TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

CLIENT: All right. So I think I got a lot of practice on the whole repeatable process that we talked about last time. I don't know if that's good or bad. (Laughter) It is a little frustrating. So I just got back from traveling last yesterday. I was down there for five days for work. I think being in a new place, [you're not] (ph) aware of your surroundings, tend to make my mind run (ph) or whatever, but seems like we're kind of, for some reason, going back to the same themes of, like, you know, random thoughts of, you know, harm to, like, my wife or something or, like, other women being around of, like, you know it's like this devil's advocate, like, kicks in. Like, "Oh, that girl's attractive. Oh, she seems nice. If I wasn't married, would I ask her out?" You know, just random stuff like that. And it just kind of it kind of wore me out. You know, I practiced the, "All right, I had that thought. I'm going to have that thought again. All right. I'm not sure what that means and I'm not going to really (ph) answer that question." I mean, if I was going to do your point system, I probably would have had, you know, hundreds of points this past week. [00:01:22]

THERAPIST: Yeah. And it's exhausting.

CLIENT: It is, yeah. I'm just, like, wore out. Like, whew, man.

THERAPIST: You want to go back to the other way or -you'd think it'd be -

CLIENT: No, I just -

THERAPIST: less exhausting to go the other way?

CLIENT: I don't know. I don't think so.

THERAPIST: Same, [do you think] (ph)? I mean, how would you measure?

CLIENT: Right now, I'm feeling a little exhausted just with all these little random thoughts, you know, popping up. It's like it's trying to just pop up, to try to, you know, trip me up. And I think I'm just hoping sometime in the future they'll kind of sail off, you know, a little bit.

THERAPIST: Yeah, well, that's the expectation [of it] (ph), you know, as we talked about. Best (ph) in the middle of it not to be going, "Is this working? Am I "

CLIENT: Right, yeah, yeah. I did find catching myself a few times. I almost skidded into an actual obsession with recognizing I had a thought and not answering it. I felt like I got into repetition at some point, repeating that thought over and over in my mind and kind of trying to, you know, not answer the question.

THERAPIST: Help me understand that (inaudible 02:33). You called the question up again on purpose?

CLIENT: Yeah. I feel like I was calling it up again on purpose, like -

THERAPIST: In order to ?

CLIENT: Recognize that I had the thought, and then not answer the question.

THERAPIST: And what do you imagine the motive was to do that? I have my guess (crosstalk 02:57)

CLIENT: I'm probably assuming it's going back to the old days where I was trying to clear the thought or -

THERAPIST: How would this routine help clear the thought, calling it back up again?

CLIENT: To, you know, almost find a way to satisfy it by, you know, calling it back up and then kind of saying, I'm not going to answer that question. And I felt like, a few times, it was I'd kind of get caught up and all right, I'd kind of step back and, you know, I don't need to compulse over repeating this thought just to repeat it and, you know, shut out the question.

THERAPIST: Right. So I think you labeled it right, as a compulsion, because you're doing it. It's a mental compulsion.

CLIENT: (inaudible 03:47)

THERAPIST: In order to satisfy something (ph) as opposed to even though it's a question, it's not popping up spontaneously as an obsession. It's like a mental check. Maybe it I mean, if it were a mental check, do you think you're checking anything about is this still intense? Am I drawn to this? Do I feel anything when I ask the question? Do you think any of that's going on, or you just think you created this kind of stilted routine?

CLIENT: Yeah, I think my mind is (crosstalk 04:21) searching for trying to bring something up again and I'm, you know, searching for an answer. But I'm it's like trying to remind me of, you know, you had this thought. You know, trying to dive into the details, which is not what we want to do.

THERAPIST: So if you'd never been here and you're just doing your usual thing, how would the trip have gone, regarding all of this stuff?

CLIENT: I think I probably would have, you know, [fallen back into] (ph) my own patterns of trying to reassure myself that, you know, the thought that I had, I actually didn't really think that, and I'm not sure why it came up. And yet, I haven't actually done the, you know, routines I used to do in the past where I would, you know, almost ask for forgiveness. You know, go through that whole thing. I haven't fallen back into any of that old stuff.

THERAPIST: Yeah, good. But I'm just wondering what kind of stress that would have been or what the preoccupation might have been like. I understand you're saying, "Boy, I had a lot of frequent contact with..."

