TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: There you go.

CLIENT: Seconds ticking by.

THERAPIST: Alright. (pause)

CLIENT: So, I’m feeling better, I think.

THERAPIST: Good. What do you mean?

CLIENT: Recognizing some of the patterns I was in that were in my mind thinking were supposed to help, you know, me get through a situation or an uncomfortable feeling, I think. Just talking to you and recognizing that that’s not the right way to go about it kind of helped that go past and realize, hey, I guess I don’t really need to structure parts of my life around, you know, routines and behaviors that might, you know, reinforce things in a negative way.

THERAPIST: So what did you experiment with?

CLIENT: Well, I just, I don’t think I really did any of my thought process that I told you I sometimes rehearse, you know, in my mind. I don’t think that really ever came up. I think, you know, I had a couple of times where, you know, I might have noticed somebody was attractive that example I gave you and I just felt that feeling of, “Okay, well, maybe I’ll feel uncomfortable, maybe I won’t. I’ll just take that in and I’m not going to, you know, try to punish myself or feel guilty or whatever I would do in the past.” [00:01:31]

THERAPIST: What did you do instead?

CLIENT: I just said, “Give me some more. Let’s feel it,” and kind of just went. I mean it wasn’t like it -

THERAPIST: “Kind of just.” What do you mean? What does that mean?

CLIENT: Um.

THERAPIST: What kind of just, what?

CLIENT: It didn’t weigh on my mind.

THERAPIST: Hm.

CLIENT: It didn’t -

THERAPIST: Well, what a surprise.

CLIENT: Yeah, I know. Isn’t that crazy.

THERAPIST: Huh.

CLIENT: (laughs)

THERAPIST: How do you make sense of that?

CLIENT: I don’t know. You know? But it’s funny because that’s what I would be almost afraid of in the past is, you know, I’d, you know, feel [like something in my subconscious] (ph) and try to find some little thing to try to make me feel guilty about or feel bad about. And then for me to let go of that feeling, you know, I’d have to get stuck in my routine. But, you know, I really don’t have much head pressure I was expecting. I was expecting [00:02:29]

THERAPIST: So, let me make sure I understood what you said then.

CLIENT: Mm hm.

THERAPIST: So, the little thing came up and maybe you saw somebody who may or may not have been attractive to me, and minimally, I just allowed it to be there. Maximally, I said, “Hey, whatever reaction, go ahead and -

CLIENT: Yeah.

THERAPIST: “Go ahead and come, whatever it’s going to be.” And then nothing really came of it?

CLIENT: Mm mm.

THERAPIST: So these like maybe lightweight kind of offense?

CLIENT: Yeah.

THERAPIST: So maybe a heavier weight one would go a different way?

CLIENT: Yeah. Potentially. I guess it will -

THERAPIST: Because you will feel guilty?

CLIENT: No. I think I maybe just realized that certain feelings are maybe natural and they don’t need to, you know, weigh heavy on you because -

THERAPIST: Well, what would you have done if you started feeling guilty in that scene (ph)?

CLIENT: Well, I would have done like we talked about last time. I would just let that feeling come and brace it and not try to just get rid of it, but like feel that feeling. [00:03:37]

THERAPIST: Mm hm.

CLIENT: And then -

THERAPIST: And then, really, nothing.

CLIENT: Nothing. Right?

THERAPIST: Let a feeling be a feeling.

CLIENT: Yeah. Right.

THERAPIST: So, I mean, that’s an interesting design to continue because what you’re saying to me is, “I have so I maybe see someone I have a feeling of guilt and then what I typically do is shift up into my thoughts.”

CLIENT: Mm hm.

THERAPIST: “And maybe that’s a mistake. Maybe if I have a spontaneous feeling, I have a feeling that comes out of my unconscious, let me allow that to exist.”

CLIENT: Right.

THERAPIST: “Like it has a right to exist. Like, because it showed up it’s legitimate.” Does that make sense when I say that?

CLIENT: Right. Right.

THERAPIST: “If I had the feeling, I’m having the feeling, and I’m going to give it positive space and maybe nothing will happen after that. Maybe it will just, anything that’s fully experienced will just dissolve away. And if it doesn’t dissolve away, well we’ll see what happens next.” I guess. Right? [00:04:54]

CLIENT: Right. Yeah. Some other things I noticed where, you know, I might get fixed on a pattern of, you know, talking about different senses. You know, I gave the potato chip example. That I was more aware of not going on that route, it seemed like it was actually fairly easy to not get stuck in that routine.

Example, we were at a friend’s house on Friday or Saturday. There was some buffalo chicken dip and some chips and I was eating them. And once I almost caught myself kind of getting stuck in a little, you know, “one chip, two chip, three chip.” Then I just had one and that was done and I kind of walked away.

THERAPIST: But did you walk away to not be tempted to get into the pattern.

CLIENT: Kind of, yeah.

THERAPIST: Oh, because it’s kind of new for you and you don’t want to -

CLIENT: It’s kind of new, yeah. Tempt fate, yeah. (laughs) Right. Alright, the best thing to do is let me just, yeah. [00:05:55]

THERAPIST: Which is fine. You’re trying out something brand new -

CLIENT: Yeah.

THERAPIST: and instead of getting stuck in it, let me just divert. Right?

CLIENT: Yeah.

THERAPIST: I mean, you don’t have to sit there and torture yourself in some ways.

CLIENT: Right.

THERAPIST: So you just go, “Well, okay, I’m just going to get up and leave.” So, okay. You know. And what happened?

CLIENT: Nothing.

THERAPIST: No. Okay.

CLIENT: (laughs)

THERAPIST: So interesting.

CLIENT: So I think a lot of it So in the past it seemed like kind of like conscience or unconscious, or whatever, almost controlled me.

THERAPIST: Mm hm.

