, grief over lost time, lost quality of connection again, over this kind of scarring that can happen when the primary is unaware of what they're doing and why and they're saying things and they're behaving in ways that are really not aligned with how they hope to be.
- [31:21]
A
Yeah.
- [31:22]
B
And so working with the primary and having the partner witness the primary, that's really key. Right. Having the partner witness the primary experiencing and being in that vulnerability of, wow, this is. This is where I feel I messed up. It can be so incredibly healing for that to happen in a dyadic setting. Right. That's where eft really comes in. We slow that conversation down and we allow the partner to witness that. And we also tend to the primary who wants to apologize, typically who wants to in that point in time and has the capacity to take some ownership for the way in which their behavior has impacted their partner. And that is. It's so hard, I think, to look at the ways in which, again, we. Our fear drives behavior that can be hurtful to the people that we love. But I'm like, it's so thrilling to see oftentimes the graciousness of the way the partner reacts, how healing it can be to have that space and how healing it can be for the primary to access that and continue to work, whether in their own individual therapy or in the context of the couples conversations, to see that they are human, that mistakes happen, that no relationship is perfect. And I think most importantly, that what they have done does not need to be some kind. You know, yes, the relationship is messy, right. But what relationship isn't? And I think there's such a, you know, there's such a. What a lesson that we can still have a really worthwhile, high quality connection with our partners. And even if things aren't perfectly clean anymore.
- [33:15]
A
Yeah, yeah. And they. They never were. Right. It's just an illusion. Like you say, relationships are messy.
- [33:22]
B
That's Right.
- [33:23]
A
And yeah, I'm forgetting what I was going to say, that. Oh, yes, rupture and repair. So as you know, that's a very normal, healthy part of all relationships. Ruptures are normal just as long as we can repair. And I guess here what you're kind of saying is you're allowing for that in the room. You're allowing to repair those ruptures and for forgiveness to happen and understanding and, and also speaking of eft, you're allowing each person to see, really see the vulnerability because in all couples therapy, as far as I gather, all my own personal experiences, it's tearing down those walls so you can connect because when you, when you can be vulnerable, you can connect deeply and then that brings closeness and all of that absolutely can go in a long term relationship. Right?
- [34:13]
B
Yeah, those are really special moments. And they're moments I think that we, you know, we have interpersonally with our clients when we're doing one on one therapy. But couples therapists, I imagine, you know, I'm not, I'm not one by trade, but I imagine they kind of live for those moments where you just watch a couple be able to see each other past those walls and defenses that we all build up in relationships. So it's, it's beautiful to see that and it's beautiful to see the relationship begin to rebalance. And for that, the third, you know, the OCD is the third to, to, you know, for its impact to be more proportional, it's minimized to a point where, you know, I've described this for my clients with rocd that sometimes they can't believe me when I say this. And I get why it's hard to imagine that the goal really is to get to a place where ROCD is like pretty irrelevant in the relationship. Regardless of whether or not you're having the intrusive thoughts, you are behaving and acting in a way that is so aligned with your values and with the respect that you have for your partner and your partnership. Not all the time, not perfectly right. But the majority of the time that it's, you know, the partner might almost be like, oh, I, I don't even. Is OCD is you. Are you still experiencing ocd? Like, we would consider that a really, that's, that's really the aspiration. Like it really goes so underground that like, yeah, you're struggling on your own days, but it's not some, it's not, it's not some third in your relationship.
- [35:50]
A
Yeah. Yeah, I like that. I like that. Cool. Is there anything else you want to say on it before I ask any questions?
- [35:59]
B
I think a piece that I want to bring up as well. It's so important. It's so part of it. I just want to sort of touch on sex and intimacy as well, because I would be remiss not to talk about the impact of a relationship focused obsessional cycle on a person's ability to be intimate and connect intimately. On their desire to be intimate and connect intimately. Right. And of course, the impact that that can on the partner as well. So I think just a note for anyone who's listening, that it's really, it's incredibly common for relationship ocd. For OCD in general, for relationship OCD to sort of wreak a bit of havoc on one's sex life and for that to be impactful on your relationship. The interesting thing about, about sex in a relationship and sexual health in a relationship is sort of say it's like when it's going well, it actually accounts for very little proportionally of a couple's happiness. But when it's going poorly, it's a massive problem for the couple typically. So for many people with rocd, we're going to be seeing compulsions in that space, avoidances in that space. And that can be especially tricky to navigate in large part because we think that we should come to sex with full 100%, you know, happiness and joy and. Yes. And you know, of course consent needs to be there. That is not at all what I'm saying. And the sexual relationship can't be coercive in any way. But introducing these ideas of like values based sex is sometimes an interesting one for people. Right. That you can engage intimately with your partner, not because you feel it in that moment. ROCD and anxiety can make it very difficult to feel it in that moment. Right. ROCD sends the message. Anxiety sends the shutdown switch button, not the turn on button. But to have to be intimate with your partner, to engage intimately, of course, not just emotionally, but physically for values based reasons. And to have that be like a perfectly okay way to get in.
