TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

CLIENT: So, spill it. Spill it, huh?

THERAPIST: Yeah.

CLIENT: I guess I've always struggled a little bit with just some slight OCD I think. I've kind of known I have, but it really hasn't affected too much and it's just kind of been slightly been more of an annoyance. And I was like, well, you know, I feel like it's starting to actually interfere or something with my life.

You know, I should probably kind of get control of it. So, my OCD things are, you know, like touch and feel. I'm not like a light switch flipper or on-off-on-off. But there's certain times I feel myself I get stuck into these patterns of repetitive thought or, you know, repetitive action. And if I don't, you know, do those and satisfy whatever you're satisfying -

THERAPIST: So, touch and feel. What's the feel part? [00:01:01]

CLIENT: I don't know. Like for instance, you know, it might be the way I set down a coffee cup or something. Or, you know, if I was to, you know, maybe pick this up, sometimes I might want to just, you know, kind of just set it down just right or something.

THERAPIST: So feel is like a sense that it's not quite right? "There's a feeling inside me and I've got to repeat that?"

CLIENT: Right. Right.

THERAPIST: Or else?

CLIENT: Or else it just feels like there's this almost anxiety or like a burden on myself, but not like something negative is going to happen.

THERAPIST: So you never predict a negative event. You don't say, "Someone's going to develop cancer," or "I'm going to -

CLIENT: No.

THERAPIST: " fail my interview tomorrow," or -

CLIENT: No.

THERAPIST: Never anything concrete?

CLIENT: Nothing concrete like that, no.

THERAPIST: And so, what is it then? Is it more like something bad is going to happen? Or, "I just need to get rid of this experience inside me?" [00:02:07]

CLIENT: Yeah. It's kind of like I need to get rid of that experience. I guess the negative side of something might be if there's something on my mind, something weighing on my mind, then it's almost like it enforces that negative thought or something.

THERAPIST: Oh, so there is a consequence?

CLIENT: Sometimes, yeah.

THERAPIST: Uh huh. So if I were concerned about bills or concerned about an upcoming presentation or whatever, and this doesn't get fixed, then it's going to bring some more -

CLIENT: Yeah.

THERAPIST: stuff on that that's going to accentuate it.

CLIENT: Right, yeah.

THERAPIST: Am I saying it right?

CLIENT: Yeah.

THERAPIST: Not necessarily it's going to go badly. Is that true?

CLIENT: Yeah.

THERAPIST: It's not necessarily that but it's just it's going to make that more intense, prevalent.

CLIENT: Yeah, yeah, that's right.

THERAPIST: Alright. And is there also the other part of, "I'm just not going to feel finished if I don't do that?" [00:03:10]

CLIENT: Yeah. Yes.

THERAPIST: And is that the more common feeling?

CLIENT: Yes, it's the more common.

THERAPIST: Okay. The something external is the less frequent.

CLIENT: Right. For instance, you know, something for me that makes, you know, no sense that I've done for years, sometimes, you know, what I'm doing is where say I'm eating some potato chips or something random, where I need to keep eating them until I feel like I've, you know, gotten the right chip or, you know, had just enough where it shouldn't mean anything at all, you know?

THERAPIST: Mm hm.

CLIENT: [It's simply] (ph) to stick your had in the bad and start eating. "Well, that one wasn't quite the right," you know.

THERAPIST: Mm hm. So it really overrides the function of the task.

CLIENT: Right.

THERAPIST: All of a sudden you're preoccupied with taste or crunch -

CLIENT: Yeah.

THERAPIST: sense of the number, sense of it.

CLIENT: Yeah, sense. Yeah.

THERAPIST: [That it's going to] (ph), you know, what is this? It's taking all the pleasure out of this particular event. [00:04:16]

CLIENT: Right.

THERAPIST: So do you have any ways that you predict that's going to happen and have started avoiding things to keep it from kindling this feeling?

CLIENT: Um.

THERAPIST: Or there's really no way to do that?

CLIENT: I don't think I've quite figured out yet how to Sometimes I'll catch myself in those repetitions or action and sometimes I won't. I don't know why sometimes I do and sometimes I don't.

THERAPIST: So you're like semi-conscious sometimes around it and you then you finish it and then it's all over and then you went, "Oh, that was just it." Or you may not even highlight it for yourself, it's just been done.

CLIENT: Right. I think sometimes when you go back to the, if there's something that was negative going to happen, I think a lot of the times it's my mind tries to make me feel guilty for something I may have done. Even though it's not something bad, and I feel like if I don't satisfy that, you know, that certain chip then I feel like this guilt from not doing that. [00:05:31]

THERAPIST: From not doing the satisfying with the chip?

CLIENT: Yeah. Yeah.

THERAPIST: Uh uh. But not about some other things?

CLIENT: Well, I feel guilty about something by not satisfying eating that certain chip, for instance.

THERAPIST: I'm sorry, I didn't follow that though. I'm trying to understand. Are you saying that there is a specific something -

CLIENT: Yes.

THERAPIST: other than the chip?

CLIENT: Yes. Sometimes there is.

THERAPIST: Okay. So, example?

CLIENT: Example, sure, yeah. Sometimes, and I don't know why, for instance, you know, say we're out, you know, to dinner or something and, you know, I notice there's another, you know, attractive woman, you know, and I'm with my wife, for instance. Then, you know, I immediately start feeling guilty that, you know, I notice that she is attractive. Or there's these little things that my mind tries to make me feel guilty for. And then almost, you know, punish me for I don't know how to explain it, but that's [00:06:31]

THERAPIST: Okay. So if I start fighting this thing here that's going to accentuate. If I can just go ahead and do this it will -

CLIENT: Right.

THERAPIST: quiet things down and I can go back to normal and be able to -

CLIENT: Right. You got it.

THERAPIST: move on. So it gets, you know, it moves my mental life along.

CLIENT: Correct.

THERAPIST: And it's like, "Well, it's not going to take me but a few moments to handle this compulsion and then I can Why would I not do that?"

CLIENT: Right.

THERAPIST: Right? So and then you go ahead and satisfy that.

CLIENT: Mm hm. To go back further, I often wonder sometimes like I shouldn't even feel guilty in the first place. That's such a petty little thing that it shouldn't even, you know, weigh on my mind. I think I find a lot of those little things now and then that I'm going to just try brush off because It's like my mind is always saying (ph), it's working too fast sometimes.