CLIENT: And it was like I was being controlled by it. But now it’s like I can -

THERAPIST: But wait a minute. So let’s slow down there “I was controlled by it,” how?

CLIENT: With the either thought of uncertainty or negative repercussions by not satisfying that pattern or repetition.

THERAPIST: Okay. And you labeled that as your unconscious?

CLIENT: Well, I don’t know what you label it. [00:06:58]

THERAPIST: Okay. And so you were controlled by that. And so now what?

CLIENT: Now it’s like I’m in a new sort of way to think about it where I am really the one in control, and it doesn’t need to feel a certain way when I do something for it to feel like it’s satisfied. You know? Things can just happen and the thoughts can happen, and it doesn’t have to “Oh my God. I thought about that.”

THERAPIST: Mm hm.

CLIENT: You know, “That’s crazy. I need to really think about why I thought about that.” And keep thinking about why did I think about it. And I kind of pushed that aside because that doesn’t need to happen.

THERAPIST: So, I’m going to try to restructure that a little differently and see if this makes sense to you.

CLIENT: Okay.

THERAPIST: And I don’t mean to be like angels dancing on the head of a pin but -

CLIENT: Right.

THERAPIST: when you said, “My unconscious was controlling me, and then...” Right? I would tend not to put it on my unconscious. [00:08:05]

CLIENT: Okay.

THERAPIST: Because I think what we’re finding out is, you know, my unconscious is fine. It has, you know, some spontaneous thoughts and some spontaneous feelings and some reactions from history and so forth. And then the OCD tendency comes in.

CLIENT: Right. Right.

THERAPIST: And that’s really a thought process.

CLIENT: Right.

THERAPIST: So that’s less the unconscious. See, I would rather give the unconscious respect -

CLIENT: Okay.

THERAPIST: and a little space. That’s what you did around the chip really, right? And then, you know, the unconscious produces that, then the OCD tendency comes in and says, “You’ve to fix that.” So I’m hearing that so I’m not changing anything about what you did.

CLIENT: Right.

THERAPIST: I’m just kind of relabeling it a little bit because -

CLIENT: Okay.

THERAPIST: I want us to consider the unconscious as relatively healthy.

CLIENT: Okay.

THERAPIST: Alright. And then there’s the pattern. And I hesitate to say, “Oh well, simply because you’re breaking the pattern,” I hesitate to call that, “Oh, there’s a habit that I’m just breaking,” because this is more rough, tougher than a habit. [00:09:20]

CLIENT: Right.

THERAPIST: So we don’t want to diminish it down to a habit. The reason you might say that is because you notice how easy it is to reverse it.

CLIENT: Yeah.

THERAPIST: When you think differently.

CLIENT: Yeah.

THERAPIST: So, I want to reinforce that you have a pattern that you experimented with this week that is powerful enough, simple, but powerful enough to reverse the tenacious hold that OCD has had on you. But what I was trying to say to you before, this is not complex -

CLIENT: Right.

THERAPIST: but it is, but OCD tendencies are quite powerful. And we want to have deep respect for them because, boy, when you get under stress they are right -

CLIENT: Yeah.

THERAPIST: They love that.

CLIENT: That’s right.

THERAPIST: As soon as you’re vulnerable, weak, tired, threatened, got something big happening, that’s when it comes in. [00:10:27]

CLIENT: Yeah.

THERAPIST: So we want to keep respect for the OCD tendency too. But I want you to also be appreciating you’ve got a clever little maneuver. And if you can be working it and practicing it on these lower level ways like you are, you can lock into that routine -

CLIENT: Mm hm.

THERAPIST: and start breaking it. How are you receiving my kind of reframing or relabeling it?

CLIENT: I think I’m doing good with that. I think maybe I might need maybe one or two more examples of how I can go about the way I was trying to, if you call it, “correct” the pattern. Unless there’s a -

THERAPIST: You were doing it.

CLIENT: Right. Right. I just didn’t know if there was any other examples of something, or if that’s a good way to.

THERAPIST: Well you got any other examples this week?

CLIENT: No.

THERAPIST: Nothing came up at work? Nothing?

CLIENT: No. I do notice though, like when you said, if you start to get nervous or something or, you know, a presentation at work, whatever, you know, a normal person probably gets a little anxious an that’s normal. And I do notice -

THERAPIST: Or a lot anxious. [00:11:37]

CLIENT: Yeah.

THERAPIST: You know, it depends on what the risk is.

CLIENT: But it does seem like if there’s, you know, a situation that maybe makes me feel uncomfortable or excited, it is easier for those OCD patterns to kind of come in and try to make you feel more eased, but -

THERAPIST: And do you know how it does that?

CLIENT: I don’t.

THERAPIST: What it might say to you? Because the typical way that it does is it’s going to look for those opportunities and say, “This is too expensive not to fix.” Or, “You’ve got a lot riding on this.” Or, “You’re going to need your mind focused well here.”

CLIENT: Right.

THERAPIST: And so you you’re not going to want to keep going with this confusion in your head.

CLIENT: Exactly.

THERAPIST: You’ve got to clear the slate so you can get back to work.

CLIENT: Mm hm.

THERAPIST: That’s the seductive piece of it. So that’s why I’m saying when something big is coming up, or [00:12:40]

CLIENT: I think I’ve experienced that. I don’t have a great example, but I know what you’re saying where something big is coming up and you’re like, “I’ve got this feeling that’s going to take me over. I need to get rid of it.” And you do this pattern to get rid of it.

THERAPIST: Right. And, “I’ll just do it for now.”

CLIENT: Yeah.

THERAPIST: I’ll do it for this one because this is important.

CLIENT: Exactly.

THERAPIST: And when you start giving an inch it’s going to take a yard.

