← The OCD Stories
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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 through interviewing inspired therapists, psychologists and people who have experienced OCD. Welcome to the OCD stories and welcome to episode 517 of the podcast. And in this one I got back on Spencer Gavin 7. Spencer is now a therapist, specifically working with OCD. He when he came on many, many years ago, he hadn't quite trained as a therapist at that point and he was sharing his story. I met him at the 2017 ISDF conference in San Francisco. So it's great to hear his story back then. So it's great to have him back on now as a therapist. And in this one we discuss his ocd. He briefly recaps his ocd, talks about becoming a therapist, his thoughts on Ian o' Brien's episode which was on the podcast not too long ago where Ian, as part of his master's research took 100 stories from or 100 more stories from the episode, transcribed them and interpreted them, analyzed them, did an analysis to find themes later, looking at, you know, what gets in the way of people doing erp. So Spencer wanted to reflect on that episode. He was a fan of the episode and he just wanted to give a clinical perspective to some of Ian's points in his research. In particular, we look at dropout rate in erp, explaining how ERP links to life, setting expectations. ERP is a lifestyle and motivation in erp. We also discussed building trust in therapy and therapist disclosure, self advocacy and much more. So thanks again to Ian for his episode. It's the episode that keeps on giving. Thank you to Spencer for reflecting on it and covering more insights as well beyond that episode. So I appreciate Spencer, Always nice to chat with him and thanks to our podcast partners. Nocd. If OCD is interfering with your life, NOCD can help. They're licensed therapists, specialize in exposure and response prevention therapy. The most proven therapy for OCD with no CD. 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 journey@nocd.com or I'll put the link in the episode description. Thank you so much to you guys for listening. As always, it means a lot. I appreciate you and thank you to Spencer for his time and you. Thank without further ado, here he is. Welcome Back to the podcast.
- [02:49]
B
Spencer, great to be here still.
- [02:51]
A
Yeah, it's good to have you on. And as we were just discussing or reminiscing, I think you were on in 2018 a long time ago now, sharing your story. So I'll link that into the show notes if anyone wants to go hear the whole thing, but maybe just like give it. Give an elevator pitch of your ocd, maybe like the core areas that affected you and all of that, and. And then just give us an update on where you've been since 2018.
- [03:18]
B
Yeah, so you can go back and if you want all the details, you can go into the 2018 episode, which does feel like quite a while ago, in essence. I mean, I had a couple different themes, but they were mostly regarding contracting HIV and the ramifications of that. And I mean, that was my main obsession starting around when I was 19 years old. 18, 19 years old or so. And so I would obsess about getting a cut and getting it this way and then having to get HIV tests. And so, yeah, that was a struggle for a while. I, fortunately did find treatment rather quickly, which is pretty unusual, but I've had other obsessions, kind of mental review of past events, sort of moral obsessions, things like that. So a little bit of scrupulosity there too. Not necessarily religious, but just on doing the right thing. So I was lucky enough to find treatment pretty quickly and find Jonathan Grayson's book, really just a year or two, kind of after I had symptoms, and it made a ton of sense to me and so it helped. And symptoms have kind of gone up and down, but I'm 35 now and I would say not. Not too many symptoms in the last, you know, gosh, I don't know, seven, eight years. I mean, really since that episode, you know, I guess a little bit here and there, but. But not too much. And so now I'm a therapist that specializes in ocd. I'm a licensed marriage and family therapist. And let's see, in 2018, I had been kind of noodling with the idea of being a therapist, but. But wasn't really ready to take the dive. I made that change in 2019, you know, really when I started thinking long term about how I wanted to spend my life. And I wasn't really very content with the job I was working and went to grad school in 2019, went to grad school during the pandemic, which is a whole nother can of worms. And yeah, that was a whole nother thing. But 2021 finished grad school, and then it took a couple more years to get licensed in California, where I am, it is, you know, a five to six year haul to really get through it for most people, sometimes a little faster if you're lucky. But. Yeah, so, yeah, it's been. It's been a long road and I've done a couple of those CD conferences, IOCDF conferences, which have been great. And. Yeah, well, we could go into all of that in more detail, but that's the potted summary.
- [06:19]
A
Yeah, no, thank you, Spencer. And yeah, it's awesome to see you retrain. And obviously we met in 2017 in San Francisco, Cisco. And yeah, it's. It's. I think it's inspiring for anyone that that's considered retraining to be a therapist. And, you know, because I. I'm a couple years. A few years older than you, but I. Yeah, we both retrained, like in our late 20s. Right. Or started that journey. Late 20s, early 30s. So, yeah, you know, and. And I trained with a lot of people, not specifically in OCD, but people who became therapists. And they were like 50, 55, you know, so there's no. If it's something you want to do. So we're gonna just chat about a few things today. Firstly, you know, in our initial briefing, we were talking about Ian's episode. So Ian o', Brien, who's in Dublin, he's a therapist, and he was. He came on the podcast recently talking about how he took the data from the OCD stories and. And reviewed where people would stick in points with erp. And you'd listen to that and had some reflections on it. So. Yeah, why don't we start there?
