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What is EMDR?

Written by Carrie Bock on . Posted in Anxiety, Counseling, OCD.

When people first hear about Eye Movement Desensitization and Reprocessing (EMDR), they are often skeptical. That’s OK because I was too once. I wasn’t sure how waving my fingers back and forth in front of my clients was going to change how they felt about the past. However, I was desperate. Cognitive behavioral therapy for the treatment of trauma just wasn’t cutting it for the complex client presentations I was seeing. We could talk for hours about how the abuse a client experienced wasn’t their fault. They could give me the right answers, but didn’t feel it. They could change their thoughts, but their bodies were still reactive. Once I started using EMDR and saw first hand how great my clients were feeling, I was hooked.   

What is EMDR?

EMDR is an experiential therapy that allows clients to process trauma at a brain level to access healing at a different level than traditional talk therapy. Other approaches to healing from trauma such as Exposure Therapy or Cognitive Processing Therapy (CPT) require the individual to tell the entire story of the trauma repeatedly in order to become desensitized from it. However, with EMDR, telling the story of the trauma is not a requirement. This brings a sense of relief for clients who do not want to retell the entire story, cannot remember the whole story, feel it would be too lengthy to tell, or are bound by security clearances. 

The other difference between EMDR and cognitive based therapies is that EMDR addresses body sensations associated with traumatic memories. A rape victim may no longer believe the rape was her fault (changing the thought), but may still carry a sense of shame and distressing body sensations that accompany that emotion. Trauma is often stored in the body can manifest as physical sensations such as chronic digestive issues or panic attacks. I have seen several clients have a reduction in physical symptoms after EMDR therapy. 

What is the EMDR process like?

There are eight phases of treatment in EMDR. The initial phases involve screening and preparing the client for being able to reprocess the trauma. The therapist works with the client on building awareness of their present experience emotionally, physically, and mentally. The client also develops skills to tolerate a variety of emotional states and cope with day to day symptoms such as anxiety, nightmares, or intrusive thoughts/memories about the trauma. Clients with an extensive trauma history may take months to prepare for trauma processing. On the other hand, clients who have had previous talk therapy and have coping skills to manage their day to day life may find more value in doing an EMDR intensive. 

The next phases are focused on targeting traumatic memories to reprocess the various aspects of the trauma. The client may see pictures, feel intense emotions, and experience body sensations that were happening at the time of the trauma. This process can be difficult and disturbing to the client, which is why not rushing the preparation phase for clients with complex PTSD is crucial. Bilateral stimulation to the brain is utilized through the use of eye movement, tactile stimulation, or alternating audio sounds. The bilateral stimulation is not painful and does not cause the client to go into a hypnotic trance. The client will be present during the reprocessing.   

EMDR allows the traumatic material to get unstuck and connect to more positive, adaptive material in the brain. At the end, memories that were highly distressing are no longer distressing to the client. Sometimes the change is very surprising because the client expected to always be bothered by the memory! By healing from these past wounding experiences, clients are able to respond to present situations in new ways. Sam no longer blows up every time there is a conflict at home. Susan is no longer having frequent pain attacks. John still has intrusive thoughts related to OCD, but he is able to dismiss them instead of giving into compulsions.    

How do you get trained in EMDR therapy?

If you are interested in learning more about EMDR therapy, you can visit www.emdria.org. This is the website for EMDRIA, the EMDR International Association. Therapists who have been trained in EMDR through a training approved by EMDRIA have completed six days of training and 10 hours of consultation. Training in EMDR therapy is an experiential process. The therapist has to perform EMDR on others and receive it themselves in the client role. Those who have been certified in EMDR have completed an additional 12 hours of advanced training along with an additional 20 hours of consultation with an EMDR consultant. An EMDR consultant has gone through additional hours and has had their consulting supervised by another consultant.    

I was initially trained in EMDR in 2013, pursued certification, and became a consultant in 2019. Over the years, I have been able to help clients suffering from PTSD, recent traumatic experiences, anxiety, phobias, panic attacks, OCD, depression, and dissociation to name a few. I have also started providing intensive therapy in EMDR for individuals who are looking to heal faster in a shorter amount of time. 

Carrie Bock, LPC-MHSP of By The Well Counseling is a Licensed Professional Counselor who specializes in helping clients with trauma, anxiety and OCD get to a deeper level of healing through EMDR via individual and intensive therapy sessions. Carrie is the host of the Hope for Anxiety and OCD podcast, which is a welcome place for struggling Christians to reduce shame, increase hope, and develop healthier connections with God and others.

Is ERP the Only Option for OCD?

Written by Carrie Bock on . Posted in Counseling, OCD. No Comments on Is ERP the Only Option for OCD?

Individuals who are diagnosed with Obsessive Compulsive Disorder (OCD) are often told that they need to receive Exposure and Response Prevention (ERP) in order to treat their OCD. While ERP has been widely researched and works for some individuals, ERP is not the only treatment option for OCD. Eye Movement Desensitization and Reprocessing (EMDR) can be effective for treating OCD, especially with individuals who have a history of childhood trauma.     

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Hope for Anxiety and OCD Podcast – One Therapist's Story of Discovering Her Scrupulosity OCD with Rachel Hammons

8. One Therapist’s Story of Discovering Her Scrupulosity OCD with Rachel Hammons

Written by Carrie Bock on . Posted in Counseling, OCD, Personal Testimony, Podcast Episode. No Comments on 8. One Therapist’s Story of Discovering Her Scrupulosity OCD with Rachel Hammons

  • What is Scrupulosity OCD?
  • How Rachel discovered she had been struggling with it
  • How to determine if this is a normal level of spiritual concern or could be OCD
  • Exposure and Response Prevention
  • Learning how to sit with discomfort and ambiguity  
  • Getting to know the character of God and filtering information through that lens

 Verses discussed: Phil 4:6, 2 Cor 10:5 

Resources and links:
Rachel Hammons
More information on ERP and OCD

By The Well Counseling

More Podcast Episodes

Transcript of Episode 8

Hope for Anxiety and OCD Episode 8

Hello, if you are new to the show, we are all about reducing shame, increasing hope, and developing healthier connections with God and others. 

Today on the show. I am interviewing Rachel Hammons. I did not know Rachel until I started doing some research for this podcast.

I wanted to talk with people who were struggling with anxiety or OCD and were Christian and also listen to podcasts. So I did probably almost 10 interviews with people and Rachel happened to be one of those people. I was able to glean so much valuable information that helped me in knowing what to put in the show. I ended up following up with Rachel a while later and just saying, “Hey, would you be willing to share your story on the podcast?” She graciously said yes. 

Rachel Hammons is a counselor in the Nashville Metro area. She specializes in working with people who are struggling with OCD. She also struggles with OCD herself.  [00:01:36] She is going to talk with us a little bit more about scrupulosity OCD, how it’s affected her life and how she came to find out that she had it, which is a very interesting story.

Without further ado, here is my interview with Rachel Hammons. 

Carrie: So Rachel, tell us a little bit about yourself and the work that you’re doing.

Rachel: I’m in Nashville, Tennessee. I’m licensed in the state of Tennessee. I’ve been working with a lot of individuals with OCD over the past year or so. As I’ve started to do more private practice work, I started off thinking I was going to go more like the trauma route. As I started to learn more about what OCD was I also started to actually see that in myself. I really found a passion for it. So doing my practice work with OCD. 

Carrie: So you really didn’t recognize OCD traits within yourself until you were in school, studying OCD?

Rachel: Well, yes and no. I know we’re going to get a little bit into some of my story but I definitely recognized that there were what I would have called more type-A tendencies.

Even though I never really wanted to be a type-A person I always saw myself kind of “I want to go with the flow. Everything’s fine but then I had these really strong needs for structure, black and white thinking things that I would misunderstand, and a really big obsession with making sure that I was doing the absolute best and the absolute right thing.

I just always attributed that to, “I was very type A” or in the more nonchalant way like, “Oh, I’m so OCD.” Even though that phrase is not super helpful, but then after I do more of my professional life and after I graduated even in grad school, we covered OCD but it was more just their obsessions and compulsions, and usually related to like cleaning or going back and checking to make sure you didn’t hit someone with your car.

As I started to do more research and finding my niche with counseling, I’m learning more about what OCD was, especially the subtypes of OCD. This whole subtype called scrupulosity that had to do with moral and religious OCD. As I started to learn more about the symptoms and signs of that, I was like, “Oh my gosh. That’s me.”

Carrie: A lot of people don’t know that that exists. I’m glad that we’re talking about it today. A lot of times people do associate OCD with people that have an organized closet or that clean a bunch or are obsessed with germs. There are these different subtypes. We’re talking about scrupulosity, OCD. How would you kind of define that a little bit? 

Rachel: First of all when it comes to OCD, there are several different subtypes that you can experience. There tends to be overlap between lots of them and any one person. I mean, typically you had kind of one or two that’s like those are your struggles, but it can vary over your lifespan. Each of them has kind of unique facets. 

OCD in general is going to be comprised of obsessions and then usually followed by compulsion. So if you take that same model and you apply it to what we call scrupulosity, it’s going to be obsessions and then usually followed by compulsions all-around religious and moral issues.

What I think is interesting is you don’t have to be of a religious faith to have scrupulosity. Personally, I am and I would identify myself as a Christian, but there are lots of people who will still experience the obsessions. Again, usually followed by compulsion, but not always around these moral issues.

So in a nutshell, that’s what it is. There are a lot of specific symptoms and things that I’m sure we’re going to get into. 

Carrie: How has this affected you personally? 

Rachel: I’m actually really excited to share just a little bit about my story because as a counselor I don’t use a lot of self-disclosure, so I’m not sharing my story with all my clients. It’s a piece that I’ve learned about me within the past couple of years, a lot of people don’t know the whole story. So I kind of looked back in preparation for this, just at several different things that I noticed, like from my past, as well as some of the things that I’m still struggling with.

I’ll kind of start with looking back. As I said, there was a lot of black and white thinking. There was a lot of doubt and OCD is sometimes termed like the doubting disease. So I was definitely doubting like, “Is this right? Is this the best thing? Is this true?” I definitely liked some aspects about that, about myself because I like being able to really seek truth, but then OCD twists that, especially with scrupulosity and having it be so much of a mental obsession. It twists what is good and what is truth and what’s most important to you and turns that into this obsession. I know we’re going to get into a little bit later, what does support look like from other people. 