CLIENT: Oh definitely [take a yard.] (ph) “I’m going to do this pattern one more time to get rid of this feeling.”

THERAPIST: Right. And you start to negotiate.

CLIENT: “And I’ll be fine.”

THERAPIST: We’ll you start negotiating.

CLIENT: Well, you think you’re fine. (laughs)

THERAPIST: Yeah. Right.

CLIENT: Yeah. No, that’s interesting.

THERAPIST: I’ll give you two examples. When I had a kid you know, they’re all kids now but early twenties, and he had kind of a tic, more like a tic disorder, but his belief in his head was, “If I can contort my body in just the right way, one time, I’ll be free forever.” And so he would literally do things -

CLIENT: Oh right.

THERAPIST: that curled himself up to try to get it right, because there was that belief, “If I can get it. I just have to do it once and now I’m free.” [00:13:47]

CLIENT: Mm hm.

THERAPIST: And, of course, then he’s crippled. The other example is a lot of the stuff that happens with people that feel like they’ve done, they’ve hit somebody in the road or they felt a bump and they don’t know.

CLIENT: Mm hm.

THERAPIST: You know, it’s like, “If I don’t turn around now I’ll never find this spot again.” And a number of people with that particular one it’s like, “I will regret “ (laughs)

CLIENT: Right.

THERAPIST: “I’m going to regret going any further.” And just the whole thing of, “just to be safe.” “I don’t know. Maybe it was nothing, maybe it was this. But “ So here’s a good example of the content dominating them, like this is really a big deal.

CLIENT: Mm hm.

THERAPIST: And the moment, like “If I don’t do it now it’ll be lost to me forever.”

CLIENT: Right.

THERAPIST: Right. People with contamination will do that too. “If I don’t wash now, actually when I bring this ‘whatever’ inside my home, everything will then be contaminated. And so, you know, I’m at the threshold here.” [00:15:01]

CLIENT: Right.

THERAPIST: “Is it worth it.” So most people with the OCD tendencies have that. That’s how it gets you.

CLIENT: Mm hm.

THERAPIST: So how do you relate to me with that.

CLIENT: I don’t know if I’ve really had, you know, feelings like that. But, you know, for instance sometimes I realize little things that I’ve, what do you call them, tics or whatever. Sometimes if I’ll blow my nose I’ll notice that I’m kind of wiping and wiping and wiping. And I’m like, “What am I doing.”

THERAPIST: Mm hm.

CLIENT: Done. I don’t need to be in this special routine where I go up this way, that way, up, down, left, right, whatever it is. You know?

THERAPIST: Mm hm. Mm hm.

CLIENT: I just notice there’s little things like that that I’ve -

THERAPIST: Right. Because when we start to have at tic thing like that -

CLIENT: Yeah.

THERAPIST: And I’m doing this only because you’ve now made me itch my nose.

CLIENT: (laughs)

THERAPIST: So we get the tic thing, you’re typically not going to have an obsession.

CLIENT: Okay.

THERAPIST: Right. So you’re going to just go, “What am I doing?”

CLIENT: Right.

THERAPIST: That’s why it’s an OC spectrum disorder because it’s got mainly the compulsion and very little of the obsession. It’s like, “Oh, if I stop doing this it’s not going to do anything, it’s just that it “

CLIENT: Yeah, and I think I noticed through the -

THERAPIST: It’s just an urge.

CLIENT: time (ph) when I’ve noticed that I’ve had these, what do you call them, tics or little things. Some of those things might come and go. [00:16:20]

THERAPIST: Mm hm.

CLIENT: You know, for maybe six months I’ll kind of wipe my nose -

THERAPIST: Of a pattern.

CLIENT: A pattern. Then it will completely go away.

THERAPIST: And it will get replace after a while.

CLIENT: With some other pattern.

THERAPIST: Yeah.

CLIENT: You know, maybe I’ll wash my hands now because I’m worried about germs, but I’ll just wash them until I feel like I’ve washed them enough.

THERAPIST: Mm hm.

CLIENT: Which doesn’t really make sense because you’ve washed them, whatever. But you know what I’m saying.

THERAPIST: Well let me just ask you about, “I’m going to wash them until I know I’ve washed enough.” What is the signal of “enough?”

CLIENT: I don’t know. Just until it feels like the physical touch of you’ve got all the soap off, or it’s enough.

THERAPIST: Yeah.

CLIENT: (laughs)

THERAPIST: Well, what we might think goes on is, I wash until I get a physiological sensation that little kind of psycho-physiological relief, and then I say, “I’ve washed enough.”

CLIENT: Yeah, pretty much.

THERAPIST: Now people who are really in contamination they’ll say, “I’ll wash until I feel clean.” And I try to challenge that with them because I don’t think it’s about clean. [00:17:32]

CLIENT: Mm hm.

THERAPIST: I think it’s about the psycho-physiological kind of shift came. I became less distressed, I then claim, “Oh, I’m clean.” But it’s not about clean it’s about something else that goes on. Right?

CLIENT: Right. I think noticed, like I have some little thing that I might get in a pattern on, and it doesn’t really have any repercussions if I stop. I think there’s more now me recognizing that, you know, I don’t really need to do those things. And not getting stuck in a pattern doesn’t have any negative effects other than -

THERAPIST: Mm hm.

CLIENT: maybe for a short time I might feel a little anxiety but then that, you know, tends to go away.

THERAPIST: Yeah.

CLIENT: But it seems like, it’s funny, it’s almost like the more these patterns you pick up, the more you tend to pick up more. And it’s almost like an uphill thing, or that it seems that a lot of stuff you’re doing is in a pattern. But if you start kind of chopping those away, you kind of, I don’t know, it’s almost like you don’t even think about it as much. [00:18:38]

THERAPIST: And so can you be more specific around how you’ve noticed that?