THERAPIST: Mm hm. Now are you, this is another category when you say that. Because now you're just talking in general around guilt.

CLIENT: Yeah.

THERAPIST: "I tend to occasionally get hooked into some of these minor things and -

CLIENT: Yeah.

THERAPIST: " elevate their importance, when "

CLIENT: Yeah.

THERAPIST: " why am I getting stuck on that?" Right? [00:07:42]

CLIENT: That's correct.

THERAPIST: So that's a little different from this.

CLIENT: Yeah.

THERAPIST: But it kind of leads you to that.

CLIENT: Um.

THERAPIST: So those guilts, are there other ways you have dealt with those guilts in the past?

CLIENT: Yeah. I guess the way I've dealt with those in the past are, you know, internally I try to coach myself through, you know, thinking that, you know, I didn't do anything wrong. You know, there's nothing to worry about.

THERAPIST: So you reassure yourself.

CLIENT: I reassure myself. And then where it gets really frustrating is if I get stuck in a pattern of reassurance.

THERAPIST: Uh huh.

CLIENT: If I have to reassure myself in a certain way and a certain pattern. And that's why I'm starting to realize. I'm like, well I need to, you know, figure out a good way to overcome this because -

THERAPIST: Mm hm.

CLIENT: it's starting to get a little annoying. (laughs)

THERAPIST: And can you say and example of around a certain way I might reassure myself? [00:08:45]

CLIENT: Yeah.

THERAPIST: Could you give me an example of what you mean -

CLIENT: Um.

THERAPIST: by ways or tone of voices, is it specific words or phrases. Is it a number of times.

CLIENT: It's specific words or phrases and it kind of changes and I don't know how For instance, you know, I might internally think, you know, "There's nothing to worry about. I didn't do anything wrong." And often times I'll, you know I'm pretty spiritual, so I'll almost like ask God for forgiveness. "God, do you forgive me?" "Yes, I forgive you, Barney." "Okay." And then I kind of, you know, move on.

THERAPIST: God talks back to you?

CLIENT: Well, not really, but, no. (laughs)

THERAPIST: Well, so why did you say it that way? "God, will you forgive me." "Yes, I forgive you."

CLIENT: I think it's almost like me -

THERAPIST: Is it like a knowing God would forgive you?

CLIENT: Yeah, yeah.

THERAPIST: Uh huh. And so you get a little taste of a prayer?

CLIENT: I wouldn't say it's a prayer. More of like a reassurance feeling.

THERAPIST: Right, but the reason I say that is some people with this issue have a ritualistic prayer. You might just ask for reassurance from God, not a prayer, but just say, "God, will you forgive me?"

CLIENT: Yeah.

THERAPIST: So there might be a question that you would use that way -

CLIENT: Right.

THERAPIST: and then get free from it. [00:10:09]

CLIENT: Right.

THERAPIST: Does that make sense?

CLIENT: Yes, it does.

THERAPIST: But just a little further down the continuum are people who get caught up in ritualistic praying.

CLIENT: Okay.

THERAPIST: In case you don't know that.

CLIENT: Okay.

THERAPIST: There but for the grace of God go you.

CLIENT: Yeah. I guess I wouldn't When I do these repetitious thoughts I never think of it as a prayer. I just I think I think of it as a higher being giving me reassurance, and not -

THERAPIST: Absolutely.

CLIENT: Yeah.

THERAPIST: I totally understand what you're saying.

CLIENT: Okay.

THERAPIST: Because I was going to ask whether you ever use some form of confession to your wife about thoughts that you've had, because it's another way people do it. They have to report how (cross talking at 00:10:57).

CLIENT: Well I was just going to say, I have in the past kind of done some of that and I felt like it got really annoying. And, you know, sometimes she was just like, "Well, yeah, that's stupid. Why are you worrying about that. You know, you don't need to tell me that." But internally I feel like I have to tell her that.

THERAPIST: Right. [Bear witness.] (ph)

CLIENT: And if I don't do that I need to do this repetitious asking for whatever. You know?

THERAPIST: So is it And now you don't do that with her anymore? You're kind of off the list, or it happens occasionally?

CLIENT: I try not to if I can help it.

THERAPIST: And do you require something back from her, or is it just that you've said it and that she knows.

CLIENT: Um. I think it's either I said it and she knows, and sometimes if I'll say something and she'll respond with, "You know, that's okay." Or, you know, "You don't need to worry about that."

THERAPIST: Okay. So the reassurance from your wife, reassurance from God, same territory.

CLIENT: Same territory.

THERAPIST: Right. And reassurance from myself occasionally can happen but it tends to not be sufficient. Or I have to work it a little bit to get -

CLIENT: Right.

THERAPIST: I have to put more energy than I should be bringing to this particular thing. [00:12:11]

CLIENT: Exactly. Yeah.

THERAPIST: Okay. "It would be nice if I just didn't have the thoughts altogether."

CLIENT: Yeah. That's what I, yeah.

THERAPIST: Are there any other consistent types of repetitions that you find yourself getting involved in?

CLIENT: Hm.

THERAPIST: Eating? Are there categories?

CLIENT: Not really. I don't I mean there's little things I know that I don't know if it's like habit or OCD, but sometimes I'll, you know, several times a day I'll maybe adjust my neck this way or that way and I'll have like a series of cracks and turns and twists.

THERAPIST: That's more like a tic.

CLIENT: That's, yeah, more like a tic.

THERAPIST: That's an OCD spectrum.

CLIENT: Okay.

THERAPIST: So it's the same kind of thing. The distinction around spectrum disorders, well there's body dysmorphic disorder and trichotillomania and tics and so forth. With tics it's you have less of an obsession and more of the compulsion. [00:13:13]

CLIENT: Right.

THERAPIST: Right, you just have the behavior that moves. You don't necessarily have much of a trigger other than the sensation of, "It seems like I need to do this now." Like that.

CLIENT: Right.

THERAPIST: But that still falls in the same category. In fact, when it shows up for kids the first symptom tends to be blinking, sniffing or clearing the throat.

CLIENT: I'd say I probably have all of those tics.

CLIENT: Okay.

CLIENT: Yeah, sometimes.

THERAPIST: And so if sound is associated then we tend to talk about it as turrets.

CLIENT: Okay.