- [07:34]
B
Yeah. Well, I just want to say that was a great episode. Sounds like Ian's done some. Some excellent work. I didn't fully dive into all of his data and everything. It sounds like it was very thorough. And also, I just want to say it's just incredible, Stu, that you've done 500 plus episodes and, I mean, you really have accumulated so much data that really goes well beyond, to me, traditional research and academic research. It's really kind of qualitative research and people speaking really honestly in a way that's hard to get out there. So it's just such a treasure for the OCD community, and I totally mean that. And you deserve all the credit in the world for being so consistent over the last 10 years. Thank you with that. Yeah. So I think it's one thing to think about is the dropout rate, and I know that he brought that up. And I think that's something that I didn't think so much about, especially early on when I was training to be a therapist is, well, you know, you have to make treatment palatable for the client. So I've been thinking about some parallels between mental health therapy and, like, personal training. Cause I just did a credential in that. And so if you think about personal training, if someone's coming in and maybe they're completely deconditioned and they haven't exercised at all, and then you ask them to do a max bench press or to do a VO2 max test, you're probably. I mean, a lot of the time going to essentially kind of scare the client off or kind of demoralize them, because you're just really bringing to light the fact that they are so deconditioned. So just. And then as it comes to ocd, just thinking about how. How can we actually build up someone's confidence piece by piece versus, you know, just trying to overwhelm? I mean, of course you don't intentionally overwhelm them, but I think that's an important piece to think about versus just kind of what the textbook thing is to do. How do we create an alliance with someone where they trust us enough so that they, you know, they understand the process, they understand why we're doing what we're doing. All of that is really crucial. And I think that's something you can do to try to get that dropout rate down. Because, you know, if a client doesn't understand the therapy, if they don't think that they can do it, like, maybe they think that it works, but that they don't have the confidence or the skill set or whatever it is, that to actually get it done, you know, then it. The truth is that it may, from their perspective, it makes sense for them to drop out. And so I just. That's something that I think a lot of clinicians don't like to talk about. Because, I mean, for lots of different reasons, maybe it reflects poorly on them or whatever it is. But, you know, he made a great point. I think it was something like whatever, 30% of whatever many millions of people. I mean, that's a ton of people. So how. How can we create treatments that are. That are palatable? I took this one training where the instructor had this. I don't think he'll mind if I steal it here, but this analogy that, say somebody had an infection, whatever bacterial infection, and there's an antibiotic that'll cure it, but the antibiotic is the size of a watermelon and you have to eat it in one bite. How many people are going to take that cure? Not very many. Not because it doesn't work, but just because it's not palatable.
- [11:36]
A
Yeah.
- [11:36]
B
So. So that to me is the art of being. Well, a good therapist in general, but also a good OCD therapist is how, you know, we, we know ERP works, right? It is, it's an excellent treatment. We understand. And we can get into the EDNA Foa like, you know, structures of fear and all. I mean all that nitty gritty stuff. We, that's been, that's been proven by 100 years of psychology research. But the part you really is more of an art form is how do we get the client to actually see that, believe in it, believe in themselves. There's not going to be a one size fits all solution to that. But that was something I think a lot more about now having about five years of clinical experience under my belt.
- [12:26]
A
Yeah, I really like the watermelon idea. Yeah, the, the watermelon can help, but it's just too big. So it's not same as it with ac erp Obviously it's too much too soon. Or do we need to break it down into much smaller chunks or rather than maybe rush people into this short term protocol, sometimes it needs to be a lot longer because of the, you know, it needs to be adjusted for the person.
- [12:53]
B
Yeah, yeah, yeah, absolutely. It's. It doesn't. And I think right when you read the treatment manuals, maybe, maybe they'll put a line in there about adjusting it. But I think that's something. The truth is we get more skilled than that as we get more experience. It's something that's hard to teach in a kind of one to one simple way.
- [13:19]
A
Yeah, yeah, absolutely. Is there anything else from that podcast you want to. Or made you think about?
- [13:27]
B
Well, let's see. He talked about. I mean, that was kind of one of the. I like the phrase failure modes. Do you know that one? It's big more in like the startup world of trying to understand actually why things fail versus just, you know, do they fail or do they not fail, but actually trying to learn something from it. And you know, actually that's, I mean, just a general reflection is, I mean that's a big part of actually becoming. Becoming a therapist is again, not often talked about, but failing and then really learning from that and understanding, well, what is it I could have done differently? And I mean, the same thing is true with OCD and that's why I liked Ian's episode is that. So I was just pulling up, just as a refresh for me, some of his takeaways. So revisiting the why I think this is one thing that, well, in my experience with clients, it's not enough time is spent on it. So maybe they understand ERP and they get that they can kind of habituate to the fear, but maybe they're not necessarily clear on, well, why do they want to do these exposures. There's all kinds of things that people are afraid of and you could go out and have them face those things, but they need to understand, well, what is it that's going to open up in their lives based on overcoming this fear? So maybe someone has a fear of bungee jumping. Right. And maybe you could get them to bungee jump and they would get a little bit less afraid of that, but they actually don't want to bungee jump.