CLIENT: Yeah.

THERAPIST: But I wonder about the depth of attention that you would have been giving to these. Do you think it would have been different? Or do you feel like you had a ritual that worked well enough that you could kind of clear it and then wait for the next one, clear it, then wait for the next one?

CLIENT: I think that's more like it. And I think in the past, the ritual would have led towards a, you know, a physical thing or I always kind of do this, and that would kind of clear it. And now it seems like a lot of the physical compulsions, I don't really have anymore. I feel like I don't -

THERAPIST: The urge doesn't come up even?

CLIENT: The urge doesn't come up. [I have] (ph) every so often, and I kind of just don't let that urge take me over. I feel like it's been easier to overcome the, you know, the physical compulsions. [00:06:26]

THERAPIST: Any sense of why it might not be coming up as spontaneously, as frequently? Why it's so easy just to handle?

CLIENT: I guess maybe because those are just to me, they're not directly, like, related to my thoughts as much. It's just kind of something that's off to the side that would, like, you know, supplement.

THERAPIST: Oh, okay. Because I thought you were saying that helped clear it.

CLIENT: Well, it would, but the thing or item wouldn't be directly related from the thought. So...

THERAPIST: So it's not as much of an attachment to -

CLIENT: Right.

THERAPIST: And a requirement, right?

CLIENT: Right. And I keep trying to remind myself that, you know, I think I got fixed on content before. And, you know, I came to understand that whatever the content is doesn't really matter, whether it's, you know, my subconscious or whatever you call it, giving me a thought of, "Oh, would I," you know, "Would I harm my wife?" Or, you know, would this other girl, you know, "Would I ask her out if I was single? Or, oh, and does that mean that I actually like this girl now and that, you know, I think she's pretty or whatever?" and, you know. Then that subject kind of, like, tumbled down, and I would have to I'd bring that thought up again. I wouldn't answer it. And then it feels like I was just (sound effects).

THERAPIST: You just said, "I would bring that thought up again and answer it." So even back then, you would do that as a kind of pattern of bringing the question up and -

CLIENT: Yeah, in the past I -

THERAPIST: trying to close the book more tightly but (ph) it sounds like maybe and I'm just making this up. You didn't say [much about it] (ph). But (inaudible 08:19) it's more tidy that way. It's a clean little event. I can bring it up, close the book, push it away, then that one is gone. As opposed to it seemed a little fuzzy when I'm not asking a question, nailing the answer, and then -

CLIENT: Correct. Yeah, that's right. Which I know that's what we wanted to feel, is make me feel uneasy. So I guess that that's a good thing then, yeah, and definitely make me feel anxious or, you know, uneasy about, you know, why would I even have these thoughts. But I'm not you know, I know that it's a, you know, (inaudible 08:55) thing and I'm going to try to not answer the, you know, the question (inaudible 09:00).

THERAPIST: So what's it do for you, to elevate about the content. But what happens when you go? Or that's content when you think about, "Am I drawn to this women or would I ask her out?"

CLIENT: What does that ?

THERAPIST: When you go, "Oh," you know, whatever way you do it. That's the content. That's not my job to pay attention to the content. What happens then? What's that do for you, to be able to say, "It's not about content. It's about being uncertain or being anxious"?

CLIENT: I think it still just has this little feeling in the back of my mind that there's still that little bit of guilt or ashamedness or whatever, not knowing why I would have ever even had -

THERAPIST: No, you're supposed to have that.

CLIENT: Right, I know.

THERAPIST: Right, okay. Yeah, that doesn't go away.

CLIENT: No, that doesn't go away.

THERAPIST: It's not supposed to go away, but you have to tolerate a little bit of guilt and shame that you have an urge to get rid of.

CLIENT: Right.

THERAPIST: Okay. But does it do you feel like it offers any kind of leverage to be able to shift focus off of content and over to the different protocol, what we would be calling a therapeutic protocol?

CLIENT: (inaudible 10:30) not really sure how to give an answer on that.

THERAPIST: Okay. Because in my mind, I was, you know, the thought comes up, "Am I attracted to her? Or would I harm my wife? What's wrong with me? Why would I have that thought? I'm "

CLIENT: Yeah, that's (crosstalk 10:48).