Specifically, right now with the church and the environment I grew up in when you see a very studious, responsible kid that’s reading their scripture, that’s asking questions a lot of times, the initial thought is, “Oh wow. This kid is really on fire for God.” 

There was a huge mental health component to that where I was like wrecked with anxiety over making sure I got the right answer. Some of the things that I look back on and some of them I kind of laugh about. The first one I’ll just tell you is I think the most obvious obsession and compulsion that I ever experienced. When we were younger, my mom had specific TV shows that we were allowed to watch and that we weren’t allowed to watch. There was never any really comparison like this one’s really bad or this one’s really good. It was just like, “these are the ones you can’t watch.” So one of those that I wasn’t allowed to watch was SpongeBob, but for some reason, in my head, SpongeBob became like the epitome of evil. My mind was just like SpongeBob is bad. 

So initially you can start to see that black and white thinking, but where that would come up for me is at the time a lot of people had those SpongeBob flush toys in their car or the dice that you would hang from your rearview mirror. I remember specifically walking past cars as we’d get out to go to the grocery store and seeing those [00:08:43] and I had to say “I hate you” a certain number of times to SpongeBob to get rid of the evil. I thought it wasn’t necessarily super distressing unless there was a lot of SpongeBob or like SpongeBob was on at the doctor’s office. I felt so guilty and this evil was next to me. I had to keep saying, “I hate you. I hate you. I hate you.” Sometimes out loud, sometimes in my head. 

Carrie: Sometimes I think people don’t realize that the compulsions can be internal. Their child may be struggling with something and they say, “I don’t think they’re really struggling with that” but they don’t realize what’s going on necessarily in that child’s head at those times.

Rachel: That’s I think is one of the reasons that OCD in general, but particularly scrupulosity tends to go really under noticed or underdiagnosed because what you see is this kid that’s working really hard to follow God or to follow even their schoolwork or obey their parents, but what you don’t see is the internal distress that kid is going through. Especially in my case, if you don’t know that that internal distress isn’t necessarily normal or doesn’t have to be that way, you just assume that that’s like what you’re supposed to be doing or that you’re more on fire for God than other people are. Not like in a judgment way, like I’m holier than now, but just in a way of like I’m really, really trying hard to know who God is and what he expects of me.

Carrie: It was just the water you swam in basically. You didn’t necessarily know anything different. 

Rachel: Right. One of the ones that developed as I got a little bit older and one that I think is still fairly difficult for me is, I don’t know if you remember the verse it’s like the classic worry verse where it says, “Do not worry about anything, but in everything by prayer and supplication, present your request to the Lord.” [00:10:48] I think this is an example of where OCD twists what is really good, and makes it very confusing. As I read that, I always read it as a command like my biggest fear just as a heads up was sinning. So my obsessions revolved around making sure that I didn’t cross whatever this random black and white line was, and making sure that I didn’t sin.

Other people with their scrupulosity can have things like “this is going to send me to hell, that’s my biggest fear,” “I have blasphemy.” Mine was specifically “did I sin or not?” 

When I would read that verse, it was comforting in the sense that I knew God didn’t want me to worry, but I read it as don’t worry and this is the command. If you’re worrying, you’re sinning. The thing that I always struggled with was I couldn’t control my worry. I knew especially as I got older I can’t control my emotions. I can control what I do with my emotions, but my thoughts and my emotions are going to come into my head and yet still in the church, they talk about like, “if you’re worrying, give that over to God and then your worries go away.”

Carrie: “Take every thought captive and make it obedient to Christ”, which I imagine is super challenging.

Rachel: Right. So I was trying to find and I am still trying to find this balance of God comforting me by saying, “Hey, you don’t have to worry because I’m here or is God saying “don’t worry.” I think that’s one of the ones where OCD is still like, “I don’t know. It might be a command.” And so if it’s a command, you better make sure you’re not worrying at the same time. I’m also like, “That doesn’t make any sense because I can’t control my worry. I’m doing my best.” So there’s still this struggle or I guess this fight of “am I sinning or not.” 

Even though you know in your head what you feel is probably accurate, OCD still brings in that doubt and that tiny bit of doubt or that tiny bit of uncertainty is where the individual OCD tends to struggle the most because OCD says, “it’s better to be safe than to take that risk” and that risk is really big. So in my head, I’m like if I take that risk of don’t worry being kind or gentle or like you are okay instead of a command, then what if I start to just let myself worry and then I’m sinning. So it’s better just to not worry, which doesn’t exactly work. 

Carrie: Right. I think another thing that’s important to point out is the compulsions provide some temporary relief, which makes it super hard not to engage in them. So it’s like, there’s this temporary relief but then the kind of feeding that cycle just ends up increasing the whole picture and making it worse. It’s hard because you want that momentary peace, I guess.

Rachel: Exactly. Which is what you see. I think the contamination aspect of OCD is where you see it most clearly. If I’m afraid that I’m contaminated by germs then my compulsion is to wash my hands. Washing my hands initially makes me feel like I’m clean from the germs, but then the OCD brings in doubt. That probably contaminated me so I have to wash my hands then and that probably contaminated me. So I have to wash my hands then. You see this cycle start to develop and actually changes in your brain start to develop where your fire alarm sense of anxiety is heightened.

If you look at the physiology of what’s going on in the brain in individuals with OCD and anxiety, that amygdala, that emotion center of the brain is actually hyperactive and it’s more active, more sensitive to things going wrong in our environment. 

The way that I like to describe it is like it’s a broken fire alarm. [00:15:05] If my fire alarm is really great if there’s an actual fire, but if I’m cooking some steak and some steam gets up to the fire alarm and it goes off, that’s really annoying. So OCD is basically turning that fire alarm into something that is much more sensitive than it needs to be. Then as you follow that pathway of these obsessions and compulsions that pathway gets stronger and stronger and that fire alarm continues to be heightened and heightened.

If you apply that to scrupulosity individuals with OCD, their brains are going to get more and more sensitive to this potential, like times that I might be sinning or fears that I did something that angered God. If you aren’t able to resist those compulsion’s or practice ERP in a way that is helpful, not overwhelming, but helpful, those portions and that connection between the two is just going to get stronger and stronger. 

ERP basically just says we’re going to restructure that so that the pathway isn’t as strong, but that ultimately means you’re not doing the compulsion, which is what calms you in the first place.

Carrie: Right. ERP stands for exposure and response prevention. So how does that work? 

Rachel: ERP in general, like you said is exposure and response prevention. Basically, there’s two aspects to it. There’s the exposure piece. The part of exposing myself systematically in a way that’s not overwhelming to my system, but systematically exposing myself to what I’m afraid of in my case, potentially sinning.

The response-prevention is basically asking you to stop doing the compulsion. So you expose yourself to the thing you’re afraid of. You also take away the safety net of the compulsions and you do those simultaneously again in a systematic way so that eventually you learn one anxiety isn’t dangerous.

Anxiety is going to go up and it’s eventually going to come back down or at least I’m going to be able to tolerate the distress of the anxiety and that whatever my OCD said was actually so fearful is probably not as fearful as OCD made it up to be in my head. That being said, I think there’s one really important piece when it comes to scrupulosity, for example, contamination OCD. If I’m really afraid of mud getting on me and I think mud is contaminated in any environment, touching mud is going to be something that brings up anxiety. 

When you talk about scrupulosity, you’re not only dealing with these obsessions and compulsions, but you’re dealing with something that’s so central to what this person believes is right and wrong. You’re dealing with this core value. If I asked somebody to do something that’s against their core value, which is not what ERP promotes, but if you misunderstand it and I asked them to do what I might think is a sin, I’m essentially creating this moral injury. That’s not treating the OCD, but instead eliciting this potential sense of shame and going down this I just have to do what’s wrong. 

ERP instead promotes sitting with that uncertainty piece. So the obsessions where I’m really concerned, “is this a sin?” “Is it not?” “I’m not sure where’s the line”. We’re kind of coming up to that line and playing around with it a little bit, to sit with that uncertainty to recognize there’s probably not a line at all, but again, in a way that’s not violating this person’s sense of right and wrong. I feel like that was a little confusing.

Carrie: It is. For example, if you’re having a fear and uncertainty about sinning, does that look like going a couple miles over the speed limit? Does it look like sitting with the sense of, “what is this right or wrong” or just sitting with that anxiety for a little bit and not trying to avoid it? 

Rachel: Yes and no. Everyone experiences their scrupulosity or their OCD a little bit differently. For some people, if they also have the core fear of not sinning, that OCD tends to fixate on certain aspects of not sinning. So there may be certain aspects in your life that you’re totally okay with uncertainty, but then OCD is going to take certain ones and be like, “this is the one you’re going to focus on.” 

I think where you can start to differentiate, is this OCD, or is this a legit thing I need to kind of explore. 

Stepping back just a little bit, one thing I like to talk about with my clients is this difference between information seeking and reassurance seeking, meaning when I’m looking at if I sin or not, am I going through that scenario in a way that’s not anxiety-provoking like I’m just thinking, “Okay, is this a sin? I’m not sure. I think I need to do some more research. I think I want to reread that passage in the Bible. I think I just want to understand” and that’s not an anxiety-driven cycle. That’s just like, “I want to understand and I want to grow closer to God in the way that I’m acting” and that’s good.

When it becomes reassurance-seeking, it’s usually this anxiety-fueled like, “I’ve got to see if I did it wrong. I’m not sure I might’ve. Let me read the passage. Let me read the passage again. Let me double-check.” Holding those two is one way you can assess if it’s OCD or just an issue that needs to do a little bit more research on, [00:21:07] or is it a little bit of both.

Carrie: So often they have a tendency to seek reassurance from the people that are closest to them. That could look like a parent or a spouse or with some of these types of things that may be even a pastor or a church leader. I think that’s why I’m so excited that we’re doing this to open up that conversation.

[00:21:27] There maybe somebody listening to this who’s been providing a lot of reassurance and not realizing that that person may have OCD. 

