OCD: Recognizing the Signs and Finding Help

Obsessive Compulsive Disorder (OCD) is one of the most misunderstood mental health conditions, often reduced to stereotypes about cleanliness or organization. In reality, OCD is a complex disorder marked by distressing intrusive thoughts, overwhelming uncertainty, and compulsive behaviors that can significantly impact a person's daily life. Specific phobias are equally powerful, leading people to avoid situations, places, or objects in ways that can quietly limit their freedom and quality of life.

In this episode of Finding Your Voice, host Jason Carrasco, LMFT, sits down with OCD specialist Erin Smokovich Dorflinger, Clinical Social Worker/Therapist for an in depth conversation about what OCD and specific phobias really look like beyond the myths. Together, they explore the lived experience of intrusive thoughts, compulsions, shame, avoidance, and the emotional toll these conditions can take on individuals and families.

The conversation also examines how OCD and phobias are accurately diagnosed, why they are so often misunderstood, and the evidence-based treatments that have helped countless people reclaim their lives. Erin explains Exposure and Response Prevention (ERP), the gold-standard treatment for OCD, as well as exposure therapy for phobias, offering practical insight into how facing fear rather than avoiding it can become the pathway to healing.

Whether you live with OCD or a specific phobia, love someone who does, or simply want to better understand these conditions, this episode offers compassionate education, practical guidance, and hope. Recovery is possible, and with the right support, people can learn to live meaningful, fulfilling lives beyond fear, doubt, and avoidance.

Join us for an honest conversation that challenges stigma, builds understanding, and reminds us that healing begins when we have the courage to face what frightens us and to find our voice.

Transcript

SPEAKER_00 0:00

Hello, I'm Jason Carrasco, and welcome to Finding Your Voice. I'm a licensed marriage, family, and child therapist and a lifelong student of human resilience. For years, I've sat with people and some of their hardest moments, moments that have challenged their identity, their spirit, and sometimes their will to keep going. One thing I've learned is that human beings can survive the unthinkable. And with support, a person's pain can become great purpose. This podcast is a home for stories about mental health, human rights, and the courage it takes to move through darkness and toward healing. In these episodes, you'll hear from survivors, clinicians, and everyday people who are brave enough to speak honestly and bold enough to use their voice. You deserve hope, you deserve healing, and you deserve to be heard. Welcome to Finding Your Voice. Let's get started. All right, everybody. Welcome to another episode of Finding Your Voice. And I am extremely honored and very excited with the guests that we have today. So, real quick, I am gonna go back to the year 2009. I had finished my practicum for my master's program, and I was looking to apply and to get hired as a clinician for the first time at an agency to be able to work at a clinic and be able to get into the field. And so I received a phone call from this woman that sounded so warm and so pleasant and so happy on the other side of the phone. And, you know, she introduced herself as Erin Dorflinger, that she was the program director for this particular agency, it was called Pacific Clinics, and if I'd like to come in for an interview, so I was so excited. So I remember I go, I go there, I go up the elevator in the waiting room, waiting on the stairs, I see her come out. Instantly, I was impressed just by her professionalism, her demeanor, just the way she carried herself. And so I walked in, I interviewed with Erin. At the time, there were two other people, Jaime, who I've had on this podcast before, and I interviewed with the three of them. Thankfully, they decided to bring me on to this agency. And before we get started, before I do the introduction, I I just cannot express enough what an amazing leader Erin is in terms of the passion, the motivation, the integrity, the work that she created, the the environment, sorry, that she created for all of us at this agency. All of us were proud and happy to serve under her, wanted to do well for her. So, Erin, such a phenomenal leader. I am so glad my first experience as a clinician was under you and the tone that you set for us at that agency.

SPEAKER_01 3:09

That is a lot to take in. And wow, it's really moving to, you know, to hear that. Really, it's wow, just bringing myself back to that time. And thank you so much for those words. And I am so grateful that you were interested in that position. And I think we knew probably the first 30 seconds that we wanted to hire you, but we probably did the whole interview anyway.

SPEAKER_02 3:32

Yes.

SPEAKER_01 3:32

But you know, you were you were and are such a gift to all those that you encounter, and that was just very clear from the beginning. So I feel truly honored that I had the opportunity to work with you. It's just so nice to be connected again. Yes. That was a very special time. And we had a really phenomenal team that we got to work with and had the absolute honor to to serve the community that we were able to serve. So it was a really special time, I think, professionally.

SPEAKER_00 4:03

I I agree 100%. Since, of course, Pacific Clinics, you've gone on to do so much more amazing work. You know, I know that you you're licensed in New York, of course, California, Connecticut as well. I believe you have private practice where you help individuals across various stages of life and that are dealing with various stages of mental health in terms of them seeking treatment, wanting to improve, whatever their functional impairments are, with anxiety, depression, life transitions, parental stress, relationship challenges. And in addition to your clinical work, I know that you're still a respected leader in behavioral health. You're currently vice president of clinical services for a virtual first behavioral health care organization. Throughout your career, you've also held numerous roles, of course, clinical director, director of quality management, and program director for partial hospitalization and intensive outpatient programs. So you, Erin, you are just continue to evolve and lead, and you're an amazing example of a strong woman in this field.

