Q&A with an ERP Therapist

Erin VenkerMeet Erin Venker. I know her through the leadership team for OCD Twin Cities. Erin is lovely, thoughtful, and smart– and she has a unique experience of having OCD and being an ERP therapist. I’m so pleased to be interviewing her on my blog today!

Tell us a little about your background in regard to OCD, Erin.

I first had symptoms in 5th grade but I wasn’t officially diagnosed until 7th grade. At that time, my OCD was mostly rituals of “breathing in” and “swallowing on” the letter A so I would get A’s in my classes. I also did a lot of magical thinking, for example, having lucky and unlucky colors. It soon evolved to include repetitive praying and confessing to mom thoughts, worries, and “bad” things I did, or else I believed something bad would happen. I frequently had horrible intrusive thoughts, both sexual and violent. That period of my life is fuzzy; I just remember it was extremely painful. Daily life was exhausting. I thought I was a horrible person and in constant fear that something bad was going to happen to my family.  I was too embarrassed to talk about my intrusive thoughts, so I didn’t realize that was a part of my OCD until years later.

In college and post-college, my OCD evolved into primarily mental symptoms with rumination, trying to“figuring things out” by replaying scenarios over and over in my head, a constant fear of offending people, and reassurance seeking.

What led you to become a therapist? What are your educational credentials?

I didn’t receive the proper treatment for OCD until 14 years after I was diagnosed. It was at the OCD conference in Boston where I learned that exposure and response prevention therapy was the evidence based approach to successfully treat OCD. I also learned there how common taboo intrusive thoughts were, and that was a huge relief. I decided to become a therapist to help raise OCD awareness and expand the availability of treatment.

I received my master’s in counseling psychology at the University of Saint Thomas and have attended several workshops on exposure therapy. I currently work under the supervision of Dr. Vernon Devine who has 46 years experience treating individuals with anxiety disorders while I work toward my license as a professional clinical counselor.

What services do you offer, and what is payment like?

I specialize in OCD, agoraphobia, hoarding, body dysmorphic disorder, social anxiety disorder, phobias, panic disorder, basically all forms anxiety. I use exposure and response prevention therapy and integrate mindfulness and some dialectical behavioral therapy techniques.

Due to the rising costs of health care, insurance benefits have increasingly become more complex. Self pay ensures that the client’s records and diagnoses are entirely confidential documents as I will not have to submit them to insurance or a third party payer. The content of the sessions stays between myself, the client, and Dr. Devine.

Treatment often involves appointments that need to be longer than an hour, multiple sessions a week, at-home sessions, and public exposures. Self pay allows for treatment freedom as well as the time to get to the root of the problems the client is facing. It makes treatment much more effective. Typically treatment lasts no longer than three months before going to an as-needed appointment basis.

What are the benefits of exposure therapy? How does it work?

Exposure therapy works by essentially helping you confront what you fear the most. For example with contamination OCD, I’ll have clients work on touching and interacting with whatever they believe to be contaminated. If a client has a mental obsession fearing that they are attracted to a family member, we will make a script that they are in fact attracted to that family member. Basically whatever they avoid to protect themselves from their fears, we work up to doing that by creating a hierarchy. We start with whatever trigger the client finds the least distressing and expose them to that trigger until their anxiety decreases. We then gradually move up the hierarchy until the client is ready to confront the most difficult exposures.

Can you briefly describe how you guide a patient through ERP, especially what the first couple sessions might look like?

In the first session, I get to know the client, gather some background information, and go over an assessment I have them fill out before the appointment. We go over details about their presenting symptoms and explore their triggers.  We then begin to build a hierarchy of ways to expose the client to the thoughts, images, objects, and situations that they find distressing and provoke obsessions/compulsions. ERP is no walk in the park, but it is an evidence-based approach that has shown to be incredibly effective.

Many of my blog readers are very concerned about being judged by a therapist who doesn’t truly understand OCD. What advice would you give to them?

Know that whatever intrusive thoughts or rituals you have, no matter how embarrassing, weird, or perverted you believe they are, I guarantee they are extremely common in OCD, and thousands of individuals have similar if not the same thoughts and compulsions. Everyone has intrusive thoughts– people with OCD just get them stuck in their head and distressed. Whatever you find most upsetting, OCD will latch onto it and continuously project it in your head like a song stuck on repeat.

Find a therapist who truly understands OCD. It breaks my heart when I hear about individuals who saw a therapist, tell them about sexual or violent intrusive thoughts they are experiencing, and the therapist does not recognize these symptoms as OCD. This can create further isolation, shame, and hinder the therapeutic process.

Erin Venker 2One last question: reassurance is often a compulsion for OCD sufferers. How can a therapist practice compassion without reassurance? What is your approach to this?

I use a lot of humor in treatment. I try to help clients notice when there OCD is sneaking up on them. Depending on the context and the individual, I will push the exact opposite of the reassurance they are seeking.

