TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Welcome back.

CLIENT: Thanks.

THERAPIST: What’s the story?

CLIENT: Well, I’ve think I’ve made some progress forward and in some aspects I’ve maybe taken a little step back. I feel like after the last session I was feeling pretty positive, things were going pretty well. A lot of the physical OCD things I feel like I have a handle on. I feel like I have a pretty good handle on those an they’re not, you know, coming up as much.

THERAPIST: Does that include the screw driver?

CLIENT: Yeah.

THERAPIST: You’ve even had an opportunity around that?

CLIENT: Yeah. Actually this past -

THERAPIST: Or a reasonable facsimile of that.

CLIENT: And I just thought about this weekend I was putting up a deer stand in a tree. And all these different bolts and junk I had to put together. And actually yesterday I just thought about, “Well, that’s weird. I never really even got fixated on how many turns it had, if it was just right. I just got to the more the fact of, “I’ll make sure it’s nice and snug.” [00:01:07]

THERAPIST: Mm hm.

CLIENT: So it’s, you know, stable up in the tree.

THERAPIST: Well, how do you make sense of that? That it didn’t require conscious effort. You didn’t notice How do you make sense of it just spontaneously being normal?

CLIENT: I don’t know. (laughs) I guess I don’t -

THERAPIST: Any guesses?

CLIENT: Maybe there’s really no There’s something that’s not triggering in my head that something is either right or wrong with something being, you know, physically manipulated. Or it didn’t really even come up with a thought, I just -

THERAPIST: Well that’s what I’m wondering.

CLIENT: Yeah.

THERAPIST: How do you make sense of the fact that you didn’t even have to put out little conscious efforts and say, “Wait a minute. I need to -

CLIENT: Yeah.

THERAPIST: “ back off on that. And let me just be uncertain and uncomfortable.”

CLIENT: So I don’t know if it was just maybe just practicing doing things where I’ve kind of stopped that repetition. And then now maybe it’s more subconscious where you don’t have to really even think. [00:02:16]

THERAPIST: Mm hm.

CLIENT: I don’t know. I’m just guessing.

THERAPIST: Yeah, well I think that would be a decent guess or a hypothesis we could have.

CLIENT: Mm hm.

THERAPIST: Which is, “If I can do my side of it consciously enough, it will get relegated to the unconscious eventually. And also that it will generalize. Because you really haven’t had to work on that specific, I don’t think.

CLIENT: Right.

THERAPIST: I remember it from last time. And so maybe it also will start generalizing. The unconscious takes over and then you don’t have to -

CLIENT: Right.

THERAPIST: get triggered and have to use a lot of effort. It would be nice that were true -

CLIENT: Yeah.

THERAPIST: as opposed to some fluke. I don’t know that we have enough data yet.

CLIENT: Right.

THERAPIST: But it’s something to be thinking about.

CLIENT: Right.

THERAPIST: So, I mean, if you start noticing that, in hindsight, more, you know, it would be a nice conclusion to have. [00:03:07]

CLIENT: Right. No, I think the think I took a step back on, I think I’m I just, it frustrates me as I get, I feel like things get pretty normal where I’m not having any patterns with thought or physical things. And it’s like something in me tries to bring up some little thing that I start to analyze and think about an look at that might be like a negative thing. And then that triggers the whole, we talked about last time, there’s you know, stop that thought and don’t analyze -

THERAPIST: Mm hm.

CLIENT: down that route. And I think I get stuck in these little devil’s advocate scenarios where, we were camping, I don’t know if it was like three weeks ago or whatever, and it was my brother, my wife and his wife. You know, we were sitting around having some drinks, you know, and grilling, whatever. And I bring my little pistol and keep it concealed just in case an animal or something bad comes. [00:04:15]

And I had this random negative thought of, “Oh my gosh, what if I unconsciously in the nighttime were to harm somebody with this gun. You know, now I would never do that, I would never even think that. But that that triggered the thought of, “How come I even was worried about that happening in my subconscious.”

THERAPIST: Mm hm.

CLIENT: So then, you know, I woke up in the morning and I was like, you know, “Is everybody okay?” You know, my wife’s there, okay, good, she’s okay. And then I went down the path of my mind kept saying well, “How come you had that random potential fear?” And then I kept trying to analyze and analyze it. I’m trying to shut that out and I just -

THERAPIST: You were trying to shut which out? The analyzing?

CLIENT: The analyzing, yeah.

THERAPIST: Okay.

CLIENT: I mean it just seems like there’s little -

THERAPIST: How did you, how were you trying to shut it out? What were you attempting to do to shut it out?

CLIENT: Just stop -

THERAPIST: Do you tell yourself -

CLIENT: Yeah.

THERAPIST: “Don’t dwell on that?”

CLIENT: Don’t dwell on it.

THERAPIST: Oh. How did that work out?

CLIENT: Not very well.

THERAPIST: Ah. (snap) Darn. [00:05:20]

CLIENT: I think it, and that’s the thing I know you said to be careful about last time was tell yourself, you know, “Push that thought to the side.” Or however we talked about it and, you know, “Don’t analyze. Don’t go down that path.” And I caught myself giving the repetition of telling myself over and over, “Stop that thought. Stop analyzing.” And then I was like, I feel like I was back in.

THERAPIST: Mm hm.

CLIENT: You know, and I was like, “Shoot.” You know, I made some progress up and now I’m making some down.

THERAPIST: Well, there’s a point of clarification. We will work on something other than, “Stop that thought.”

CLIENT: Okay.

THERAPIST: Because that’s, I don’t want you to try to block the thought.

CLIENT: Right.

