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In this episode of Your Anxiety Toolkit, Kimberley Quinlan guides listeners through practical strategies for managing the fear of medical procedures, such as needle and blood phobias. Drawing from both professional expertise and personal experience, she shares actionable tips to help listeners confront their fears with compassion and resilience. Learn how to turn anxiety into a manageable experience and feel empowered through the process.
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Finding Your Perfect Rest-to-Productivity Ratio The Burnout Dilemma
Ever felt like youâre constantly running on empty, juggling a never-ending to-do list, and battling that nagging voice that tells you youâre not doing enough?
Youâre not alone.
In a world that glorifies hustle and productivity, finding the right balance between rest and work can feel impossible.
But what if I told you that striking this balance is not only achievable but essential for your well-being? Today, let's dive into the concept of the rest-to-productivity ratioâa game-changing approach to ensure youâre resting enough to fuel your productivity and thrive without burning out.
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In todayâs discussion, weâre delving into the seven mistakes some OCD therapists are making in 2024. While the title might seem provocative, the goal is to highlight concerning trends in OCD treatment and provide insights that could enhance therapeutic approaches. Remember, this is my opinion based on what I've observed in various forums. I don't claim to have all the answers, but I hope to spark a constructive conversation.
Mistake #1: Insufficient Initial EducationImportance of Education at the Start of Treatment
Many clients report feeling thrown into exposure and response prevention (ERP) without adequate preparation. Therapists must take the time to educate clients about OCD, their obsessions, and compulsions, and what to expect from treatment. This foundational knowledge empowers clients, giving them a sense of control and a clearer understanding of their journey.
Mistake #2: Failing to Instill Hope and ConfidenceThe Power of Hope in Treatment
Therapists must remind clients that they have the potential to succeed. Treatment for OCD can be highly effective, and it's crucial to communicate this. While maintaining a realistic perspective, therapists should focus on the positive aspects of available treatments and instill a sense of hope and confidence in clients.
Mistake #3: Neglecting Evidence-Based ModalitiesTherapists should prioritize evidence-based treatments, particularly ERP. While it's important to integrate supplementary approaches like ACT, mindfulness, and self-compassion, the core of OCD treatment should be grounded in proven methodologies. Clinicians need to stay informed and ensure their clients understand the rationale behind chosen treatments.
Mistake #4: Misconceptions About ERP Being TraumaticERP: Not Abusive When Properly Delivered
Concerns about ERP being traumatic often stem from poor delivery rather than the method itself. Proper education and a strong therapist-client rapport can mitigate these fears. Itâs vital to ensure clients understand why theyâre facing their fears and to provide a supportive environment throughout the process.
Mistake #5: Rigid ERP PlansFlexibility in Treatment
While structured plans are important, rigid adherence can be detrimental. Treatment should be flexible and tailored to the client's evolving needs. Engaging clients in the planning process and adapting as necessary ensures that the therapy remains client-centered and effective.
Mistake #6: Overlooking Barriers to ProgressExploring Underlying Issues
When clients struggle with certain exposures, therapists should explore the underlying barriers. Understanding the client's fears, trust issues, or other relational dynamics can provide insights that help adjust the treatment plan accordingly. This approach prevents avoidance behaviors from taking hold.
Mistake #7: Not Assigning HomeworkThe Role of Homework in OCD Treatment
Homework is a critical component of OCD treatment. Without it, progress can be significantly hindered. Therapists should find creative ways to ensure clients complete their assignments, offering support and accountability measures. This empowers clients to practice skills outside sessions, enhancing overall treatment efficacy.
ConclusionThese seven mistakes highlight areas where OCD treatment can improve. It's essential for therapists to remain flexible, informed, and supportive, tailoring their approaches to each client's unique needs. Open communication and a collaborative mindset can help address these common pitfalls, ultimately leading to more effective and compassionate care.
Remember, this discussion aims to foster growth and improvement. If you're a client, don't hesitate to discuss these points with your therapist. Together, we can create a more effective and empathetic therapeutic environment.
Transcript
Today weâre talking about the seven mistakes some OCD therapists are making in 2024. Now, I know the title sounds spicy, but in no way am I trying to be spicy. What my goal is today is to talk to you about some of the things Iâve heard, whether that be on social media, on podcasts, on blogs, or at conferences, when people are talking about the treatment of OCD that deeply concern me.
