Tag: Scrupulosity

Carrie: Welcome back to our themes and treatment series on the podcast, where today we’re talking about all things scrupulosity. I feel very honored and privileged to have Dr. Connie Salhaini on the show, joining me to talk about this important topic. Dr. Salhaini is the founder and clinical director of Cognitive Therapy of Staten Island and the founder of Catholic Mental Health Professionals.

As someone who originally trained in CBT and exposure and response prevention, I think she provides some really unique insight ICBT. Inference based cognitive behavioral therapy has shifted and changed her practice over time, specifically in working with clients who are dealing with scrupulosity.

Hello and welcome to Christian Faith and OCD with Kiri Bach. I’m a Christ follower, wife and mother, licensed professional counselor who helps Christians struggling with OCD get to a deeper level of healing. I couldn’t find resources for my clients with OCD. God called me to bring this podcast to you with practical tools for developing greater peace.

We’re here to bust through the shame and stigma surrounding, struggling with OCD as a Christian, sharing hopeful stories of healing and helping you replace uncertainty with faith. I’m here to help you let go of the past and future to walk in the present abundant life God has for you. So let’s dive right into today’s episode.

Tell us a little bit about

Dr. Connie: yourself. Sure. I’m a clinical psychologist from New York, and I have a husband and children and grandchildren and a dog. And I’ve been doing this work since the stone ages. I’ll say it’s since the mid 1980s when I was a student. So it’s a long, long time. Has this been your only career that you’ve had?

Well, when I was a college student, I worked in Burger King and lots of other places, but this has been my one and only profession.

Carrie: I just know a lot of people in the counseling field have had other careers or things and shifted gears, but I’m similar. I have not been in the field as long as you have, but this has been my only career.

That’s awesome. Your kids are grown now and you have some grandkids.

Dr. Connie: Yep. Great life, yeah. So many blessings.

Carrie: How did you get involved in the process of becoming a clinical psychologist? Did you start out working with OCD, or was that something that you just started seeing a lot more of? How did you get into the OCD work?

I knew

Dr. Connie: that I wanted to treat anxiety disorders. I knew that I wanted to do the best I could, so I researched. And at that time, CBT for anxiety disorders. I just got my hands on everything that I could. I landed an internship at a non profit patient advocacy organization called Freedom From Fear. At that time, they still do a clinic.

And so I worked in the clinic and it was A super exciting time back in the mid 1980s. Now I’m talking before Prozac, folks were using exposure, but not like with ERP that we know today. So we were using it and they had a satellite at the place that I was working, which was a research through Columbia University, College of Physicians and Surgeons and the Psychiatric Institute.

It was just such a blessing to be there at the time when they’re doing all of this groundbreaking research because the people who were coming in with OCD weren’t getting better with the tricyclic antidepressants and with some of the treatments that were done at the time. And there was like a buzz of excitement.

I had this great mentor and she was wonderful. And she was, oh my goodness, head over heels in terms of all of the research and everything, and it was really contagious. And then from there, I mean, I just kept learning. I always wanted to try to learn as much as I could for my patients. And so I learned Becky and CBT and I learned some ERP and I took classes with whoever I could take classes with, follow up with whoever I could to learn anything that I could to help people.

It was really a passion.

Carrie: You were starting to see like, Oh, what we use for anxiety. We can’t necessarily use the same strategies or the same approaches for OCD. Exactly.

Dr. Connie: Yeah, it was really, really exciting time to be there.

Carrie: And then you got trained in exposure and response prevention that was considered.

the treatment for OCD as far as the psychotherapy standpoint.

Dr. Connie: And as well as a variety of other treatments that I learned for other anxiety. Well, at that time, they were anxiety disorders, now OCDs by itself. So I learned everything that I could. And now, what’s really interesting is that two and a half years ago, I became aware of ICBT, inference based CBT.

And that spark that I was telling you about, Yeah. And it was like this contagion, this fever, it took over and I wanted to, again, to learn everything I could about ERP. And then ICBT became my thing. It threw myself in and I started to see amazing things happening.