Rachel: Right. So like you said if that looks like you going to a pastor to check like, “Hey, is this a sin? Did I mess up?” or going to your parents, “Hey, was this wrong? Is this okay?” Those are good questions, but OCD is going to bring in not only are you asking that question the one time, but it’s going to bring up this doubt and this doubt it tends to also be followed along with, for me personally, like “where is that exact line between this is right and this is wrong? By asking that question over and over again, maybe I’ll get a certain total response. Maybe I’ll get a certain phrase and response and that lets me know everything is okay. Whereas when I’m information seeking, I’m not looking for a specific response, I’m just wanting to learn more.

Carrie: I think it’s good to normalize. There is a normal level of doubt within group identity. “Am I saved?” I hope we all ask that of ourselves once or twice in our lives. Is there evidence in my life? Is this situation right or wrong? Are they moral things? Does God love me or not? Those types of things are normal doubts, but then what you’re talking about is something that’s repetitive and it’s very anxiety-provoking and ongoing.

Rachel: Right. In some ways I wish that there was like a list of this is what scrupulosity is and this is exactly how you treat it. Like you were saying earlier some people are obsessing over like, “Did I go a couple of miles over the speed limit?” Scrupulosity shows up and OCD shows up very differently for different people. The way that you treat it while ERP tends to be fairly foundational for every person, that’s going to look a little bit different. For me, when I challenged myself with recognizing the signs that come up, it’s usually like am I analyzing for doubt? Is there a lot of doubt going on? How long have I been thinking about whether or not I’m sinning? Because usually If you sin, you’re able to look back and probably within five minutes, you’re able to assess like, “Yeah, that wasn’t good” or “that wasn’t right.” 

I find going back and forth and back and forth. I’m starting to obsess. [00:24:06] I’m like, “Am I thinking about this really, really black and white? Am I looking for the line between what was right and what was wrong” How anxious am I? Am I anxious to find the answer right now?” 

One thing I talk about with my clients a lot is when our anxiety goes up, our judgment or our ability to make rational decisions naturally comes back down. So if I’m feeling really, really anxious, it’s going to be really hard to think about rationally and systematically what I need to do about that anxiety. So if I’m really, really anxious about finding the answer to whether or not I sin it’s going to be really hard to even systematically look at. So instead, I need to maybe take a break and let that anxiety naturally come down. If I’m still worried about it after the fact, maybe I can come back and revisit it, but if it kind of went away, that was probably an indication that it was OCD. 

Carrie: I think that’s a good first step obviously with making any behavior change. We have to recognize what we’re dealing with. [00:25:14] 

I’m sure you’ve seen this in your practice and I’ve seen it in my practice as well. It’s very common for people to believe that they have generalized anxiety disorder or they may have been to other counselors who have diagnosed them with an anxiety disorder. As we start to dig and ask more questions like, “Hey, do you seek out reassurance from other people in your life?” Or “Do you tend to get stuck on these certain things?” Some of the people recognize, like, “Oh wait, this is not anxiety. This is OCD.” At some level that can be overwhelming, but at some level, it can be freeing. 

Rachel: When I read through some of the signs and symptoms of what scrupulosity, what OCD was, there was so much relief in that. Just knowing that you’re not crazy. You’re not totally out there. You’re not dealing with something in isolation. It’s normal in the sense that it’s OCD normal and there’s treatment for it. I don’t have to consistently live with this overwhelming anxiety over whether I’m doing the absolute best thing or the absolute right thing. [00:26:37] That’s going to involve some anxiety in the process. 

Going back to what you said, I think what’s really tricky sometimes in the counseling world is assessing, is this anxiety or is it OCD? And while the two have a lot of similarities, obviously each case is different, but with anxiety, you can provide coping skills. Something that’s going to help bring my anxiety back down. “I’m really anxious.” “I’m going to practice deep breathing.” “I’m going to practice grounding skills.” If I do that with OCD, I’m actually not exposing myself to the fear. That’s probably not realistic. 

I’m never actually sitting with the uncertainty because I’m just trying to reduce the anxiety cost from the uncertainty. So you kind of get caught again in a loop of, you can almost ride the line between either you’re doing your compulsion to bring the anxiety down, or you’re doing your new coping skill to bring the anxiety down. Then you never actually face and fight and deal with the anxiety that isn’t even necessarily over something realistic. Meaning my anxiety over is this right? Is this wrong? Where’s the line? Am I sitting right now? If I don’t sit with that uncertainty of, I don’t know, I’m not sure I might’ve sinned. Instead, if I try to beat that with coping skills and try to calm that anxiety down, that anxiety is just going to get stirred up the next day, because that’s what OCD does. It brings in that doubt. It brings in that “what if.”

While there are a lot of similarities and while coping skills are even helpful with OCD at times, to know that difference is really important and really crucial because your treatment is going to be a little bit different.

Carrie: Absolutely. With the ERP, there’s an exposure hierarchy, and you’re not going to expose somebody to their worst fear in the beginning. You’re kind of building up to some of those things because I think some people may be listening to this and going like, “Oh gosh, that feels too big to sit with that anxiety.”

Obviously, if there are counselors who are trained in this, who know how to walk you step-by-step through that process to get there. It’s also working sometimes in tandem with other people or providing guidance to the clients of how their parents, spouses, or whoever might be able to respond to them in a helpful way.

[00:29:13] Sometimes that means holding off on the reassurance seeking that’s part of the response prevention. 

Rachel: Right. I think that a lot of times we think If I just calm this person down if I reassure them if I tell them everything’s okay. Naturally, that’s what we want to do, to comfort somebody, but in reality, there’s a level of uncomfortableness that is so crucial to sitting with to be able to recognize that my OCD was way over exaggerating this fear. There are times where my fear is really legitimate and I’m still obsessing over it in a way that’s taking over my life. So again, sitting with a certain level of uncomfortableness is huge in learning how to treat and sit with OCD. 

I guess I’ll use a contamination example cause I think it’s a little simpler. If my biggest fear is sitting in the room with the dog, like maybe I had a bad experience, I’m not going to ask my client to go sit in the room with the dog and play with it for an hour. Instead, I might have them sit, look at a picture of a dog and practice that over and over again. I might have them listen to a dog barking and practice that over and over again because exposures don’t have to be this huge and overwhelming. Not to say that the anxiety itself is dangerous because even if you do get overwhelmed by an exposure, that’s okay. 

The anxiety isn’t dangerous. It’s just flooding your system like that. It’s probably not going to be super helpful. So finding systematic ways to work up to getting the life that you want to get is really what you’re going for. If you have a scale of zero to seven, seven is like the fullest anxiety I can have. Zero is fine. You want to find with exposure that starts around a level three or four. So something hard but manageable. 

If I was to give you one more example, like in my own life, one of the things that I dealt with a lot as a kid, and it kind of died down for a while and it’s recently come back over the past probably year. I have this phrase or this compulsive phrase that I have to say and it’s, “God, please help me to do the right thing” and that falls in line with a lot of my “I don’t want to sin, I need to do the best right thing, the absolute right thing.” 

So whenever I feel a little bit anxious even if I think I might’ve sinned or even if I just am feeling anxious because I have to get up early the next morning, I’ll say, “God, please help me to do the right thing.” 

For some reason, that phrase helps bring that anxiety down, even though it becomes really compulsive. The phrase itself starts to make me anxious because I’m like, “Oh my gosh, I keep saying it over and over again” and I don’t need to. 

If I was to look at my own hierarchy, I know that if I was not to say that phrase it would make me anxious, but it wouldn’t make me overwhelmed. It would work because it comes up honestly, a lot but eventually I know that anxiety will ultimately kind of dissipate, but right now my brain is still kind of stuck in that loop of “this is just naturally, this is automatic.” So if that gives you just any example of where you might start on your hierarchy, that’s probably where I’d start on the line.

Carrie: Great. Good to know. So how can support systems, spouses, churches help someone who’s struggling with OCD?

Rachel: First of all, I think I’d recommend counseling, but secondly, being able to recognize that the kid who is really perfectionistic on the surface, really diligent, really seeking hard to make sure they understand the right thing. Just checking in like, “Hey, what’s it like for you as you’re trying to understand more about scripture?” Even just asking like, “Is there ever an anxiety that you experienced?” So knowing that the kids who are much more like perfectionistic have a hard time with, I guess, hard time accepting uncertainty, noticing gray areas. All of those could potentially be signs. They may not be an issue for that kid and that’s fine too. Then you start to dig a little bit deeper under the surface and you recognize, “Oh, that kid is actually really struggling with anxiety.” It might just be good to kind of like, “Hey, have you ever thought about what it would be like if you didn’t have anxiety?” “Is that a possibility like a world that you want to live in?”  

I think the easiest people to inform or that I think would be really great to know a little bit more about OCD would be the people in the church, the leaders in the church because if they can recognize what is going on I think we’re going to be able to identify scrupulosity a lot easier.

I think that you see a lot of it again. I said earlier, underdiagnosed going on in the church and then parents too, especially if your kids are seeking reassurance all the time, that can be a really big indication. Even in schools, like noticing, “Hey, this kid is really struggling when they make a mistake on their test.”

So any place that those people are in all the time if you can recognize those signs and then just kind of give a quick check-in and then knowing the resources, knowing somebody who is in the counseling world who does treat OCD, who does know ERP is going to be like your best bet.

Carrie: Right. So really just supporting that person and that, “Hey, it’s okay to get counseling.” Sometimes we need help that’s professional to help us work through some of these things. 

Rachel: Right. There are also several books that you can look into that’s more of like a self-help book, it’s by Dawn Huebner. It’s something like when your brain gets stuck. That’s more of a kid’s guide to working through OCD and so if the signs are really minimal or even if your kid is on the younger side, and you’re just starting to see some of these signs, like exploring what that looks like, it could be a really great resource. At least a good first step to see if that’s all the support that they need. 

Carrie: At the end of every podcast, I usually ask guests to share a story of hope, which is the time that they received hope from God or another person. 

Rachel: I think that there’s a lot of little moments of hope for me. Looking back on my story like I mentioned earlier, the biggest piece of hope for me was learning the fact that I had OCD. That was eye-opening and huge. I also know that one of the biggest pieces of hope too that I had is if you’re a Christian or if you’re a religious faith reflecting on who you think God is, or even doing some research on not necessarily this specific event, this specific sin, this specific fear, but who is God?