SPEAKER_01 5:18

Thank you, Jason. That means a lot.

SPEAKER_00 5:21

Yeah, of course. And today, what we wanted to talk about and what we thought we would would focus on, I believe Erin can really bring some unique perspective to, you know, she's worked with with a variety of patients. We were talking about obsessive-compulsive disorder and then also specific phobias as well. I thought that would be a great topic because there's I think there's more people than we realize that maybe are trying to work through this, that are trying to do the best that they can if they're diagnosed with maybe OCD or specific phobia. So, and there's not, it's not talked about too much. Like I think, like a lot of other diagnoses. So I wanted to bring some light to it to help bring some understanding with that for someone hearing about obsessive-compulsive disorder for the first time, like let's go beyond the stereotypes that are out there. How would you describe what it really is?

SPEAKER_01 6:23

Yeah, it's a great question. And I do think there are a lot of stereotypes out there which can be really, in a way, harmful. Really, when it comes down to it, it's a combination of profoundly intrusive and distressing thoughts that a person does not have control over. They're egodystonic. You know, it's not something that they feel really in control of. And then those thoughts are followed by compulsions. And the compulsions that most people are kind of familiar with are more behavioral compulsions, like in a contamination scenario, let's say with germs, it would be the hand washing. So the obsession would be kind of the fear of contamination. The compulsion would then be the hand washing, for example. That's kind of a stereotypical presentation. What often people miss though is that they're mental compulsions and safety-seeking behaviors that individuals engage in that are when they're mental compulsions, you can't see them. And so this could look like rumination, mental review, seeking reassurance, it could look like self-reassurance, even avoidance. So there's so many things that could be happening with an individual that you cannot even see. And that individual is fully immersed in engaging in an actual compulsion. And so because of the nature of the obsessions that are met with compulsions, there is a very cyclical component that occurs where the compulsions make the actual obsession stronger. It really solidifies the obsession and it gives it power. And so understanding, I think, that there is a cycle that happens is crucial because part of treatment is really rupturing that cycle and understanding the nature of the obsessions and the compulsion so that you can then take action and really help that individual take the power away from that the comp the obsessions.

SPEAKER_00 8:35

In terms of the compulsions developing, are is there a certain age or a certain time that these compulsions begin to develop? And then why do they feel so compelling or so necessary to that particular person?

SPEAKER_01 8:53

OCD, you can see this developing in school age children. And then also it develops throughout the lifespan. I think that unfortunately, on average, it takes individuals between 12 and 14 years to actually have an accurate diagnosis. So it's often missed or underdiagnosed, misdiagnosed. And I think as a result of that, folks end up living with OCD for a significant amount of time without it being kind of appropriately diagnosed or you know, caught, if you will. And so why do compulsions feel so necessary? The brain really in that moment believes that you must engage in a compulsion to perhaps keep yourself safe, to ward off that anxiety. And it's not, there's such a strong urgency that comes with it that I think that the individual doesn't really know that they have another option. And it's super tricky, right? Because when you have when you engage in a compulsion, it may provide temporary relief. You may even get a little dopamine hit. So it's it's counterintuitive for someone when you say, we actually need to delay your compulsions. And ultimately the goal would be to completely eliminate those compulsions that feed the obsession. So it's tricky, it's a very hard thing for people because you get used to doing the thing that makes you feel relieved in the moment and create safety even though it's never going to be enough. There will never be enough compulsions to make you certain or feel 100% safe. There's always going to be a sense of urgency to do more. And that's often what happens with mental compulsions. Someone will get will get lost in ruminating, replaying these events from the past over and over and over again. And all of a sudden they realize they've been kind of in their head, just replaying these scenes for a very long time. You know, and of course, that has an impact on someone's functioning, their overall mood, their ability to just be present in the moment because they're all consumed by these sessions and then compulsions as well.

SPEAKER_00 11:24

And going back a little bit, you talking about it often taking longer for it to be diagnosed, right, than a lot of other things. So I'm thinking about children or people that are younger, and then they're starting to have these compulsions in their head or things that are happening.

SPEAKER_02 11:43

Right.

SPEAKER_00 11:44

What does that start looking like to parents? Or what are, or what are maybe they get are they getting misdiagnosed with if they're going to get mental health treatment?

SPEAKER_01 11:55

Yeah.

SPEAKER_00 11:56

And, you know, it's it's hard, like you said, it's hard to diagnose for the OCD, or it might be missed by somebody. What do they mistake that for at times when they're having those compulsions?