Carrie: You’re one of the people in the ICBT community that is really kind of known for treating scrupulosity.

Certainly, there’s a lot of clinicians who treat it, but that’s one of your specialty areas within ICBT. That’s what we’re really trying to explore today is what is scrupulosity? Like, how would you define that just for the lay person?

Dr. Connie: That’s really a great question. Scrupulosity, like if we look at Where it dates back to, I think it’s always been here, but we can see maybe 15th century Roman Catholic Church and this notion that folks who have worries about sin, about committing some grave sin, a need for atonement.

Yes. And it’s kind of like. We could say like seeing sin where there isn’t sin, or it actually comes from like a little pebble, a scruple. The idea is that this little sharp pebble, right, would be like sharp or hurting and think about like a sensitive conscience and the person being exposed to this pebble and the pain.

Just thinking about the term scrupulosity, you know, depends on the literature, it depends on what you’re reading. So sometimes scrupulosity looks like a subset. of OCD. Okay. We could be religious scrupulosity or moral scrupulosity for people who aren’t religious but they’re just worried about violating some kind of moral code or value that they have.

Also you’ll see religious OCD, and that’s more about Practices, it could be practices in whatever the faith tradition is, messing up those practices.

Carrie: Like I’ve got to pray a certain way, or I’ve got to pray with sincerity. I have to, like for Catholics, I have to confess constantly.

Dr. Connie: Did I do a fast correctly?

Did I observe certain feast days correctly? We can go on and on. But the idea is that this is grave. This is terrible. This is something that’s going to result in damnation and all of that. And the thing with, um, scrupulosity, we can also see spiritual scrupulosity, again, in people who don’t belong to any faith tradition, but they may have doubts about energy forces, or it almost looks existential at times.

So this overlaps. I think of scrupulosity as OCD and you can see so many ways that scrupulosity can be involved with other forms of OCD. Like for example, pedophilia OCD, someone could have that, right? Oh no, no. What if I’m attracted to children? Oh no. What if I’m going to harm children? Oh no, then God will never forgive me.

Then I’ll be damned forever. It’s interesting because you could even see it in somebody who has symmetry. OCD, just still OCD. I don’t line these things up correctly, these religious objects or whatever. And is this going to be offensive to God? Does God think I’m disrespecting? So it’s quite interesting.

Carrie: That was one of the things I wanted to ask you about. Cause I’ve seen that quite a bit in my clients where you start out with OCD and then everything, it could be even they’re feeling like they’re going to be careless and accidentally hit somebody, hit a pedestrian. What really is then they keep going with that obsessional doubt and say, Oh, well, if I hit a pedestrian, then that would be just terrible because then I would be offending God and be on my fault, all of these different things, even some things that aren’t really moral issues that are just decisions that we make in life, someone might make that a moral issue, become really, really obsessed about it and have God connections to it.

I mean, I think, do you see this a lot with like relationship OCD? Yeah. Am I marrying the person that God has for me, that type of thing.

Dr. Connie: Yes, or vocations, the same thing. No, so we could see it. It seems like there’s anything that’s important to the person. And one of the things that ICBT does so well is it identifies the self theme under it.

And that’s the person who’s afraid of becoming this person that they’re not. Like a person who could be negligent or a person who could be bad. And then we need to define what that means to that specific person. But that theme is like the big story underneath all of these different obsessional doubts.

And I’m a cognitive behavior therapist for years and years and I never saw it explained in this way. And I think that’s why I took a liking to ICBT because we can see how all of this different themes fit. Or interconnected.

Carrie: Yeah. I love that vulnerable self peace and then also looking at the real self.

Who are you really according to your beliefs and in terms of, I think that helps Christians a lot to be able to say like, okay, if I really see myself as a child of God, I mean, that makes a huge difference in how I live out my life.

Dr. Connie: Mary, you are so right about that. I think that is the most important thing about scrupulosity and the treatment of scrupulosity is when people can come to know that they know that they know, like really trust.