I can learn more about the character of God, and I know that times that I’ve learned more about the character of God the way that Jesus treated people, that’s going to look vastly different than the way that my thoughts tend to speak to me. So when I reflect on who God is, or at least even if that’s a question cause sometimes I’m like, “I don’t know who God is” like, I don’t know how He responds. 

Just reflect on something that you know about God. I know that God is love. So if God is love, He loves me and He wants the best for me. So at least I know that I have that support. I have that hope that God just any parents are loving their kids, God wants the best for His kids. God wants the best for me. So at least in that, I know that I have someone on my side that’s walking through OCD or walking through my struggles with me. I think that’s kind of what I tend to reflect on especially when I’m really stuck in the obsessions and I really don’t see an end to this particular one, reflecting back on what you know, grounding yourself in what you know to be true. 

Carrie: Right. I think that may be hard for some people to sit with and wrestle with because there’s a sense of, “I do love God. I am trying to serve him with my life and be a good Christian all of those things and yet I’m wrestling with this on a day-to-day basis.”

I’m just kind of curious what you would say to someone with that thought process. 

Rachel: One of the biggest struggles for me is making sure that I was doing the right thing. Even in that compulsive phrase that I talked about, like, “God help me to do the right thing.” I’m consistently trying to understand this situation, this particular anxiety. What I tell a lot of clients, honestly, at the beginning of some of our sessions is OCD is really confusing, scrupulosity is really confusing, especially scrupulosity because it’s so foundational to our thoughts and I want to do the right thing so badly.

[00:39:12] So it can get really easy to think about and to get lost in all of the things that I don’t yet have, or that I don’t yet know, or I don’t yet know how to fight. So one, I like to paint a picture of how ERP works, counseling works. 

There’s hope. There’s a lot of hope with OCD at the same time remembering the things that you do know. Like I mentioned a little bit earlier, reflecting on, even if it’s not like God’s character still what are some of the things that are your strongholds? What are you anchored in? Maybe I can anchor into the fact that I know I’m saved. Maybe I can anchor into the fact again that I know God is. At least I can take that of the very phrase from the Bible and know exactly what this says, God is love. I can ground myself in that. I can ground myself in even knowing the people around me that I have as my support systems. I can ground myself in knowing that at least I have the letter from God, the scripture in my head. 

So going back to at least what you know while you don’t know everything, you know, some things, and it’s gotten you this far. So can we start there and know that there’s hope to build on from there. 

Carrie: I think that’s relevant to so many people, not just people who are experiencing OCD, but anxiety, or even just a traumatic experience or a hard season in your life. I know that there have been times where I’ve gone through difficult things and exactly what you said, “Okay. What do I know?” I don’t understand this situation in my life at all. I don’t know why God allowed it here, but I do believe that God loves me. I do believe he has a plan somehow in the midst of all this mess like that, He’s gonna take this and make something good out of it and that really helped me get through that until that was resolved.

Rachel: Yeah. There’s one moment, I guess, that I like to reflect on and this, I guess has a little bit less to do with OCD, but more of just one of the most profound moments that I felt like I had with the Lord. I remember it was when I was in high school, maybe early college. I was preparing for leading a Bible study that night and The Lord had really laid this passage on my heart. I don’t remember what the passage was, but I remember just wanting to know really badly what it meant. I was really confused because there’s a lot of different religions that interpret that passage differently and so I was like, “I’m going to learn what this passage means that I’m going to figure it out and we’re going to talk about it in Bible study.”

So I was like spending probably a couple of hours reading this passage, reading research on the passage, trying to understand. Even then, I guess you can see some of the OCD of like, I have to miss out and I have to figure out the right and wrong answer between it. And I got so, so frustrated because I couldn’t figure out the answer and I wanted to have it for the Bible study. I went outside and I was about to start doing even more research to understand it. I just kind of felt like the Lord say, “Hey, wait, wait, wait, can we pause here?” I remember looking up at the trees cause I was on a back deck that was a screened-in porch and I just felt like the Lord was saying, “Hey, Rachel, look at the trees around you” and I was like, “Okay, so I’m looking and I’m seeing them blow in the wind” and the Lord was like, “Do you see them blowing in the wind back and forth like that?” I was like, “yes.” I was kind of blown away that I was having this conversation with God. The Lord was like, “Do you know, like how I did that? I was like, “No, I don’t know how you made the trees move” and he’s like, “Do you know all of the intricacies of exactly what type of wind and what exactly, what type of molecules and atoms and particles that went into me being able to move those trees back and forth?” And I was like, “no” and he was like, “but you know that I was the one behind it” and I was like, “Oh, yeah.” 

So for some reason, hearing that the Lord even though I didn’t understand how the trees were moving, I knew that the Lord was behind it. I know that God is good. I know that He knows the answer, even though I don’t. I kind of took that and I felt like the Lord brought me back to that passage that I didn’t understand.

God was like, “Today may not be the day that you’re going to understand that, but you know that I know the answer and you know that you’re trying to know the answer and that’s okay. Because you know that I know the answer and you are following me. You can just keep following me and eventually, we’re going to get somewhere then we may never know the answer to this specific one, but you at least know that I know, and if you can trust me, you can follow me to the end.”

So that’s I guess kind of my message of hope too for OCD, in general, is if you’re religious or not, like, who are you following? Where are you walking? Where do you want to be in your future? 

If you’re religious and you know that God is good and that you’re following Him, at least, you know, that you’re following somebody who knows what they’re doing. That helped me a lot. 

Carrie: Awesome. Thank you so much for being brave and bold and sharing your story and what you’ve been through. I hope that really helps and encourages someone else today. 

Rachel: Thank you for the opportunity. Just to be able to share some of my story is really exciting for me.

_____________________________________________________________.

I am so thankful for Rachel being willing to be so vulnerable with us and talk about her symptoms and how OCD has affected her. This is actually the second person on the show that has talked about exposure and response prevention. I’m a little bit frustrated with myself only because I’ve been wanting to talk about EMDR and how it can be helpful for OCD.

I know that I’m going to have some episodes in the future on EMDR and how EMDR can be helpful for OCD. Even though it is not a therapeutic approach that most people think of when they think of OCD treatment, I plan on doing a solo episode in the future regarding why I have chosen to utilize EMDR prior to using any type of exposure-response prevention methods with clients.

If you find that interesting, stay tuned in for later. I just want to throw that out there that exposure and response prevention is oftentimes the recommended therapy for OCD, but it’s not the only thing that works. So I’ll dive more into that in a future podcast. Just wanted to throw that out there.

[00:46:19] Until next time let’s continue this conversation on Facebook or Instagram, or you can always reach me at hopeforanxietyandocd.com

Hope for Anxiety and. OCD is a production of By The Well Counseling in Smyrna, Tennessee. Our original music is by Brandon Mangrum and audio editing is completed by Benjamin Bynam.

Until next time. May you be comforted by God’s great love for you.

Should I Take Medication for my Anxiety or OCD?

Written by Carrie Bock on . Posted in Anxiety, OCD. No Comments on Should I Take Medication for my Anxiety or OCD?

Maybe this is a question you’ve asked yourself. Perhaps you have concerns about side effects, becoming dependent on medication, or wonder if this option is for you. My response to this question is always the same: It’s a personal decision. Each person has to decide what is best for their body depending on their own symptoms. Some of my clients are able to tolerate medication with little side effects while others try several different medications and react negatively to all of them. Some want to try counseling first before starting medication. I respect and honor each individual’s decision.  

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6 Factors to Consider Before Searching for a Counselor

Written by Carrie Bock on . Posted in Anxiety, Blog, Counseling, OCD.

Note of clarification: In this article, I am using the terms counselor and therapist interchangeably to refer to a provider who is trained and licensed by the state to practice. I am not referring to someone who may engage in counseling or counseling techniques who has not been formally trained to practice professionally. 

If you want to find a doctor, there are several ways you could approach this. You could ask a friend, check the insurance website, the doctor’s website, or read reviews. Finding a therapist comes with unique challenges. I have listed the important factors to consider when finding a therapist below. Understanding this information helps you know what information to cover in the initial phone call or email when reaching out to a therapist.      

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Welcome to the page

1. Carrie’s Welcome to Hope for Anxiety and OCD

Written by Carrie Bock on . Posted in Anxiety, OCD, Personal Testimony, Podcast Episode. No Comments on 1. Carrie’s Welcome to Hope for Anxiety and OCD

In episode one of Hope for Anxiety and OCD, Carrie Bock discusses the reason she started a podcast for Christians struggling with anxiety and OCD. She shares her own personal story of loss and how her faith in God got her through it, learning more about His character along the way.

  • Learn the inspiration for Hope for Anxiety and OCD
  • My story of going from a religious person to a spiritual one
  • When life turns out not as you planned it, but somehow better

Resources and links:

By The Well Counseling

For more information on foster care and adoption in the US:

Adopt US Kids

Court Appointed Special Advocates

Wendy’s Wonderful Kids

Listen to more podcast episodes

Transcript of episode 1

Hi, my name is Carrie Bock and I’m the host of Hope for Anxiety and OCD podcast. Two of my most defining characteristics are that I’m a Christian and I’m a Licensed Professional Counselor.

All Truth Belongs To God

It’s been an interesting journey being caught between two worlds, so to speak. If I use anything in addition to the Bible, I’m too secular for some Christians. Don’t get me wrong. I love the Bible. It’s my guide for life. You know, the big stuff like how to be saved, love God and others, find spiritual peace. However, there are many things the Bible never taught me that I had to figure out that was important in life like how to change a tire or pick which college I was going to go to, or how to cook salmon in the oven just right. I’m not going to find these things directly in the Word of God. I have to go elsewhere for that information. That’s okay because all truth belongs to God. Put lemon slices on top of the salmon. Trust me. It’s delicious.