- [38:15]
A
So when you say, just to clarify, then it's like value might be that physical closeness, you know, or to, or even to make my partner feel loved or again, that you're not forcing yourself. But it's a value of. Yeah, yeah, it's interesting. Yeah. Because if you, if you wait to feel it, you might never feel it for some people, especially with varying sex drives. Right?
- [38:43]
B
Absolutely, exactly. So now you're also talking about different response and desire types of responsive desire, you know, their spontaneous desire. So you're coming into a person's biological predispositions there as well. And you just on top of that, you're layering the anxiety and how fraught it can become. And we just need a different way to decide to initiate in that with our partners. It can't simply be that we feel it or even that we're turned on in the moment or even that we've, you know, there must be another way. So this concept is. People raise eyebrows a bit at this concept. And I have to be very clear when I describe it that I'm not talking about, like you said, forcing yourself or non consensual behaviors, but the same way that we would choose to drive a car when we are afraid because we have a value around freedom. We want freedom and mobility in our life. We might choose to engage sexually with our partner because we have a value around pleasure in the relationship or, or you know, making our partner happy, warmth. Right. Goodwill. There's nothing wrong with that being the reason why. And oftentimes, as we find with compulsive avoidances that reduces, you know, the barriers reduce the more we are, are willing to engage.
- [40:05]
A
Yeah, that's, that's a good point. And I got another question on sex because, you know, it's a good topic. There's that therapy that I cannot remember the name of where the therapist will. Basically it's usually when couples are completely lost sexual connection and obviously it's then scary maybe to get back into it.
- [40:28]
B
The sensate focused therapy.
- [40:30]
A
Yeah. Is that it where the therapist is like right this week, all I want you to do a couple times is lay next to each other and hold hands or, and then hug, but you can't do any more. The therapist like bans it then obviously adds a layer of excitement because we're being told not to do it.
- [40:46]
B
Yes.
- [40:48]
A
Yeah, I think that, yeah, I think you're right. Yeah. Do you, do you guys sort of factor in some of those principles to get people started again?
- [40:55]
B
Absolutely. We certainly, we certainly can and do essentially erp, like you're saying, erp for sexual initiation and closeness. Definitely. And I think that if you, if you sort of are pairing sort of like, hey, this week we're just going to hold hands when we don't want to, or you're going to feel like you wanted to be here on the couch and you're going to sit here on the couch or we're going to block out some time to just be close to one another. Absolutely. That is a way in which we might intervene sort of erp for sex anxiety. And, and if you pair that again with that sort of broader concept of we don't need to wait until we feel it, we need to put ourselves in situations where we are allowing for the anxiety to decrease enough for us to sort of be like, okay, that wasn't so bad and maybe I can try again that yes, those are definitely ways we can, we can approach in a more bite sized way.
- [41:52]
A
Yeah. Cool. Yeah. Because I think many people know about that therapy and I think it's really interesting. Yeah. Because I think many couples when, if the sex goes, they feel it's over, you know, and actually Maze, you will look for ways back and sometimes it's, it's a slow, slow and gradual.
- [42:12]
B
Right. And I think just to sort of remember that sex, like any other aspect of a relationship is a skill. And we've sort of come to think of sex as something where, like you said, it's gone, it's gone or if it wasn't there in the beginning, it's never going to be there. And we are so, I think we're so hush hush and we tend to be sort of culturally prudish around talking about it but we must allow for sex skill, connection compatibility in that arena to sort of evolve as a couple evolves. So I'm, I'm one of the things that I've done personally in the last couple of years is joined a consultation group with Doug Braun Harvey, who is a, he is just a master. He's really into the sex therapist, ASEC certified sex therapist and seeing all the ways in which the world of sex therapy helps and informs the ROCD work. It's just been, it's been so fascinating for me. I'm the only OCD therapist in this consultation group, but it's incredibly rich to see how, I mean even clinically we're so uneducated in that world and to see these experts share their wisdom, it's been pretty game changing.
- [43:27]
A
Yeah. Wow, that's fascinating. What a job. So, yeah, it always reminds me like Irving Yolom in one of his books, he, he said unless you ask your clients about sex, they will not bring it up. Obviously some will but most won't. And I think that absolutely goes to what you're saying about us being prudish and you know, it's not something you talk about and when it's something, in fact we all do because there's 8 billion people and we've survived, you know, many, many years because of that thing called sex.
- [44:01]
B
Yes. And I have to share, you know, this is something my own therapist shared with me once, and I think it's so true. It's. She said something along the lines of, you know, sex is one of those things that the more you know someone, the harder it gets. And I think that's such a fascinating perspective because now you are. You are so. The stakes are so high, and you are so. They know you so intimately, and if they were to reject you, it is. It feels like such an ender, right, to be rejected by somebody who knows you that deeply. It's. You know, it's so deep and painful. So I think that's why sometimes you can see more casual interactions being low stakes. But then you have these couples who have been together for 15, 20, 30 years who really want to be together and just cannot get past these knots. So I think it's pivotal that we talk about sex and pleasure in the human experience. If we're treating humans, it's going to be in the mix.