THERAPIST: When you attempt to block a thought or image it tends to increase.

CLIENT: Right.

THERAPIST: So we’ve got to more like manipulate that thought or, you know. [00:06:22]

CLIENT: (sigh)

THERAPIST: So I’ll tell you some things to do about it. Now three weeks ago? Weren’t we here two weeks ago?

CLIENT: It might -

THERAPIST: So that might have been an event prior to the last session.

CLIENT: Yeah. And I think, like I said, sometimes it’s not really even -

THERAPIST: You don’t recognize it as an obsession.

CLIENT: I don’t recognize it, or I don’t recognize the, you know, negative -

THERAPIST: You were here on October 22nd.

CLIENT: Yeah, I know. I think we went camping the second week in October.

THERAPIST: So it’s prior to that, yeah.

CLIENT: But it’s like sometimes, you know, there might be this random negative fear, thought like that and I don’t think much of it. And then when things start to normalize, it’s like my brain somehow is like -

THERAPIST: Come back to it.

CLIENT: “Well, what can I bring up to make me feel bad, negative.” And I just sometimes like, “Damn it! Just stop that!” (laughs)

THERAPIST: Any other backslides or struggles? [00:07:24]

CLIENT: No. Just the one before that was the first session where, you know, out to eat and you notice the other, you know, attractive woman and you feel bad. You know, that we talked about.

THERAPIST: Mm hm.

CLIENT: And that was, you know, the thing that I was obsessing about.

THERAPIST: No more of those?

CLIENT: No. No more of those.

THERAPIST: Oh. Okay. You were not looking at your friend’s wife as you were camping, I guess, no?

CLIENT: No. Not at all. No.

THERAPIST: Another great opportunity to practice if that had -

CLIENT: Well I have had other opportunities where if I’ve, for that same instance, you know, I’ll notice somebody, you know, attractive, I let that feeling come in, know that it’s not like I’m wanting that other person or anything, and letting that feeling exist. And I’ve been able to not feel that anxiety rush, I guess, that I used to. So it seems like that there are certain things I am better at overcoming and there’s other things that my brain tries to think of something negative that can bother me. [00:08:36]

THERAPIST: Mm hm.

CLIENT: Even though it’s not like a real thought. You know? And it’s just I don’t know how to get past that. It seems kind of different from the other situations we talked about. You know?

THERAPIST: So the camping trip thing is an example of that?

CLIENT: Right.

THERAPIST: Uh huh. Okay. Where you feel like it’s a drive of some inner part of you to have something to be focused on.

CLIENT: Yeah.

THERAPIST: Is that what you’re saying?

CLIENT: Yeah. That’s different.

THERAPIST: And why do you say that that’s different.

CLIENT: No, sorry. The difference this time is something very negative, like something bad happening. Like a gun and shooting someone. That’s bad.

THERAPIST: Uh huh.

CLIENT: That’s different from before where it was just the guilt feeling of noticing someone who is attractive.

THERAPIST: Uh huh. Okay.

CLIENT: But this time it was something that was like something bad could happen. And then that started to, you know, just eat at me. Like, “Why would I even have that thought?” You know, that would never happen. But if -

THERAPIST: Is that a brand new type of thought? Something bad happening is not a kind of thought you had? [00:09:42]

CLIENT: Not generally, I don’t think.

THERAPIST: Oh. So isn’t that interesting? Huh. So how rare do you think that kind of thought would be for people?

CLIENT: I’m not too sure.

THERAPIST: You ever been to the Grand Canyon?

CLIENT: Yeah.

THERAPIST: You ever sat on the edge of one of the cliffs?

CLIENT: No. I’d probably get a little scared of that.

THERAPIST: Well, what might you think?

CLIENT: I’d fall off.

THERAPIST: Yeah. I mean, because I can remember clearly sitting there and then all of a sudden having the thought, “You know, it wouldn’t take much for me just to pop my hands on the ground here and flip myself right on over.”

CLIENT: Mm hm.

THERAPIST: And then I stepped off. (laughs) I stepped back. I didn’t like it.

CLIENT: Right.

THERAPIST: My first grandchild was born back in January. So she’s nine months now. But when I went out to visit she was three weeks old and, you know, I’ve got two kids -

CLIENT: Mm hm.

THERAPIST: I’ve been around babies and so forth. But I was there five days and I probably had fifteen times when I thought, “Oh my God. I could drop her and hit her head on the coffee table. Oh my gosh. I could be walking out the door and her head on the threshold.” Right? My daughter and her son were going to go work out at Crunch gym and it’s on the second floor of an outdoor kind of mall area. [00:11:09]

CLIENT: Mm hm.

THERAPIST: So I was watching Emma and so I’m holding her and I can’t get within twenty feet of the railing because I’m having a thought, “I could drop her over to the traffic below and kill her and then jump over after her and kill myself.”

CLIENT: Mm hm.

THERAPIST: And, you know, I just stayed back. Fifteen times, you know, in three days probably or so, probably more at the beginning. What do you think of that? What’s wrong with me? Are you normal or abnormal? What do you think?

CLIENT: I think the initial of those fears I think would probably be normal. As far as, I don’t know how many times we would qualify as being normal. I mean fears are normal. But to -

THERAPIST: Well a flash of doing something harmful to an infant.

CLIENT: Yeah.

THERAPIST: You’re looking at me with a little suspect now.

CLIENT: Well.

THERAPIST: You know, are you wondering, “It takes one to treat one.” [00:12:16]

CLIENT: No. (laughs) I’m just, I know that sometimes there’s random fears or flashes that come up. But I think when you tend to obsess about it for days or weeks, like I have, I feel like that’s -

THERAPIST: But we’re only talking about right now. I’m just addressing having the flash in your mind, “Oh, my gosh. Could I grab this gun and harm someone?”