- [15:22]
A
Yeah.
- [15:23]
B
So it doesn't really make sense to do the exposure. So I mean that it's, it's. There's a lot of different examples we could talk about clinically, but if someone doesn't really understand how in the big picture this is going to improve their life, they're going to be able to explore more things socially, they're going to be able to challenge themselves, they're going to be able to travel, you know, whatever it is, they're not likely to want to want to do it. I mean, maybe they would. They feel like, oh, my therapist thinks it's a good idea and I've heard this treatment is good, but they're not going to be really internally driven to stay with it when it gets hard. Yeah, just setting expectations. I do think there's a sense that clients, if they do the exposure once and they just sort of stay with it for a few minutes or whatever, that that's going to cure the ocd. And of course that's not the case. And unfortunately, I think if we implicitly set that expectation, we are going to set the client up for disappointment and then that kind of demoralization and then of course that can lead to dropout. So having to artfully explain that ocd, it is a long term problem and it does require kind of maintenance work. Again, I go to exercise since it's a big part of my life. A personal trainer is not going to say, well, if you come in stu and do these workouts for three months, you're going to be fit for the rest of your life. And you don't have to ever work out again. Right. I mean, if there were such a program, maybe the guy would be making a lot of money. But since we don't have that. Yeah. We have to set the realistic expectation that this is going to be a long term process and that ERP really should become almost like a lifestyle. It's a daily practice, not something that you sort of, you know, the, the 60 minutes of therapy once a week is when you do ERP and then the rest of the week you do, you know, you do your compulsions and you, you know, do do what you're normally doing. Yeah, that's, that's not going to make for, for progress. It's going to have to be a daily practice, daily mindset that you, that you get into. So yeah, that's. I don't know if you had any follow up questions on that, but yeah.
- [17:59]
A
I think it's, yeah. Like making ERP a way of life. Like it's a way of being. It's just who I am now when I, when I feel afraid of something, I lean into it or when I feel that avoidance, I move towards it and it's, you know, becomes a habit almost.
- [18:13]
B
Mm.
- [18:15]
A
The other thing that I guess come comes up in my mind is, especially in America, I've seen a lot of people use the term I graduated from ERP or graduate from cbt. My first thought is Americans love to graduate things.
- [18:32]
B
For myself, it's, it's is our unyielding optimism stu progress.
- [18:39]
A
Well, funny enough, the, you know, your preschoolers, kindergartens or whatever you do graduations for them. Right. At the different years and each year.
- [18:49]
B
I believe last time I checked, it has been a minute since I was in kindergarten.
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A
But okay.
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B
Yes, we love celebrations. Graduate. Yes we do. It's very American.
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A
Yeah. Well, it is seeping over here now. So my daughter, when she left nursery and preschool just before she went to school at 5, they did a graduation for her and it was really nice actually. So I am part joking, but part not. But there's just something in that term. I graduated ERP because when I graduated uni, I finished uni, you know, so, so like if you graduate erp, it's kind of implying you finished ERP when actually it's you don't graduate. It's a skill set. You might have finished ERP for the time being or forever, but in terms of a structured with a therapist, but it's ongoing. Right. And I'm being really pedantic, but I just think there's something in that Wording around graduating erp?
- [19:49]
B
No, I mean, I think that it's important the language that we use and what's kind of implied by that language. Of course, I hope to graduate every patient, every client from therapy, but that does not mean they're never going to have to face something they fear or confront a compulsion. Right. My goal is to teach them the skills so that they can do it for themselves, which, you know, is of course, the gift I, I got so many years ago. So. But, but yeah, there, there are going to be triggers that come up there, there are going to be obsessive thoughts and probably at some point you're going to be, you know, you feel like a need to do a compulsion. So that doesn't mean we have to restart therapy necessarily. It just means you have to continue using the tools. And, you know, one thing I've thought about too, I mean, especially since, you know, becoming the therapist, is that, I mean, life, life is an exposure. You know, every time you kind of challenge yourself in life, you're facing something you fear. And that's for people that have OCD or don't have ocd. And so hopefully it's a practice that can just expand your world in many different respects, not just with ocd.
- [21:15]
A
Yeah, exactly that. I gave a talk recently to some A level psychology students. A level is like 16 to 18 in the UK, so the top end of your high school, I guess. And, and obviously I've done lots of public speaking, but it's still daunting, you know, especially to that age range, because, you know, I'm worrying they're going to judge me on my fashion sense or my, my dad humor. But they are.
- [21:41]
B
They are going to judge you on all those things.