CLIENT: Um. I guess, for instance, say, you know, one week I’m picking up a lot of patterns. You know, I’m doing my nose thing when I’m blowing my nose, I’m doing the hand thing. The more of those things I’m doing it seems like it’s easier to pick up more little -

THERAPIST: Ah, okay. Uh huh.

CLIENT: touchy feely things.

THERAPIST: Uh huh.

CLIENT: Or if I can kind of just nip it in the butt, recognizing, “Oh, I don’t need to “

THERAPIST: You did say, “Nip it in the butt,” didn’t you.

CLIENT: Yeah.

THERAPIST: As opposed to, “Nip it in the bud.”

CLIENT: Is that what it is? Bud?

THERAPIST: Yeah. It’s, “Nip it in the bud.” But that’s cute, I like that though.

CLIENT: (laughs)

THERAPIST: I did think I caught that.

CLIENT: Well, you know, I’m from Iowa. So, okay.

THERAPIST: Yeah. (laughs)

CLIENT: But if I notice a little thing I’m doing I just kind of cold turkey. You know?

THERAPIST: Mm hm.

CLIENT: I’m going to stop this little pattern. It seems like it’s a lot harder to pick up additional patterns. [00:19:38]

THERAPIST: Yeah, they just don’t start coming.

CLIENT: Right.

THERAPIST: Yeah. The other thing I was going to say before that, which is So that’s good to know that you can do it that way. And the other is, “Okay, well my patterns keep changing up.” So those are different. What is the same? What’s the common denominator if the type of routine changes?

CLIENT: I don’t know.

THERAPIST: Well what’s the lowest common denominator about all those?

CLIENT: You mean the -

THERAPIST: Of the tics.

CLIENT: The feeling of nothing, you mean? Or the -

THERAPIST: What did you say the feeling of?

CLIENT: The feeling of nothing.

THERAPIST: The feeling of nothing? What does that mean?

CLIENT: If I catch myself and I don’t do them, I mean I just won’t have a feeling of anything negative or foreign.

THERAPIST: Okay. But what is common among all the tics when you do them?

CLIENT: Oh.

THERAPIST: What is the common denominator? [00:20:47]

CLIENT: (pause) It’s almost like Hm. That’s a good question.

THERAPIST: Because the answer to that is what you intervened about. So you’ve got to -

CLIENT: So the feeling of satisfaction, I guess.

THERAPIST: Okay. From what?

CLIENT: A particular pattern of -

THERAPIST: Some time of movement pattern.

CLIENT: feel, a pattern.

THERAPIST: So that’s what you want to know. Right? Because it changes up all the time. It moves chess pieces around the board. But it is seeking out a relief or a sense of satisfaction by doing some routine physical movement or gesture.

CLIENT: Mm hm.

THERAPIST: Therefore to combat that I would have to need to tolerate what?

CLIENT: Tolerate the feeling of not doing those. [00:21:51]

THERAPIST: Which would be? If the feeling of doing them is satisfaction?

CLIENT: Unsatisfaction.

THERAPIST: Yeah. Right? So I’ve got to be willing to be unsatisfied.

CLIENT: Right.

THERAPIST: Frustrated.

CLIENT: Right.

THERAPIST: Right? Because that is how I overcome it is that I go, “I’m willing “ So you’ve got to have faith in the protocol or the treatment in some way.

CLIENT: Mm hm.

THERAPIST: Right? That this is going to help me. If you don’t have that, why would you suffer? So there is a way out of this. And so you’re starting to get some feedback that that’s possible.

CLIENT: Yeah.

THERAPIST: You know, I’m supposed to come across like I know what I’m talking about, because that’s the placebo, that’s the beginning. Which is, “Okay, he’s making it sound I think he understands me.” So two things from last time that I wanted you to have. “I think he understands me. He asked the right questions. He’s been here enough.”

And then, “I get what he’s suggesting is a little kooky, but I get it, it makes some sense.” Enough for you to then try it out. And then we’ve got on top of that the experience that you’re having. [00:23:00]

CLIENT: Mm hm.

THERAPIST: Which is required. What just happened this last week is required that you go, “Okay, well I did that. Here’s the feedback I’ve got.” Now we can double down on the theory, you know, the protocol, the sense of it. Now we’re talking about tics and go, “Okay, well, if the tic disorder has me be drawn to a particular ritual in order to feel satisfied “

CLIENT: Mm hm.

THERAPIST: “ or get rid of a sensation, then if I’m going to undo that I’ve got to be willing to risk feeling dissatisfied.” Or another word that we might use is “unfinished.”

CLIENT: Right.

THERAPIST: I’ve got to feel unfinished. This doesn’t feel done to me. And so that’s what I’m going to shoot for. I’m going to shoot for a feeling of being undone because the disorder will dominate me out of my desire to feel complete. [00:24:05]

CLIENT: Mm hm.

THERAPIST: Right? So then we can go right back, you know, that’s the tic stuff, and we go right back to the OCD stuff. It’s the same kind of way. I’m not going to feel finished unless I say something to her, unless I end on this certain number, and so forth [to be well] (ph).

CLIENT: Mm hm.

THERAPIST: Okay. Well, you start seeing how it all fits together. That’s what we want. We want to have a common protocol that anytime any reasonable facsimile of what you’ve got now rises up later, you go, “Oh, well now this is a new one.” You’re going to get caught by new ones.

CLIENT: Right. I think the one thing that I’m I tend to frustrate myself easy. So, for instance, you know, I practiced what we learned last time. You know, I think it worked pretty well. And, you know, there was times where I might have felt a little, whatever you call it, unsatisfied or whatever. But then I think a lot of times I’m too hard on myself, where I start questioning, “Well, why do I even have these repetitions and patterns.” [00:25:10]

And it’s almost like playing devil’s advocate. “Well, why do I even do this.” And it’s almost like, you know, I blame myself for having some of these things when I’m trying to get over them. And it’s like you can’t get over them unless you don’t blame yourself. And it’s like you’re chewing on an egg.