THERAPIST: weird. I'm still having that thought. So, to me, I would imagine that that's more kind of a grueling process than going, "Oh, there's that thought again. I ain't going there." And so I would think it would help disengage you to the kind of suffering that comes when you go, "Why would I have that thought? What does that mean?" Do you sense that at all, that there is a kind of analysis that quiets down and that that helps you in any way?

CLIENT: I feel like it kind of comes and goes, as far as understanding the contents are relevant and not answering the question. Sometimes it's just one thought, done, boom. It doesn't come up again. And I feel like the times where it would come up and for that split second, I might do what you just said where, "God, you know, what's wrong with me? Why would I even have that?" It's like that's when it kind of gets me stuck back in that cycle of, you know, thinking that thought again and, you know, not answering the question and trying to kind of move on.

THERAPIST: Oh. So let me see if I understand what [you're saying] (ph). So I'll catch myself sometimes getting into the content a little bit. When I get that perspective, I go ahead and ask the question again, and then don't address it. What do you think about that?

CLIENT: I think that seemed to help, but I feel like I found myself going back to those thoughts again and asking them again. Maybe that's good. And then not answering them. And -

THERAPIST: Yeah. So theoretically, I think that first time that you do it, so, like, if you're a checker, right, or a mental checker, if you do some kind of reassurance or whatever, that you go ahead and conjure up the question again that freaked you out, and then not answer it is a way to provoke the uncertainty again. And I think that, in that first time, would be a move to make. But then, we you start getting caught in asking that question over and over again, then I think you and I agree that that's some kind of compulsive pattern, right? [00:13:15]

CLIENT: Right. So I feel like I go in spurts, where I feel like I'm doing pretty good. I'm bringing the thought up, not answering it. And then there's times where I bring the thought up, kind of get, like, a split second of trying to answer it, then I don't answer it, then I bring it up again. Don't answer. Bring it up again. Don't answer.

THERAPIST: Yeah. So what are you going to do about that?

CLIENT: Good question.

THERAPIST: Did you start catching on that that was happening? Did you try and end that pattern at all?

CLIENT: I did, yeah. I realized, okay, this [and I] (ph) used your example in my mind of taking a walk in the woods and something came up, and you were trying to (inaudible 13:58) answer that question. Then you said, "What do I do for a living? No more of that, you know, type of pattern." So I kind of try to use that as a -

THERAPIST: Good.

CLIENT: you know, an example of that.

THERAPIST: (inaudible 14:11) thanks a lot. Give that to me again.

CLIENT: Yeah. I feel like there's times when I make progress, and I feel actually kind of good about that. But there's always this little part in my mind that is still reminding me, "Gosh, you know, why are you having these thoughts to begin with? Like, what on earth is wrong with you? When is it going to go away?" And then that, like, kind of bring back up, "Oh, what was that thought I had earlier. Okay, that's the thought [I have] (ph). I'm not going to answer it."

THERAPIST: And do you have a rationale, logical explanation for why you're having this?

CLIENT: Not really. Wish I knew, but no.

THERAPIST: Well, you think you have OCD, right?

CLIENT: I presume so, yeah.

THERAPIST: And you had some brushes with it just for two years. Nothing before.

CLIENT: No, I've had it for a long time.

THERAPIST: Oh, okay. Not in your family? You're the only one, that you know of?

CLIENT: That I know of, yeah.

THERAPIST: So you know there's some genetics that are connected into OCD? Pretty much that's how it is. It's pretty much a genetic disorder.

CLIENT: Okay. I have no idea, yeah.

THERAPIST: There's nothing that we look at developmentally to say anything about childhood. Now, of course, if your mother or your dad is an active OCD, you know, washer, and then they engage you in making sure everything is clean, you may actually catch some of those patterns, just because they freak you out so much. so anxious parents are a risk factor for anxious kids. There are only one of them though. There's no gene that we found around anxiety and OCD, but clearly, there's a proclivity to the anxiety disorders. And then it tends to run the life cycle, so... And I think it'd be good to have some understanding. That's like, well, if my son has Type 1 diabetes, well, that's genetic. But there's nobody in our family on either side that has had it that we know of. So that's kind of strange, but still, it gets passed down. Somehow, it did get passed down. I would look at it as a genetic predisposition to OCD. And it could have panic disorder or another anxiety disorder, and it wasn't.