Now, let me first say, in no way do I consider myself the moral police on OCD treatment. In no way do I believe that I am the knower of all things. In no way do I think that I know more than other people, my way or the highway. That is absolutely not what Iâm saying here today.
However, I am going to give you my opinion on some of the things that I hear that deeply concern me. Iâm just here to share what I think is helpful. I hope, if anything, itâs here to really reassure clinicians that theyâre on the right track because there are some amazing, amazing OCD specialists out there. If not, if this is something that you may find is calling you out a little, please, Iâm here to hopefully bring some goodness into the world. Letâs talk about the seven mistakes some OCD therapists are making in 2024.
As I said, this is all about my opinion. Again, in no way am I the moral police, but letâs talk about it. My guess is youâre probably going to agree with everything I say. If not, Iâm totally okay with being disagreed with.
Mistake #1: Not spending enough time at the beginning of treatment educating their client about the research and the science-backed treatment approaches that are here ready for us to use for OCD
So often, I hear clients saying in my office that they had this experience of ERP exposure and response prevention where they were just thrown into it, and they were like, âLetâs just go.â I get that. I love an eager therapist. I love a therapist thatâs not going to waste peopleâs time, but we have to spend a lot of time in the beginning educating them about the condition of OCD, helping them to understand their obsessions and their compulsions and how we get stuck in them and how they can be so seductive and how they can trick us, and also talking about whatâs coming, what treatmentâs going to look like, and what you can expect.
We have to spend a lot of time talking about that as well so that the person whoâs engaging in this treatment feels a sense of mastery over whatâs about to happen. They feel like they can make decisions as they go because theyâve got a plan. They can see them crossing the finish line. They can keep that. They know what thatâs going to look like, and they can use that to inform their decisions and how they connect and communicate with the clinician.
Mistake #2: Not instilling hope and confidence in the client
We have to remind our clients that they have everything that they need, that the treatment can be very, very successful, and that itâs an experiment. We donât have to get it perfect the first time. This is a collaborative experience. Thereâs a lot of hope here that by us collaborating and by us talking through whatâs working and whatâs not working and having them understand that this is actually a really good thing to have in terms of there are many conditions that the treatment sucks, the treatment isnât that effective. The treatment doesnât help as much as it does with OCD.
I never want to do the toxic positive thing with clients, but I also want them to acknowledge the conditions. This is one that we actually have some good research on. We have some good treatment options. We have these great supplement modalities that can help us along the way. We want to infuse them with hope. We want to infuse them with confidence in this process.
I do often see particularly younger therapists not spending enough time really bringing a sense of hope to treatment because itâs so scary. Theyâre already in so much pain. Theyâve probably been through treatment that sucked in the past. What we want to do is really focus on that hope, because hope is often what motivates us to take those first baby steps.
Mistake #3: Not engaging in evidence-based modalities
This is a huge one. I could spend a whole podcast episode or a week on this topic. There is so much misinformation about treatment and what is considered evidence-based.
Now again, Iâm not here to tell anybody what their treatment should look like. Thatâs a personal decision, and every client gets to make that decision. Who am I to judge? People need to come and know that they have agency over their lives and the decisions they make. But clinicians should be educated, and they should educate their clients on the options for evidence-based treatment modalities.
Now, I am a huge supporter of exposure and response prevention. I have been trained in it. I have been doing it for 14 years. I have seen it succeed over and over and over and over again. As Iâve been public in saying, I see no reason to abandon that.
Now, thatâs not to say that I havenât introduced modalities that supplement ERP. I love the use of ACT. I love the use of mindfulness-based cognitive therapies. I love the application of self-compassion. In many cases, I have applied dialectical behavioral health therapy to clients who are struggling with emotional regulation. Maybe theyâre having self-harm or suicidal ideation. Absolutely. As time continues, weâre seeing newer approaches and modalities come up. But I see it in my job as a clinician to educate my clients on the treatment, what has worked, and what Iâm skilled at doing too.