CLIENT: Right.

THERAPIST: I’m comparing that with what I experienced on the cliff and what I experienced with my daughter, and wonder if there’s, those don’t sound pretty similar.

CLIENT: Yeah, I guess they probably do.

THERAPIST: And for me, I would, with my granddaughter I would say, you know, “I love her like mad.” (laughs) I mean, it’s just and there’s this precious little infant that’s incredibly fragile. And I haven’t been around her and acclimated to holding her and so forth. And it’s the perfect scenario for OCD to come in.

CLIENT: Right.

THERAPIST: That’s what it looks for, that kind of scenario. And if I were prone to that, then I would be off to the race track. [00:13:20]

CLIENT: Right.

THERAPIST: But I’m not. But I think it probably accounts for why my mind was so active at that point.

CLIENT: Mm hm.

THERAPIST: Right? So we’ve got one thing of normalizing. I mean, I think it’s helpful to go, “Well, whatever. You know, I’ve got OCD. I’m kind of sensitive to having thoughts of harm -

CLIENT: Right.

THERAPIST: or bad things happening.” Because, you know, looking at another woman and getting all That’s still a bad thing happening.

CLIENT: True.

THERAPIST: So it’s just this one just has a, you happen to have a gun in your waistband. (laughs)

CLIENT: Right.

THERAPIST: So you’ve got a little provocative -

CLIENT: Right.

THERAPIST: circumstance. So there’s that piece which I think we want to go to the place of, “Fine, I just had that thought.” You know, one is, “I’ve got a gun in my waistband. I don’t do that very often and I’m in close proximity.

CLIENT: Yeah.

THERAPIST: “And people accidentally shoot their foot off by, you know, it’s in my pocket.” [00:14:25]

CLIENT: I think it was like the uncertainty of, you know, they’re dangerous enough as it is. And I practice so much safety around it, whether I’m hunting or in a range. And I think the fear was, you know, we’re sitting here around a camp fire drinking. What if subconsciously in my sleep, you know, I pull this out and harm somebody or I’m hurt.

THERAPIST: Mm hm.

CLIENT: And it was that, “Oh my gosh. How could I even have that thought?”

THERAPIST: That’s the OCD piece. Right?

CLIENT: Right?

THERAPIST: It goes against it.

CLIENT: Right. Like you said.

THERAPIST: “What’s wrong with me that I have that?” Right?

CLIENT: Yeah.

THERAPIST: And so for a while, for you maybe, you know, days, but for a while you may obsess and not even recognize it as an obsession. You know, in the moment you go, “Well, this is legitimate. I should be concerned about that.” So whenever you can have the awareness to step back and go, “Oh, I think it’s happening.” You don’t want to go, “I’ve got to stop having those thoughts.” That’s bad form. You don’t want to do that. [00:15:33]

CLIENT: Yeah, I think down part of that.

THERAPIST: Well, of course. That makes sense. You didn’t know any better.

CLIENT: Yeah.

THERAPIST: And anybody would do that. “I don’t want to have that thought. I don’t want to get caught up in it. I don’t need to pay attention to that.” You’re trying to reassure yourself.

CLIENT: Right.

THERAPIST: And all the stuff that doesn’t work.

CLIENT: Yeah.

THERAPIST: But it’s normal. Right?

CLIENT: Right.

THERAPIST: So you don’t want to go down that path simply because pragmatically it does not work. You want to do the opposite, not the opposite of that. But what you want to do is you want disengage from it. So what you want to do is not embellish that thought.

And the way you embellish is either run with it consciously and start trying to analyze why it happened. Or allow yourself to continue to have negative thoughts about the possibility of doing it. Or, “How do I stop it next time.” You know, “What’s wrong with me.” Whatever. Any of those things.

CLIENT: I think I had about all three of those with (laughs)

THERAPIST: Right. So that’s what you want to stop. And so find that the thought just happened. You’ve got to Number one, content is irrelevant. So I don’t need to pay attention to the gun, per se. I mean if it’s not an OCD event, you can’t remember whether you’ve cocked the gun. I mean if there’s some legitimate thing that’s fine. But that’s not what we’re talking about, right? [00:16:58]

CLIENT: Right. Right.

THERAPIST: So we know this is an OCD moment. So if that’s true then the content is not important. I’ve got to get off the topic of the gun.

CLIENT: Mm hm.

THERAPIST: Second, fine I just had that thought. One, like me and my granddaughter, it’s a new event. “I haven’t,” blah, blah, blah. “I have been drinking.” There’s another little piece. There’s some justification for it. And, “I’ve got OCD. This is what we do. We create thoughts, images or impulses that scare the be Jesus out of us.”

So for those reasons, not, “Oh, so what if it accidentally goes off.” Or, “I’m not going to kill anybody. I might shoot them in the foot, but that’s all.”

CLIENT: Mm hm.

THERAPIST: We’re not okay that I had that thought in any way relevant to the content. Right? Then, so how are you on those two? Content is irrelevant.

CLIENT: Mm hm.

THERAPIST: Accept the obsession when it pops up.

CLIENT: Mm hm.

THERAPIST: As soon as you can get to that place, that’s what you want to do. You get, “Okay, I just had this thought.” [00:18:04]

CLIENT: Mm hm.

THERAPIST: How are you doing about those two ideas?

CLIENT: I think I’m -

THERAPIST: I’ll get to the next one to get you on board on the -

CLIENT: Yeah, that’s the reason on the camping thing for me. I didn’t notice it was an OCD, negative thing.