THERAPIST: That's the distinction. So like a sniffing and clearing the throat is more like a tic, I mean more like a turrets, but they're all in the same territory.

CLIENT: Right.

THERAPIST: But as you know, there's simply an urge and you satisfy the urge by sniffing and then you're done.

CLIENT: Right. Actually, I don't think I really sniff. But, anyway, I've noticed sometimes I'll have a blink or a clear my throat or, you know. [00:14:16]

THERAPIST: Yeah, so that's just in the ballpark.

CLIENT: Yeah.

THERAPIST: So I was asking about repeating. Are there any territories that you find you return to or circumstances.

CLIENT: Um.

THERAPIST: What kind of range are we talking about in terms of repetition?

CLIENT: Um.

THERAPIST: Because you've only really spoken of the chip.

CLIENT: Yeah, that was just one example. I'm trying to think of another example. (pause) Hm. Oh, here's one. Sometimes if I'm putting together a shelf or something, you know, I have a screw driver and I'm, you know, screwing the screw in the shelf, whatever. I'll have to turn it just right or just not too tight or whatever. My mind is telling me that it's just right. You know?

THERAPIST: Mm hm.

CLIENT: And I don't know what that means. [00:15:16]

THERAPIST: Mm hm.

CLIENT: But -

THERAPIST: And "it would be just right" is in a world of its own?

CLIENT: Exactly.

THERAPIST: Not related to -

CLIENT: Anything.

THERAPIST: tightness and so forth.

CLIENT: Right.

THERAPIST: And you're thinking of that as, "Oh, I just remember that one incident where I had that." Or, "I can remember times when I was putting together something and things like tightening tend to catch me."

CLIENT: It seems like a lot of times when I'm using a screw driver or something I tend to fall into that pattern of, "Oh, it's not the right turn or tightness," or whatever.

THERAPIST: Okay. Any other thing that pops out, just to make sure I'm oriented well around all this. How often does this happen?

CLIENT: It kind of depends. Like I said, I feel like I can get stuck in a rut for a while and then I kind of come out of it. And then I partly feel like I'm not doing any, you know, OCD things for a while. And then something like trigger it like, you know, that original guilt thing we talked about -

THERAPIST: Mm hm.

CLIENT: Where I notice somebody else attractive and I feel guilty. And I feel like I'm stuck doing things and patterns to try to overcome that feeling. [00:16:30]

THERAPIST: Mm hm.

CLIENT: And then the longer I don't overcome it the more things I pick up.

THERAPIST: Uh huh. Okay. So, like it kind of starts accumulating. Like, "If I do this maybe this will be the secret. Maybe this will get rid of it for good."

CLIENT: Right. Right.

THERAPIST: Okay. So, in a week's time you might have a few events?

CLIENT: I'm sure, yeah.

THERAPIST: And, are you saying, "I'm sure, yeah," because it goes by so quickly and you handle it so rapidly that you're kind of not alert to it. But if you were to like wear a heart monitor or something, you know?

CLIENT: Yeah. (laughs)

THERAPIST: If you were to have your mind alert to it, do you think you would actually be catching more of them?

CLIENT: I think I feel like I'm conscious a lot of the time that I'm doing them. It's just hard to stop that thought or action.

THERAPIST: Well, sure. You're not quite sure how to do that.

CLIENT: Right.

THERAPIST: What to do, whether stopping is the right thing to do or it's like trying to not itch a scratch, or scratch an itch. And so why get some help now? [00:17:43]

CLIENT: I just feel like because it's actually starting to bother me enough that I should probably, you know, talk to someone.

THERAPIST: So help me understand the, "bother me enough."

CLIENT: Mm hm.

THERAPIST: Because when I ask you how frequent it doesn't sound like it's very frequent. So, help me guage (ph) that.

CLIENT: Yeah, I feel like, so okay, some of the, you know, maybe physical reassurance of picking something up or putting it down, it might not bother me too much. But if I get in the mind reassurance, you know, like I was saying earlier, where you're almost asking for forgiveness or reassurance, I feel like I get stuck in that every day over some little thing.

THERAPIST: Oh. So it's going to be more about the little things you might get stuck with every day. And you would be surprised how many people use that Kleenex box to illustrate that.

CLIENT: If I notice, or if I -

THERAPIST: So you're getting nickled and dimed.

CLIENT: Yeah.

THERAPIST: That's what I want to know about. [00:18:48]

CLIENT: Yeah.

THERAPIST: That's helpful to me.

CLIENT: That's just kind of wearing on me. So, for instance, if I notice if I'm doing something like this, say at work, you know, I'll try to stop that. And then I'll internally think, you know, "I don't need to be doing that. I didn't do anything wrong." And I'll stop doing that stupid stuff. All done.

THERAPIST: Mm hm.

CLIENT: You know, I'll try to cleanse my mind of what I was doing, or at least I think I am.

THERAPIST: Mm. Mm hm. So, again, you return to reassurance.

CLIENT: Right, reassurance, yeah.

THERAPIST: And that's a physical one but I thought you were saying, "I get into the mental stuff."

CLIENT: I do. Yeah.

THERAPIST: Is it more difficult than that or more frequent or more annoying?

CLIENT: The mental is more -

THERAPIST: or does the same thing?

CLIENT: The mental is more frequent and more annoying and sometimes harder to satisfy because sometimes your mind doesn't ever think you're doing something right. You know? [00:19:49]

THERAPIST: Right. So there's a kind of perfectionistic -

CLIENT: Right.

THERAPIST: bent to it. So you do what you think you've been commanded, so to speak, to do.

CLIENT: Right.

THERAPIST: And then, you know, that didn't work, and now I've got to go tweak it somehow.

CLIENT: Exactly.

THERAPIST: Or do it with some more reverence.

CLIENT: Right.

THERAPIST: Or if I didn't have the right mindset when I did it.

CLIENT: Exactly.

THERAPIST: I wasn't attending to it proper. I think I got distracted for a moment and didn't bring it all.

CLIENT: Yeah. I didn't quite say the word correctly.

THERAPIST: Mm hm.

CLIENT: I need to do that pattern again.

THERAPIST: So it can be really insatiable.

CLIENT: Mm hm.

THERAPIST: Then it might happen again later on in the day around some other -

CLIENT: Thing.

THERAPIST: whatever.

CLIENT: Yeah, whatever.