The other thing is there is some research on other treatment modalities besides ERP. I think thatâs wonderful. I mean, my hope is that one day we have something that is a sure thing, 100%, and we can absolutely promise that weâve got guaranteed results. This is going to be something that I continue to learn and educate myself on, but my opinion is that Iâm sticking with ERP. I love it. I find it so helpful and empowering. It lines up with everything and my treatment that has helped me. For those who are wondering, I am a committed ERP therapist.
Mistake #4: Saying that ERP is traumatic or abusive
Now, in fact, this concerns me so much that I did an entire episode with Amy Mariaskin. Itâs Episode 365. We talk specifically about this very sensitive and important topic, âIs ERP abusive?â What came from that episode, which is very similar to this one, is I donât actually feel like ERP is an abusive treatment modality. I think that sometimes how itâs delivered can be concerning, but thatâs the truth for any treatment modality. You could say the same about cognitive behavioral therapy. We could say the same about any medical treatment in terms of how the delivery can determine whether it harms people who are vulnerable.
One thing that I will be very clear, and I believe this in my heart, is the narrative that exposures, that facing your fears is mean, is a traumatic experience. I agree that if youâre having someone face their fear without giving them the education that they need and not explaining to them why theyâre doing it -- believe me, guys, let me also disclose here. Iâve made a lot of these mistakes myself as a clinician. Letâs just be open. I have been in this particular situation. Actually, if Iâm going to be really honest with you, number one, that mistake of not educating your clients, I learned that by a client telling me, âKimberly, I do not understand why youâre having me do what youâre doing. Iâm someone who needs to know what Iâm doing, or Iâm not going to trust you. Slow down and tell me what this looks like.â Again, no judgment over here. Iâve made a lot of these mistakes myself. But I think that throwing people too fast and too hard can feel very overwhelming, very activating.
Again, these are things we learn as we get better. Every clinician makes mistakes. Thatâs what makes them good clinicians. In no way do I want clinicians to feel blamed or judged here. Weâre human beings. Weâre doing the best we can, and every client is different. Sometimes we also need to build a rapport with clients so that they can share with us. We talked about that in the episode with Amy.
The most important piece here is having a rapport and a connection of trust and respect so that the client knows that they can tell us that this doesnât feel right, that this crosses my values, my limits, and my boundaries. This doesnât feel like itâs something that lines up with my values. We can have a conversation about that and be respectful about, âThis is what works for me in this relationship, and this is whatâs not,â or âHere are my concerns about ERP. Could you help me to work through this, or could we consider having a conversation before we move forward?â I think thatâs what also helps this from being experienced as a trauma as well.
But if this is something that is a hot topic for you, go and listen to that because itâs such an important, compassionate, respectful episode. Amy did a beautiful job of going deeper into this specific topic.
Mistake #5: Following an ERP plan that has zero flexibility
I get it. When I first started as an OCD therapist, I was trained to use a very structured exposure and response prevention plan. There were modules and systems, and you had to follow the manual. I loved my training. My training literally set me up. It was some of the best OCD training I think anyone could ask for. But there were times when I stuck to the plan so diligently that I missed the client. I missed their needs. I missed hearing from the client on what they think the next step is.
Now, what I have found to be so beneficial is to talk to the client. What would you like to do next? This is our plan that we originally made together because we talked about it at the beginning of treatment. Do you feel like youâre ready to take this next step? Whatâs getting in the way of you taking this next step? Letâs discuss. Is this the right step based on what we thought we knew, or are we going to shift it up now?
I think that the flexibility in treatment helps teach clients how to be flexible in their daily lives as well. We donât want to follow a rigid plan unless thereâs some clinical reason to do so. I think we also have to understand here that some intensive treatment programs require really rigid plans because of the severity of the disorder. Absolutely, I completely get that. But I think where weâre really going with that is it has to be individualized. We have to understand the clientâs needs in order to make a plan. And then from there, we can decide whatâs best. But we have to stay away from rigidity.
I also donât love any treatment modality that has modules that make the clients go through modules because, again, I think it misses the client, where theyâre at, what their needs are, and what else is going on in their life. Again, every clinician delivers it differently. I respect every clinician to know whatâs best for their clients, but itâs something that we can look out for.