SPEAKER_01 12:07

Is it anxiety or yeah, yeah, it could look like anxiety, it could look like school refusal. I mean, OCD and depression show up often together. It could look like social anxiety. So I think that often, especially if the person isn't sharing what's going on with them as far as the intrusive thoughts and maybe their behaviors, the compulsions, if they're not sharing what those things are, it's even hard, it's it's even harder to catch. Often the intrusive thoughts also are taboo. And as a result of that, individuals often feel a tremendous amount of shame and guilt. And so then it further kind of closes their world and they end up carrying this alone, you know. That can be super frightening for people, and so and they there's a lot of attaching meaning to the thoughts, like if I think these things, it must mean I'm a bad person, or I deserve to suffer, or I'm evil, or I'm somehow damaged. So I think that the nature of shame and guilt, kind of being a part of what keeps OCD alive, makes it very, very difficult.

SPEAKER_00 13:28

What was it that got you some of the passion that you have about working with with OCD or what what experiences motivated to get into the work?

SPEAKER_01 13:40

Yeah, absolutely. It's a good question. I mean, I'm sure you can relate to this that we've probably always been helpers. You know, we've been those individuals in our family and friends' lives who provide that guidance and support. And also, I think just in general, we're lifelong learners and were curious. And so specifically with OCD, you know, I had worked with lots of individuals with anxiety and depression and some of the other diagnostic presentations that you had mentioned earlier. And and then I had a personal experience with my daughter. She several years ago, we had this situation where we had this really intense storm. It was called a micro burst. It came out of nowhere, and all of a sudden there were really wild winds, and it got very dark very fast. And as a result of the winds, two things happened. Our neighbor, who is a very close friend, kind of like family, he was just finishing mowing his lawn, and we have these huge pine trees here. One of the pines snapped in half and it fell on his lawn mower and almost killed him. And that's not an exaggeration. And then another tree fell through their house right next door, and then a tree fell in our backyard and like hit our swing set, and it was loud. And I actually wasn't home at the time. My husband was home, and it was a very chaotic scene. It was really scary. And from that moment, right? So we have kind of this precipitant. My daughter started getting very focused on the weather to the point where I was watching her, you know, stare outside. She was looking at the leaves, she was looking at the clouds, and then she started checking the weather app on the phone. Can I check the weather?

SPEAKER_02 15:43

Can I check the weather?

SPEAKER_01 15:44

Can I check the weather? And so as her mother, I was like, of course you can check the weather. Look, everything's fine. The weather's, it's gonna be fine. So what I was doing without realizing it was actually reinforcing her obsessive thoughts because I was accommodating and I was providing this reassurance, which is actually the opposite thing that you want to do in this treatment approach called exposure response prevention. So after that, you don't think it's that big of a deal. Okay, whatever. Of course, that was scary. And she wants to kind of check the weather and plan for things. Well, this got progressively worse to the point where she wouldn't, she stopped wanting to go certain places. And my husband and I were at a wedding once, and my dad was watching her and it was stormy. And I mean, she was having a physiological reaction where her heart would start beating, she'd get sweaty, she'd get tearful, shaky. And so then now, now we're at this wedding and we leave the wedding. And then there was a, there are many stories like that where things got progressively worse. And I'm going, okay, I mean, there's definitely a traumatic element to this. And what I'm seeing now is these kind of obsessive thoughts about what if that happens again and the weather and kind of all related to harm, you know, and bad things, disasters happening. It started to kind of translate into flying and traveling. And I guess the final straw with me is we were away on vacation and she just couldn't leave the hotel room. And she was so afraid. And I was actually with my mom and my other daughter. And I'm, and at this point, she's checking the weather like 40 times, 50 times a day. And I'm letting her. And so this whole time I'm reinforcing it. And then the other thing was I started to do things like minimize weather. So now, so when we were on vacation, we were in Florida and there are a lot of thunderstorms, and she she didn't need thunder today. I'm like, probably not. I think it's fine. So now I'm doing another accommodation. It was at that time where I said, Oh my gosh, I'm sitting there and I'm thinking, okay, you can't diagnose your child. That's not appropriate. And I'm not able to help her. I'm not helping coping skills and relaxation and helping her manage the discomfort. This is not working, and it's not appropriate for me to do that. So I did a lot of research. I at this point I'm thinking this is she looks a whole lot like she's got some kind of OCD presentation. Again, there's that kind of crisis precipitant, if you will, with the the big storm. Anyhow, I ended up doing research. I found a therapist who specialized in exposure response prevention therapy and OCD, and then came trying to navigate finding someone who I didn't supervise and um who I didn't know professionally, which thankfully I ultimately did for like. But I do remember find like having this long conversation with the insurance company because I ultimately went out of network because they'd say, Well, what about this person? I said, I worked with them, I supervised them, and we went through all these people. So thankfully, and after much advocacy, which we also need to tap into, I found this wonderful therapist who I adore. We went from meeting with her twice a week, and now we see her once a month, sometimes once every two months, just kind of in maintenance mode. What I recognized when I started meeting with her and our daughter, you know, started receiving treatment was yes, she performed an OCD diagnosis. And then we started really working on developing her fear hierarchy and doing exposure exercises as it relates to weather. And we went from checking the weather 40 times a day, multiple times for lengthy times, also. So definitely reducing the frequency and then reducing the amount of time, delaying checking the weather, making sure that I wasn't and my husband wasn't in accommodating her in any way. So, like not leaving events, basically working through hard things and essentially enabling her to tolerate the discomfort in managing these thoughts and then not engaging in the reassurance. And so at this point, for example, if she asks to check the weather, she can check it. I think that I mean she never does anymore. It's like check it every two months, but she has to wait an hour after she asks. So by the time an hour rolls around, she's not interested anymore. They do have flare-ups every once in a while, but the bottom line is I saw firsthand as I'm in this treatment that it is wildly effective and also counterintuitive. So it's your instinct as a parent to give reassurance and to make sure they feel safe. It was a learning experience for me too. And I thought, hmm, this is a little bit out of my comfort zone. Why don't I push right into this and learn more about this modality and also help people who are kind of suffering in silence? I really decided to dive in and get my own training, and and that's the story. I just uh it's amazing. Thank you. Yeah.