THERAPIST: And so, let me just make sure I'm understanding. The, of course the obsessions are all mental, but the trouble you have the most, the thing you have the most trouble on right now is the mental rituals. [00:20:56]

CLIENT: Mm hm.

THERAPIST: Not the physical rituals.

CLIENT: Right. That's correct.

THERAPIST: Is that right.

CLIENT: Yeah.

THERAPIST: So having to say something correctly and so forth. Now do we have any other examples of the type of things I have to say?

CLIENT: Um.

THERAPIST: In my head. Do they vary in the broad range or do you get some narrow range of things?

CLIENT: It's almost like there's a certain pattern that my mind will use for a while, and then for some reason that pattern might change a year down the road or a half year down the road where, you know, I might be You know, a pattern in the past I have stuck in was, you know, "There's nothing to think or worry about. I didn't do anything wrong. I didn't say anything wrong. I didn't think anything wrong. I didn't do anything wrong. So there's no reason to feel guilty or bad."

And that was a particular pattern I was stuck in because I felt like I was covering all my bases on, you know, why I should not feel a particular way that I do. [00:22:01]

THERAPIST: And, "I shouldn't feel guilty."

CLIENT: Right.

THERAPIST: Or, "I shouldn't feel bad."

CLIENT: Right.

THERAPIST: And so that would be literally what you would say to yourself?

CLIENT: Right.

THERAPIST: Okay. Did you say that was kind of how it used to be in the past?

CLIENT: Yeah, I guess sometimes I'll maybe use that or a combination of it or something.

THERAPIST: Right. But you're saying there's a trait that has to do with making sure I've -

CLIENT: Yeah.

THERAPIST: covered all of the bases: do anything, think anything, say anything, feel anything wrong. And, therefore, I shouldn't feel bad or feel guilty.

CLIENT: Right.

THERAPIST: And that can become a statement -

CLIENT: Right.

THERAPIST: a reassuring statement that becomes kind of a ritual because it sealed it off or/and it worked last time, and so let's not vary that. And it's hard enough to get it right and that was a right one.

CLIENT: Yeah.

THERAPIST: And so there's a, if you work it through and get one that, you know, then you remember that because -

CLIENT: Yeah. You know, you don't want to invent the wheel again. [00:23:09]

THERAPIST: But here's one that doesn't work.

CLIENT: Well here's the kicker. So I, you know, have that repetition of words or whatever you're saying, but then, you know, say you're thinking that when you're in the shower doing whatever, you know, you're doing this repetition thinking this. And then after you finish the repetition you maybe bump your arm on the soap thing. Well then that (snaps) triggers something saying, "Nope, I actually, that messed it up. Start over." And so sometimes it's really hard to finish what you're doing -

THERAPIST: Mm hm.

CLIENT: because some little thing (snaps) will set it off. Like, "No. I've got to do that again. That wasn't good."

THERAPIST: Well, there's a kind of a "just right" thinking.

CLIENT: Exactly.

THERAPIST: Okay. Now, so the thing you're doing with the Kleenex box and the chips and so forth is not really repeat Just to clarify with you, it's not really repeat that same behavior until I have an absence of that bad thought of feeling. But I'm going to fix that behavior or land on just the right feeling. So that's the "just right" piece. [00:24:23]

CLIENT: Right.

THERAPIST: As opposed to, you know, if you walk through the threshold of that door and have a negative thought. You know, like you were referring to the light switch. Right? It's not, "I'm going to walk through there and have a positive thought or a neutral thought. And I'm going to keep walking through there until I get that."

CLIENT: Right.

THERAPIST: That's a repeater.

CLIENT: Right.

THERAPIST: But you don't have that. You've got more like the "just right" sensation. And so any little thing can derail you.

CLIENT: Yeah.

THERAPIST: Which has got to be frustrating.

CLIENT: Yeah.

THERAPIST: And that's also why it's so reinforcing when you stumble upon a communication that tends to work.

CLIENT: Yeah.

THERAPIST: You know, "Forgive me." You know, "Will you forgive me, God."

CLIENT: Exactly, yeah.

THERAPIST: Or what you just went through.

CLIENT: That's like all that sometimes make me just super sensitive. Sometimes my wife, I'm like, you know, anything she says I'll take that she's, you know, upset or it's a big deal when it's not at all. And it's just kind of been an added annoyance, you know. [00:25:26]

THERAPIST: No. So tell me more about it. That sounds like a new thing for you and I.

CLIENT: Sure.

THERAPIST: So that's similar to, "Gosh, I just tend to get guilty about things that seem small."

CLIENT: You're right.

THERAPIST: And now you're saying something about, "I'm reading -

CLIENT: Yeah.

THERAPIST: "‘ into her tone of voice."

CLIENT: Exactly.

THERAPIST: Or whatever. And clarifying or asking her a question about it to say, "Are you upset about something? Are you mad at me?" Does it go like that?

CLIENT: Yeah. Sometimes, but I feel like it's not all the time. It's, you know, one week I might for some reason I perceive things way differently than she probably means them. And I'll, you know, I'll have to ask her, "Are you upset about that?" And she's like, "No, why?" "Well, I just, you know, your tone of voice seemed to indicate so." And that just gets frustrating because, you know, she's a great wife and I don't need to be picking at her about these little things. [00:26:25]

THERAPIST: Yeah. Now, when she says, "No, it's nothing," can you let it rest or do you have to inquire again? Do you have to find some subtle little sophisticated bright guy way to check it out at another level?

CLIENT: I think I tend to I'm actually trying to give you a good example here. (pause) Say she says something and it somehow either offends or upset me and she doesn't mean to, I tend to hold on to that for like an hour or two.

THERAPIST: Mm hm.

CLIENT: It's hard for me to just let it go right then.

THERAPIST: "Let it go," meaning let it go by asking her or let it go to reassure yourself it was nothing?

CLIENT: Not even asking her for reassurance, just let it go like where it doesn't bother me.

THERAPIST: Uh huh.

CLIENT: I'm trying to give you an example.

THERAPIST: But why would you let it go if you think she said something that -

CLIENT: Well that's the thing. Here, let me go back. So if she said something and I'm like, "Wow, that was a little harsh, don't you think?" And she's, "No, I didn't mean it like that." I'll say, "Oh, okay." That doesn't -

THERAPIST: That's not sufficient for you.

CLIENT: No.

THERAPIST: Uh huh.