THERAPIST: Yeah. Oh, yeah.

CLIENT: I just, it was different from It was more of like a fear when the attractive woman was more of a guilt. And I think I, like you said, the content is irrelevant. I kind of didn’t notice it at the time, but I think So would you just reiterate.

THERAPIST: So when there’s a novel event, all yours has been guilt around this. And then suddenly you have an event that is about physical harm of somebody. And that’s the first time that you’ve had that.

CLIENT: Mm hm.

THERAPIST: That’s going to be much harder for you to immediately perceive it as an obsession.

CLIENT: Right.

THERAPIST: So it’s going to get you and going to run with it for a while.

CLIENT: Yeah.

THERAPIST: And you’re going to be the victim for a while until But apparently now you have that sense that it was an obsession. Right? [00:19:09]

CLIENT: Yeah. Now I realize that and I think it just, I mean, it was really stressing me out the past couple of days. Like I couldn’t get past the thought of, “Why would I even have that thought?”

THERAPIST: Right.

CLIENT: “I’m a terrible person.” You know, I felt guilty again.

THERAPIST: Right. So as soon as you can get your wits about you.

CLIENT: Mm hm.

THERAPIST: Like right now in this room is the first time you’re getting your wits about you. Right? Regarding this.

CLIENT: Yes. Yeah.

THERAPIST: And so, therefore, first step is to go, “Okay, well it’s not about the gun.” How are we doing on that one?

CLIENT: Good.

THERAPIST: Accept the obsession.

CLIENT: Mm hm.

THERAPIST: Now you have to do it in hindsight, three weeks ago.

CLIENT: Right.

THERAPIST: But you’ve been obsessing about. So you’re not just obsessing, you’re also compulsing. You’re doing a thinking ritual.

CLIENT: Right.

THERAPIST: So it gets a little confusing for some people around, “Well, is this an obsession or is this a compulsion.” But you’re reviewing in your mind, trying to get an understanding of, “Why I would have that thought.” You know, but to release yourself from the thought. So when you’re doing that, that’s a compulsion. [00:20:20]

CLIENT: Right.

THERAPIST: Does that make sense to you?

CLIENT: Yeah.

THERAPIST: When you’re going, when you ask the question simply to scare yourself. “What is wrong with me?” As opposed to, “God, I wonder what was going on with me that I had that thought.” As opposed to a curious question.

CLIENT: Mm hm.

THERAPIST: You go, you know, into alarm. That’s the obsession.

CLIENT: Right.

THERAPIST: “What was wrong with me?” “Let me try to figure this out.” What was wrong with me,” obsession. “Let me try to figure this out,” compulsion. So you’ve got both going on in your head now.

CLIENT: Mm hm.

THERAPIST: So accept it instead of treating it like it’s a horrible thing. Are we on board with this one right now?

CLIENT: Yeah.

THERAPIST: Now that you’ve -

CLIENT: It’s making more sense now.

THERAPIST: Okay.

CLIENT: The whole content’s irrelevant, and accepting. Yeah, that’s making more sense.

THERAPIST: Right.

CLIENT: With this situation. Yeah.

THERAPIST: So now, with an obsession, what can you do with an obsession? Well you can do anything you want with an obsession or thinking compulsion. You can sing it in your mind, you can write it down every time you have it as a way to make in arduous task. Okay? “If I’m going to thinking this, I’m not going to “ Because you can have a thought a thousand times in a day. You can’t write it down a thousand times. You know? [00:21:35]

CLIENT: Right.

THERAPIST: Eventually you’ll just go, “Gosh. Ditto page two or something.” So you can change modes of communication as a way to make keeping the obsession more work than letting it go.

CLIENT: Mm hm.

THERAPIST: Did you follow that? So if I’m, every time I have an obsession I’ve got to pull my note pad out and dictate what I’m thinking in my mind.

CLIENT: Mm hm.

THERAPIST: That’s annoying.

CLIENT: Right.

THERAPIST: It’s a lot more effort. But it’s an intervention because I’m making focusing on the obsession more difficult than letting it go and paying attention to something else.

CLIENT: Right.

THERAPIST: So you can You know, very often I have people do some kind of point system. And, you know, it’s like every time you have that thought you’d go, “Great. Scored another point.” I mean points don’t have to add up. You ever see, what’s the show that Drew Carey used to have? The comedy, the improv show called? [00:22:42]

CLIENT: Oh. Whose Line is it Anyway?

THERAPIST: Right. Whose Line is it Anyway. You know, and he says that points do matter and, you know.

CLIENT: Right.

THERAPIST: Alright, so points don’t matter. But if we’re trying to develop a response to the obsession opposite of what OCD needs, then we could go over and be glad I just had that thought. “Cool. There’s another one. Thanks a lot.” Now you’re done with the transaction.

Every time you have an obsession if your response is, “Great. Thank you. Give me another one.” That’s exactly the opposite of, “God, why did I just have that thought. I shouldn’t have that thought. This is a bad thing.” So what we’re working on is having a response that is different. I can’t control it popping up. That is unconsciously mediated.

I need to focus not on the symptom but on my response to it. So if we’re playing this game to get me out of the trap that I do crazy things like, “Hey, great I’m working now. This is good.” [00:23:50]

CLIENT: Okay.

THERAPIST: Okay? So you can play around with any of that kind of stuff. When I do these two day treatment groups, we formulate the whole weekend around point system. I give them a tally counter, they’re clicking away at lunch, scoring points by -

CLIENT: Mm hm.