- [21:43]
A
Yeah, they, yeah, they are and they did. But I, I had to use the skills of ERP to lean into it and lean into my values and what matters to me. So bringing an act there as well. But, you know, and there's like going for interviews, if I do any of them or anything else, like there's. It all comes in and it's all learning how to manage those overwhelming thoughts and feelings. So it's well beyond ocd, whereas a lot of people never learned how to deal with that. So for them, going for an interview is disabling because that. Disabling in the sense of that emotion and they just somehow get through it, but it's like torture. Whereas for people who've gone through ERP and graduated erp, they have that skill set that they can. It's still Going to be anxious, but it's much more tolerable.
- [22:37]
B
Well, right. And you talked about some things that. Right. So getting back to that question of the why, what is the thing on the other side of the fear? Like, what is the potential reward? So, obviously with ocd, people are so tuned in to the negative thing that could happen, the worst possible scenario. I think it's so easy to lose sight of actually all the good things that happen in life, all of the joy that can come in life, all of the growth that we can experience when we do challenge ourselves. So just for example, from my life, I don't know if I brought this up in 2018, maybe I did, but I was terrified of swimming for most of my life. I would really not like going to the pool and just swimming, even, like a lap. And I wanted to become a better swimmer and really just learn how to swim at all so I could do triathlon in my, you know, my mid-20s. And so I had to gradually start from just the shallow end of, like, the YMCA pool and get to the place where actually now I can swim in the ocean and be relatively calm. And through that process of doing that, I actually met my wife, who's a lifelong swimmer. And if I had not really challenged that fear, I wouldn't have met her. I mean, who knows what kind of life I would have? But the point just being that there are kind of these downstream effects that can be really positive when we do challenge ourselves and do something we're afraid of. Now, when we're in the grips of ocd, of course, we're not going to see that very well, but I think it's helpful to. It needs to be in the client's own, you know, own experience and own language. But try to understand from their perspective what will get better in their lives if they do see the other side of this.
- [24:44]
A
Yeah. Yeah. That's awesome. Where you're at with swimming and. And especially, I'm guessing you're swimming off the coast of San Diego. Is that.
- [24:53]
B
Yeah, yeah, yeah.
- [24:54]
A
Then you have great whites off the coast of San Diego.
- [24:57]
B
You know, we do. And look, I think that in my life, I'll speak for myself. Going through the sort of the ERP stuff pretty early on was great training for dealing with uncertainty in all of life. Look. Yeah, there are shark attacks. I think it's like seven people a year are killed in shark attacks.
- [25:21]
A
Yeah.
- [25:22]
B
Well. And I think in the US it's something like 40,000 people are killed in car accidents.
- [25:27]
A
Yeah.
- [25:28]
B
And we go on the road Every day, most of us, without thinking that much about it. And so, you know, it just is a good training for dealing with uncertainty. I think it's, it's probably Dr. Grayson that talks about this, but most people don't necessarily think about the uncertainty. When you've actually gone through the ocd, you know, ERP therapy, you're taught to try to accept that and really ground into that. And that practice can help you in lots of other areas of life. 2020 with the pandemic and the world turning upside down. I guess maybe this is a little bit conceited, but I like to think that I was maybe a little bit more prepared for that because I had dealt with accepting uncertainty in my life. Everyone had their best plans for 2020 and what they thought they were going to accomplish that year. And then the world told them what it thought of that. And so, yeah, just that it's. We're, you know, that building the tolerance for, for uncertainty is something that can help you in all areas of your life, whether it's really OCD related or not.
- [26:52]
A
So, yeah, really good points. And I'm honestly joking about the ocean because, yeah, I know the stats and it's, it's so, so minimal compared to so many other things we do day to day. But that's just an area of my own fear I'm yet to conquer. And that's what I'm projecting on to you. There you go. Maybe one day I'll fly out to San Diego and do an open.
- [27:13]
B
We'll go for a swim still.
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A
Yeah, yeah. That's when the podcast will stop. Yeah, yeah, yeah, yeah, yeah, yeah, yeah. Okay.
- [27:26]
B
Look again, it's. I mean, you know, yeah, swimming does come with, with its own, its own risks. Yeah, yeah. There's no doubt about it.
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A
Absolutely. There's worse things, more dangerous things with swimming than sharks.
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B
Yeah.
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A
And I don't mean other creatures, just anyway, so.
- [27:46]
B
Yeah.
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A
And I think going back to like, what their life will look like for me, I use a lot of act and, and there, I would think in the, the language of like, values based exposures, like less. Not just touch the door handle because you think it's contaminated. Let's touch the door handle because actually you want to move freely your house or you want to be able to open the doors in your school building without people looking at you weird because you're maybe using your sleeve or an elbow or maybe avoiding it completely and sneaking behind people and that's embarrassing for you socially. So, you know, so linking it with that. But then Also. Yeah. How do we link it to your actual values? What matters to you in life, where you want to go in life? And can we link that of exposures? Because often people are avoiding those areas and just by going towards them. That's an exposure in and of itself.