CLIENT: I'll kind of hold onto it and kind of hang my head for a little bit. And, you know, she'll be like, "Well what's wrong?" "Oh nothing. The thing you said earlier I just kind of was -

THERAPIST: "I got stuck on it."

CLIENT: " stuck on it." [00:27:48]

THERAPIST: Well that's got to be hard.

CLIENT: Yeah. I think it frustrates her a little bit.

THERAPIST: You get a little mopey.

CLIENT: I do.

THERAPIST: Yeah. And then -

CLIENT: She calls it pouting.

THERAPIST: Right. Moping, pouting.

CLIENT: Yeah.

THERAPIST: Yeah, they're all derogatory expressions.

CLIENT: But I'm doing it.

THERAPIST: You don't really want to be labeled [with that.] (ph)

CLIENT: Yeah. I feel like I'm generally, I feel happy. I feel happy with my life. I just don't feel happy with how I process things sometimes.

THERAPIST: Right. Right. And so how are Do you have a system yet with her to work this stuff through? Or how annoyed is she? Is it lightweight enough that she's not really so bothered by it? Where do we stand with her?

CLIENT: It's pretty lightweight as far as, well she knows I'm, you know, working on some things and talking with you. And she said, you know, she supports me in everything I want to do. And she said she, you know, hasn't really noticed that I was having internal, you know, issues going on. So I don't think it's really [00:29:00]

THERAPIST: But what about this reassurance and questioning and checking with her -

CLIENT: Um.

THERAPIST: about what her tone was and so forth? Is that, that hasn't gotten to an annoying degree?

CLIENT: Um.

THERAPIST: I thought you were saying that maybe -

CLIENT: It's annoying being like -

THERAPIST: You're saying, "I don't want to do this to her." But she's not going, "Can you give it a rest?"

CLIENT: Well, maybe once a month she'll be like, "Gosh, I feel like anything I say or do is upsetting you." And she's like, "I don't want to have this happen all the time." And I say, "You know, yeah, you're right." You know, "It's my bad."

THERAPIST: It's me.

CLIENT: I need to work on that. You're right. But it's not all the time.

THERAPIST: Yeah. Okay. Now, are you, so at work are you having any kind of issues around reassurance and having somebody check behind you? Or do you have to verify -

CLIENT: No.

THERAPIST: that somebody is okay with what you said? I wonder why it doesn't happen. Because communications can be really -

CLIENT: Right.

THERAPIST: tricky with people.

CLIENT: Yeah.

THERAPIST: So if you're sensitive to this I wonder why. Do you have any idea why it doesn't flip over into other No other relationships? [00:30:09]

CLIENT: Mm mm. Wait, no other what?

THERAPIST: No other relationship where this kind of problem comes up.

CLIENT: Oh.

THERAPIST: Or this self-doubt.

CLIENT: I don't know.

THERAPIST: Or not sure whether you said something wrong or what they implied by that. Or feeling sensitive about something when it's really unnecessary.

CLIENT: Not that I really can think of.

THERAPIST: Okay.

CLIENT: I think at work I'm just so focused on work -

THERAPIST: Which is a problem too because that's why you're going to do these compulsions without thinking about them, because you want to get them off your plate so you can get back to concentrating.

CLIENT: Yeah. It seems like sometimes there's one thing that will hang over my head for a long time that I'll, you know, for instance say feel guilty about. Go back to the thing where I'm noticing somebody else is attractive. I feel like that hangs over my head for quite a while. Maybe a month or two. And these repetitious things are trying to clear that guilt or thought. And you keep doing those until maybe that goes away. There's some new thing that comes up and replaces that feeling of displeasure. [00:31:19]

THERAPIST: Yeah. And so I think I understand that that So you say "new thing," as opposed Do you mean like a new guilt?

CLIENT: Right.

THERAPIST: And other than having looked at an attractive woman, what else? Is there another theme around guilt?

CLIENT: It seems like the theme is around things that would make me, things that my wife would disapprove of or I'd feel guilty about because of her. Something like that.

THERAPIST: Yeah. But is there a concrete example of it? "I drank too much when I went out with the guys." Or, "I -

CLIENT: Could be. Yeah.

THERAPIST: "I didn't get enough rest when I was traveling."

CLIENT: Could be, yeah, something. You know, drank too much when I was out with the guys. You know, maybe said something I shouldn't have or did something I shouldn't have. You know, I'll feel bad about that. Whatever. [00:32:22]

THERAPIST: And those don't tend to lift to the level that, "Did I glance at that woman wrong?" Or, "Did I have those kind of thoughts."

CLIENT: Right.

THERAPIST: But it could happen.

CLIENT: Right. Exactly.

THERAPIST: Okay. Well, you're classic. Sorry, I know you're special and unique.

CLIENT: (laughs)

THERAPIST: But also, you're just classic.

CLIENT: (laughs) I told Emma, I go, "Man, what if " I go, "I'm kind of nervous." Because I've never talked to somebody before. I said, "What if I go and Reed's (ph) like, man -

THERAPIST: (whistles)

CLIENT: "‘ we're going to have to sedate you and just ‘"

THERAPIST: Going to have to pull out your molars.

CLIENT: (laughs)

THERAPIST: That's the problem really. Your teeth. Any of your teeth that has mercury and it is the cause -

CLIENT: (laughs) Yeah.

THERAPIST: and we're just going to have to pull them. Well, how's it going to so far?

CLIENT: I think it's good.

THERAPIST: Okay.

CLIENT: I just hope I'm I feel like I'm articulating what I'm feeling and I hope that I'm, yeah.

THERAPIST: Sure. And I'm asking, you know, ask questions just to delve a little -

CLIENT: Yeah.

THERAPIST: You know, the whole thing around, "Is he a repeater or has he got this ‘just right' thing going." I just needed to sort those things and I needed to make sure I covered all the bases. It sounds like we've got it, right? [00:33:27]

CLIENT: Yes.

THERAPIST: You've pretty much nailed -

CLIENT: I feel like we're -

THERAPIST: And if we don't, you just tell me next time. That happens all the time. "Oh, I forgot five other things."

CLIENT: (laughs) Yeah.

THERAPIST: That's not uncommon. I don't think that's going to happen with you. Well, so we've got about ten minutes.

CLIENT: Sure.

THERAPIST: So let me try to tell you what's wrong.

CLIENT: Sure.

