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.