- [44:56]
A
Yeah, good point. Good point. Yeah, it's really interesting. Well, thank you for bringing that up. And, yeah, I think. I think sex can be problematic for a lot of people with ocd, as, you know, even aside from rocd, because you're anxious, you're not aroused necessarily in the way you want to be. Yeah. All your head's filled, so hopefully that helps them too. Yeah. Anything else you want to say on this?
- [45:27]
B
I'm thinking I covered most of the basics and I think, as usual, just wanting to express a message of hope and just to sort of say we've been so excited developing this work and seeing it make an impact and sort of be one of these additional interventions that I think our world, the OCD world, is just getting better and better at integrating in. And I think, as a community, we're getting better at working with OCD because we're being less rigid about what it means to recover.
- [45:59]
A
Yeah. Oh, yeah, absolutely. And are there any plans to train other clinicians or practices in this or write a manual, or is it. Yeah, that's a CA OCD exclusive.
- [46:14]
B
You know, it has been so far. We would be more than happy to develop, you know, a training. I think that's actually a fabulous idea and something we would certainly look into. So far, it's been something that we've just been practicing for ourselves, but we. I would love to. To take this a bit broader, and certainly it might be something that we choose to do.
- [46:33]
A
Nice. Awesome. All right. Amazing. I'm trying, if I've got any other questions on it. It's really interesting. I'm glad you've developed it, I think. Yeah. We need more treatment options. And with rocd, this makes perfect sense that you would. You would do this. We do it with. With kids, with space, obviously. So this is a logical extension. Yeah, I know I'm gonna have many questions as soon as we end this call. I can't think of them right now, so let me ask you a different one. Yeah. Okay, now I won't do that. All right. At this bit. Okay, so you've got a billboard. What do you want written on the billboard?
- [47:21]
B
Oh, the billboard question, Stu, the billboard question. I didn't prep for this one. The billboard question. Oh, you know what? I know what I want to say. You said it earlier, and I really want to reinforce it. That all relationships are a cycle of rupture and repair. Rupture and repair. Like breathing. Like breathing. And to trust that your relationship can not only tolerate rupture and repair, but that every repair leads us to more. Not only closeness and understanding of one another, but more understanding of ourselves. So some version of that, I think with that have to be edited, but. But some version of recognition that relationships are not this, you know, stagnant, simplistic. They're so dynamic. They have such a. There's such an opportunity for us to become our highest selves, to evolve. But that never comes without struggle, that never comes without pain, that never comes without suffering. So hold on for the ride.
- [48:30]
A
Yeah. Yeah. It gets richer. Yeah, I like that. And you know, you're a. You're a mum now. What would you. If you could pick up the phone and call the pre mom, you. What. What would you tell her?
- [48:50]
B
Mm. It's just possible that it is better than you could have ever imagined on the other side, especially motherhood. And that's maybe a conversation for another time, but there's so much understandable anxiety around your whole life falling apart and never sleeping again. And. And all of that is true, but it's also such a journey of fulfillment. I think that's motherhood. I think that's just experience. I think that's living that I find myself more and more comfortable the older and more lived I get. And I would just tell her that it's going to get better and better.
- [49:29]
A
Yeah. Yeah, I like that. Nice. Nice. Cool. Well, thank you so much for coming on, sharing this. This new idea. Like I said, I'm glad it's. I'm glad it's in existence and thank you for Sharing it with me. Is there anything else you wanted to finish on saying or sharing?
- [49:48]
B
Just that we are offering this 10 session protocol and you can obviously reach out to our center for more information. And for individuals who are unable to visit us in person here in California or work with us in that capacity, the Relationship OCD masterclass is going to be offering a lot of fantastic concepts that we are featuring and sort of the couples work here, but through a sort of one on one therapy style with me. So that's an option for anybody who is sort of unable to partake in person in the couples course and the concepts we've discussed today.
- [50:24]
A
Nice. Thank you. So you've. Because you've got the masterclass currently, is the couple stuff in that already?
- [50:31]
B
There is couples modules in there, yes. Specifically explaining sort of how to speak, how this was the reassurance pieces in there, teaching your partner how to respond in a way that's productive. The shame pieces are in there. So the heavy hitters are definitely going to be incorporated in that master class as well. Although that is aimed at the individual.
- [50:50]
A
Okay. Okay, Cool. All right. Amazing. Well, thank you so much for coming on.
- [50:55]
B
Such a pleasure, Stu, thank you so much for everything you do.
- [50:57]
A
As always, thank you for listening to this week's podcast and thank you to our Patreons 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 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. If 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. It.