THERAPIST: (laughs)

CLIENT: You know what? Before you say that.

THERAPIST: Yeah.

CLIENT: I feel like I'm pretty strong. Like a pretty strong, mentally focused guy. I just want to say, I don't feel like I'm nuts. I just feel like I have something I need to control.

THERAPIST: Yeah.

CLIENT: But otherwise I feel like I'm pretty sound.

THERAPIST: Right. Sure. And I'm sure that that's true too. And there's no way you could possibly know how to control this.

CLIENT: Okay.

THERAPIST: Because it's paradoxical. It's, you know, what you're doing is what everybody does. What you're doing is what I would do if I were in that circumstance. I would be seeking reassurance, I'd be trying to remove it, I'd be irritated with myself that it's going on and so forth. And so all that makes sense and nobody figures it out on their own, or the ones who do we never see, of course. [00:34:38]

CLIENT: (laughs) Alright.

THERAPIST: But it makes totally good sense that you're doing what you're doing. And it can't possibly work.

CLIENT: Sure.

THERAPIST: So that's the other thing to know. What you're doing now is totally wrong.

CLIENT: Mm hm.

THERAPIST: (laughs) So is that good news?

CLIENT: Sure.

THERAPIST: But, you know, and the other piece is this is absolutely not complex. It is simple. It's difficult but it's simple. And I'll tell you, you know, there's lots we know.

CLIENT: Mm hm.

THERAPIST: So we'll put this under the umbrella, certainly it's the end of the big umbrella of anxiety disorders. We've now, for some reason they've carved OCD out of the anxiety disorders -

CLIENT: Okay.

THERAPIST: and put it stand alone.

CLIENT: Okay.

THERAPIST: So it's not with panic disorder and social anxiety and generalized anxiety and so forth. But we don't, practically speaking, we don't need to think of it that way. Think about it as an anxiety disorder. You have something that goes on that makes you feel uncomfortable and you've got to get rid of it. Right? [00:35:39]

CLIENT: Mm hm.

THERAPIST: When we go to that umbrella of OCD, like with all the others, there's lots of things we know about it. But, again. you and I just want to think about pragmatics. And the pragmatics of getting better have to do with thinking about intolerance of uncertainty. And if you and I just go, "Okay, let's try and make sense of this." And, "What do you do when you've got intolerance of uncertainty."

So OCD is going to live inside someone who must clear things out and know for sure everything is okay around particular themes.

CLIENT: Mm hm.

THERAPIST: So as soon as you get outside your themes you're like most everybody else. You're probably a risk taker in certain ways. You, you know, step into the excitement of not knowing how things are going to go because it's the only way you're going to progress.

CLIENT: Right. Yeah.

THERAPIST: You want to have a job where you're not supervised all the time, then you've got to be independent thinking and the chances you're going to have to face, blah, blah, blah. [00:36:47]

CLIENT: Right.

THERAPIST: But within these realms that you and I have just talked about, you have an intolerance of uncertainty. And, therefore, the treatment would be what?

CLIENT: I don't know.

THERAPIST: (laughs) Well if the problem is you can't tolerate uncertainty, what's the treatment?

CLIENT: To tolerate it.

THERAPIST: Right. So that is what we've got to do. And the way I work is that we don't really learn tolerance, is that we address and seek it out. Not put up with it, but seek it out. Okay? So one of the mistakes that you're making is you're seeking reassurance and you've got to take that off the list.

CLIENT: Okay.

THERAPIST: So, you know, the second thing is, I'll talk about it -

CLIENT: Sure.

THERAPIST: as many times as you need to because it's not complex but it's not always easy to understand. You focus on specific content. [00:37:45]

CLIENT: Mm hm.

THERAPIST: And you've got to stop doing that. Alright? So when the content comes up of, "I feel guilty about looking at another woman," that's completely and totally irrelevant to what you need to pay attention to. Your OCD, if we personify OCD, your challenger, is going to give you doubt and it requires you to seek to get rid of the doubt. That's the only way it lives inside you is if you play your role properly. So we don't want to pay attention to what pops up.

CLIENT: Right.

THERAPIST: We want to pay attention to your response to it. So right now you maybe feel annoyed at yourself or frustrated or self-critical. And also you've got to get rid of it. We want to, you know, understand why I'm frustrated, annoyed and all that stuff. And, fine. [00:38:52]

CLIENT: Mm hm.

THERAPIST: But I want to do the opposite of get rid of it, which would be what?

CLIENT: Not have it be an uncertain feeling. I need to -

THERAPIST: What's the opposite of getting rid of something?

CLIENT: Getting something.

THERAPIST: So keeping it.

CLIENT: Keeping it.

THERAPIST: Right. So your goal is to keep it. Okay. I'll make it a little more complex.

CLIENT: So an example of that would be to keep it as far as?

THERAPIST: "I don't know what it means that I looked at that woman and kind of found her to be attractive."

CLIENT: And just accept that.

THERAPIST: Accept it is too neutral.

CLIENT: Okay.

THERAPIST: Want to get rid of it has more energy in it. So one opposite would be to be neutral about it, and that's fine. But it's too hard to go from the energy that you've created to get rid of it to neutral. When you're all better you will go to neutral. "Oh yeah, there's that thought again. It will be gone." [00:40:07]

Where I want you to start is to go over here with match this energy with that. Which is, "I see this woman, find her attractive for a few moments, I don't linger on it very long. But there it is." But then what I want to learn to do is to go, "Okay cool. I just got an image that is making me feel uncertain and uncomfortable. Great. That's what I want. I want to feel uncertain."

CLIENT: Okay.

THERAPIST: I want to feel uncomfortable. So when you go to uncertainty, as you know, in all of your life, any time you feel uncertain about something that is important, you're going to feel anxious. "Can I complete this speech." "Will they accept my bid." (laughs)

CLIENT: Mm hm.

THERAPIST: Am I going to get there in time. So there's that uncertainty and distress that goes. So anytime you feel uncertain and welcome that instead of get rid of it, you've got to welcome being anxious too because that comes on the heels of it. So I have You're okay I use this example around seeing somebody, you know? [00:41:18]

So I've had this content. Alright? We don't care about the content. The only reason we go to content is to generate generic uncertainty. Because what you have is a personality, so to speak, that can't tolerate uncertainty, in general, related to OCD themes.