You know, that they’re trusting, not in a something, but in a someone, in the relationship that they have with God. And that makes all the difference. Lots of folks know it, but because of the fear, it’s intense. The suffering is awful. When they come to know that, it changes everything.

Carrie: It really does. And I find that a lot of people will seek help from a pastor or a counselor.

A mentor, someone in their church before they seek mental health help because they think this is a spiritual issue. Well, I’m somehow doubting God or what if I’ve committed this sin? What if I have not asked for forgiveness? What if this means I’m going to hell and those types of things? So it looks at mass as a spiritual issue, even though it’s not a spiritual issue.

This is a OCD affects people’s brains. And so I think it’s really important for people to understand that, that this is not a, a deficit in their spirituality. Absolutely. Yeah, the people that I meet really, they want to connect with God in a positive way. That’s really like their true desire underneath.

And all of this OCD gets in the way of them having that really Authentic, genuine connection that they want to have.

Dr. Connie: I agree completely. And I think that’s what draws me to the treatment of scrupulosity. It’s the people, they have such beautiful hearts and real great desires. Just want to please God. They just want to live a good life.

They are really beautiful and they’re so tortured by a story that has nothing at all. And in treatment, if we can restore them to that, it’s amazing. There’s nothing better. This is like a joy if we can help folks to get there. So I love this work for that reason.

Carrie: Exposure and response prevention for scrupulosity relies on a lot of imaginal scripts. Did you have some discomfort surrounding that when you would try to utilize it with clients? Can you tell us more about that?

Dr. Connie: Sure. First off, we know that ERP works great treatment. For myself, in my treatment of folks with scrupulosity, I always shied away.

From imaginal scripts with script, I would do it with other things and I would also do exposures, let’s say, a more, I guess, in depth way with other things. I have no problem sticking my hands in the garbage, touching my face, touching my hair. Modeling that no problem, no problem at all. But I remember even in training, I was like, please don’t give me a script case.

Please don’t give me a script case because I felt so uncomfortable with that. There’s a lot of reasons why I didn’t want to add to someone’s distress, but I also didn’t want to confuse the person in terms of what their faith practice was and what was an exercise in treatment. So then I relied a lot on ACT.

Group. I did a lot, a lot of act work. I’d still do response prevention, but I wouldn’t do, yeah, like those hard, those exposure exposures. Exposures like, oh gee, that a person could be possessed by the devil or wanting to sell their soul. I wasn’t doing, it wasn’t coming from me. It violated something within me.

Again, I leaned on that a lot.

Carrie: Acceptance and Commitment Therapy.

Dr. Connie: Correct. Acceptance and Commitment Therapy. But even then, it wasn’t the best fit. I can see it now. Yeah. I’m not saying that Acceptance and Commitment Therapy doesn’t work. I’m not saying that, or that ERP doesn’t work. But for me, this is a better fit.

And I think it’s also a better fit for a lot of the people I see. Some other folks would never do those exposures. Or how about convincing clergy to allow that. Oh my goodness. That was part of what we used to do. Yeah, let’s talk to your priest. Let’s talk to your minister. Let’s explain to them what we’re going to be doing. That was a hard

Carrie: Sure, that makes a lot of sense. I think really what you’re talking about is we have to, as therapists, have to be aligned with a particular treatment because our clients are going to feel it if we’re not fully aligned or we’re not fully bought into it. And that affects, obviously, our ability to provide the services.

And I think what you said is true is like when we find something that feels like a really good therapeutic fit for our people, then the people that come to us, it kind of just fits with them as well. It’s like this nice, natural flow. How has ICBT been helpful for your clients with scrupulosity?

Dr. Connie: One of the things that I think ICBT does is it restores. The trust in themselves, in who they really are, and also it helps them grow spiritually. So when we’re removing those obsessive doubts, and some people have told me they don’t believe those obsessive doubts anymore, and I love it. I say to people, why not? And they say, well, it doesn’t make any sense. Yeah, I love that when we can do that with someone and they’re free to then practice their faith in the way that they want to, their relationship can become so much more close.