Mistake #6: Moving on without exploring what was getting in the way
Letâs say you had a treatment plan and the client said, âAh, that doesnât work for me.â And then you just say, âOkay, fine,â and you move on without slowing down and getting curious. Tell me about that. Whatâs getting in the way of you being able to do this exposure? Is there an obsession Iâm not aware of? Is there something else happening thatâs happening relationally, or is there a trust issue or rapport issue between you and I that might be getting in the way of us not completing that part of the treatment plan that we had originally agreed would be helpful for you?
Itâs really important, and Iâve seen this with my own staff, with my own consultation with other clinicians. Moving on too quickly can allow OCD to get sneaky and help them engage in avoidant compulsions. We have to be really careful about not engaging in compulsions with our clients. Sometimes our clientâs OCD can be very convincing in getting us to not address certain issues because of an avoidant compulsion.
Again, complete transparency. Iâve been there a million times, so absolutely no judgment here. These are all things we just have to keep an eye out for and do the best that we can. Consult as much as we can. Do a little check-in with ourselves. I try to do a check-in every week. How is each client going? How are they doing? Where am I stuck? Where are they stuck? Am I having any blind spots here for this client? And this could be one where thereâs a real big blind spot.
Mistake #7: Not assigning homework to clients
This one is so hard. Again, Iâve been there. Often, when clients are in a lot of distress and they have a busy life, a family, or a job, we might assign homework, and they might show up on Tuesday at nine oâclock and say, âIâm so sorry, I didnât do my homework.â You say, âNot a problem. Letâs try and get it done this week.â Send them home with the homework. Next Tuesday at nine o'clock, they show up and still havenât done their homework. Sometimes, I see this a lot, therapists go, âOkay, theyâre not someone who does their homework. Iâll pivot, and Iâll make sure weâre doing extra exposures in session.â
Thatâs a really great pivot. But I would usually stop there and have a conversation with the client and really help them understand, not from a place of judgment or shame, but that their success in treatment goes way down when they stop engaging in their homework assignments. We have to really stress to clients that one hour a week is not enough and that we have to find creative ways and motivation tools to help them make sure theyâre engaging in their assigned homework.
I have allowed clients to send me the thumbs-up emoji in an email to show me that theyâve done it, or maybe theyâve called into my voicemail to confirm that theyâve completed their homework. Again, I donât make them do this, but I always offer them, what can I do? What service can I offer you that will help you stay accountable for your homework? Because for every minute of homework you do, you have massively pushed the needle in the success of your treatment.
I often see a lot of clinicians just disregard homework and say, âItâd be great if they did it, but they wonât.â I would stop and pause there and really explore with the client and make sure they understood that treatment wonât be that super successful if theyâre not engaging in homework.
Again, we want to get creative. We want to collaborate with them as much as we can.
What can we do to help get that homework done?
Can we set more realistic goals?
Can we stack it onto another routine that you do?
Can we help with accountability?
Can we bring in a loved one or someone who can support you?
What can we do to help increase the chances of you getting better?
Because I always say to my patients, my hope for this treatment is to teach you everything I know so that you can be your own therapist. Not to say that I donât want to treat you, and I think you shouldnât need a therapist. I just want you to be trained to think about it so that when youâre at home and youâre struggling or maybe youâre in recovery, but you have a little lapse, you can recall, âOh, I remember the steps. I remember what I need to do. I feel empowered. I know this works. Iâm going to get to it and trial that first.â
There are the seven mistakes some OCD therapists are making in 2024. Please know, there is zero judgment here. Please also know, this is just my opinion. I fully respect that every clinician is going to come from a different perspective. I fully believe that every clinician comes and sees their client and has the ability to really meet them where they are. I just wanted to bring this up because these are topics Iâm discussing with my staff, and I think that itâs something that maybe would help you today.
Iâm going to send you off with a big, loving hug and remind you that today is a beautiful day to do hard things.
If youâre a client and your therapist is engaging in some of these behaviors, donât be afraid to bring it up. Weâre a collaborative team here. I always tell my patients, I want to hear your honest feedback. I want to hear if somethingâs not working for you because that helps you, and Iâm in the business of helping.
Have a wonderful day. Iâll see you next week.
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