So I don't want to go, "Fine, I just had that thought. It's okay for men to look at other women. It's alright. I've talked to Emma, she's okay with that. It doesn't mean anything." You don't want to go there.

CLIENT: Okay.

THERAPIST: Do you know why?

CLIENT: Because I'm reinforcing.

THERAPIST: You're reassuring yourself.

CLIENT: Reassuring, [that's what I meant.] (ph)

THERAPIST: You're reassuring yourself. Although it makes totally good sense to go there, that's going to be your instinct to go, that's how you think you're going to fix it. To give yourself permission to do it. The error is that it's permission regarding the content. You cannot address the content at all and get better. [00:42:29]

CLIENT: Okay.

THERAPIST: How are you doing with that idea?

CLIENT: Good.

THERAPIST: You can't address the content at all. "Now I'm eating my chips and I've gotten this sense of I've got to get to the ‘just right' one." Now what do we do with that example if we're going to have some kind of therapeutic response to that moment?

CLIENT: I guess you want to accept the uncertainty?

THERAPIST: Okay. By doing what?

CLIENT: I guess not continuing -

THERAPIST: Right.

CLIENT: to search for that.

THERAPIST: Yeah. So either immediately stop eating it because something is not right. Or, now I'm just going to take a random number and put them in my hand and as soon as I'm finished with those I'm done.

CLIENT: Actually, I've done that before. As weird as this sounds, I'll be like, "I'm going to have three more chips. That's it." [00:43:33]

THERAPIST: Well, that's it. That's how you do it.

CLIENT: Yeah.

THERAPIST: Right?

CLIENT: So that's a good way to -

THERAPIST: Well, you've got to be careful around -

CLIENT: Yeah.

THERAPIST: When you say, "three more chips," people just stumble upon that and go, "Oh, three is a good number. I want to land on threes."

CLIENT: Right.

THERAPIST: "As soon as I say three more chips, that worked, so three more." You know? So I'll have bad numbers and good numbers. So you've got to be careful around We'd rather mix it up a little bit just to make sure. So that's why I said, "Oh, I'm just going to reach in and grab chips and however many I have in my hand now."

CLIENT: Right.

THERAPIST: "That's what I'm going to eat." Or, "I'm going to close this up now because I just had the thought of ‘I need to do this until I get one just right.' Well I'm not going to have any more, because that's pretty much going to guarantee that I'm going to now feel uncertain."

CLIENT: Mm hm.

THERAPIST: And now, when we talk about working with kids, and parents start putting limits on their kids and say, "I'm not going to reassure you," or whatever, "anymore." We have what is called "extinction bursts." The kid will go nuts because they don't want the parent to change. [00:44:43]

And so the same thing, OCD, could very easily go nuts on you. It will start because you tend to satisfy. And then you actually don't know a lot about what happens when you don't satisfy. And so one of the things you might predict is it will escalate on you. It will go, "Dude, what are you doing, man?"

CLIENT: Right. I think -

THERAPIST: You know? This could stay on your mind. You've only got one chance to finish this off. If you don't do this now you're going to be dwelling on it. The least it will do is this: you're going to keep dwelling on this. You're trying to concentrate, you've got a paper that's due at the end of the day, this is that. Or it will come up with something concrete and go, "You're not going to "

CLIENT: Right.

THERAPIST: you know, x, y, z.

CLIENT: Right.

THERAPIST: So you were going to say something. I interrupted you.

CLIENT: Oh, I feel like when you said, you know, these ways I can, you know, help get over it. I guess in the past, you know, I wanted to reassure myself, or whatever I would do to reassure. If I don't, I don't know, I feel like I get this little pressure stuff in my head. I don't know if that's anxiety. [00:45:52]

THERAPIST: We just assume it is.

CLIENT: Just assume it is?

THERAPIST: As opposed to brain cancer developing?

CLIENT: Yeah. (laughs)

THERAPIST: I mean, what else would it be?

CLIENT: That would be my example of -

THERAPIST: It getting worse.

CLIENT: What do you say? You need to recognize that, accept it, not try to reassure that it's okay. I feel like it's going to be a challenge just because now I might -

THERAPIST: So the reassurance is, "Oh, I expect this. This is, you know, I'm fighting the OCD right now. I'm not playing by this game. I'm now having some weird sensation in my head. Of course."

CLIENT: Yeah, okay.

THERAPIST: So you always reassure yourself regarding, "Oh, this is it." You know? "This is going on." Again, the caveat is, if you start going, "This is OCD. It's just an OCD moment and so it doesn't mean anything. And so I'm going to do this now with the chips because I know it doesn't mean anything." That starts to get the border of, "I'm reassuring myself that this doesn't mean anything."

CLIENT: Mm hm.

THERAPIST: So the way you just, the best way Again, to understand all this the first time.

CLIENT: Yeah.

THERAPIST: But the best way to go is like, "I don't know what this means or whatever, but this is what Reed says to do and so I'm going to do this. And we'll just see how it goes." [00:47:08]

CLIENT: Sure.

THERAPIST: And, you know, you can take notes about how it goes. I mean that's part of the thing is to experiment. (ph) In behavior therapy you do exposure. You know, over and over again you repeat it and then you get better. And that's what everybody will say to you if you go to them to get over OCD.

You and I want to be thinking about, "I'm just doing behavioral experiments. I'm going to, you know, Reed's giving me a belief system to begin to adopt and so I'm going to experiment with this belief system and see how it goes. I've experimented with it before around the chips, I'm just going to have three more. So let me move in this direction as soon as this thing comes up. I'm going to have the urge to say something to Emma and ask her if there was a tone."

You know, a transition way you can do it with your wife if it comes up is to go, "You know, I've got a question I'm going to want to ask you right now about something that just happened, and I'm not going to ask you. I just want to let you know I'm trying this stuff out." [00:48:08]

CLIENT: That's actually a good idea.

THERAPIST: So if you need to, you can just say that, and then she knows you're practicing and she can go, "Well good for you. That's great."

CLIENT: So eventually will that tightness or pressure or whatever in my head from not doing what I've been doing in the past, go away?

THERAPIST: Well, let's find out.

CLIENT: Okay.

THERAPIST: Maybe it will turn into a brain tumor.

CLIENT: I mean (laughs) not a tumor but just -

THERAPIST: What are you afraid might happen?

CLIENT: Nothing, really. I mean -

THERAPIST: What do you mean? Why did you ask me that? You said, "Eventually will this go away?" What are you worried about?