SPEAKER_00 21:24

Yeah. I I have a couple questions because I'm not as familiar with OCD, right? I mean, we have, of course, schooling about it, but yeah, a lot of us may not encounter it that much or may not see it that much professionally. So with somebody, say, in particular, like with your daughter, it was with the weather, that was her compulsion, right? Was checking checking the weather and wanting wanting to know what was going to happen. Is that the only compulsion that there that there is for a person? Do they usually only have like one specific compulsion, or does it go into other areas? As well, too. Like how does that yeah, absolutely.

SPEAKER_01 22:03

Yeah. So her obsession was really what if something bad happens? What if my house is, you know, destroyed by a tree falling through, or something happens to mom and dad, or mom dies in a plane crash because of the weather, things like that. And then the compulsion would be to check the weather.

SPEAKER_02 22:21

Right.

SPEAKER_01 22:22

You know, in the current location, or if I was traveling, you know, she wanted to know, where are you traveling? And I need to look at the weather there to see if you're going to be safe. And and then the hyper-vigilance around looking out the window, being in control things. So, like I had mentioned, she was staring at the leaves. And if they just moved ever so slightly, that was a sign to her that there was danger. And so what happens with the brain is that there is when there's that intrusive thought, the brain is perceiving this as true danger, not perceived threat, but true threat. Like your house is on fire, danger. And so your flight, fight, freeze, you know, gets activated. And that's different than me thinking, okay, well, this isn't a fire. Like the microwave is burning something, so there's smoke. It's a it's a little bit different. And you react as if you were in real danger. And then the urgency to manage that is why you act on those compulsions with such urgency. There's there's no other way to describe it as I have no other choice. I need to do this right now in order to feel safe. But there are all sorts of compulsions, you know, depending on what the obsession is, what the intrusive thought is, the compulsion kind of will go with that.

SPEAKER_00 23:49

Can there be more than one? Yeah. Like, oh, really? Okay. There may be people that like say it sounds like for her, she had one obsession and compulsion in relationship to the weather and being safe.

SPEAKER_02 24:02

Yeah.

SPEAKER_00 24:03

And for had were there any other obsessions or compulsions for her? Or no? It was just the it was focused on that.

SPEAKER_01 24:12

It was mostly that, but it kind of started moving into travel. She had never had any fears about being on a plane before. Then she it started kind of creeping into travel where it was, what if the plane crashes because of the weather? So it was still somewhat connected, but not entirely. It started to kind of take on a new, a new obsession and compulsion. And then is the plane gonna crash? Mom is the plane gonna crash, mom is the plane gonna crash. Are we safe? Are we safe? Are we safe seeking reassurance? Which PS, I hate flying. Yeah. But I don't love it. To be, you know, working with introducing uncertainty, which is one of the things you have to do, is hard. It's it's kind of like, well, maybe the plane will crash or maybe it won't, but that's not something we have to figure out right now. So as someone who does not like flying, that was very hard to say.

SPEAKER_00 25:07

Yeah, absolutely. Yes.

SPEAKER_01 25:10

But the whole idea is helping individuals understand again that they can tolerate the uncertainty. And OCD wants you to seek like the it really wants you to seek certainty about everything. The idea is working with the uncertainty to kind of retrain the brain and help the individual understand that they can tolerate hard things, they can tolerate the thoughts. The thoughts don't indicate intention. It doesn't, the thoughts don't have meaning, they don't predict things. You know, there's a CBT element in there too, you know, catching those distorted thoughts and not letting them run rampant. But the first part, of course, is the awareness and really, really taking a deep dive and understanding what are the obsessions and what are the compulsions. And because so often people do things automatically and have done them for a very long time, they don't realize that these safety-seeking behaviors that make them feel a little bit better in the moment are actually compulsions. So the reassurance seeking, am I okay? Are we okay? Or the review, you know, looking, doing the mental replay, research is a really big thing. And chat GPT right now, while it's great for many things, is not great for someone who, let's say, has concerns about health and is, you know, thinking about all the diseases they may have going into Chat GPT. I've had the experience where someone's gone in there to ask for reassurance. And so now they have a whole reassurance sequel conversation going on with Chat GPT that reinforces their intrusive thoughts. So their compulsion is actually engagement with the research and the chat GPT conversation.