If all truth belongs to God, that includes every psychological study that’s ever been done on how we learn, what motivates people towards positive behavior, how the brain and the body are affected by trauma, [and] the methods of therapy that are effective for different disorders. The list goes on and on. I could totally geek out about all of this, but in certain therapists circles, if you start to mention Christianity, some therapists look at you a little sideways and start talking to you about how many people they have in their caseload who’ve been traumatized by religion. I get it. So now you know, I’m a misfit who doesn’t fit in. I don’t fit in with the Christian counseling community because I’m too secular for them. I don’t fit in with the secular counseling community because I’m too Christian for them. It’s okay. My conscience is clear that I can have all of Jesus and all of the really good therapy techniques too. Enter my clients. Of course, I can’t tell you all about them. That would be a major HIPAA violation.

You Can Have Jesus and Therapy

Let’s just say that I specialize in treating trauma, anxiety, and OCD. My clients aren’t all Christian, but among the ones who are, some have repeated similar statements people have told them about Jesus and therapy. Some are secretly in therapy because it doesn’t feel safe to talk about it in the church. Some are ashamed to be struggling with anxiety or OCD as a Christian wondering if it makes them less spiritual for having these struggles in the first place. They have verses memorized about anxiety. They’ve been told all kinds of things from church leaders about not seeking secular counseling and medication is wrong, and to just pray and read their Bible more. Others are told they’re struggling because they don’t trust God enough.

I’m so sick and tired of these negative, shameful, and non-biblical messages being sent to Christians that I can’t stand it. I can’t stay silent any longer. I want to scream from the rooftops, “You can have Jesus and therapy!”

Anxiety affects people physically, mentally, emotionally, and spiritually. Each of these domains must be addressed in order to find healing. How can I love God with all my heart if I am stuck in anger due to past trauma? How can I love God with all my soul if it is dry and thirsty, lacking connection? How can I love God with all my mind if it’s plagued with worry? How can I love God with all my strength if I don’t take care of my physical body?

Hope For Anxiety and OCD Podcast Is For People From All Walks Of Life

It takes time for my clients to unpack these negative messages and evaluate them based on scripture. I guess you could say this podcast is for my clients, but it’s not really. No offense meant to any current or former clients listening here. This podcast is for all the people I may never meet but who need to hear that it’s okay to struggle, and it’s okay to take steps towards greater health and freedom.

Hope for Anxiety and OCD exists to reduce shame, increase hope and develop healthier connections with God and others. I invite you on this journey as I interview pastors, Christian leaders, therapists, and everyday people who found hope in the midst of their mental health struggles. I want you (yes you) to help me out along the way.

What burning questions do you have about the intersection between faith and mental health? Who do you want me to interview? What topics are important to you?

Feel free to reach out anytime via our website: www.hopeforanxietyandocd.com. I’ve already recorded some shows that I am super excited to share with you. We’re going to be talking about unanswered prayer, how to rule out potential physical causes of anxiety, help for parents who have anxious children, [and] different types of therapy techniques that can be helpful for anxiety and OCD.

Hope For Anxiety and OCD Has Something For Everyone.

There’s something for everyone. Every show is unique and special and I pray it’s a blessing for the person that needs to hear it that day.

There is also something I want you to know about the guests on this show. It would be easy to assume that every guest on a Christian podcast is automatically a Christian. This show is a little bit unique and different because as I talked about in the beginning, we’re combining two different worlds. Some of the guests are Christian and they are combining the worlds of counseling, psychology, the Bible, Christianity, the church, and it’s so valuable for us to hear that information.

There are other people who have valuable, helpful counseling information that I also wanted to include on the show, or who are friends of mine and don’t follow Christ, the Bible, or Christianity.

The really cool part of that I think that has opened up is an opportunity for us to learn how to talk to people who believe differently than we do and how to ask important spiritual questions. I’m fully prepared for this podcast to probably upset somebody, but that’s okay. Jesus ended up upsetting a lot of people. So as long as I’m doing all that God has called me to do, we’re good.

More About Me

Now that I’ve introduced the podcast, I’d like to tell you some background information about myself, so you can get to know me, the host a little bit better.

I grew up as a shy kid seeking to fade into the background. My dad likes to tell the story about how we went to a new church and everyone knew who my brother was and that my parents had a son, but they had to tell people that they also had a younger daughter. Let’s face it, the kid that got seen also got in trouble more.

Growing up in a conservative family, I was pretty conscientious about things like right and wrong. There were lots of fears about doing the wrong thing and getting in trouble.

I made the decision to follow Jesus and make Him Lord of my life at eight years old, but I put on Jesus, my experience with other adults. If I do wrong, I’m going to get in big trouble and God will be really mad at me. He seemed harsh and mean in some of the Bible stories, and I was scared of Him. What did God want from me? Whatever it was, I knew I was probably going to mess it up.

Being the quiet shy kid also made me the observer. I was keenly aware and had a heightened sensitivity to other people’s emotions, and I didn’t know how to handle them at all. My sensitivity caused me to take everything personally.

It’s a little rough in the making friends’ department when you’re quiet, and you tend to get bullied more. I used to replay social interactions over and over in my head and always felt a little awkward.

How Did I Become A Therapist?

Did I become a therapist because I was the person everyone naturally gravitated towards with their problems? No way. But if I had studied the DSM at the time, I probably could have diagnosed my high school class. All joking aside, it was the opportunity to take psychology in high school that steered me away from the path of becoming a sign language interpreter towards well, I don’t really know, other than I thought psychology was the most interesting thing I’ve ever studied, and I wanted to help people. Mom said helping people is not a career. So you have to narrow that one down a little bit more.

I was a religious person into adulthood, running around, doing the good things, hoping that my works were going to keep me in right standing with God. I believe I was saved by grace but after that, it felt like I was under the law all the time, and God was just waiting for me to mess up. That’s a non-biblical, messed-up theology by the way.

As a religious person, checking boxes of all the things I was supposed to be doing, was exhausting. I completely missed the heart and intimacy of having a relationship with Jesus.

My Experience As A Foster Parent

In 2013, my husband and I had gotten the phone call we’d been waiting for. Department of Children Services or DCS asked us if we would like to take two girls: a five-year-old and an eight-year-old into our home. We were ecstatic. I had a dream previously that I believe to be from God about having two daughters. We were led to believe by DCS that these children would most likely not have an appropriate family placement to go back to.

We gave the girls several different options of things they could call us, and they decided they wanted to call us mom and dad right away. I was not expecting that. We all seem to be enjoying the new normal of our instant family life. I even got asked where babies come from on my first week of parenting.

The girls came during the summer and we helped them get ready to start a new school year, at a new school. There’s something really profound about having two children call you mom, eat at your dinner table and play in your front yard. But at the end of the day, they aren’t your children. My heart didn’t know the difference, and my heart would be completely broken six weeks later when DCS lost in court, and the girls immediately went back to their family. We weren’t even informed there was a court date, so we were in complete shock to find out that we had a few hours to pack up all their stuff and get them to the DCS office.

My husband and I came home to two empty rooms, one decorated with Monster High and the other with decals of a boyband. I can’t even remember which one now. A behavior chart was stuck on the door. Whatever we were trying to correct at the time, suddenly didn’t matter anymore. I wasn’t prepared at all for how to handle this and the physical pain of loss was so deep that it sent me to the doctor’s office. I had never felt anything like that before. I now jokingly say that was the day I spent $200 on bloodwork to find out that I was going through grief.

Other foster children came in one over the next year. Meanwhile, several foster parents we were connected with were in the process of adopting their first placements. I was very discouraged. Why wasn’t God allowing me to have the gift of family? I felt like God called us into this foster care and adoption journey but really questioned His plans.

Questioning God

In the fall of 2014, we received another sibling placement; this time, a boy and a girl. It was looking like they might become a part of our forever family, but what happens when you check all the religious boxes, believing you’re doing the right thing, and then something goes terribly wrong? It happened to me on what should have been a normal Sunday in January of 2015.

I threw my cell phone against the wall and swore before bursting into tears. I’d gone in my bathroom in hopes that my foster children wouldn’t hear the phone conversation. My husband of nine years was telling me that he was done and wanted to divorce.

I knew that our marriage wasn’t perfect, but I didn’t see divorce in our future anywhere. That hadn’t even been discussed at all. Wait a minute God. I married a believer. We’re in church every Sunday. We’re in a small group. We pray at every meal. We read Bible stories with our foster children. How in the world did this happen?

My head was spinning. I had so many questions for God and most went unanswered. Why didn’t he answer my prayer to restore my marriage? Then divorce devastated me. Not only did I lose my husband, but my dreams of having a family were gone in an instant.

Overcoming A Divorce

I went from being a household of four to all alone, looking for roommates to pay a mortgage, in survival mode. My thoughts kept me up at night. Where did I go wrong? What should I have done differently? I couldn’t sleep or concentrate at work. I had no energy and felt hopelessly sad, all symptoms of depression.

I made the decision to take an antidepressant for six months and I can confidently say it was one of the most healthy decisions I’ve ever made for myself.

I carried around a lot of shame regarding being a divorced woman in the church. I remember thinking “my life is over now.” I didn’t mean that in the suicidal sense, but I didn’t see any kind of positive future for myself. What godly man is going to be with someone who’s been divorced?

Unpacking Emotional Baggage and Experiencing God In New Ways.

I had a lot of emotional baggage to unpack from childhood and beyond. Sometimes, that meant talking through my thought process, and sometimes that meant reprocessing trauma with EMDR therapy. It was this process of unpacking the baggage that caused me to experience God in new ways. It was as if there were clouds blocking my view of the sun and when they moved, I could see the sun clearly. God hadn’t changed, but my view of Him is less cloudy now. My faith doesn’t just have knowledge and rules. It has heart and understanding of the depth of the love of God, and the promise that He would never leave me.

I found God as a good father who had blessed me in many ways, and some I just couldn’t see yet. I also had a greater understanding of grace that God showed me as I walked through dealing with my own sin and how that impacted my relationship. I could connect with Jesus knowing that He understood suffering and pain that’s both physical and emotional.

I’m thankful for my pastors, divorce care recovery group, therapist, primary care, physician, and close friends. They all played an important role in my recovery process.

Jesus Transformed My Tears into Triumphs

Today, I am thankful for my divorce, not that it happened but how God used that experience to shape my character and view of him. I’m a more thankful, positive, and compassionate person due to what I’ve been through. I want to help Christians recognize that they can have the abundant life Jesus talks about in John 10:10.