THERAPIST: saying something like, “This is just what I want.” Right? So content is irrelevant, accept the thought when it pops up, seek out uncertainty, seek out distress. Those are the four things. Okay? Seek out uncertainty, which means when the thought, the question comes up, “Why did I have that thought?” Your job is to not answer it.

CLIENT: Okay.

THERAPIST: Alright? Not reassure yourself. “Oh, that’s just OCD. I don’t have to think about that.” Even that. I mean if you said that one time and it was gone, that’s a fine intervention. Just go, “Oh there’s my OCD again.” That’s how it will be when you’re all better and say, “Oh, there’s my obsession.”

CLIENT: Yeah, I felt like that worked for like a week and then when I had this thing reoccur, I went down the rabbit hole again and stuck. [00:24:58]

THERAPIST: The only time I would suggest that you say, “That’s just an obsession, I don’t need to pay attention to that.” The only time I would have you say that is if you can say it once and it’s gone.

CLIENT: Right.

THERAPIST: If it comes back, see because you’re going to content. You’re going, “That’s not content. You don’t need to pay attention to it.” There’s a reassurance about content. Do you follow that one?

CLIENT: Right.

THERAPIST: Even though you’re saying, “That’s not content,” it is.

CLIENT: Right.

THERAPIST: Right? And so the obsessive side of you goes, “How do you know it’s not content? Maybe this time it’s serious. The other thoughts are all about, you know, guilt. This one I literally have a pistol in my waistband. How do I know I’m going to “ Right?

CLIENT: Right.

THERAPIST: So you play straight man. So you don’t want to get into that kind of argument.

CLIENT: Mm hm.

THERAPIST: So if you’re seeking out uncertainty, the way you do it is you let the question come up and you go, “I’m not answering it. What I want to do is sit with doubt.” Not doubt specifically about the gun, if we’re still talking about that, right? So I want to have So you don’t want to go, “Oh, could I?” That’s not what I’m saying. So you’ve got to really pay attention to this one. [00:26:22]

It’s not, “Could I actually pull the trigger and harm somebody? Did I?” Not that, but the uncertainty is knowing what I’m doing at the moment. “Oh, okay, well I have this question. The last thing I want to do is reassure myself. I’m just going to sit with not answering it.” It’s a generic.

CLIENT: Hm.

THERAPIST: See the content part was trashed. The content pops up and then I’m going to get off content and go, “Okay, perfect.” That content generated uncertainty. OCD is all about an intolerance of uncertainty. So I’m just going to feel uncertain right now, not put words on it. “I don’t know if I’m going to hurt somebody.” It’s a kind of a mental feeling state of, “Wait I’ve still got this question dangling here.” It’s, you know, right?

CLIENT: I feel like my hardest to overcome is the not answering because I’m so used to, “Could I “

THERAPIST: But you have to not answer.

CLIENT: I know.

THERAPIST: It’s the only -

CLIENT: Right.

THERAPIST: It may be hard.

CLIENT: Right. [00:27:30]

THERAPIST: And I grant you that. But it’s not complex. If you will stay focused on, you know, we’re just talking about four things to do, really. Right?

CLIENT: Right.

THERAPIST: My job is to feel uncertain as often as possible. So when it happens spontaneously, my response should be, “Good. I hate this feeling.” (laughs) You can have that to. You know, it’s fine to go, “God this is really unpleasant.”

CLIENT: Mm hm.

THERAPIST: “This is really hard for me. I’m glad I’m having it because I’ve got to do it. I’ve got to do this a bunch.” Right? “So I’m glad I’m having this.” Plus, “I’m glad I’m having this,” is opposite of what is required to sustain the disorder. So when you’ve got a question that’s threatening and you don’t answer it, how are you going to feel?

CLIENT: Probably anxious or some -

THERAPIST: Anxious. But that’s the fourth. On the heels of being uncertain about something that’s threatening to me, I’m going to feel anxious, therefore, I want to feel that too. [00:28:44]

CLIENT: Okay.

THERAPIST: That’s what I want. But it’s, you know, “I’m uncertain about “ Don’t fill in the blank. Right? It’s only a stimulus to go here. That’s the tricky part -

CLIENT: Mm hm.

THERAPIST: is that the content is like Ulysses, right? It’s The Siren Songs. Remember the old things of the Amazon women wooing sailors -

CLIENT: Oh yeah.

THERAPIST: by singing these beautiful songs. And then their ship comes into shore and they make slaves out of the men. And so Ulysses had his men tie him to the masthead.

CLIENT: Mm hm.

THERAPIST: And all of them had to put wax in their ears so they wouldn’t hear the singing. They wouldn’t respond to his requests, his demands to have them cut him free. And he got to experience the siren songs without succumbing.

CLIENT: Hm.

THERAPIST: So it’s like that. You’re going to hear, you’re going to feel this need to settle this. And you’ve got to not settle it. [00:29:47]

CLIENT: Okay.

THERAPIST: Because you’ve got bigger fish to fry. You’re trying to get over a mental health disorder.

CLIENT: Right.

THERAPIST: Not figure out -

CLIENT: Right.

THERAPIST: what in the world happened at that moment. And the other piece that you just got to get better at, and everybody has this trouble, is the novel experiences like the one you just gave me.

CLIENT: Right.

THERAPIST: They’re going to get you.

CLIENT: So if I’m going to practice, for example, staying at work until I have a I don’t even know. I’m trying to think of an example now because I only have really two to compare. But say I have a negative thought about something, and the content of that negative thought is irrelevant. It doesn’t matter if it’s about another girl or a gun or cutting my finger, or whatever. Recognize I just had that thought, kind of internally say, “Alright, that’s good,” and then just not answer.