SPEAKER_00 26:58

Exactly. Wow, it's just like going down the rabbit hole right there.

SPEAKER_01 27:02

Sure is we need to limit the amount of time that you're engaged in Chat GPT conversations with the goal of eliminating it, and we have to delay the urge to go right into Chat GPT as soon as you have that intrusive thought that maybe I have cancer, diabetes, MS, whatever it is.

SPEAKER_00 27:24

In terms of treatment, now let's say somebody like your daughter, it sounds like she's, of course, significantly right. There's been so much progress, it sounds like with her and and where she's at. When I guess the question is, when does the treatment end at some point? Or will it always maybe kind of be another episode at some point where maybe need to go in and maybe see a therapist again and do a little bit of work and you know, and then kind of be more independent again. How does that aspect work of the recovery aspect?

SPEAKER_01 27:59

Yeah, I think it's a great question. And there's such tremendous variability in that depending on the individual and their technique journey. So I think for some people it waxes and wanes, and they may have a surge of symptoms and they may need some additional support. And then for other people, they are kind of in maintenance mode for a while and they keep applying the skills and the formula, and they may be able to operate independently without support for a long time. So it just it it really depends on the individual. But there definitely is, you know, light at the end of the tunnel in that it's not gonna feel for that individual the level of intensity when they're in it and really in this in the cycle. And they will say things like, that is impossible. I will never be able to stop doing whatever compulsion it is. That is possible. The idea of stopping that is not even a thing. You have to work with these micro steps to help someone gradually change some of these things, and everyone moves at a different pace. And you have to kind of be really flexible, and and this is right, it's what we do. You know, you have to be basing your intervention and approach on that unique situation and that individual's needs. You have to you have to flex, you have to be more direct with some people. It it requires a more softness. So there's there's just it's a dance, it's an art form in so many ways.

SPEAKER_00 29:40

For sure.

SPEAKER_01 29:41

Definitely the many individuals live in in a very stable place after receiving treatment and and have that support they know they can go back to, but don't necessarily need it regularly.

SPEAKER_00 29:55

Yeah, I'm just like thinking how I know for me, just having this conversation, I mean, with you, just thinking about how challenging and what a struggle that must be for a person that is experiencing this to have these continuous obsessions and to want to act out on these compulsions. And it's like if you can't do it, it's like this constant itch that you can't scratch. And it must take such resilience and such commitment to be able to progressively work through it and and to get better.

SPEAKER_01 30:35

Absolutely. Yeah, it does. It takes tremendous strength and courage, and because it is so debilitating in the beginning, it's hard for people sometimes to see that light at the end of the tunnel. And like any other therapeutic journey, instilling hope in the beginning and helping people see the potential, even if they don't quite believe it, is is so important. And you know, providing that that framework is crucial. It's it's very overwhelming and it's very, very debilitating for sure.

SPEAKER_00 31:15

You you were talking about at the beginning, you were probably as a mother, right? Your natural instinct, what you wanted to do for your daughter was actually the opposite of what you should have you should have been doing. Yeah. And you were just you were just trying to be a good mom and an amazing mom, you know what I mean, and and support your daughter and do the right thing. So, so with that, I mean, what would you say to another parent that's out there or to another loved one that is out there that believes that maybe somebody they love or care about is going through this or experiencing this?

SPEAKER_01 31:53

Well, it's it's a great question. I do think what I would recommend is they get linked to a therapist who specializes in OCD. I mean, evidence-based practice with ERP is definitely, from my experience, both professionally and personally, I've I've seen how effective it can be. And it really is a family problem because it impacts the whole family system. And so everyone has to be on board. I mean, like when we were experiencing this, my husband and I had to be on board, my in-laws had to be on board, my parents had to be on board because everyone has to be consistent in how we're responding to her. One of the grandparents can't just sneak her a cell phone and be like, it's fine, just look at the weather, you know, and you're like, no, we have all these things. And you are absolutely right. I mean, the therapist, when we started meeting with her and she was talking about the family accommodations, you know, you start thinking back and you're like, oh my gosh, right, I left this wedding. We made an excuse for this, we did this. And all of a sudden you start looking and you go, wow, this really has actually impacted our whole family system. Our older daughter, how she was navigating that with her younger sister and how she would be so patient with her. And also it would impact our ability to go to the go to the store. She wanted to go shopping outlets and it was raining. It's like, sorry, we can't do that today. It's raining. Again, retrospectively, you start looking at all the times you accommodate. And yeah, it's a little bit heartbreaking because I think, what if we caught that even earlier? You know, the what ifs, of course, great at that. Of course, we could have intervened earlier, but what some of these things they have a way of creeping up, and then all of a sudden you go, here we are. So I would say it's important to pay attention to these warning signs, these symptoms early on. And if you start thinking and seeing that the family system's being impacted, I think that's a good indicator that it's time for some additional support, which is sometimes hard to ask for and initiate. Even being in the field, it was a little intimidating putting myself out there and I'm so glad I did. I'm so glad.