I invite you to think through what is holding you back from that abundant life. I’m happy to tell you that five years after my divorce, I met the most amazing man, and we were married in October of 2020. You’ll get to meet him soon on the podcast as he’s graciously agreed to appear with me on an episode about anxiety and dating, more my anxiety than his.

Thank you so much for listening. I pray that this podcast is a blessing to you today, and whatever you’re facing, know that you are loved by God and never alone.

Hope for Anxiety and OCD is a production of By The Well Counseling in Smyrna, Tennessee. Our original music is by Brandon Mangrum, and audio editing is completed by Benjamin Bynam.

Until next time, may you be comforted by God’s great love for you.

4. Importance of Proper Diagnosis with Jessica Huddleston, LPC-MHSP

Written by Carrie Bock on . Posted in Anxiety, Counseling, OCD, Personal Testimony, Podcast Episode. No Comments on 4. Importance of Proper Diagnosis with Jessica Huddleston, LPC-MHSP

In Episode 4 of Hope for Anxiety and OCD, I interviewed my friend and colleague Jessica Huddleston to discuss the importance of determining whether or not someone is suffering from anxiety or OCD. Many people with OCD are in therapy for years receiving reassurance-seeking, but not getting better. Jessica also discusses a common treatment for OCD.

  • Personal story of how her daughter has been impacted by OCD
  • Importance of differentiating between anxiety and OCD
  • Exposure and Response Prevention (ERP) 
  • Creating exposures for social anxiety
  • Power of a proper diagnosis to reduce shame and increase hope

Resources and links:


Sabin Behavioral Health in Smyrna, TN
More information about ERP and OCD

More Podcast Episodes

Transcript Of Episode 4

Hope for Anxiety and OCD Episode 4

Today on the show, we are going to be talking to my good friend, Ms. Jessica Huddleston. She is a Licensed Professional Counselor and Certified Psychological Assistant at Sabin Behavioral Health in Smyrna, Tennessee. She’s going to talk a little bit about her own experience of having a child with OCD, as well as talk about professionally the importance of diagnosis.

Let’s dive right in. So just to start out, one of the things that I’m doing on this show is talking to different people with different viewpoints. Instead of just going and interviewing all Christians, because I think it’s important at times for people to seek the help that they need and that may be outside the church, or it may be outside the traditional Christian community setting.

How Jessica View Spirituality

Carrie: [00:01:17] I’m curious for you, what is your kind of viewpoint on spirituality? 

Jessica: I believe that everybody has some kind of spiritual power and it’s important for them to embrace it with whatever denomination or belief system that’s important to them, but it’s really just holding their own values and their own morals. That is the bigger picture for me and my goal as a clinician is to understand that person’s values. So if that means that I need to be educated on it, so be it. I believe everybody is a bit different, but being in the setting that I’m in, as well as being a counselor and my background being in clinical, I feel like it’s important for me to not be biased and hold my personal opinions separately from whatever the clients are.

Carrie: [00:02:09] Right. Do you find it challenging at times to work with people that have a different viewpoint than you do? 

Jessica: No, most of the time. The goal is for me to understand what their belief systems are and sometimes that takes me getting educated. Sometimes it takes the individual teaching me. Sometimes it’s me going and reading things and figuring out and just having an understanding. I’m very open to asking questions, like, “What does this mean if I don’t understand” or “Why is this important?” Things like that. Having a common understanding is more important than anything that I particularly believe. 

Jessica’s Experience Dealing With Her Children Who Have Anxiey and OCD

Carrie: I know that one of the reasons I wanted to have you on the show was to talk a little bit about your own experience in your family with OCD or anxiety. [00:02:58] Can you talk a little about that? 

Jessica: My son is 19 and he has difficulty with anxiety. One of my daughters has OCD and we recognized it early on. She wasn’t even two yet. We were noticing some odd behaviors where she was collecting things and trying to hold things close to her and when she was able to talk, she told us that she collected everything because she was afraid we wouldn’t come back to the house. So every time we left, she wanted to have everything ready so she could take it with her, and that included garbage like a candy wrapper or whatever.

She would just collect everything and we’ve spent a long time, [00:03:43] she’s 12 now, I spent a long time working on a lot of those issues and she’s doing a lot better, but it does come out with her schoolwork, her wanting to be very perfectionistic and afraid of making mistakes. Her teachers have been really supportive, intentionally asking her questions that she doesn’t know the answer to [00:04:04], and then they just praise her for trying, which has been a huge help. Luckily, she goes to a really supportive school. 

I do know that one of the things that I’ve run into professionally is a lot of parents feel stuck because the schools don’t really understand their child’s difficulty with OCD. I worked really diligently to educate the parents so they can convey that information to the school because a lot of times kids will come across as just being non-compliant. It may, especially if they use avoidance as their tactic with things. I think that’s really important to me to help parents have the vocabulary and the tools to be able to get their children what they need. 

Avoidance In OCD Does’nt Work

Carrie: Right. I’m sure that the advocacy process has been ongoing because every year there’s a new teacher and more educating that has to be done.

Jessica: [00:04:57] Some parents feel compelled to pull their kids out of school or homeschool or now with everything going on, with virtual schooling, that totally makes sense. But when the parents want to take their kids out of school, I have a serious conversation with them about why and what the benefits are and what the drawbacks are. I don’t think a lot of times parents realize that they might be helping their child for the moment and hurting them in the long run especially with avoidance. 

It might be reinforcing their avoidance unintentionally. I mean, the parents are doing it because they want their kids to be avoidant. They’re doing it because their kid is struggling in school, is complaining, and all of that stuff. It seems like a straightforward solution, but sometimes kids need to learn how to get through that struggle.

How Jessica Recognized OCD in Her Child?

[00:05:45] I really recognize that with my daughter early on, because on top of her having OCD, she had selective mutism and that was difficult. It wasn’t at home though. It was only at school. She would talk. We didn’t know for the first year. She would talk at home non-stop about everything.

[00:06:08] She tells us everything that somebody did wrong at school. Got out of line, all this stuff, but at school she never said a word. It wasn’t until she got her finger stuck in a table at school and all the kids had gone inside and they realized they were missing one. They went back out and she was silently crying and they called me and they’re like, ”well, this happened.”

[00:06:29] I’m like, “Oh, accidents happen.” “Kids stick their fingers in tables.” “She’s not seriously hurt.” “It’s fine.” They’re like, “Yeah, we just didn’t know. She sat out there for about five minutes because she was so quiet.” I’m like, “Wait, what do you mean she was quiet?” They’re like, “Yeah, she never talks at school” and I’m like, “what?” That’s when I realized. She was at that point in kindergarten. She’d gone there for pre-K for two years and apparently, the most she ever talked was a whisper, and nobody ever mentioned that. 

It’s really strange but once we figured it out. Once we realized what was going on, we just started having her talk to strangers, talk to anybody and everybody and she got out of that habit pretty quick. 

Carrie: So she was comfortable with talking to family members and that didn’t make her anxious, but when it was outside family members, she was really nervous to communicate to them. 

Jessica: She would talk if somebody was close to her. If she felt like she had permission or if she felt safe, she would do it. She talked to her teacher when we went to the parent-teacher conference. So I didn’t know it was happening until they’re like, “Yeah, but I thought you knew because she was always that way.” They thought it was just something that was an abnormality of her, and I was like, “I guess it is.” [00:07:51] It’s just not one that she presents everywhere, which is one of the things that clued us in very quickly to her selective mutism. 

Carrie: I wonder if it was really hard for you at times to push your daughter towards things that you knew were going to be good for her while seeing how much distress she was in.

Using Positive Talk And Helping The Child Face The Things They Are Afraid Of

Jessica: [00:08:10] Absolutely, nobody wants to see their child in pain but when you know that it’s the same thing as getting them to ride a bike or talk to a friend for the first time. You know it’s hard for them, but you know it’s good for them. 

We use a lot of positive self-talk and trying to build that without it also becoming a compulsion, is a bit of a trick, That’s one of the things that we figured out of just reminding, “you’ve done this before,” “you’ve done things like this” “you can do this.” I would only say it once and then she would be expected to do. One of the other things that I say that annoys her profusely is “you’re fine” “you can do this.” The more that we challenge her, the easier it gets, the less resistance I get. 

What I’ve seen clinically is that parents that struggle to push their kids in the beginning, they get a lot more resistance. They have a lot more trouble with it, but afterwards, once they get in a habit of pushing the kids to expand their horizons, they get better and it gets easier the more they do it. 

Carrie: And the more that you start to face the things that you’re afraid of, the more internal confidence that you develop, and that carries you to the next exposure, so to speak.

Jessica: Right and giving them the confidence to recognize that they just need to lean into the anxiety instead of backing away from it.

Jessica’s Scope Of Work

Carrie: [00:09:41] You are a Licensed Professional Counselor and also a Certified Psychological Assistant. I wanted to ask you, tell us a little bit about your work environment and the kind of things that you do there. 

Jessica: Well, I have a lot of roles. I have a wonderful plaque in my office that says I’m the “Vice President of Miscellaneous Stuff.” [00:10:08] Here at Sabin Behavioral Health, I am the operations director, but I also do a lot of intake interviews with the other two psychologists that we have. We also do neuro-psych testing. So we’re often screening individuals for memory-related or cognitive-related changes or neurocognitive dysfunction as well as just looking at general psychiatric-related difficulties and determining what course of action needs to be taken if they need to have a psychological evaluation or a neuropsychological evaluation. or if they are in the process or in need of therapy. Those kinds of things. 

We see individuals from as young as four and as old as in the nineties. We have had somebody that was ninety-five, but we don’t get that very often, but it does happen.

[00:10:57] We kind of run into a gamut of different difficulties. We treat everything that runs in the DSM except for probably antisocial personality disorder because most people don’t see those in the private setting. Outside of that, we pretty much deal with almost anything. I have had exposure, response prevention training multiple times and so I treat individuals that have OCD, spectrum disorders, some including body dysmorphia, trichotillomania, hair-pulling, and skin picking as well as OCD. 