I have a rule of thumb that in the appropriate moment, I will only reassure once. I know you are not a pedophile, this is the one and only time I reassure you. After that, it’s all about accepting uncertainty. Well, maybe that thought does mean you want to kill someone, let’s make a script of it happening. At the same time, I validate the client that ERP is extremely difficult, and what they are doing is brave and hard work.

Thank you so much to Erin Venker for a great interview! If you are in the Twin Cities and think you could benefit from working with Erin, click here for her contact information. 

nOCD, an ERP App/Hero

If you’ve spent time around this blog, you know that I wrestled my life and freedom back from the clutches of obsessive-compulsive disorder in 2008. (Read more about my story at jackieleasommers.com/OCD).

From the onset of my symptoms to my diagnosis: 15 years.
From my diagnosis to appropriate treatment (ERP): 5 years.
From treatment to freedom: 12 weeks. (<–Read that again please.)

Exposure and response prevention (ERP) therapy is powerful, friends.

On average, it takes OCD sufferers 14-17 years to get the correct diagnosis and treatment. This is not okay. 

So many OCD sufferers cannot afford treatment. In some countries, ERP therapy is simply not available. In fact, in some countries, the stigma associated with having a brain disorder like OCD is so strong that sufferers would not dare admit to needing help. This is not okay. 

The creators of the nOCD app felt the same way. One contacted me and said, “Our goal is to reduce the time it takes for people with OCD to get effective treatment (from decades to minutes).” He said, “One thing advocacy has shown me is the need for OCD treatment in other countries! There are people in Bangladesh, India, etc that have literally nobody! My team is actually building a 24/7 support community within nOCD to combat this issue.”

The app is FREE and, I-hope-I-hope-I-hope, going to change the world.

Some of the very best things about this app:

nocd.jpg

Right now it’s available for iPhones, but this fall, the Android version will come out. Please check it out here. And be sure to tell me what you think!

xoxo Jackie

I like life.

This was a really busy– but ultimately really good– week for me.

Last week, I was (pre?) diagnosed with a sleep disorder– Delayed Sleep Phase Syndrome, which sounds totally fake but isn’t. Basically, my circadian rhythm is off, which is why I stay awake so late (even with Ambien!) and then feel impossibly paralyzed in the mornings. I’m meeting with a specialized sleep psychologist next month, and in the meantime, I had blood work done to see if it’s safe for me to go back onto Risperdal. I took that tiny .5 mg (notice that is POINT-FIVE not FIVE mg) pill for eight years, and when I went off of it (maybe six months ago?), I’ve just gone haywire. I know that for most people, mornings are not fun. But, for me, they’ve been impossible. I don’t know how else to explain it.

My favorite kiddos came over on Saturday, and later I found a sweet note from the six year old. Allow me to translate: “Ava loves Jackie’s house.” Jak E with a backward J leaves you with cake. I like cake.

My editor was in the Twin Cities, so we hung out on Monday, brainstorming and discussing Salt Novel as well as writing and publishing in general and all the things we’ve been learning lately. It was wonderful! I left feeling energized to write and excited about my manuscript. Now to find more time …
The rest of the week consisted of therapy (yay), haircut (yay) and dye job (yay? see pics.), getting paid for the German translation of Truest (YAY), and ice cream with my bestie (major yay).

How about you? I can’t believe July is half over. Where is summer going? I’m ready for cooler temps (it’s been in the nineties in Minnesota and miserably humid, though the end of this week was better) but I’m not ready for the ruckus of fall recruitment quite yet.

Think of me as I sort out my sleep/novel/work/life.

No Shortcuts

When Jeff Bell, spokesperson for the International OCD Foundation, spoke for our OCD Twin Cities event, one of the things he said that really stood out to me was that there are no shortcuts in treating OCD.

Woman and maze

That’s true, or at least it was in my case. I wanted easy answers: for deep theological conversations to solve my problems, or for comfort and reassurance from friends to be enough, for an hour-long conversation with a therapist each week to take away the anxiety, for an easy prescription to fix everything.

I definitely did not want the hard answer: exposure and response prevention therapy.

My psychiatrist didn’t mince words in his description: “It will be hell.”

It was one of the hardest things I’ve ever had to do in my life, but one of the most necessary and most rewarding. For me, there was no shortcut to healing, and since I was already living in OCD hell, the best way out was to keep going.

So, believe me, friends: I get it. ERP therapy is hard, so hard. You might think you won’t survive it. You might think your loved ones won’t survive your going through it. You might think it’s sinful or disgusting, and your exposures are probably going to be loathsome and repellent to you.

If you need to, go ahead and look for shortcuts. I know I had to.

But in the end, there were none for me, and I’d only wasted time looking for them.

While experiencing it, ERP was hell. But on the other side? It was my rescue.

 

Talk Therapy vs. ERP Therapy

Therapy through Magnifying Glass on Old Paper.Sometimes I give talk therapy a rough time on this blog– but, please know that I am not against talk therapy (I see a talk therapist weekly for panic and adjustment disorder). I am merely against talk therapy for OCD.