- [28:41]
B
Yeah, yeah. I mean, a simple one and one that I find does motivate people is just thinking about their relationships. So I mean, let's just say it's somebody that has issues with driving and maybe fear of causing an accident and then they. Or. And they tend to maybe do the compulsion where they go back and check. Well, that's really probably limiting their contact with the people in their life that they care about. So maybe their family lives a lengthy drive away. That's something that is going to impact them. And how good would it feel to be able to see them on a regular basis and spend valued time with people you love for just one example? Because right in the, when we, when we just do sort of the mini exposure of, let's say, I mean, maybe they're even having trouble getting in the car. I mean, who knows? But that, that, that goal of seeing their family might seem far away, but at least they're. They're then connected to something that they really value in their life versus, well, why am I torturing myself with this therapist? You know, I don't get this. How does this benefit me? Like, how is this going to change my life?
- [30:04]
A
Yeah, good point. And are you, during exposures, are you bringing them back to that motivation and their values and remember why we're doing this? It's what you told me before about wanting to do this or go there or.
- [30:18]
B
Yeah, I mean, I definitely will use that as a reminder and hopefully so that allows people to lean into the exposure. So this is also a common issue with doing exposures. Is white knuckling, to use the term. The client thinks that they just sort of hold my fists and white knuckle and get through this. That's going to benefit me. But really what we're trying to do is open them up to experiencing the fear, the anxiety, the bodily sensations, the thoughts. And allowing them to be there doesn't mean that it's going to be pleasant. But you're not trying to resist it. And if you are clear on I'm doing this because I love my family and I want to see them. And if I, you know, the truth is, if I don't do this, my world's going to contract further, then I'm clear on my, my reason for doing this. Exposure. And I can feel like I'll open myself up to it. So. Well, I mean, you were talking about act, and I'm trying to remember what third language is for this, but maybe it's from ACT or something else. But I think about, like, what are the necessary feelings that I would need to go through to, you know, to get to my goal? And you know, more often than not, if it's a meaningful goal, there's going to be some unpleasant feelings, some unpleasant sensations. But I think it's Nietzsche who said for someone who knows their why, they can tolerate any how something like that. And so I think that's true with the ERP therapy. If someone really understands why they want to do this, how their life is going to get better. I mean, people's motivation can be pretty incredible.
- [32:21]
A
Yeah, yeah, I agree with that. I agree with that. Nice, nice. Is there anything else on Ian's stuff or Ian's research that you want to go into before I change the subject? Let's see.
- [32:38]
B
Well, I mean, you know, it's a very simple point, but, but, you know, critically important, just that you need to build trust with your client. I mean, it's so simple that it feels almost not worth saying. But it, I mean, that's a basic principle of just psychotherapy. We have to have a strong alliance. There has to be trust in the room. You know, they have to feel understood. And that doesn't, you know, happen instantly. And that, that's a. But that's a critically important piece for things to, to work. So, so I, I mean, that's just one thing I've learned as a therapist, is slowing down at the beginning, really building that out. And then if you've got a strong alliance with someone, I mean, you can really do a lot, but if, if that, that alliance isn't quite there, you're going to run into problems. And so shoring that up is, I mean, essential at the beginning of therapy. So again, another thing with ERP manuals is they're usually like, session one, explain erp, session two, like dive into exposure. Right. And you know, there's no space for just, you know, does the person feel comfortable in the room with me? You know, are we able to maybe laugh together? Do they feel understood? I mean, those other just foundational components are really, really helpful and important. So. Yeah, yeah, I agree.
- [34:16]
A
It's the same as like, I've never done, like, gone to a personal trainer in the gym, but I imagine if I did, I would want them not to just ask me what my objective Is like I want to get hench or something or jacked. But I'd want them to like in that first session obviously take me through some exercises but generally like get to know me, understand because if I'm going to be working with this person, I want them to push me, but I also want it to be a human connection, you know, so I enjoy my time with them. That's just me. But like in, obviously in psychotherapy it's the same like the therapeutic relationship. I've been reading some research recently on, on people's responses to ERP and something they've said a few times is like they wanted more space for their story to be heard, you know, rather than just jumping into it. And like you're saying session one, session two, session three. And it depends like sometimes if you've got a time limited therapy because of funding or insurance or something, then therapists and you might have to jump in like that. But ideally you want that, that preamble that getting to know each other which builds the trust, builds the connection and then you also build that development of. I feel the therapist wants the best for me, you know, and actually cares if they care. I don't want to let them down or I want to work hard for them or whatever it is not they need to. But I think that can be.
- [35:40]
B
Yeah. Or I mean in other words, the therapist is recommending the exposure or you know, the ERP because they actually think it's in my best interest long term. Yeah. You know.
- [35:51]
A
Yes.