THERAPIST: So what do you think about that? So you felt some of that this week where you also gave yourself a hard time?

CLIENT: Yeah, I mean, [it’s a hard] (ph) time.

THERAPIST: Yeah.

CLIENT: I think once you kind of recognize some of these patterns and things, you know? I was talking to my wife last night and I’m like, “You know, it’s easy to frustrate myself because,” I told her, I go, “I’m frustrated that I would even begin to think when you say something or do something, if it doesn’t feel right to me, or if it doesn’t come out of your mouth the way I think it needs to come, that I feel upset.”

I set it up, so that’s me, that I’m even beginning to be frustrated. (laughs) That I go, “It doesn’t make sense.” You know? I said, “I’m working on it.” And I said, “But it just “ Just an example of, like I think I’m doing pretty well on, you know, putting into practice what we learned. It’s just sometimes it’s a little reminder of like, why do I even have these, you know, tics. Or, where did the come from? [00:26:24]

THERAPIST: And where does that question go? What happens after you pose that question?

Where are you heading when you pose that question? Are you heading to a self-critical, self-demeaning place? Or are you heading to a kind of analytic, “I’ve got to figure this out,” thing?

CLIENT: Um. I think it starts to be a little analytical and then I just start to get kind of like, I just kind of let that go and I just get maybe just a little bummed for a little bit, but not too long. Or I’m just like, “This kind of sucks.” You know? “I’ll get through it” You know?

THERAPIST: Mm hm.

CLIENT: Kind of a, you know, “I can’t help what I’ve been doing, but now I can.”

THERAPIST: Mm hm.

CLIENT: And it’s like I guess I can’t blame myself too much for the, you know, bad behaviors I’ve -

THERAPIST: Oh, sure you can’t. I mean you can.

CLIENT: I can, yeah. (laughs)

THERAPIST: It’s like one of the thoughts to be pulling up at that point, if you’re trying to get some perspective, is “How is this thought helpful right now?” Just go with pragmatic stuff. So when you start to do the, you know, when you go, “Well why is this even happening?” [00:27:42]

I think it probably is in two domains. It’s either you’re going to go down an analytic path and you just want to, that’s going to be bad form. You know, as soon as you start trying to analyze, “Why might I be doing that?” you’re going back up into a thinking process. And thinking processes are, you know, really the poison of the disorder.

CLIENT: Yeah.

THERAPIST: The tendency. So, you know, when you think, “Oh, I’m stepping back right now and looking at my patterns, and trying to analyze why I’m doing that.” No, you’re obsessing and then you’re having an urge to compulse. So when you obsess is typically a question. You know, “Why is that happening?” And then searching for the answer is the compulsion. “I’ve got to go if I can get this answer.” Right?

CLIENT: Yeah.

THERAPIST: But it just, you’re going to chase your tail. So when you can catch yourself going, “Well, why did I just do that?” You want to step back and go, “Oh, I’m doing it.” Right?

CLIENT: Yeah.

THERAPIST: This is one of the trickiest pieces -

CLIENT: Yeah.

THERAPIST: around it. It’s under the auspices of trying to understand, “I’m doing an obsession again.” And then, “I’m doing a thinking ritual.” So you’re not doing an action and that’s why it gets tricky. Anytime you start doing a thought to resolve something, that is a compulsion. [00:29:12]

CLIENT: Yeah.

THERAPIST: Does that make sense to you?

CLIENT: Yeah, it does.

THERAPIST: And the obsession is the question. Like, you know, if you go in the kitchen and you look on the floor, you go, “Oh, why is there water on the floor.” And then you go by the refrigerator and you go, “Well, gosh let me take this plate off. Is it coming out of that? Is the freezer messed “ You know?

CLIENT: Yeah. (laughs)

THERAPIST: And there you are.

CLIENT: [I can see that.] (ph)

THERAPIST: But that’s the appropriate way to do it. You’ve got a leak on the floor, you’re going to go analyze what’s going on and find out. But that’s the same pattern here when you go, “Oh, why is this going on. Let me figure it out. If I can figure it out, I’ll reduce my pain,” or whatever.

CLIENT: Mm hm.

THERAPIST: So there’s that component. Does that make sense to you?

CLIENT: Yeah, it does.

THERAPIST: And what do you need to do when that’s going on?

CLIENT: Recognize you’re going into a pattern and just feel whatever feeling you’re having and not go into the analytical.

THERAPIST: Right. So another way to think that is, allow the question to come up and don’t answer it.

CLIENT: Right.

THERAPIST: Don’t look, you know Which means that will cause frustration -

CLIENT: Mm hm.

THERAPIST: because there is a part of you that has obsessed, which is the question. And you’re not going to answer the question and that part of you is going to go, “What do you mean you’re not going to answer it? No, you need to answer it.” So there’s going to be an urge to answer it. [00:30:37]

CLIENT: Exactly. (laughs)

THERAPIST: Right? And then there’s also going to be some distress because there’s a question on the table that you’re not answering, and that’s anxiety provoking because -

CLIENT: Mm hm.

THERAPIST: Right? So you’ve got to go, “Okay, well there’s ‘I want to be frustrated right now. That’s exactly what I want to do. That’s part of the treatment.’ And of course I’m going to feel anxious because it’s an anxiety source.”

CLIENT: Mm hm.

THERAPIST: It’s what we do. We produce thoughts or feelings or impulses or images that make us feel uncertain and anxious.

CLIENT: Uh huh.

THERAPIST: And so I’m going to go toward being unsure, because I’ve got a question now and I’m not going to answer it. And I’m going to feel anxious. Excellent. Practice it now. Alright?