CLIENT: Okay. Yeah, that's good to know. I never knew (inaudible 16:49) you didn't know if, you know, some people developed things where, in the past, you know, if they got a spanking as a child, they might develop some behavior. But I don't have anything in the past that would, you know...

THERAPIST: Yeah. I think your job is to, again, the way you have to do it is, "I'm going to ask as though this is a genetic disorder that is just taking over. And I am going to ask as though content's irrelevant." And the reason I'm saying "act as though" is because since it's a disorder of uncertainty, you can't be certain what I'm saying is right. So it's pretty clever in that way. So even with the doubt, you have to (inaudible 17:36) instead of, "It's a genetic disorder. I know I don't need to pay attention." It's too hard. It's much easier to go, "I'm going to ask as though Reed (sp?) knows what he's talking about. Nothing's (ph) wrong. Oh, well."

CLIENT: (Laughter) I (ph) definitely use your stories to my advantage.

THERAPIST: So when did you get back?

CLIENT: I got back let's see. Got back around noon on Wednesday. I had to go right to a town hall meeting for work.

THERAPIST: Today is Thursday. You just got back.

CLIENT: Yeah. And besides, you know, I'm doing a rough schedule, that was kind of draining. I was up every day before sunrise on the hospital floor, teaching nurses how to use this software and, you know, their emotions are running high. And then I was not used to being on my feet for 14 hours a day. I come home just drained from everything. [Going to bed at night] (ph).

THERAPIST: You used to be on your feet 14 hours -

CLIENT: No, I'm not used to.

THERAPIST: You're not used to, and that's what is happening now.

CLIENT: This was just a one-time thing where newer employees have to go to a new client site, where they implement our software, and we have to go through just helping them use it. Even though I'm a developer. I'm not even a trainer.

THERAPIST: Everybody steps up during -

CLIENT: Everybody has to do it once when they start. And it was like everybody was like, "How'd it go?" I'm like, "I don't want to do it again. I like my queue." Which I actually find, when I'm at work, I'm so focused on my work and getting it done, I feel like I can focus a lot better and I don't have these things really come up as much. So it's kind of weird that I like to, you know, be at work because I'm focused, yeah (ph).

THERAPIST: You're lucky about that, because a lot of people, at work, when they have a lot of work to do and stuff comes up, they want to quickly do their ritual to get rid of it, so they can get back to work. And so, to do the therapeutic work where I, you know, postpone it and so forth, burns productive time, and they don't, you know. So how I'm just going to get rid of this and move on. So you're lucky around all that. But none of the little rituals at work?

CLIENT: Not I mean, maybe a couple times a day. Not, like, you know, I'm sitting at the hospital in Houston when these random little things keep popping up and I'm trying, you know, to shut them out when I'm getting worn out. So I was, at one point, thinking, "Well, I know."

THERAPIST: Oh, so that kind of happened on the trip, what I was just talking about, right? Your -

CLIENT: Yeah.

THERAPIST: trying to get work. You're exhausted. There probably were sometimes where you go, "Well, let me just see if I can clear this out so I can get back to..."

CLIENT: Right.

THERAPIST: You know, so I'm going to feed the monsters, really. (Laughter) One of the ways you can think about them. Feed the monster. Get him quiet.

CLIENT: Right. So I was thinking I hope I'm on the right track of having these things come up where I'm, you know, bringing up the thought again, even though it's unpleasant. And I don't know why I thought it or whatever. And just not answering the question. And... [00:20:46]

THERAPIST: Once.

CLIENT: Once. (Laughter) Right.

THERAPIST: Right, and then not letting yourself have the pattern again.

CLIENT: Right. I just didn't know if there's anything else I need to do different, or if I'm on the right track. I feel like I'm having a repeatable process, which is the first thing. The second thing I know I need to keep an eye on is not going over that thought multiple times, because I know that's compulsion.

THERAPIST: And I want this feeling. I want this doubt. [Those are positions] (ph). How am I'm going to get better. Do we talk about Nick Saban last time?

CLIENT: No.

THERAPIST: You know who he is?

CLIENT: Oh, yeah.