THERAPIST: And then what’s going to happen?

CLIENT: Anxiety will kick in a little bit.

THERAPIST: A little bit?

CLIENT: It depends on the content maybe. [00:30:51]

THERAPIST: Anxiety will kick in and the urge to resolve it is going to kick in.

CLIENT: Right.

THERAPIST: “Wait a minute. How do you know this is OCD.” This is crazy that you just had that thought. So you’ve got to know the thoughts keep coming. Every time the thought comes, “Hey wait.” You know, you don’t know. Whatever it is. Anytime you have another threatening thought, that’s totally fine. That’s another opportunity to practice.

CLIENT: Okay.

THERAPIST: So, again, the protocol, it’s a rolling protocol. One incident may give you thirty five to fifty opportunities to do these little mini practices, because every time you can go, “Okay, I’m just going to let myself be uncertain.” And then, you know, twelve seconds later, up comes the thought, “But wait a minute. This is different.” Right?

There that is again. You don’t want to get frustrated about that. You don’t want to get frustrated. You want to have just the opposite. Frustration is resistance. Everything is about resisting. [00:31:56]

CLIENT: See I think that’s why I was I was to the point where I thought I was putting a lid on these random things coming up in my head. Then I was frustrated last week at like, “Damn it. I thought I had worked with Reynolds on helping resolve these.” But I guess we’re not working on resolving the thoughts coming up.

THERAPIST: No, absolutely no. You should define success as following the protocol.

CLIENT: Right.

THERAPIST: You should never define success around the thoughts popping up. Because you don’t have power about that.

CLIENT: Right.

THERAPIST: They will fade over time -

CLIENT: Okay. That’s what I was -

THERAPIST: spontaneously, when they’re good and ready.

CLIENT: Okay.

THERAPIST: And it’s certainly, you know, we say this to kids all the time to try to have them understand if they’re going to work with us, is that your anxiety is probably going to get worse before it gets better.

CLIENT: Okay.

THERAPIST: Because you have a strategy that’s defensive. We’re now, you and I, asking you to drop your defense. [00:33:04]

CLIENT: Okay.

THERAPIST: Of course you’re going to feel more anxious. Right? So we’ve got to know, you know, maybe it will fade over time. That’s fine. But before it fades it’s going to give you it’s best shot about, you know. Like if that thing around the gun had happened in the last week we might have a different conclusion.

CLIENT: Mm hm.

THERAPIST: Which is, “Oh, I’m starting to nail it and figure it out. So it’s going to up the ante and give me one around physical danger. Harming somebody I love.”

CLIENT: Mm hm.

THERAPIST: It’s such a clever challenger. It’s going to do that. So, you know, don’t be surprised. It’s like, “Oh, another opportunity to “

CLIENT: Okay.

THERAPIST: You know.

CLIENT: So that was my question that I’m glad you answered it was, I was thinking, “How long would I have to “ You know, I like practicing and I’m going to work at whatever I need to. But you said, you know, “Eventually it might fade over time with these random.” I think that’s kind of the light at the end of the tunnel for me as far as -

THERAPIST: Well, it’s going to fade. But, you know, if I step outside the door here, you know, obviously our goal is for the obsessions to fade. But the outcome that we want and the treatment protocol are opposite. [00:34:17]

CLIENT: Right.

THERAPIST: We don’t want you to be going, “Boy, if I’m a good enough client and follow these instructions well enough, I’m going to get rid of this thing.” Those kind of thoughts work against you because it puts up a message of resistance again. “Oh, I’ve got to “ The message is, “I’ve got to rid of it.”

CLIENT: Mm hm.

THERAPIST: And so then there’s the anguish again, the anxiety around. You know? And then you start checking in. “Well, is it working? Oh it’s not working because now I’m having more and it won’t go away.” And all that kind of stuff. You’ve got to go into neutral about that. You know, either neutral -

So here you are frightened and threatened about this on this pendulum. You know, we’re going to start moving that and having you have another response. But being frightened is a lot of energy. Right? [00:35:11]

CLIENT: Mm hm.

THERAPIST: So as you move that pendulum it’s going to swing. This is, again, a lot of energy. When they talk about “mindfulness” and “letting it go,” this is neutrality. This is detachment. You can’t go from being terrified or scared to detachment immediately. It’s like assuming that the pendulum is going to stop here. And you know good and well it has its own energy.

CLIENT: Mm hm.

THERAPIST: So that’s why I’m trying to talk to you about going to a place of, “Cool. Great. Hey, thanks. Give that to me again,” is a kind of fake excitement opposite of terrified. Right?

CLIENT: Mm hm.

THERAPIST: You know, “Give me your best shot.” Right?

CLIENT: Right.

THERAPIST: As opposed to the detachment, the neutrality comes after you stop resisting. This is too hard to go to here from the beginning. You’re going to get here from this position, not from this position. How are you doing with my hands? [00:36:20]

CLIENT: Good.

THERAPIST: (laughs)

CLIENT: This is the bad side and this is the good side.

THERAPIST: This is the pendulum over here, you’re on the bad side with all that anxiety and distress and worry. And there’s no way you’re going to go from that to having that swing and stop in the middle. It can’t. It doesn’t make any logical It’s just physics. You know, it’s physics. So we want to know that there’s energy, let’s manipulate the energy somewhat by going, “Excellent!” Right?

CLIENT: Mm hm.

THERAPIST: If I keep doing this, you know what that, right?

CLIENT: Right.

THERAPIST: So I was, I’ll tell you another personal thing because I want to make sure you know I’m crazy.