SPEAKER_00 34:13

Yeah, no, I mean, I just I just think it's amazing and I have a tremendous respect for you for doing that, to be able to allow yourself to be vulnerable, to be able to allow yourself to to do what we always continue to speak with our clients about or speak you know with with others about. And as we know as clinicians, it's often hardest for us to do that ourselves. You know, when when we when we need to do that.

SPEAKER_01 34:41

Right, right.

SPEAKER_00 34:42

It can seem counterintuitive almost like me, ask for help. Like, what are you what are you talking about?

SPEAKER_01 34:48

Right, absolutely. And you pause, you're like, yeah, all right, yeah, it's time. Okay, yep, absolutely. Yeah, it's it's been it's been a beautiful and challenging journey at times, and actually don't ever talk about that with my clients. Like self-disclosure, I choose not to disclose those things. However, I feel like I can talk about things with a certain degree of confidence, and I think that's helpful.

SPEAKER_00 35:14

Absolutely. Yeah, there's so much more you bring to the table. Yeah.

SPEAKER_01 35:18

Yeah, yeah. And I just think once you start seeing people respond and feel better and kind of master the skills, it's it's a really beautiful thing to have the honor of witnessing. And and then to see folks uh experiencing joy when they haven't experienced joy in so long is again, it's such a such a privilege to to witness that.

SPEAKER_00 35:50

So yeah, very rewarding. So with I I would think some of these interventions that you've been talking about to work with OCD would be similar for specific phobias as well, too. So a little bit, can you share a little bit or define like what a specific phobia is or an example of a specific phobia and what makes it different from, of course, typical fear or anxiety?

SPEAKER_01 36:17

Yeah, absolutely. It's a great question. So an example of a specific phobia animal type is, you know, arachnophobia, fear of spiders. And we all have different fears. I like I had mentioned before, I don't love flying. Now, I wouldn't say it's quite phobic because it doesn't interfere with my follow-through, my ability to travel. So if it got to the point where it was impairing my functioning and I stopped doing those types of things, then it would probably be something to look at. Now, I'll give an example of specific phobia with spiders. Someone who I was working with, they they started, their world started getting smaller and they didn't take the trip and they didn't do the things, and it started getting more and more difficult for them to function. So as a result of that, they were seeking treatment with me to start addressing that phobia. And this is really about exposure and helping the individual understand that they can tolerate the phobic stimuli and basically develop a tolerance. And again, with this, you have to build a hierarchy. So you're not going to start with an exposure by flooding with the scariest, most disturbing image, but you start with something that's distressing and then you build on that. And it takes time, it takes time to build it, it takes time to understand what the different kind of phobic stimuli are more or less distressing. So, like, for example, daddy long legs may be less distressing than a wolf spider or a tarantula, the way they move, the color. I learned a lot, for example, about spiders and looked at so many YouTube videos trying to find distressing videos that would then enable us to kind of achieve the next level with exposure in that hierarchy. And then you also, so you have imagined exposure, you have in vivo exposure, you have hopefully these naturally occurring exposures where the individual comes across spider in their environment, and then you can work on that. So when I think about the progression, you and you, this is a team effort. You're not gonna like anyone. It's a very collaborative process where you build the hierarchy together and then you stick to, okay, today we're gonna look at this and we're gonna expose you to it. You're going to have distress, and then you're going to habituate. So you're what we call subjective units of distress scale or suds. It's going to go up, but it is going to go down, and you're going to tolerate an ability to manage the discomfort around this. And so, an example for a hierarchy could be a trigger looking at the spider emoji that was on the fear hierarchy, very triggering, or even actually reading the word spider. So you start with that. Then you get to looking at this type of emoji. And then it's like, let's look at a cartoon spider, and then there's still pictures of a cartoon spider, then there's videos of the cartoon spider, then it's let's look at an AI spider, still. I'm like, of course, simplifying this right now. Because and this doesn't happen in one session. This happens over, yeah. You know, yeah. Then let's look at stills of live spiders and then videos, and then you, you know, you start getting progressively more, you know, kind of intense in a way, almost.

SPEAKER_00 40:02

Yeah.

SPEAKER_01 40:03

It's like Goldilocks. You don't want it to be too much that it's flooding and they shut down, but you don't want it to be too little. And sometimes you have to experiment. Like if the person doesn't have distress, you do want them to have a little distress. And then if you have a really motivated person, you get really creative. What are the things we can do to kind of up the ante? Because you want them working on the exposures outside of session, right? Because we just going to the pet store, going to the farmer's market, finding, being intentional about finding spiders. And we've done print out a spider, 3D printer, get spiders hidden around your home. And then ultimately in one fear hierarchy, I feel really proud about this. But more importantly, I feel the most proud of the individual who engaged in this. The end of that fear hierarchy, I had this wild idea where I was like, what do you think if I contact this person who I met? And I didn't exactly tell her how, but I had this his, I had him saved in my phone as the animal guy. Because he brought like snakes and a spider to one of my daughter's birthdays, and he had a tarantula. So I was like, I wonder if that guy would bring a tarantula to someone's home.