THERAPIST: Yeah, yeah. They did a 60 Minutes piece on him two weeks ago. So they followed him, or they came to the university for about eight months and filmed and watched and all that kind of stuff, and then did this very nice piece, very positive piece on him. But he has a system. And I don't remember what he calls it, but it's a program, a system, whatever, you know. And all of the athletes know, which is don't pay attention to the score. You don't pay attention to the time. You pay attention to the protocol, the play. Are you running the play as perfectly as you can? And that's all you focus on, all you focus on. And they showed a clip of the quarterback. What's his name? Do you remember? McMann (ph). McGinnis, or whatever his name is.

CLIENT: Does he play for him now or (inaudible 22:33)?

THERAPIST: No, now. Anyway, he and the center are both making the call on the play, and they're making different calls. And when that play was botched, they had to call timeout, and they started arguing on the field, to the degree that the center shoved him. (Laughter) On national TV, you're seeing this. And he was saying, "Well, it was quite something." But the score was 47 to 14, you know. And he said, "Well that's, you know, that's it. It doesn't matter. I liked that, because they were so committed to trying to get it right that, you know."

So first off, you want to have a sense that it makes sense what you're doing. And second, you just pay attention to the protocol. Your success is the protocol, not you know how to go on this trip. You can certainly say, "Boy, I you know, it beat me up this time." Or, "This is harder learning curve than I imagined," you know, however you want to say that. But you just success is going back to the protocol. That's all you want to think about because as soon as you get away from that thought into expectations... In this room, we can talk about expectations and you can challenge what I'm talking about and be skeptical. But when you get out there on the field, you need to just I'm doing what I need to be doing. So do you have any questions about what you need to be doing? That are you confused about?

CLIENT: No, I -

THERAPIST: The response to what because it doesn't matter about the symptoms. Symptoms are the challenger. Your job is to change your response to the challenge.

CLIENT: I think sometimes I get so fixed on a process of thought that, you know, it's almost like, you know, when I bring that thought up once more and I don't give it an answer, it's like I almost get fixed on saying that in my mind, of I'm not going to answer that question. And that's where I feel like I got cut up a few times, and I kind of repeat the question.

THERAPIST: Okay, wait. Let me see if I'm getting what you're saying. I think I tried to do it more cleanly and efficiently, in order to have it disappear. And so I -

CLIENT: Correct.

THERAPIST: Right, okay. So now do what I need to do?

CLIENT: Not do that. There's no right way to say it or wrong way to say it. There's no clearing it. It's just -

THERAPIST: Right. And if you need to, then say it wrong. Clear it wrong. Mess the question up somehow. Just interrupt it, disrupt it. Add something to it. You know, between the sheets. Or, you know, just to undo it. Because I think we're on to that now. Okay, if I had a kid I worked with a high school kid that (pause) had a kind of Tourette's or tick kind of thing, where his belief was, "If I could contort my body " Did I tell you this?

CLIENT: Yeah, yeah.

THERAPIST: Yeah, okay. Well that's that whole thing. If I can ask the question, respond in the proper manner to the question, then everything will be all right. And so you have to I had (inaudible 26:06) in the past. This is really a conundrum. Any time I gave her an instruction, she made that an exception to the rule. So if Reed (sp?) gives me this as the homework, it's fine. I can do it because it's an exception. So it was so clever that the OCD kind of swallowed my work up in it by doing this little so, in the same way, yours took over our instruction. So it's just clever. (Laughter) It's clever. So...

CLIENT: [That's why I'm a programmer] (ph), I guess.

THERAPIST: So, you know, when you said, "My mind starts I start working, I start thinking, my mind " And that should give you a clue.

CLIENT: Right. [Oh, I'm right there] (ph).

THERAPIST: I'm working hard here. I'm trying to work through. And then you want to be suspicious of that, you know. And something's going to come up, like it did this time, where you don't know what to do because you and I haven't talked and it's I mean, this is a subtle little thing, and not everybody would necessarily even catch it right away. So...

CLIENT: Yeah. But okay. I think I hopefully, I'm getting closer and closer to having [if you want to call it] (ph) complete control over -

THERAPIST: Yeah, good luck with that.

CLIENT: Yeah. (Laughter)

THERAPIST: But, you know, the trip was stressful, you know. You kind of fell into the fire there or -

CLIENT: (inaudible 27:36)

THERAPIST: had a dance around the fire. You were more tired and, you know, just but when you were training at the hospital, was that an example of being too busy to get caught up in them?

CLIENT: Yeah.

THERAPIST: Oh, okay. And how about at home? How is this happening at home? Or not?