Me and Dr. Hanson and one of the psychologists here will treat individuals with obsessive-compulsive personality disorder, which is different than OCD. It’s a bit challenging but it can be very rewarding once you get people to understand how their behavior is affecting their life. 

I mostly deal with adolescents and adults, but I do see kids. So just not very many. I love doing the hierarchy. I think it’s very rewarding and reinforcing not only for me but for the individual to work on their anxiety and kind of getting them to push through it.

What is ERP and How Does It Work?

Carrie: [00:12:13] Right. Can you tell people a little bit about what a hierarchy is? 

Jessica: Part of exposure-response prevention (ERP) is you sit down with the individual and go through a list of everything that bothers them. I am always amazed even though I know it’s going to happen, but every single time I’m amazed with all the depends. [00:12:30] Well, what does it depend on? Getting all of those things out. There are varying opinions on where you start. Personally, I’m not extreme, I don’t just throw people in and do exposures. Usually, the first four sessions are working on rapport building and building trust so we can get to a place where they know that I’m not trying to hurt them.

[00:12:55] There are some other people who do exposure response prevention (ERP) that do very traditional exposure response prevention that you know, from day one, “okay, this bothers you, we’re going to work on it.” I’ve found that in this setting, it’s not as advantageous just because people that are coming here are having gone through other therapies that didn’t work for OCD. People that go to centers that just treat OCD usually already know they have OCD and they’ve tried other things and they didn’t work. So it’s easier for you to just say, “Okay, this is what we’re going to do and we’re jumping right into it.” [00:13:28] But in this setting, I found that easing people into it is a little bit better because often, even if they have OCD, they usually have some other issues that are interfering with their life. And so I take a little bit of time to show them how changing can be beneficial and we work on some of those easier issues like communication and with the younger kids, emotional recognition. Just recognizing what you’re feeling and labeling it. 

One of the fun things to do with some of the younger kids and sometimes with adults is we label their OCD. We give it a fun name. So when we talk about it like it’s a person external from them, that has two benefits, one is it speeds up communication because you’re like, “Oh, you know, that’s just my OCD again” or like “I see my OCD is interfering with this conversation or whatever.” It’s fun to come up with ridiculous names for them. 

[00:14:31] The other benefit is helping them understand that it is an external issue. It’s not who they are as a person. And it helps me internalize that difficulty and also recognize how it interferes with their life, but it’s not them doing it to themselves. It gives them a safe place to talk about some of their intrusive thoughts because they can be very embarrassing. They can be very damaging to their family. 

I’ve had a client before that was afraid of accidentally assaulting his sister, so he avoided her and they didn’t understand because they were younger. He had no desire to do those things, but he just had an intrusive thought about, “What if I did that?” And so he was mortified for saying that out loud. We gave him a space to talk about it and understand how intrusive thoughts aren’t things that we want. We all have intrusive thoughts. Some people say it’s the sticky brain but for people with OCD, those thoughts have a tendency to resonate a little longer and they give them more value than you.

[00:15:36] We would just have a thought and be like, “Oh, that’s weird, whatever.” For people with OCD, they have a tendency to think about it, engage with it more, and then it leads to more anxiety. Then they developed behavior or some kind of a compulsive ritual to minimize, reduce, negate, whatever that intrusive thought.

[00:15:59] I really do believe that not only engaging those intrusive thoughts but also kind of playing them out like, “Okay, what would that look like if you did that?” “What would happen?” And kind of going through those steps, doing some in vivo exposures can be really helpful in the beginning.

[00:16:19] So they see that you’re not trying to hurt them. It’s just you’re trying to get them to understand that fear is controlling them. 

Dealing with Clients With Different Level Of Insights

Carrie: Right. I think it’s important to point out that people who have OCD tend to be relatively intelligent, at least the ones that I’ve worked with. They’re aware enough to know that these thoughts are irrational and don’t make sense to them. [00:16:42] So then there tends to be some shame about getting stuck on this particular thought that I know makes no sense. 

Jessica: Well, there are varying levels of insight. People seek out therapy most often especially adults who have better insight and they come in saying things like, “I feel crazy” “I feel like I’m losing my mind” “I feel like I’m out of control.” They recognize that something is off and they don’t know what it is, but they know something’s off.

I’ve worked with people that have poor insight. It’s a bit more challenging because getting them to recognize that they have this thought doesn’t mean that will actually happen, can be very difficult, but over time I found bringing in family members and collateral support in those situations is very effective. When you start to get them to realize that what they think will happen, isn’t going to happen, they get better insight. They get faster at progressing through the treatment.

[00:17:37] I always tell people that treatment for OCD is teaching a counterfactual. It’s teaching you that something you believe isn’t true. And so that’s really hard to teach somebody that what they think is going to happen isn’t going to happen without putting them in that situation. [00:17:58] That’s why we do a lot of activities, a lot of exposure. I won’t ask them to do anything that I wouldn’t be willing to do myself. It doesn’t matter if it’s gross. It’s not going to hurt me, but if there is something like I haven’t come across anything that I’m just like, “nope, I’m not going to do that” but like all sorts of dealing with different bodily fluids or things that look like bodily fluids and eating things off of toilet seats, done it all. I’ve even had a client that, well, it doesn’t count because it wasn’t wet, we licked it, stuck it on the toilet seat, and then ate a gummy bear. [00:18:36] I didn’t die. I didn’t get sick. It feels weird, absolutely.

Carrie: So you did that exposure with them? You ate the gummy bear off the toilet?

Jessica: Yeah. I’m not going to ask them to do something and I’m like, ‘’Oh no, that’s disgusting, I won’t do it.”

[00:18:53] I’ve even played with animal poop. It’s gross. Been there, done that. I was like, “Okay, it smells bad.” We sat with it and talked with it and I’m like, “Okay, now we’re going to wash our hands.” That was part of that exposure.

I’ve had clients sometimes who’ve social anxiety, or if clients have OCD and have social anxiety, we use the exposure treatment as well for that. [00:19:22] My favorite thing is we make an extremely difficult coffee list and we walk over to Dunkin donuts. And they have to order it. I order it really, really fast and then they have to order it. 

The people at Dunkin donuts are extremely supportive. They like, “see it’s come in.” They’ve caught on. I’ve never told them what’s going on, but they’ve caught on to what’s going on. So they’re very supportive ever and they’re just being patient with this. And we go through all activities and take a lot of deep breaths and do that depending on their age. I will encourage them to take deep breaths. When they’re older, I won’t prompt them to do any self-regulation activities, but some of the younger kids, if you don’t do that, they’ll just give up. [00:20:06] So it is a preventative, “don’t give up,” “just take a deep breath” “you’ve got this”. 

Carrie: I think what you’re talking about really goes to having to have a great relationship with your therapist like you said, so people know that I’m not trying to do something to hurt you. [00:20:25] This is actually going to help you in the long run. What’s painful in the short term will be helpful in the long run, but also this element of being able to be authentic, not asking clients to do anything that you wouldn’t do. And it encourages people to stay engaged in the process because quite frankly, it’s hard sometimes, and it’s very hard and ERP has a pretty high dropout rate.

Jessica: [00:20:55] Especially with younger clients. I tell the parents because I feel like, for the parents, it’s just as hard. So I will tell them early on that we’ll do a hard week and then a soft week and then a hard week to get the kids going because if they think that it’s always going to be hard, they start avoiding therapy. [00:21:14] And that was early on. So like some of the fun sessions, the soft sessions as I call them are working on emotional recognition. We’ll spend the whole hour processing the previous exposure, things like that, just to show them how well they did and kind of gas them up and get them ready for the next one because I feel like without that they think I’m just evil and I’m mean, and they don’t want to come around.

[00:21:38] I think in certain settings, somebody could do traditional exposure response prevention where it’s gung-ho from hit the ground, running and go, but I don’t know that many people are tolerant of that. I’ve had some clients that come in and they’re like, “This is what I want to do.” and I’m like, “all right, let’s go” “we can do it.”

[00:21:56] That’s generally not what I’ve found, especially with younger children because a lot of times you’re also having to console and prevent the parents from using accommodations because they don’t mean to, but they do. And so you have to help them recognize that this exposure is just as much for them to get used to it as it is for the kid.

Differences Between Licenses and Certifications In Psychology

Carrie: [00:22:18] So just to clarify for everyone that’s listening, as far as titles and things like that because it’s very easy to get confused when you’re looking at counselors, psychologists, psychiatrists, and there are so many labels out there. So you work with psychologists? And psychologists are responsible for testing.

Jessica: [00:22:42] Well, not just testing but the American Psychological Association has carved out there that psychologists are the only ones allowed to do testing in most settings. The way that it’s actually set up is the certified psychological assistant does the testing and the psychologist actually is the one that interviews them, writes the reports, and does the feedback.

We’re a little different here plus I have both of the licenses. I am allowed to do diagnosis because I am a licensed professional counselor with the mental health service provider designation. My situation is a little bit different, but I will tell you that Tennessee and California are the only ones that really have certified psychological assistance. [00:23:22] Most other States have what is here as a senior psych examiner. So other settings, if somebody is outside of Tennessee, they might see a counselor that can also do testing. That’s just not the case here. I will tell you most people when they go and get their education, they specialize, and so even outside of Tennessee, most people do one or the other. It’s very, very rare that they do both.

Carrie: People tend to do testing or counseling, is that what you’re saying?

Jessica: On the master’s level, yes. Psychologists, however, depending on how they get their degree on what they focus on. You can get a clinical psychology degree or you can get a counseling psychology degree. You can get a forensic one. There are lots of specialties but it’s up to them to ensure that they get the training and requirements to be able to perform those services. Ultimately just being a psychologist in Tennessee, it gives them the access permission to do psychological evaluations and to do counseling.

[00:24:21] It’s also important for people to understand that the difference between a psychologist and a psychiatrist because I feel like that’s where a lot of people misunderstand. In Tennessee and in most other States. Psychologists cannot write prescriptions. They are a PhD, not an MD and for a psychiatrist. They can prescribe medication and they can do brief counseling services, but very few psychiatrists have the time to do that because there is a shortage of psychiatrists. The last psychiatrist that I knew that actually sat down into counseling retired. So most of them maybe we’ll do psycho-education with patients, but they don’t actually do any of that counseling services, like exposure, response prevention. Usually, that’s left to the counselors or to a psychologist.