- [35:52]
B
Not just because they've been trained in this or their supervisor told them to do it or you know, whatever other thing, but they care about me personally. They think that this is going to improve my life. Exactly that. Yeah.
- [36:05]
A
Yeah. I mean we, we, we downplay the, the alliance and relationship too much and I say downplay, we just don't think about it enough.
- [36:14]
B
Yeah, well. And it's, it's the one thing. And then research that there's, I mean there's so many controversies in, in you know, therapy research. That's the one thing that every study that's like. Yep. You know, Therapeutic alliance predicts success. Yeah. It doesn't. Whatever modality you want to look at, it's, it's the same, the same result.
- [36:33]
A
Yeah. Yeah, exactly that which is important for, for I think for clients and patients to find a therapist they go on with or respect or trust or whatever it is. Yeah. Because I imagine if you hate your therapist, it's going to be hard to make progress the same as we see this in School. Right. Growing up, the amount of times we all have personal experiences where we have that one teacher that like believed in us or we found them funny and entertaining. Like we always showed up to their class and we listened and you know, whereas the teachers that couldn't keep our attention or we didn't like or whatever it was, we weren't going to listen. We might not show up as often. Like it's, you know, it's. Again, that's the relationship. It's that trust.
- [37:20]
B
Absolutely. Yep. We can all hopefully think of a couple of those. Yeah.
- [37:24]
A
Yeah. I mean I only had one teacher I liked at school, which is why I didn't do very well at school.
- [37:29]
B
You had a rough time in school?
- [37:31]
A
I did have a rough time as I didn't like that. I, I respected maybe a lot of them, but they just didn't grab my attention. With one teacher, I remember him because I generally felt he cared and because he cared, I listened and I actually worked hard, whereas I didn't feel the other teachers necessarily. I was a number, you know, so. So I'm just highlighting that of like, I think that testament to their relationship even in the teacher. Student relationship.
- [37:59]
B
Right.
- [38:00]
A
It's important.
- [38:02]
B
Absolutely. Yep. Definitely can think of a few. A few myself, more than one. So I guess I could.
- [38:08]
A
Maybe I'm being harsh, I. Maybe there are a few. But I just remember this one teacher was, was special to me because he really stood out, you know. But yeah, didn't like school anyway.
- [38:21]
B
That's why you work with young adults, kids too. You want to be the teacher that you never had.
- [38:28]
A
True, partly that, yeah. And also it was OCD that stopped me. I think partly OCD stopped me from engaging and learning, which would have impacted my connection with teachers as well. So that's why I also want to intervene early. So are you working mainly with adults?
- [38:47]
B
Mostly adults, yeah, mostly adults. I, I have had some, some teenagers and you know, have done some, some ERP there as well. But yeah, mostly. Mostly adults. Yeah. Just find that, that, that works best for me.
- [39:02]
A
Yeah. And are you, are you in person and online or just online? Just.
- [39:07]
B
Yeah, I'm a hybrid right now. I have my own office in, in Encinitas, which is North County San Diego. And yeah, I also have some virtual appointments. Just getting back from paternity leave, so. Because I have a two and a half month old right now, so just kind of getting it back into the swing of things. But yeah, yeah, it's, it's great having you know, the virtual option for ERP because I have had such benefit of clients being able to, you know, go into the situation they fear, whether that's in their house or it's something with their car or, you know, whatever it is. So sometimes I find it's quite beneficial to have the virtual option.
- [39:52]
A
Yeah, I mean, it's a good point. Like, I'm predominantly in person, but sometimes I might say, actually, let's do a session when. If I can't get to their house because they're too far away or whatever, you know, you stay at home for this week in the session, and we'll zoom in. And then. Because we can do exposures where you are, where you're most triggered or. Yeah, it can be really helpful. Okay. And in your journey of, you know, retraining and now working with people with ocd, is there anything that really stands out for you in terms of. I don't know what I'm asking. Whether it's like how being a therapist now helps you within your own mental health or whether it gives you unique insight into your clients or any. Anything like that. Hmm.
- [40:39]
B
Well, I will say that I feel like the whole experience of becoming a therapist is an antidote to. I think it's called terminal uniqueness, which is, I believe, from. I think it's from AA or 12 step. But I think when people are in the midst of suffering, that they think, for whatever reason, and I'm sure I put myself in this category at one point, that their particular problem is unique and perhaps intractable in some kind of particular way, that this isn't going to work. And the more time you spend as a therapist, you just learn that your problem is shared by other people. Other people have had those similar thoughts. It's all part of the human struggle. So. Yeah, I mean, I can't tell you how many clients I've seen. I see myself in my. You know, in my client. And. And. And that's been incredibly rewarding to help. Help people that were struggling with similar things as. As I was. So I. I don't know if that answers your. Your question, but.
- [41:52]
A
Yeah, no, it does. It does.
- [41:54]
B
Yeah.