CLIENT: It comes and goes at home too. Probably now (ph) because I have a lot of free time all the time since, you know, wife's in school full-time. She's doing a lot of studying. You know, she's doing her clinicals and everything. So, you know, that makes me sit there and, you know, my mind sometimes starts (laughter) fires up twirling again. So...

THERAPIST: And how about eating and you counting? Taking certain numbers and...

CLIENT: No.

THERAPIST: That's all quiet.

CLIENT: That's quiet.

THERAPIST: So the physical stuff is -

CLIENT: Yeah, the physical stuff really is.

THERAPIST: How do you like that?

CLIENT: It's good. It's just one less thing to worry about, I guess. As far as the old, like, clear it out, you know.

THERAPIST: So do we have anything that you think you might be avoiding subtly or clearly that we need to address? Any way you're trying to protect yourself that (pause) we can help you be more vulnerable?

CLIENT: You mean in the physical stuff or ?

THERAPIST: No, just in general around this stuff. Is there anything that, you know, any environments you're avoiding or television shows or reading things or newspaper I mean, some people have to steer away from all that kind of stuff.

CLIENT: No. I've you know, me being the [creative force] (ph) I am, I'm completely refrained myself from doing just general on, like, what is OCD. You know, because I figured, you know, Reed (sp?) said -

THERAPIST: Just do it here. I mean -

CLIENT: Yeah. (Crosstalk 29:25)

THERAPIST: If you have questions like that, just ask me. Yeah. Somebody I was working with [comes to me] (ph) the other day, and he was going, "Okay, so your book, what should I read in here?" Nothing. You know, we've got a protocol. I mean, I do give him a little stuff to read, but we want to keep it as simple as we can. And if we get lost (inaudible 29:51) it throws us a curve. It can, but we'll figure it out. And also, if you get if something new comes up and you feel like (sound effects) just send me an e-mail, and I'll e-mail you back or I'll call and talk to you on the phone for five minutes. It doesn't cost anything. I'm fine. You know, I would rather you make contact with me than stay confused for a number of days. It's so cheap to, you know, get a question answered and it's expensive when you start getting tortured (ph) and then you start doubting what's going on.

CLIENT: Right. I guess the one thing that, you know, bring up the frustration point is and I know content is (inaudible 30:33) but I feel like I sometimes don't know why it seems like a lot of its geared towards, like, me and my wife and my feelings towards women or whatever. Like, my mind's trying to bring up all these, you know, thoughts of doubt on, you know, well, do you have a good relationship? You know, are you sure you really love her? Like, all these things. And it's like, well, why (inaudible 30:56) pick that subject? Why couldn't it pick, like, you know, worrying about my car falling apart or something like that, you know. It's almost like it's more draining.

THERAPIST: And you're wondering why.

CLIENT: Yeah, and I know there's no real why. I'm trying to think (inaudible 31:11).

THERAPIST: Well, let's think strategically. This is a game. Your challenger has decided to pick on this particular thing. So if we returned to the analogy of football, what does the defensive coordinator do for a week as they're planning on the next game, when they've got another game that they're going to be playing? What's their strategy? What do they do?

CLIENT: Just practice their protocol around (ph) the play.

THERAPIST: What do they do about the new theme (ph)? Do they look at film? Do they watch film of the other team playing?

CLIENT: They do watch film.

THERAPIST: What do they watch film for?

CLIENT: So they can see where their holes might be and practice to beat the...

THERAPIST: So look for their vulnerabilities?

CLIENT: Right, yeah. I guess -

THERAPIST: Okay. So then if OCD's looking for your vulnerability, would it look towards something you cherish? Your marriage? Your, you know.

CLIENT: Yeah. (Laughter) That's the hardest thing, or in my mind, is accepting that fact, that it's attacking my vulnerabilities. And, you know, I wish it was something else, but I guess I'll just -

THERAPIST: You're saying that's a hard fact to accept, that it's attacking your vulnerabilities?

CLIENT: Yeah.

THERAPIST: Why is that hard? That makes totally good sense to me. Why is it hard for you?

CLIENT: Well, no, it's easy to accept now, that it's going to attack our (ph) vulnerability. It's just hard to swallow that that's the area that I'm, you know, fighting against. Combating.

THERAPIST: But why and -

CLIENT: I guess -

THERAPIST: (Crosstalk 32:56) I understand what you're saying.