SPEAKER_00 41:18

Uh-huh.

SPEAKER_01 41:18

And so I talked to my client. I was like, this is a little bit outside of the box. And this is she's ready. She's ready for this. Like, she's finally here. It's taken a long time. She's progressed beautifully. What do you think about having someone come to your home and you handle a spider? And of course, within that, we'll develop a higher him handling it. We had a whole process. And she was, she's like, Yeah, let's do it. So I contacted this person and asked if he'd be willing to not do a birthday party. But and he he does he did a lot of educational things for the community. So he's totally down. And it went, it went phenomenally well.

SPEAKER_00 42:00

And that's amazing.

SPEAKER_01 42:02

Like brought me to tears because I just was so proud of this individual. And it went a little like, all right, we got this this tarantula on the coffee table. The lid is on. You do this progressive exposure. Okay, now we're gonna take the tarantula out, and the animal handler is going to hold it. Okay, then you know he's gonna sit closer to the individual. Okay, then the the the the client's gonna hold the tarantula but with gloves on, and then the gloves on and then handling the tarantula, and I'll just spontaneous excitement. No, I didn't. I shared my excitement because I was so thrilled.

SPEAKER_00 42:47

Yes, yeah.

SPEAKER_01 42:49

I mean, it was like one of those really memorable moments where you just are so proud. And of course, I shared that with the person and just was like, I am so impressed with your courage. And often this individual would say things like, Yeah, that wasn't as bad as I thought it was gonna be.

SPEAKER_00 43:07

Uh-huh.

SPEAKER_01 43:08

And I I just, yeah. So going from being afraid of even seeing the word to handling a live tarantula.

SPEAKER_00 43:18

There's normal people that wouldn't even do that. People don't even have a specific phobia, right?

SPEAKER_01 43:24

Yeah, totally. So, you know, that's an example, very distilled, just high level of kind of going through an exposure process with someone where they gain the ability to work through all the discomfort and can manage that. And it's not ever a scenario where you're like, you have to be happy in this situation and feel joyful. It's more about like you can do hard things and you can tolerate the discomfort. Look what you just did. It's been really very incredible. To watch people face their fears and push through with support and guidance and then feel so proud and then to see them going out in the world and doing the things that they couldn't do before, you know.

SPEAKER_00 44:14

Amazing. Yeah.

SPEAKER_01 44:15

Amazing. This is so fantastic. So it's been a really a real privilege to be folks. Yeah.

SPEAKER_00 44:22

Such good work. I mean, of course, the client is doing a lot of the work and and the the heavy lifting with a lot of things, but from what I'm hearing, you're being an amazing clinician as well, too, and going above and beyond with what you're doing. You know, like you said, you're there on YouTube, you're searching all these videos, you're looking. I can just picture you there, you know, your little snack looking at spider videos. You know. Let me ask you.

SPEAKER_01 44:47

Can I find one more disturbing? I know I know a lot about spiders nowadays.

SPEAKER_00 44:51

Yeah. Yeah.

unknown 44:52

Yeah.

SPEAKER_00 44:53

Yeah. You and you and the animal guy will continue to get closer, probably, as you continue to work through.

SPEAKER_01 45:00

He did such a great job. I was very impressed with him too.

SPEAKER_00 45:04

That's so cool. I love that. The animal guy.

SPEAKER_01 45:07

Yeah.

SPEAKER_00 45:08

What I want to be mindful of, mindful of time. What should people look for when choosing a therapist like trained in ERP or exposure-based work? What would you what would some of your recommendations be? Obviously, there's a lot of clinicians out there, right? Would you look under specialty therapists? Are there certain accreditations they can look for? What would you, what would you suggest?

SPEAKER_01 45:32

Yeah, I mean, I think that you'd want to see that they specialize in treating OCD and if they have the exposure response prevention. I mean, there's of course other modalities. So I'm not saying that this is the only one, but I think having expertise treating OCD and ERP, those, that's a good place to start. I think meeting with a person and and have the opportunity to do that, I would recommend that. So you can see if there's a good fit and empowering people to trust that goodness of fit. And if it doesn't feel like a good fit, you can meet with someone else, you know, and I think people really need to, of course, you and I know the importance of the therapeutic connection, but people need to have that in order for any treatment modality to be effective. So I'd start with the connection first and make sure that they feel comfortable with that therapist and know that they have options if it doesn't feel like a an appropriate fit.

SPEAKER_00 46:34

Yeah, it doesn't feel like a good fit. And in terms of people that are listening, what's one thing that you wish most people knew about OCD and phobias that could reduce stigma for those diagnoses?