CLIENT: (laughs)

THERAPIST: I was up, I was teaching a workshop in Arlington. And I like the Canadian Rockies are really beautiful and different -

CLIENT: Mm hm.

THERAPIST: than the US Rockies. You can drive up the valley and mountains on both sides and they’re just different. So I wanted to hike up there on my own. And I have osteoarthritis so I can’t backpack for any length of time with my knee. [00:37:24]

CLIENT: Mm hm.

THERAPIST: And so I found this provincial park called “Revelstoke”

CLIENT: Oh yeah, they make a Something is called “Revelstoke.” Is it whiskey?

THERAPIST: I don’t know. I missed that part, unfortunately.

CLIENT: (laughs)

THERAPIST: But Revelstoke has a road that goes, you know, twenty five minutes up the mountain. So the parking lot of the park for the hiking, there’s only three and half miles left to get to the ridge line. So I found this and that’s perfect. I can do that long with a day pack.

CLIENT: Mm hm.

THERAPIST: So I, you know, fly up there and go early and rent a car, find a bed and breakfast, and drive up there that morning that I’m going to hike. And I pull into the parking lot and it’s totally empty. And for me it’s like, cool. You know, I can see the ridge line, it’s snowcapped, it’s October. And it’s looking exquisitely beautiful. And I’m here in this pristine environment totally by myself so I’m happy.

CLIENT: Mm hm.

THERAPIST: And there’s the sign that says, “Beware of Bear,” because it’s the fall and they’ve come down into the hillsides where all the berries are and are eating. That’s not foreshadowing. I didn’t run into a bear. [00:38:33]

CLIENT: (laughs)

THERAPIST: Although as I started hiking I’m kind of clapping (clapping sounds) when I get around corners -

CLIENT: Mm hm.

THERAPIST: just to not spook anyone or anything. So here I am in this beautiful environment, spent some good money, planned it for a couple of months, hiking away. And I start obsessing about some dumb shit thing. I’m not going to tell you what it was because I’m too embarrassed. But the theme was, there’s something in my life that I feel like I’m missing.

CLIENT: Mm hm.

THERAPIST: So I’m stuck on it. So here I am and I’m totally not present. I’m not seeing things, I have no pleasure. I’m gone. I’m in my head. And so either I’m obsessing about this dumb thing or I’m mad. “God.” (growling sounds) Obsess, obsess. Mad, mad, mad. Obsess, obsess. And this goes on ad nauseum.

I’m, you know, going ahead and walking, hiking and so forth. And then eventually I go, “What do you do for a living?” Right? And as soon as I said that then I instantly came up with this response, which was from that moment on as soon as I heard the obsession, which is in itself an intervention. [00:39:45]

CLIENT: Mm hm.

THERAPIST: Because instead of obsessing, I’ve mentally stepped back and said, “Oh, there’s my obsession.”

CLIENT: Mm hm.

THERAPIST: Right? So I’ve just, instead of obsess, obsess, obsess, I’ve stepped back. Not just, “Oh, I’m obsessing, I’m mad.” But, “Oh, there’s my obsession.” And I started saying inside my mind, I might have said it out loud in the beginning, “Thank you. Would you give that to me again.” That was my intervention.

CLIENT: Hm.

THERAPIST: And then I would start hiking, I’d kind of look around, and it’s fine. Eight seconds later the obsession would come back. Step back, say the same thing, “Thank you. Would you give that to me again.” And then I’d turn my attention. And, again, it would come right back relatively quickly.

The position I took, I knew this wasn’t going to happen, but the stance I took was, “If I have this obsession the rest of my life, this is how I’m going to respond to it.” Because I knew enough about the work. [00:40:50]

CLIENT: So you kept asking yourself for that thought or feeling again, and then you would answer.

THERAPIST: I personified the worrier in me and externalized it. And so when the worry popped up, when the obsession popped up, I’m basically talking to the part that generated the worry.

CLIENT: Right.

THERAPIST: The obsession. And now I’m saying to him or it, “Thank you. Would you give it to me again.”

CLIENT: Mm hm.

THERAPIST: So, “Give that thought to me again.” Now as soon as I say that I’m done with the transaction.

CLIENT: Mm hm.

THERAPIST: I’m not waiting for it to give it to me again. I’m not listening and going, “Is this working? Is it starting to fade.” I’m done. I don’t need anything else from it. I’ve got nothing else to say. I’m back in my valued activity, it happened to be hiking. It could be anything. It could be, you know -

CLIENT: Mm hm.

THERAPIST: at work doing some drafting some plan, or whatever. It doesn’t matter. If I’m disturbed by it again, I maintain the stance which is, I have a single transaction back which is opposite of what it expects. It requires me to go, “God, there it is again. This is never going to go away.” [00:42:03]

CLIENT: Mm hm.

THERAPIST: Right and you see my hands and it just So the opposite of that is, “Thank you. Would you give that to me again?” And, you know, the punch line is that eventually it faded away. And it did.

CLIENT: Hm.

THERAPIST: It just, it was gone. It took a bit. I mean this has been seven years so I really don’t remember how long it took and so forth. But I tell you that story to say that’s what I’m interested in you doing -

CLIENT: Mm hm.

THERAPIST: some reasonable facsimile of that.

CLIENT: Right.

THERAPIST: Which is, “I’m going to generate a response opposite of what I’ve always done. Totally opposite of it. And opposite of what I now understand OCD needs to sustain itself.” It cannot exist without you, without you having a proper response. You change that, you change everything. How are you doing around this idea? [00:43:00]

CLIENT: Well that story sounds like something I’ve been in probably tons of times where you feel like you’re, you know, out on a walk or riding a bike and there’s this thing that keeps going in your head. And you don’t even really know that you’re out on a walk.