CLIENT: It’s crazy, sometimes I feel like you’re plugged into my brain and you can just like regurgitate whatever I am (laughs)

THERAPIST: Okay, but that’s what I want you to think -

CLIENT: No, I see.

THERAPIST: because then, again, you go back to, “Oh, he understands me and he’s “

CLIENT: You know, one of the things I -

THERAPIST: Let me say, one of the things we’ve got to do is this other piece over here, which is the kind of mood problem that comes in around -

CLIENT: Right.

THERAPIST: the question. But we’ll get back to that. Go ahead. [00:31:45]

CLIENT: Well one thought was the way I’ve got to be careful with this analytical thing is, being a software engineer and a mathematician probably doesn’t help me. (laughs)

THERAPIST: Yeah, this is what we do. Yeah, we engineer, we look for problems and solve them.

CLIENT: So I think that’s, I’m generally a very analytical person and it’s probably, for my job it’s really good. But, yeah, I need to separate -

THERAPIST: But there’s that obsessive compulsive tendency -

CLIENT: Right.

THERAPIST: that you use for your betterment. You know, “I’ve got an obsessive compulsive tendency in all the good ways because I can organize a lot of information and synthesize it down. I can track, you know, or follow something and track it.” So all those things are good. That makes you a good engineer.

CLIENT: Mm hm.

THERAPIST: We don’t want to give those things up. But you take one further step to the left and all of a sudden you’ve got you’re susceptible to, you know -

CLIENT: Yeah.

THERAPIST: Like I can get susceptible to worrying sometimes, so. [00:32:48]

CLIENT: Yeah.

THERAPIST: I’ve never had an anxiety disorder, I’m not trying to say, “Hey, I’ve fixed myself and now I can help you.” But I have an affinity towards all that. So what about this other piece around, because you -

CLIENT: (sigh)

THERAPIST: So the other piece around you going, “Why did I even have that thought in the first place,” I think is that kind of mood -

CLIENT: Mm hm.

THERAPIST: bring yourself down, and so forth. But that’s not OCD, that’s mood.

CLIENT: Okay.

THERAPIST: Right? There’s the anxiety and then there’s the kind of depressive piece or mood piece, which is, you know, sinking in and “What’s wrong with me?”

CLIENT: Yeah.

THERAPIST: And, “This shouldn’t be happening but it is. I’m not “

CLIENT: Yeah.

THERAPIST: “I’m not a whole person or I’m not, you know, this is a flaw.” And so, go ahead.

CLIENT: See I don’t ever feel like I get, you know, real hard on myself where I’m so low I’m just like, you know, can’t go to work, can’t get up or anything. But I feel like sometimes I’m just, like you said, get stuck in those analytical things where it almost starts to beat you up and you start feeling [00:34:02]

THERAPIST: “It” starts to beat you up.

CLIENT: Whatever thought -

THERAPIST: Oh.

CLIENT: you’re rehearsing, or whatever. Or, when you recognize you’re having these little tics or obsessions it sometimes, just I feel like I’m too hard on myself on accepting that I, you know, I’m trying to overcome a pattern of thought or certain behavior. And, you know, usually like I want something fixed (snap) right now.

THERAPIST: Mm hm.

CLIENT: You know, so I’m -

THERAPIST: But talk from the voice of being too hard on yourself. If you were a hundred percent that voice, what would you be saying?

CLIENT: Um. (pause) (whispers) What would I be saying? (pause)

THERAPIST: So you had this thought around your wife and you want her to say something in particular, and then you go, “Oh God, I can’t believe I had that again.” And then you get hard on yourself.

CLIENT: Yeah. Yeah, I just start to feel kind of like -

THERAPIST: What would that voice say if you played a hundred percent that voice? [00:35:04]

CLIENT: Um. You know, almost like, “What’s wrong with you?” Or, you know, “Why are you doing this to your relationship.” And then it starts, you know, devil’s advocate and saying, “Well, we’re really good together.” You know, I’m maybe not good to her and I’m having these negative thoughts and I think it’s just more it tends to fall on the analytical piece, like you said. Or the twenty questions. And I think that just kind of wears me out.

THERAPIST: Right, but I’m going to challenge you around that.

CLIENT: Okay.

THERAPIST: Around you say, call it, “The twenty questions.” But are those twenty curious questions?

CLIENT: Yeah.

THERAPIST: Really?

CLIENT: Well, I don’t know.

THERAPIST: Because they don’t sound like it. They sound like they’re being used to -

CLIENT: Yeah.

THERAPIST: put you down.

CLIENT: I think it is.

THERAPIST: As opposed to, “Wow, why did? Then that’s interesting. Why did, when she said that, why at that moment?” [00:36:08]

CLIENT: Yeah. Right.

THERAPIST: “Well, I wonder what was going on in that moment?”

CLIENT: No, you’re right. They’re not -

THERAPIST: I think you come across with a higher voice curiosity. Like, “Why is the engine not starting right now. Let’s trace the line and see.” You know? Like it’s not that. Well, what is it then?

CLIENT: Yeah, I think, yeah, you’re right. It’s not real like a high ending curious. It’s more of a -

THERAPIST: It’s not a problem solving.

CLIENT: Right, it’s more of a demeaning thought process, question, that goes down the route of piling bricks on my back of either doubt or negative -

THERAPIST: One second. So hold on. So if the questions What are the questions implying? What’s the statement behind the questions as we focus more on this voice? Is it, “What’s wrong with you?” Or, “There’s something wrong with you.” Or, “She doesn’t deserve this.” “Why are you doing this?” [00:37:10]

CLIENT: I’m trying to think.

THERAPIST: I don’t want to put words in your mouth.

CLIENT: Yeah, I’m trying to give you a good example. Um. (pause) I think it’s almost like I’m asking myself like, “Why am I doing this?” Like going to this round of repetition.