SPEAKER_01 46:52

Yeah, I think that that OCD is more complex than the contamination or symmetry stereotype, if you will, and understanding that it's far more complex, the subtypes, whether they be relationship OCD or sexual orientation OCD or pedophilic OCD or harm OCD, there's so many things that fall in these subtypes that, if not handled appropriately, can can really lead to interventions that may be very harmful to a client. So I think really important to understand what is going on diagnostically. And with specific phobias, I think like taking it seriously and understanding that that too creates a functional impairment for an individual. And at times, I think they can be minimized. But truly, truly, if someone has a specific phobia, it needs to be honored and the person needs to be supported in their journey so they can effectively manage the discomfort and ultimately face that fear with support and guidance. So it doesn't have to be a thing that is all-consuming and interfering with their life.

SPEAKER_00 48:05

Like looking back, like say you were looking back at past Aaron, right? When this was kind of before you knew that your daughter had OCD, before you knew that this is what was happening or or this was going on, but there were some things that were starting to happen. What would were what were some of those things that I don't want to say you missed because you didn't miss them, you just didn't understand them at the time, right? But so what are what are some of the things that if you looked back, you would tell yourself, be mindful or watch out for this, this, this, and this at the beginning stages?

SPEAKER_01 48:46

I think the urgency, the urgency that she experienced when needing to check the weather or receive reassurance and the repeated questioning, because it's never enough.

SPEAKER_00 49:03

Yeah.

SPEAKER_01 49:03

You'll never win the debate with OCD of Burr, and it's never gonna be enough. There'll never be enough reassurance, there'll never be enough weather checking or whatever kind of checking. And so paying attention to the urgency and the locked-in focus, something to to be aware of, and and then noticing your own as a partner, parent, whoever you are in that person's life, noticing what role you are having in this kind of process that could be actually maintaining or in my case accommodating some of the compulsions, which then unfortunately, you know, do strengthen the OCD cycle there.

SPEAKER_00 49:55

Yeah. Excellent, excellent information. Thank you. Well, all right, Aaron. So I have I always end the episode. I have these four last questions, but they're just kind of like, you know, just give like quick one-sentence, you know, maybe two sentence responses.

SPEAKER_02 50:13

All right.

SPEAKER_00 50:14

Okay. If someone listening feels powerless right now, like over their situation, things that are happening in their life, right? That's that's affecting them in a difficult way. So if someone listening feels powerless right now, what would you say to them?

SPEAKER_01 50:30

I would say that you are not alone and you don't have to carry this burden on your own, that there's always someone out there who can support you in navigating whatever it is you're managing in this moment.

SPEAKER_00 50:45

Nice. Okay. Second question: What's one thing an everyday person can do to make a real impact?

SPEAKER_01 50:56

I'm a big believer in showing up for people and being present. So being there, listening, not distracted, not on your phone, not halfway, halfway in it, but really showing up and saying, I'm here.

SPEAKER_00 51:13

Amazing. Okay. Who have you become because some of the pain that you've lived through in the past?

SPEAKER_01 51:22

It's a great question. I think I've become someone who has a lot of compassion and empathy and patience. And it's a great question. Getting me, you know, getting me into a thoughtful place. I think someone who can not only offer that to others, but also offer that to myself, which has been harder. And we've got to do that for ourselves too. I'm I'm getting a lot better at that as I evolve in that growing.

SPEAKER_00 52:03

Nice. Yes. All right. And the last question: what do you want your legacy to be? And not your career legacy, but your soul's work.

SPEAKER_01 52:15

Oh, wow. You know, really knowing that you have offered that kindness and compassion, and that you've been able to lend a hand to individuals that you have the great fortune of crossing paths with, both professionally and personally. But really, I mean, I think it comes down to showing up for people and loving them, bring that that part of your heart and being fully present and and giving.

SPEAKER_00 52:54

Beautiful. Aaron, thank you so much. All right, now I think you should come back to LA and start another organization, and then I will be your right-hand guy, okay? That's very interesting.

SPEAKER_01 53:09

We got my wheels uh turning now.

SPEAKER_00 53:13

Yeah, but no, but thank you so much. I mean, you were an example to me all those years ago. You're still an example to me now, both professionally and personally. You know, you walk the talk, you really do. And you were saying, I I can appreciate, you know, you showed up for me. You know, we haven't we hadn't talked for a while and reached out, and you know, you're like, I'll I'll I'll do this. I'm there. I can't thank you enough for that. I really can't. And you need anything, you let me know.

SPEAKER_01 53:45

I really appreciate that, Jason. And I know I can always rely on you for that for sure. And even though it's been a while, it feels like no time has passed.

SPEAKER_00 53:54

I know.

SPEAKER_01 53:56

I know. It's just it speaks to you know the power of connection and you know, time can pass and you still have that. And I'm really grateful you out and so happy we got to spend this time together.

SPEAKER_00 54:09

All right. Well, thank you everybody for listening and for listening to another episode of Finding Your Voice.