- [41:55]
A
Yeah, yeah. Do you. Do you ever disclose, like, some of your own journey if you think it's relevant to the client?
- [42:02]
B
I do. I think the timing of that is incredibly important. Yeah. You know, I think the research, what I remember does bear this out. That, you know, disclosing too early I think can come off wrong and perhaps for some clients, maybe hurt your credibility. But I think disclosing at the. Maybe a little bit later when there's some trust. And I think it can be really, really healing. I mean, I've had experiences where clients have really appreciated that. Look, the truth is, if you Google me, I think my episode from 2018 is, you know, pretty towards the top. Some clients come in that they've already listened to my OCD story and, you know, I. I really have to say that. I mean, maybe I don't know about the cases where it didn't work out, but for the most part, people really like that.
- [43:02]
A
Yeah.
- [43:03]
B
You know, it takes you out of sort of the expert role and, you know, I'm. I know everything and just listen to what I have to say because I'm the therapist. It. And it just makes you very human. And so clients tend to really like that. I would say the only thing is, if you're spending half the session talking about yourself. Yeah, you need. You need to refocus, but you need.
- [43:30]
A
To get a therapy. Yeah.
- [43:31]
B
You need to go to your own therapy and have your own session.
- [43:34]
A
Yeah, exactly. No. Yeah, that's interesting. Yeah. I think doing it in a timely manner can be very impactful. I will generally be broadly at the very beginning, actually. So it's interesting what you say about that research of. In the first session, I usually say, look, there's nothing you can tell me that I said, I have lived experience of ocd. There's nothing you could tell me that I've even not fought myself or done or. Because I work with clients with ocd, have heard. And I. And then I caveat. I say that just to let you know, you don't need to be embarrassed or ashamed in here. You know, you can tell me any of this and I'm not going to be worried for you of your safety or anything. And.
- [44:18]
B
Yeah.
- [44:18]
A
So I'm not disclosing in detail other than the fact that I have experience of it. And I find that. That especially with the young ones, that seems to really help because I find there's so much hesitancy and fear of what's he going to think of me if I say I'm worried about hurting people or.
- [44:35]
B
Yeah, yeah, yeah, yeah. So, you know, I haven't looked in depth at that research. I would think it's pretty hard to create standardized sort of research on this sort of thing because it's so nuanced and so individual to the relationship.
- [44:53]
A
Yeah.
- [44:53]
B
I mean, that. That sounds like it's. It's kind of. Okay. There's a lot of questions with disclosure. The timing, you know, how much to disclose, you know. Okay, that's that's just like a little nugget, and it's a really important nugget. But you're not. Oh, hey, I'm going to start my session. Your session, with 15 minutes.
- [45:11]
A
About my OCD story is my fairest shocks. Yeah.
- [45:15]
B
Here's my fear of sharks, and here's what I did. And on and on and on. Of course, the client rightfully is going to feel like you're taking over the session. I think that that's. That sounds like. That's very judicious, and it sounds like it's working great for you.
- [45:27]
A
So, yeah, I spit it out in like 20 seconds. So it takes. Because we know there's a high level of shame on average of people with ocd. So that's what's always in my head. And I think to normalize that for the young ones. I'm not this clinical. Just this clinical person. I'm a human being. And you. You know, I'm also not a teacher. That's always, you know. I know it is because sometimes they'll come to me and call our work lessons, and I'm like, yeah, it's a session.
- [45:56]
B
Yeah, I've had that too. Yeah.
- [45:58]
A
Now I get my whiteboard out a lot, but it's not.
- [46:03]
B
Do you have a chalkboard and a.
- [46:06]
A
Pointer and I have a whiteboard with markers if I'm a person. Yeah, no, chalk's too messy. Yeah. Okay, cool. Now, it's interesting. I mean, I have one friend who. Who had trouble with alcohol, and he did more relational therapy over a couple years. And I think about. And it really helped him, and he's so different now to who he was, you know, years ago, so really worked for him. But he. He says one of the most powerful things that happened in his therapy was when after about two years or 18 months of working together, his therapist said, you know, I'd hesitate to tell you this for so long, but I used to be addicted to alcohol or have substance use issues myself. And for him, that was so powerful for her to share that at that time, she didn't go into huge amounts of detail, but it really allowed him to feel seen and normalized and. And I've had another friend say something very similar to that, which is.
- [47:08]
B
Yeah, well, well, just one more thing on self disclosure, because I think it's a really interesting topic that's not talked enough about. You know, I. I think. Well, one thing is, I would say my experience in graduate training, just where. Where I was trained and so on, it was really discouraged. It was don't say anything about yourself. You're a tabula rasa. Blank slate.
- [47:33]
A
Yeah.