Importance of Proper Diagnosis

Carrie:[00:25:12] What do you think is the benefit of proper diagnosis? Because I think sometimes people are very hesitant to get a label, but if you’re labeled with or diagnosed with anxiety and you actually have OCD, that can be detrimental to you. 

Jessica: I’ve seen counselors that had good intent trying to help a client. [00:25:36] They were unintentionally becoming an enabler for their OCD by accidentally giving them reassurance when they’re reassurance seeking or telling them that it’s understandable that they have irrational fears and things like that, which inadvertently reinforces the irrational beliefs. And it exacerbates the problem and it gets worse. [00:25:59] They will, in that situation often get addicted to their counselor, not addicted in the sense of an addiction, but as a person that accommodates them. They will seek that person out to reassure them. That can be very devastating when a counselor changes or things like that, and the fact that they’re not going to get better. It’s just shifting their compulsive behaviors.

[00:26:21] It’s not changed. It’s not getting to the root of it. I often refer to OCD as a personality disorder. It’s one of those things that comes up and goes away when they’re not stressed out. It doesn’t really go away. It just gets better. It’s easier to tolerate. It kind of ebbs and flows with their stress level.

[00:26:39]  When somebody gets really stressed, they will get very entrenched in some of their compulsive behaviors. If one of those compulsive behaviors is seeking reassurance on a regular basis, they can be very hard on counselors. With emails, phone calls, appointments in between, and it’s not their fault. It’s because that person makes them feel good for a second and so they want to feel relief for a second. The problem with the compulsions is they relieve the anxiety. They just kind of take the edge off, but it also does is increase the global level of the person’s anxiety. [00:27:18] So each time they do it, it just takes a little bit of the edge off, but the anxiety continues to grow and so it kind of defeats the purpose. That’s why it’s beneficial to get at the root of the intrusive thought and really address that than it is to address the compulsions. You just prevent them from doing the compulsions.

Why Proper Diagnosis Is Important In The Treatment of OCD?

Carrie:[00:27:36]  When you’re doing the exposures, do you find that you have people who seek out psychological testing who have been in counseling aren’t getting better and are trying to figure out why?

Jessica: Actually more frequently, we see counselors sending people to us saying, “I’ve done everything I’m supposed to do” “something is wrong here, something isn’t adding up.” And they’ll send them to us and clarify the diagnosis and send them back. That’s very helpful for a lot of counselors. They’re trained in making diagnoses, but some of them may be new. Diagnosis are so intertwined and it’s possible that somebody has OCD and generalized anxiety. [00:28:17] The likelihood of that is low, but it’s possible. 

Sometimes counselors will take diagnosis that where somebody was hospitalized or a diagnosis from a doctor, things like that. And they’re kind of following off of this assumption that that’s accurate information, but they don’t realize that in those other settings, somebody only saw it for a snapshot usually when they’re not in a good place. So it’s not very accurate and so doing psychological testing can be beneficial for even somebody that’s just starting out in counseling. The reason it can be beneficial is it helps speed up the therapy process in that you don’t fall into landmines. You don’t fall into, “Oh, why weren’t we talking about this the whole time.”

[00:29:00] It already starts coming out in the evaluation. So even if the client struggles to recognize some of the difficulties that they have, we can’t just by making a full diagnosis, we can still alert to ”there is an issue in this area” so then it can be addressed in counseling.

Carrie: I know that in my experience, providing a proper diagnosis has been very relieving and helpful for clients who have been labeling themselves with other things such as “I’m crazy”, or “there’s something really awfully wrong with me.” [00:29:37] And when you’re able to say, “okay, well these symptoms lineup with this diagnosis” and it actually makes sense. Not only that, but there’s hope because this is something that’s treatable. We can help you with this. We can help you have a better life. 

Jessica: It’s also making something that’s very vague, very distinct, and it gives them a path that they can work on. It helps them see that there is a light at the end of the tunnel. I believe that by doing psychological evaluations, I really build buy-in with clients. You get more effort into changing their behavior. If they know what you see and the way that you see it, they know what we think in that situation. [00:30:17] They get to look at it in black and white, just the way we do and so we’re working on the same thing. It’s not like that old bully for the psychologist or most people think of old Freudian psychoanalysts sitting back behind you on a couch and just taking notes about you and all that stuff. What we’re doing is I want it to be dynamic. I want it to be an interactive process. I’m here to help you. I’m not here to tell you what to do. I’m here to guide you what I think might be beneficial. I could be wrong. You need to tell me so we can discuss it.  And so it’s an exchange rather than a dictation.

Carrie: [00:30:55] That’s good. I like that a lot. I would say that collaboration is really helpful for the things that we just talked about. We want people to come back. We want them to be involved and engaged and so we want this to be working for them. If something’s not working, it’s helpful for people to let us know that so we can shift gears a little bit.

Jessica: And move the needle. I always say therapy isn’t about getting you to the end really fast. It’s about moving the needle every time. We just want to move it a little bit more and a little bit more. 

One of the other things that testing does that makes it very helpful is that every client, at some point plateaus. They’ll start to plateau. [00:31:35] Even though they’ve got more work to do, having the psychological evaluation, you can go back and show them how far they’ve gone, how much they’ve grown. So this is where you were in this stage, “look how far you’ve come.” That gives them a little bit of that inertia to keep going. The push from the inertia. I think that is one of the things that’s really beneficial for doing the evaluation. I do know that it can be time-consuming because it takes time to get the authorization from the insurance company and those kinds of things, but I think the information that comes out of it is very relevant clinically.  [00:32:08] It gives you a kind of an approach. It gives you information on modalities that are more beneficial for that person instead of just kind of going in blindly and taking six weeks to figure that out.  We can use that time to do the evaluation and kind of move things forward. 

Jessica’s Story of Hope

Carrie: Since this podcast is called Hope for Anxiety and OCD, I like to ask the guests at the end of our show to share a story of hope, which is the time where you’ve received hope from God or another person.

Jessica: [00:32:41] Well, I feel like I get hope every time somebody is successfully improving. I had a client that came in. He’s a middle-aged man. He was convinced he was narcissistic. He was convinced he was a narcissist and so in talking to him, it was really that he had OCD. He was just very entrenched in his compulsive behaviors, and so he would force them on other people. He thought that he must’ve been narcissistic to do that.

He successfully terminated treatment. We got to the end. He was doing great and the last therapy session I’m like, “You still feel like a narcissist?” He got so much better about being able to talk about what was bothering him.It improved his marriage, it improved his work relationships. He had even gotten fired from a few jobs because of how his behavior was so ingrained. That gave me a lot of hope. It gave me hope, not only for my own child but hope for my other clients that things can get better. You just have to keep working at it.

[00:33:48] It’s a process. It’s about the journey, not the sprint. You got gotta stay on it on the long haul. It’s about making sure that you’re moving the needle. It’s not about making anything happen quickly because if it happens quick, it doesn’t stick. I really believe that and that’s what gives me hope for clients. That it’s about using behavioral techniques and efforts to help them understand their cognitions to change their behavior, which is the epitome of cognitive behavioral therapy. 

Carrie It’s always so exciting when people are at a healthy level of coping where they feel they’re in a good place to stop therapy. [00:34:30] That’s just a really exciting time. It’s like, “let’s celebrate and let’s talk about how far you’ve come” and “call me if you need anything.” That’s awesome. 

Jessica: I go as far as giving them a certificate and telling them it’s revocable at any time, so they can come back whenever they need to. “Here’s your literal certificate” “You’ve done all the hard work.” “You earned it, you earned your degree because it is hard.” And if somebody trivializes that and doesn’t take it as serious, you have a tendency to get people that drop out of counseling before, but just because they think things were better, better doesn’t mean great, it just means better. 

[00:35:03] We want to get things where they’re moving in the right direction and you’re not likely to have any kind of relapse of it because OCD is insidious. It’s anxiety in general. They’re both very ingrained in our world and they’re required for function of life. So if we just remove anxiety, that wouldn’t be good for people either. We have to get to where they’re back at a more normal, responsive range and that’s important. It’s kind of hard to do, but  sometimes things can hit people really hard and out of the blue. The world gets turned upside down and some of those old behaviors can have spontaneous recovery of those old behaviors, and so teaching them the tools on how to deal with it. Sometimes they can manage it on their own. Sometimes they come back to therapy, but knowing that we’re here is what’s important for me. They know that they can come back at any time. We can talk about it when we figure out what needs to happen.

I have had a client come back after three or four years and it was due to, they lost their wife and so it was grief and we’re like, “Okay, this is grief” “We can work through this, absolutely.” They were afraid that it was going to cause their OCD to come back, but it was really just working through the grief. At least they also felt very comforted knowing that they had somewhere to go in that moment instead of having to start from the beginning because the idea of that was overwhelming.

Carrie: [00:36:33] Well, thank you so much for being on the show and sharing with us your wisdom about a variety of topics. I think it was great. 

Jesicca: You’re welcome.

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I just want to say that if you’ve been in therapy for a pretty good chunk of time and you haven’t been able to see improvements, it’s really an opportunity for you and your therapist to sit down and evaluate why that is because there may be several different reasons that you’re not getting better. It may be a situation where you’re having a hard time integrating what you’re learning and practicing it at home. It may be a situation where, what you’re trying to receive from your therapist, they might not have as much training on, or it may be that their approach might not be working for you.

Jessica’s talking about moving the needle, if you’re in therapy and you don’t feel like your needle is moving, it’s really important for you to evaluate why. Definitely, get the help that you need and if you’re stumped and your therapist is stumped, then psychological testing may be the next best step for you.

I hope that sharing this information will really help someone get what they need. If you really like the show and you find the content valuable, will you do me a huge favor? Will you go on your favorite podcast platform and review us. I would appreciate that so much. Reviews really give a personal firsthand account of what people can expect from our show.

Hope for anxiety and OCD is a production of by the world counseling in Smyrna, Tennessee. Our original music is by Brandon Mangrum and audio editing is completed by Benjamin Bynam.

Until next time. May you be comforted by God’s great love for you.