THERAPIST: Okay. Stop. So you say, “Why am I doing this?” So take that phrase and that question and What’s behind that question? What’s the position behind it? If it’s not a curiosity -

CLIENT: Well, it’s definitely negative.

THERAPIST: Right. So if we get rid of the question mark and answer that, you would come up with what? (pause) See, you’re disguising something by going, “Why are you doing this?” I mean I can say that to somebody. “Why are you acting this way?” I’m not asking them a question, I’m making an implication. [00:38:13]

CLIENT: Right.

THERAPIST: And so what’s your implication when you go, “Why are doing this?”

CLIENT: It’s almost like I’m so used to negative thoughts sometimes fueling me, or fueling me into -

THERAPIST: What’s the negative thought?

CLIENT: I don’t know, it could be -

THERAPIST: “Why are you doing this?” What’s the negative thought?

CLIENT: I don’t know if I can answer that right now.

THERAPIST: How does it make you feel? What emotion do you end up having when you go down that track?

CLIENT: Just tired, frustrated, just with myself, I guess.

THERAPIST: Tired with my What’s another word for “tired?”

CLIENT: Tired of feeling frustrated, I guess.

THERAPIST: Okay, but tired is this physical thing.

CLIENT: Right.

THERAPIST: So what’s an emotional thing. “Frustrated,” is emotional.

CLIENT: Mm hm.

THERAPIST: I’m frustrated with myself. Any other emotion with that?

CLIENT: Exhausted. I guess that could be physical.

THERAPIST: That’s physical. [00:39:20]

CLIENT: Yeah.

THERAPIST: Uh huh.

CLIENT: Overwhelmed.

THERAPIST: Okay. So, let’s split you in half, right?

CLIENT: (laughs)

THERAPIST: So we’ve got kind of, I’m trying not to put words in your mouth, but there’s a critic -

CLIENT: Right.

THERAPIST: that’s frustrated with what you’re doing.

CLIENT: Mm hm.

THERAPIST: So there’s kind of a, you’re irritated, disappointed critical voice.

CLIENT: Mm hm.

THERAPIST: Is that fair?

CLIENT: Yeah.

THERAPIST: You know, then there’s the guy that’s receiving that. How does it feel to be feeling, receiving criticism and disappointment and frustration. What’s it like to be on the receiving end. Because you’re also receiving that.

CLIENT: Right.

THERAPIST: You’re giving it and you’re receiving it. That’s why I’m splitting you. Right?

CLIENT: Mm hm.

THERAPIST: You are giving it, but you’re giving it internally to yourself.

CLIENT: Mm hm.

THERAPIST: What’s it feel, what’s it like to be on the receiving end of that?

CLIENT: Just overwhelmed might be a good word for it. [00:40:31]

THERAPIST: Okay, “overwhelmed” like a younger part of you that there’s these expectations on you that you can’t meet.

CLIENT: Yeah.

THERAPIST: And yet you’re having to do the action. What do you feel right now when we talk about it?

CLIENT: Um. I guess I’m a little, I feel a little anxious right now, but -

THERAPIST: Your eyes look a little sad.

CLIENT: Well -

THERAPIST: I may be misreading -

CLIENT: No, no.

THERAPIST: No.

CLIENT: I think I’m just trying to search for a good (sigh) answer to give you on how exactly I feel. But I think sometimes I don’t know how exactly I feel.

THERAPIST: Okay.

CLIENT: Um.

THERAPIST: Yeah, and I’m kind of coming at you, so it’s hard. It’s not easy for you.

CLIENT: Yeah.

THERAPIST: But I do image you when you’re talking with your wife and having that go on, and I’m imaging you kind that sulky kind of place that you get to. [00:41:34]

CLIENT: Mm hm.

THERAPIST: And that’s the feeling I’m looking to understand.

CLIENT: Right. I think I just kind of shut down.

THERAPIST: Right. And so I’m thinking there’s this demeaning part, and then there’s the part that shuts down in response to it. So if we don’t get this piece up here, the top dog -

CLIENT: Then you won’t get the bottom one.

THERAPIST: Because the bottom dog is in response to the top dog position.

CLIENT: Right.

THERAPIST: So we do want to start addressing him. And there is another voice that’s available to you that feels compassion for what you’re going through. “Because, you know, this is a mental thing that happens and I’m working on it,” and so forth. So there’s a kind of a supportive, nurturing side of you that would take care of any kid that was going through this. Right?

CLIENT: Oh yeah.

THERAPIST: And then there’s this kind of top dog critic, “What’s wrong with you? Why are you doing this? She doesn’t deserve this from you,” part. What I would suggest is that we use this side to quiet this side. Because if you don’t get a hold of this side, you’ve got these three pieces -

CLIENT: So, give me an example now. [00:42:54]

THERAPIST: You’ve got the critic.

CLIENT: Yep.

THERAPIST: Like, “What’s wrong?”

CLIENT: Mm hm.

THERAPIST: “Why, you know, can’t you get it together.”

CLIENT: Mm hm.

THERAPIST: You’ve got the part of you that’s having to perform under the pressure of the critic.

CLIENT: Mm hm.

THERAPIST: Like your Dad breathing down your neck when you’re trying to do a proof -

CLIENT: Mm hm.

THERAPIST: or something. You’ve got those two sides.

CLIENT: Mm hm.

THERAPIST: You’ve got this other part of you that’s available, we know you have it in you, which is a caring and nurturing and you’d be, you know, if a kid fell down and skinned her knee, you would take her into your house and clean off her knee. You’ve got that part.

CLIENT: Mm hm.

THERAPIST: That is being underutilized right now. So what happens is you’ve got a critic and then you’ve got the guy that’s getting victimized by trying to go, you know, “Could you get off? This isn’t fair.”