It’s difficult work and it requires the willingness of the person to do this work, but I have seen that kind of success. I think it also, ICBT doesn’t blur the lines. As much as for me, the therapeutic exercises and the spiritual practice ICBT is value free. So anyone can come with their value systems intact and there is a respect for that and so that you don’t have to go there at all with ICBT.

And I think that another thing that happens, you mentioned the real self, and this is so important, restores what people they know, but they’re doubting their true intentions, their true desires. And who they really are. It provides this other story. The doubt has this whole set of reasons behind it. We clear that up and then we look at obsessional narrative and come up together with an alternative narrative, which in my experience often is about how they are the beloved child of God.

And it just changes everything. And then after that, then we can get into situations with reality sensing and get them back into doing things in a non OCD way. It’s just so different.

Carrie: Yeah, I loved what you talked about with the true desires and intentions because that’s something that gets really doubted heavily in some of those things that we talked about before, like the pedophilia OCD and then leading into the scrupulosity OCD.

I think there are so many Christians that because they haven’t necessarily just worked on OCD in general, it’s, oh, well, I have all these horrible thoughts, whether they’re violent thoughts or thoughts about harming children or thoughts about blaspheming God. Then they’re making some type of spiritual meaning surrounding that.

Well, because I have these awful thoughts, that must mean then therefore that I’m not a good Christian or I’m not close to God or I’m not going to heaven, whatever type of meaning they’re making out of it. And so really just being able to peel back and provide some just general education about OCD, you’re not choosing to have these thoughts.

You’re not wanting to have these thoughts. This is a process that’s happening in your brain, and we can retrain your brain and retrain your ability to reason with these types of thought processes differently and really targeting that obsession that you’re having and kind of debunking the argument that it’s making.

It has led people to be kind of aligning what you were saying with their head and their heart. Well, I know that God’s loving, but I feel this fear towards God, or I feel, I notice when I have these obsessions come along that I’m really super scared, but I know that God is loving. I know that I am practicing my faith.

I know that I’m doing the right things, but it’s not aligning. And so really going through this process of teaching people the modules of ICBT is super helpful. And also, I think just really letting people know that they have options for their treatment is so huge. You as the client have the options that somebody feels like ERP is really the way that they want to go and they feel aligned with that, that they can certainly pursue that.

And if they want to do ICBT, that they can pursue that. And I think that that’s really huge for the OCD community and something that we’re trying to continue to educate people on and let them know.

Dr. Connie: Absolutely. It’s so important what you said about the reasoning process with. ICBT, it’s kind of validating for people that these thoughts don’t just intrude upon them, that there’s a reasoning process behind it.

Once they can see that, and once they can clear that up, then they can realize that those horrible feelings that they’re having, the fear, the guilt, the false guilt, as well as that, is coming from the story. Yeah, that’s where it’s from. They change the narrative and everything changes. So how does it work?

Go back to the obsessional doubt and we’re upstream as we say. Right.

Carrie: Well, for sharing all of this information. Our listeners will find it really helpful and we’ll put links for them to find you in case they’re in New York or want to pursue seeing you.

Dr. Connie: Oh, that’s wonderful. Thank you. Thank you so much.

And thank you for the work that you do. It’s so important to have somebody like you doing these podcasts, especially faith based work.

Carrie: I just want to share with all of you what God has been working with me on in my life. As I Have been studying the scriptures and coming across very specific scriptures that maybe I have shared with certain clients dealing with scrupulosity or scriptures that I felt, Hey, wow, this could really unlock something for someone with OCD.

I’m starting to take notes on those things, write down questions, and I’m not sure what this is going to turn into, if this is going to come out in podcast form or it’s going to come out in written form, but. I know that when I have it all collected and gathered together, I will be sharing it with you. I definitely have a passion for helping Christians with OCD to have a really healthy understanding of theology because oftentimes wires have gotten crossed along the way from Things that we’ve been told or things that we learned from imperfect parents, church situations that maybe weren’t the best or the healthiest, and sometimes those things can get us really stuck and keep us from being able to move forward in a healthy way in our relationship with God and God.

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