- [47:33]
B
You know, be very professional. And quite frankly, I don't think that's good advice from five years of clinical experience. You really want to be a human being. It's good to have some vulnerability and not, you know, act like that sort of perfect robot therapist. I would also say, just generally speaking, I think some people maybe lean too far towards the professional and the clinical and some people inherently kind of lean a little bit too far towards like a peer to peer relationship and just disclosing kind of everything. It's all about finding that sweet spot. My personal flaw is I actually lean too far. Professional, clinical, I've definitely figured that out. So I just try to hone my instincts. Okay. Is my concern really that I'm going to not be professional, clinical? And then from my experience, am I maybe overly concerned about that? And I. Yeah, I found that I'm trying to think of negative experiences I've had with self disclosure. Now that I think about it, I can't really think of very many.
- [48:49]
A
Yeah, I mean, I've had a few where it's landed really flat. And, and it doesn't mean it's not gone in. It just. It might, but it might be that it's literally been like, why are you telling me this? But that's been, that's the rarity. Like most of the time it's been received and appreciated, I think. But yeah, it's very much. Yeah. Just for anyone listening, if your therapist is talking a lot about themselves, then, yeah, you question that. But if it's, if it's timely and an occasional. And you feel they're doing it for a. They've got a strategy of why they're doing it. They're not just talking about themselves. There, there's a reason why they're sharing that. That's actually, I think a really good therapist or one who. Yeah, he wants that connection. Yeah. Yeah. Okay. In last couple minutes, is there anything else you wish you could have said today?
- [49:40]
B
Gosh, I mean, there's, there is so much. We could, we can talk about it. What's coming to mind now is just, you know, I did just complete this, this personal training certification and you know, they, they talk about adherence. Right. That, that there's that word adherence. And I don't know if maybe the language in the UK is, is different, but I, I typically thought about that from the medication perspective. Like we talk about adherence to medication, which of course is important, but it was helpful for Me to think about that in terms of OCD therapy and just therapy in general. This is in keeping with everything we just talked about today. But how do we get someone to see a path and really try to stick to the path? So again, physical training, personal training, you know, it's. It's not enough for someone to do the protocol for. For one week or let's say, or. Or the first three weeks of the year, and then a lot of them fall off.
- [50:51]
A
How.
- [50:51]
B
How do you get someone to stick to it over the long term? And, you know, there's a lot of different components to that. You know, may. Maybe one piece we didn't talk so much about is there's this concept. It's a. It's kind of fancy clinical term of self efficacy. To what extent does the client think that they can master and achieve things in the world? And so you want to build that incrementally with the client. And I would say one struggle I've had, well, in the five years is sometimes maybe overestimating what I think the client is ready to do. And, you know, if. If the client, you know, doesn't really think that they can do the exposure for whatever set of reasons, maybe they're. They're. It's hard for them to tell. Tell the therapist this, but, you know, they're gonna. They're probably not gonna do it, and then they're probably gonna feel shame or they're gonna do it, and maybe they don't know how to do it or whatever it is, and then they. They experience that as failure, and that can be really demoralizing. So, of course, we don't want that for the client. So I would just say, how do you set someone up for success for those early successes so they feel that sense of momentum? Again, this would go for personal training too. Okay. You give someone that's deconditioned a task that maybe is a little difficult, but they're able to do it, and they feel, oh, well, maybe I'm underestimating, underestimating myself. I can actually do more. Yeah, that. You know, look, therapy is. The more I do it, I see it as a lot more of an art form than a science.
- [52:41]
A
Yeah.
- [52:42]
B
You know, all of these things are really nuanced and take just sort of skill and, you know, and discernment, and it's difficult. But that's something that I think we should all be thinking about, and I. I try to think more and more about.
- [52:57]
A
I agree with that. Yeah, absolutely. I. I think it is an art as well as A science, but the. The. The skill of it is an art based on science.
- [53:07]
B
Yes. Yeah.
- [53:11]
A
Yeah, No, I. I agree with what you're saying With. With, like, adherence. And I definitely find with the clients, they're much more open. They'll. They'll tell me, like, no, or they'll tell me that's no, that's too big. And then we adjust. But for some clients, and maybe when there's interpersonal stuff or social anxiety there, that they may struggle with being honest and open with the therapist based on their own histories and stuff. So the more we can pick up on that, therapists and say, you know, is this too hard or are you struggling to tell me it's too hard? Or whatever it is. I definitely have some clients at the minute like that, but for those listening clients who are like that, I know it's scary, but, yeah, do your best to try and communicate and be open with your therapist is hard, but you can see that as an exposure in and of itself.
- [54:01]
B
Yeah. Yeah. I mean, the more open you can be, you know, the more likely you'll. You'll have some. Some success. And nothing breeds success like success.
- [54:12]
A
Yeah. There you go. Nice. All right. Good way to end well. Spencer, thank you so much for coming on again.
- [54:18]
B
Thanks so much. Du. Always fun and amazing what you're doing. And, yeah, 10th anniversary. I'm looking forward to that. That episode.
- [54:27]
A
Thank you, man. Thank you. Thank you for listening to this week's podcast and thank you to our Patreons who helped 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.