THERAPIST: Mm hm. Yeah.

CLIENT: Because your head is just full. But I think that’s a good anecdote of if something comes up like that, regardless of the content, I can now -

THERAPIST: So while you’re doing it you’re still distracted, because doing the intervention, therapeutic intervention, requires attention.

CLIENT: Mm hm.

THERAPIST: You’re still not able to focus. I can’t still focus on my work while I’m doing this kind of clumsy thing. And so you have to understand. I mean it’s like if you were afraid of the dark and you were going to the movie theater to practice being in the dark for two hours, you won’t concentrate on the movie very well because you’re working on your stuff. And so in the same way, as you’re doing this intervention, even though it’s therapeutic, it will take some chunks of consciousness to do it. And you still won’t concentrate well. [00:44:06]

CLIENT: Mm hm.

THERAPIST: And you’ve got to go, “Hey, you know, it’s part of the deal I’m in.”

CLIENT: Mm hm. So if I’m out on a walk and I get some, you know, random thought. Instead of telling myself or going down the path of, “Gee, I wonder why I had that thought?” Or, “No, I would never do that.” Just recognize, “Oh, I had that thought? Cool. I’m not going to answer it. Just, I had that thought.”

THERAPIST: Yeah.

CLIENT: Okay.

THERAPIST: You know, there’s So that’s kind of fine. Then if you want to do slight, a little more of an exaggeration or a caricature of it, you go, “Wow, you’re good. Ah, you got me.” You know, if you get caught up in it for a little bit and then you catch it and you go, “Nice one. Boy, you tricked me on that one. I’ve got a gun in my belt and, yeah, that’s clever. So you’re good at what you do. You scared the hell out of me.”

CLIENT: Mm hm.

THERAPIST: “So, got me going for a little bit.” So, you know, again -

CLIENT: Yeah.

THERAPIST: I think, you know, if you can grab the obsession (raspberry sound) throw it outside of you and deal with it that way, that’s dissociation. And that, in and of itself, gets you on first base. That’s going to help you -

CLIENT: Right.

THERAPIST: as much as anything. [00:45:18]

CLIENT: Recognizing that.

THERAPIST: Right, is to take it outside of you and go, one, “Oh, there’s my obsession.” And two, “Oh, I’m going to address you now.” You know?

CLIENT: Mm hm.

THERAPIST: And you don’t have to quite do it that way, but like you said, “Hey, yeah, cool. That’s great. Yeah, thanks for showing up. Yeah, cool. I love this.”

CLIENT: Okay.

THERAPIST: I mean, even if you’re sarcastic to some degree, you know, that’s fine.

CLIENT: Right. Okay.

THERAPIST: So we’re going to stop in a minute.

CLIENT: Yeah.

THERAPIST: Do you want to ask me -

CLIENT: No I think I’m just getting a better handle of noticing now if, or having myself notice if something is actually, you know, a random thought that was OCD, where I might not have thought it was because I was too fixated on content.

THERAPIST: Mm hm.

CLIENT: And now I think I can better, “Okay, cool. I thought of that. That’s fine.”

THERAPIST: Okay. Good. And, you know, you’ll get caught by the new ones.

CLIENT: Right.

THERAPIST: Everybody gets caught by the new ones. And it’s totally fine. You won’t, it’s not like Whac-A-Mole. [00:46:25]

CLIENT: (laughs)

THERAPIST: It really, it’s not going to be, it’s not symptom substitution. You fix this one and then it comes over here. It’s not.

CLIENT: Okay.

THERAPIST: It’s a transitional time and, you know, again, to the degree we personify OCD it’s going to get a little rougher on you possibly. Not necessarily, not necessarily. But it could get rougher just because it wants to stay in place.

CLIENT: Okay.

THERAPIST: And it needs to teach you to not cross it. And so you can You know, I say it to you in case that starts happening that way. That way you can go, “Okay. Well that’s “ Alright?

CLIENT: Okay.

THERAPIST: Because you don’t want to get discouraged. Same way working on it with a little kid. If they don’t realize that we’re going to get more anxious as they start to try something new, and they need to be courageous, then they’re going to try something new and then bolt and not want to do it anymore.

CLIENT: Okay. Yeah, I think I understand a little bit better now. I feel like I’m better equipped to, I’d like to say fight fire with fire. [00:47:27]

THERAPIST: Exactly.

CLIENT: That’s what I actually told Emma -

THERAPIST: That’s what you want to do.

CLIENT: after the first session. I go, “I think basically I’m fighting fire with fire.”

THERAPIST: Yeah. And I can do this. I’m your coach and we got a plan. And this strategy you know works is just, and am I explaining it well enough for you to -

CLIENT: Yeah.

THERAPIST: be able to metabolize it.

CLIENT: Yeah.

THERAPIST: And then what new things come up that surprise you that you don’t have a hold of the model well enough to get it. And sometimes you’re just going to, you’re kind of just getting started around this, so you’re going to stumble over some things or be awkward about some of it. And we’ll just kind of fix that.

CLIENT: Okay.

THERAPIST: So let’s at least go two weeks. I do want you to have some experiences.

CLIENT: Yeah. Exactly.

THERAPIST: Do you We’ve got two ways to go. We can put something in the books for two weeks and then you can call me or e-mail me if things are too quiet, and we’ll just bump it back. It’s okay to get rid of an appointment and put it later. Or, if you would rather go three weeks, we can just do it in three weeks. Or what would you like?

CLIENT: Let’s do two weeks. I’m out of town in Houston for work late next week. (pause)

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