CLIENT: I'm not worried about it turning into anything bad, just kind of a constant reminder of feeling uncomfortable. There's something foreign feeling.

THERAPIST: Yeah, and how do you want to respond when you notice that?

CLIENT: I don't know.

THERAPIST: Excellent.

CLIENT: (laughs) There we go.

THERAPIST: "I'm feeling anxious and I don't know what this means. I'm having a thought that this may stay around forever. Okay. Great. I'm practicing this. Great. Alright!" Now, you know, I'm being absurd to go, "Okay. Great!" Right? But really I mean that. [00:49:12]

CLIENT: Okay.

THERAPIST: I mean, you know, part of what we're doing is we're trying to work on the prefrontal cortex. We're not working on the amygdala, we're not working on the limbic system, we're not working on the, you know, "fight or flight" response that we talk about. We don't care about that. That's going to settle itself on its own. We will work on the prefrontal cortex, what I am literally saying to myself.

I'm continually going, "When is this going to go away. This will be terrible if it sticks around. I've got to fix this." And so, I'm going to go over here and go, "I'm not fixing anything. I'm staying with this. I want this." "I don't want this. I've got to get rid of it." "No I want this. I want it to stick around." Now I'm going to go, I've got to stop in a second, but -

CLIENT: Mm hm.

THERAPIST: Frequency and sense of duration. Remember that? You need We didn't talk about those three, right? So, if you get a -

CLIENT: Oh.

THERAPIST: So, habituation.

CLIENT: Okay.

THERAPIST: Is how you get over a fear.

CLIENT: Mm hm.

THERAPIST: And that takes frequency of practice. If you want to get over an elevator you've got to ride up and down the elevator enough. And so frequency. Intensity. What we know now that we didn't know fifteen years ago. We used to do relaxation and, you know, that kind of stuff. We don't do that anymore. [00:50:20]

We want intensity. You're actually on a scale of zero to a hundred, you want to be up to fifty or higher in terms of distress. This is behavior therapy. You and I are not doing behavior therapy, but it's the logic behind what we're doing.

CLIENT: Okay.

THERAPIST: Okay? We want to activate the brain circuits that are associated with the fear. Activate them. So you get in the elevator and become anxious because you've had an association between the elevator and something going wrong. So we've got to activate those circuits in order to manipulate them, in order to fix them.

CLIENT: Okay.

THERAPIST: You've got to have them fire off in order to begin to modify them.

CLIENT: Okay.

THERAPIST: That's why we want to have, we want to get distressed in that, and then you want duration. You sit in that distress forty five to ninety minutes. That's how they do practice -

CLIENT: Okay.

THERAPIST: for getting over a fear. Right? So we come to your OCD. If getting over my obsessions requires frequent exposure in which I feel moderately or higher in terms of stress -

CLIENT: Mm hm.

THERAPIST: that lasts for forty five to ninety minutes. If that's what I need to get better, I want to get better, I want this. I don't like this, it's uncomfortable, it's hard for me. [00:51:49]

CLIENT: Okay.

THERAPIST: But I want frequent exposure that gets me distressed and lingers enough, because that will habituate, help me habituate to it and I won't be as bad. So that's one of the reasons to say that, "I want this." Right? Because one is I want the outcome and this is the treatment, so I want that.

CLIENT: Mm hm.

THERAPIST: But even more important, the way you and I are working is to want this is the opposite of what OCD uses to keep me under it.

CLIENT: Yeah. That's interesting.

THERAPIST: Right? Because I've got to go, "Oh, this is wrong that I'm having this feeling. I have to get rid of it." No. "I want to keep this. I want more of it." Now the reason I was bringing that back up to you is, here is how it goes in reality, I mean, how I want you to think about it. Your job is to have the frequency. In other words, when an event occurs you go, "Okay, good. Got it." Right? [00:52:54]

CLIENT: Okay.

THERAPIST: Ask the OCD to give it the intensity. Ask the OCD to give you the duration. So, in other words, you glance at a woman, have a bad feeling, "Oh. What's wrong with me?" "Okay, good. Here's an event. I've got a frequency of one. I want as many of these as I can get. Okay that's great."

CLIENT: Mm hm.

THERAPIST: And then, again, this is kind of advanced graduate level work.

CLIENT: Okay.

THERAPIST: But at least we'll plant the seed about this. Now when I have that I want to go, "Hey, make me feel worse, would you? Hey, I don't feel bad enough about what just happened. Could you make me feel more guilty?"

CLIENT: (laughs)

THERAPIST: "Could you? Come on. You know, I want to keep this feeling around. Would you keep me upset? Alright, would you?" So as soon as you say it, if you literally say that in your head, literally say that in your head. As soon as you say that, then you're done with the transaction.

CLIENT: Hm. [00:53:54]

THERAPIST: As soon as anything kindles up again. "Why did you look at that woman? And why did you look, I think that was like four or five seconds. I think that means something." "Oh great. You're doing it to me. Hey, man, you're scary. You got me going now. Thanks a lot. Could you give me a negative thought again all about that. That's great." And then you're done.

Go back to whatever task you're doing it. If it kindles again, you simply ask for more of it and then you're done. You don't go, "Hey, would you give that to me," and "that was great. Did that make it go away?" Okay, you want to have nothing -

CLIENT: Okay.

THERAPIST: nothing to do with the sensation in your temples going away. Nothing, no evaluation about, "Is this technique helping me. Am I starting to feel better. Is this working." None of that. That happens spontaneously as you work on this. Your only job, and how you define success, is that you're running the protocol. Not what the protocol does. You following me on that? [00:54:58]

CLIENT: Yeah.

THERAPIST: Because as soon as you start checking in to see if it's working, checking in to see if it's working is always going to plug you into, "Am I feeling better? Is it going away? Is my attention to this fading?" We don't want that. That's bad form.

CLIENT: Okay.

THERAPIST: So we'll go through this again next time, whatever it is.

CLIENT: Sure.

THERAPIST: You want to look for a time to? Did we schedule anything else?

CLIENT: Yeah, we've got not week on the twenty second.

THERAPIST: Okay. Is that alright with you?

CLIENT: Yeah. That's fine.

THERAPIST: Okay. Anything you want to ask before we stop?

CLIENT: No.

THERAPIST: Okay. Good.

END TRANSCRIPT