CLIENT: Mm hm.

THERAPIST: But he’s not very strong. The part of you that could feel compassion for you is also a limit setting part. “Hey, back off. Stop. Don’t run him down.” You know? “This is not helpful.” [00:44:01]

CLIENT: Mm hm.

THERAPIST: And that’s what I want.

CLIENT: So, how do I -

THERAPIST: Next time we talk to each other -

CLIENT: Okay, we’ll discuss that.

THERAPIST: Next time we talk, let’s talk about coming from this position of, “It’s not helpful right now.” You know? The question I asked before is, you can ask yourself, “Is this a helpful thought?” Right? But sometimes when this critic comes in you need to have a voice inside you that goes, “Hey, enough already.”

CLIENT: Right.

THERAPIST: Alright? “We’re doing “ Okay. That’s all that I’m saying.

CLIENT: Okay.

THERAPIST: Because there’s no This little pattern we’re talking about is not a (snaps).

CLIENT: Right.

THERAPIST: Not like the OCD thing is.

CLIENT: Right.

THERAPIST: Where you can flip it around. This one we just need to talk a little bit further about it because think that’s a different piece.

CLIENT: Okay.

THERAPIST: We’re all complex people.

CLIENT: (laughs)

THERAPIST: It’s not that complex.

CLIENT: Right.

THERAPIST: But it is a mood thing that’s kind of getting you sulking and drag your tail around for three hours or whatever.

CLIENT: Yeah, yeah.

THERAPIST: Uh huh. You’ve got enough to keep doing the practice you’re already doing?

CLIENT: Okay. Yeah.

THERAPIST: Let’s go two weeks.

CLIENT: Okay.

THERAPIST: I’m not here next week so we don’t have a choice about it. [00:45:13]

CLIENT: Okay.

THERAPIST: And let’s see how that’s going. We’ll see where we are in two weeks.

CLIENT: Okay.

THERAPIST: And how you’re doing and how things are playing out.

CLIENT: Right. I do feel, from the side of, you know, just the occasional time where, you know, you talk about the frustrated piece up here attacking down here -

THERAPIST: Mm hm.

CLIENT: In general, I feel very positive about the experience I’ve had in talking with you and coming up with, you know, corrective measures.

THERAPIST: Yeah.

CLIENT: So I do feel like [sort of good about that] (ph).

THERAPIST: So, we just want to, let’s get it all in place -

CLIENT: Yeah.

THERAPIST: and like it’s a well-oiled machine. And we’re just going to go session by session. Next time we may decide you don’t need to be back here because you got what you need.

CLIENT: Sure.

THERAPIST: We won’t have you come back for a month, or whatever.

CLIENT: Right.

THERAPIST: Or we’ll see where we are and we’ll put another one in place.

CLIENT: Yeah.

THERAPIST: And a couple of weeks after that. We’ll just go session by session. We’ll stop when you feel like -

CLIENT: Okay.

THERAPIST: nothing else that you really need.

CLIENT: Sure.

THERAPIST: And you’ve got it together or you want to put some space in, or whatever. [00:46:18]

CLIENT: Okay.

THERAPIST: Does that seem like an okay way to go?

CLIENT: Yeah.

THERAPIST: Okay. So we -

CLIENT: I actually feel when I leave, like I feel like when I left last time, like it gave me confidence in understanding more about myself -

THERAPIST: Yeah.

CLIENT: so that I could go correct things that -

THERAPIST: Right.

CLIENT: Yeah. So I mean it’s -

THERAPIST: That’s what I want. I want you to have confidence about that so that you can be courageous around those times when you go, “I’ve got to do it the old way, because ehhh.” And then you go, “Well, I’m just going to step now “

CLIENT: Right.

THERAPIST: “ and throw the die.” It feels like I’m throwing the dice.

CLIENT: Mm hm.

THERAPIST: And, “Oh, well.” (laughs)

CLIENT: (laughs)

THERAPIST: I’m going to throw the dice. So the confidence helps you be courageous, and that’s what I want.

CLIENT: Yeah.

THERAPIST: And you’re doing fine. You’re right, you’re great, you absorbed the information, you utilized it immediately. You’re not throwing up a bunch of smoke here and fighting me around content.

CLIENT: Right.

THERAPIST: And, you know, as soon as you’re, once you’re here you’re going to be fine.

CLIENT: Okay.

THERAPIST: Where I get stuck with people is right from the beginning. Either they get it in the first session or they don’t get it in the first session. And it’s because I didn’t explain it well or they’ve got a lot of, they’ve got a big mass. [00:47:32]

CLIENT: Yeah.

THERAPIST: You know, we talked about inertia at the end after the tape was off. And their mass is so big they don’t want to change it. And I can work with people for years because of that piece.

CLIENT: Okay.

THERAPIST: And we don’t have that piece with you.

CLIENT: Good.

THERAPIST: And so this will be fast work. And we have an opportunity just to get that mood piece together too and get enough repetitions around this other thing. And now we’ve got fourteen days so that will -

CLIENT: Yeah.

THERAPIST: help us a little bit in clocking it. And, again, if you need to write things down because it’s two weeks, that’s good.

CLIENT: Mm hm.

THERAPIST: The only other thing that happens when there’s a two week space is that people do pretty well for the first four days and then they drop everything.

CLIENT: Sounds like a fitness class, more like. (laughs)

THERAPIST: Yeah, so I’m just letting you know, they sign up for the semester, or whatever, and they only go, whatever. So I want to highlight that to you, the tendency now, the mistake will be you’ll stay with it for four days and then you’ll go, “Ehhh.” Alright? So that’s in general what will go wrong now.

CLIENT: Okay. I’ll keep an eye on that.

THERAPIST: Okay.

END TRANSCRIPT