CLIENT: It makes me feel worse about myself, that it's something I'm very vulnerable about than something else, where I'd be like -

THERAPIST: No, I may be misconveying it to you. It picks the most important thing to you. The thing you cherish the most. Not that's not implying, "Oh, I'm vulnerable. You know, I don't have a strong enough faith in my relationship. I feel bad that I don't." I'm not saying that. You understand that?

CLIENT: Right.

THERAPIST: So you say what you were saying again (inaudible 33:38).

CLIENT: So I'm saying I just wish that this OCD wouldn't have picked my vulnerable spot.

THERAPIST: Oh, yeah. Too bad. (Laughter) You want to trade some of the others that other people have? I mean, you know. It's just the way it goes. I mean, (inaudible 33:53) people. I meet (ph) people and it's like, "Who do you want to switch with?" You know. I may sexually molest my six-year-old daughter. I mean, would you want to trade that one? You know, so I may write "fuck you" on a check and mail it off to my client. (Laughter) So it's I get that it's too bad, but that's how clever it is.

CLIENT: I think just accepting it's helped me in a lot of ways too. Just, you know, accepting what I'm working through and that there's, you know, light at the end of the tunnel. And just -

THERAPIST: Do you think there is?

CLIENT: Yeah, I definitely think so. I mean, I feel like I've made some pretty good progress in some areas, and (pause), you know, I feel like [I get on track] (ph) and I might get off track just a little bit. And then I get back on track again, but I feel like I'm definitely making progress, which is good. I mean, the physical stuff, like I said, has -

THERAPIST: Fallen (ph) away.

CLIENT: Fallen (ph) away.

THERAPIST: Yeah. Easy stuff falls away, and then you're left with the hard stuff. That's common, and a lot of people drop out at that point because the harder stuff, they this, you know, what they're vulnerable to. They don't want to pay attention to it. They want to, you know they'll say, "Well, this must mean I am weak [and not] (ph) being a husband, and I can't tolerate that, so I have to go " you know, and they'll then they just drill down around the OCD and leave treatment because they can't tolerate the idea of being uncertain around that topic. So it almost always comes down to content that causes people to quit. Almost always. I don't know anything else that causes somebody to drop out of treatment, and people drop out of treatment. With OCD, so...

CLIENT: Well, I'll keep (pause) working through it until some day I don't know. Is OCD something that I'll struggle with for the rest of my life, or is something kind of maybe...

THERAPIST: Well, you I mean, I (pause) personally, I think you can fix it.

CLIENT: Right.

THERAPIST: But I think you're always going to be sensitive to it.

CLIENT: Correct.

THERAPIST: When we say the anxiety disorders run the life cycle, it means this can totally clear out and three years from now, all of a sudden, something shows up again OCD-related or a specific OCD thing, event occurs again, and you you know, it's like just now, when you're practicing, you forget. And all of a sudden, you're doing the ritual again, and then you catch yourself. Well, you know, three years from now, you may have another brush with it, and you have to brush of your skills and go back to work. That's probably how I would look at it. It's like, oh, I'm not in control of whether it comes back or not. I'm in control of responding to when it does. And the stronger I get around you know, if you nail this one, you go, "Okay, I got it. It's just the hardest because I've never done this before, and now I got the system." [That's what you want] (ph).

You know, try to trust me and (inaudible 37:12) believing I know what I'm talking about to get you to do it and get the experience to go, "Okay, that seems to be something's work. I'm not doing the physical stuff as much, and I'm not getting tangled as much, even though it's really hard." And then over time, it quiets down. Then the next time, if it shows up (crosstalk 37:33) absolutely will, but if it does, then you go, "Okay," you know. And you'll drop your skills, and you'll get surprised, and you'll kind of forget what to do, and you get caught up in it. Then you go, "Oh, yeah." So you will drop your skills, and that's totally fine. You don't want to stay on guard. You want to just live your life, right? So do we have anything else in the books?

CLIENT: No. (inaudible 37:58) probably have to be... two weeks?

THERAPIST: Two weeks. I was thinking two weeks. This seems we should probably do two weeks instead of one week.

CLIENT: Yeah, give me time to -

THERAPIST: Yeah, to have experiences and have this be more worthwhile. So let's look at that schedule.

END TRANSCRIPT