I spent about four years meeting with talk therapists about my OCD. Once a week, I’d sit down, talk about my fears and confess my struggles– and my therapist would reassure me.  In other words, it was a one-hour compulsion fest.

Not good.

Every single OCD expert will tell you to skip talk therapy and do exposure and response prevention (ERP) therapy.

Look, I get it: talk therapy is easier. In fact, in comparison to exposure therapy, it’s a walk in the park and ERP is a walk in hell.

But it’s not effective for treating OCD.

Talk therapy, which is lovely and helpful and beneficial for so many other disorders, naturally enables many OCD compulsions.

Four years in talk therapy didn’t make a dent in my OCD. Twelve weeks in ERP therapy mastered my OCD.

It’s just about know what treatments are effective. Band-aids go on scrapes, insulin is used for diabetes, chemotherapy for cancer, ERP for OCD.

I do love my talk therapist, but I don’t ever let us venture into the realm of treating OCD. Yes, we draw parallels– all the time, actually!– but I know that if my OCD flares up, I will turn to an exposure, not to a compulsion.

Have questions about ERP therapy vs. traditional talk therapy?  Let’s chat!

Co-Morbidity

comorbidDo you know the term?

Co-morbidity is the presence of one or more other disorders co-occuring along with the primary one. For those of us with OCD, our OCD is often co-morbid with depression. The depression seems to usually be a result of the OCD (as opposed to the other way around).

On their website, the Stanford School of Medicine writes:

Patients with OCD are at high risk of having comorbid (co-existing) major depression and other anxiety disorders. In a series of 100 OCD patients who were evaluated by means of a structured psychiatric interview, the most common concurrent disorders were: major depression (31%), social phobia (11%), eating disorder (8%), simple phobia (7%), panic disorder (6%), and Tourette’s syndrome (5%).

They also say:

In Koran et al.’s 1998 Kaiser Health Plan study, 26% of patients had no comorbid psychiatric condition diagnosed during the one year study period — 37% had one and 38% had two or more comorbid conditions. These proportions did not differ substantially between men and women. The most commonly diagnosed comorbid conditions were major depression, which affected more than one-half, other anxiety disorders, affecting one-quarter, and personality disorders, diagnosed in a little more than 10%.

OCD is enough of a beast on its own, but the truth of the matter is that many who struggle with OCD are fighting other demons too.

In my experience, OCD and depression teamed up against me, though, as I wrote before, the depression was secondary to the OCD (in that it was caused by the OCD). Some days I would be full of intense, manic fear caused by OCD, and other days all my sharp edges would be dulled by depression and a feeling that nothing in the world sounded exciting or worthwhile.

I’m so grateful that when ERP helped me steal power away from OCD, the upshot was that depression was defeated too.

For (lots!) more about OCD and ERP, go to jackieleasommers.com/OCD.

 

Image credit: Gerald Gabernig

 

Not a Therapist, Just a Resource

unsplash5It’s true: I know a fair amount about OCD. I experienced it for 20 years, I successfully went through ERP therapy, I wrote an (unpublished) novel about a character who struggled from it, I am part of the leadership team for OCD Twin Cities, and I blog about it regularly.

But I’m not a therapist.

I’m only a resource. I can tell others what I know, what I’ve experienced, what to look for in an ERP therapist, what books might be helpful, etc.  But I cannot walk them, hand-in-hand, through exposure therapy. I have to remind others AND MYSELF of this. Often.

To those of you who blog about OCD and ERP, do you have this same problem?  How do you handle it?

For (lots!) more about OCD and ERP, go to jackieleasommers.com/OCD.

Image credit: Unsplash

Black Dot: My Narrative Therapy

kooshToday I’ll share with you one of the tools in my toolbox; some (most?) of you will probably think it’s bizarre, but it works for me. Maybe it could work for you too!

I picture my OCD as something completely separate from me. I think of it as a black dot about the size of my fist. It is not a part of me; it is only in my vicinity, and when it is, it has a horrible influence.

But I have learned that I am stronger than the black dot. I am in charge of it, not the other way around. My OCD/black dot takes itself very seriously, and so it absolutely hates to be belittled. It is also masculine, somehow, someway.

So, when my thoughts start to go to ugly places (these days, this usually only happens at night before I fall asleep), I recognize that my OCD/black dot is in the room with me, and I make it put on a tutu or something else that makes it feel ashamed, and then I give it specific instructions for where it needs to go.  I mean this literally.  Most nights, I banish my OCD/black dot to the balcony outside my apartment.

It has to listen. (Which still amazes me sometimes.) (P.S. It’s ERP that helped me realize my immense power.)

In fact, sometimes it’s so ashamed of the tutu I force it into, or of any number of strange and childish dot-sized outfits I make it wear, that it doesn’t even want to be on my balcony where others could see it, so it crawls down the block to hide in the nearest doghouse.

Weird. I know. Believe me, I know.

But it works for me.

Do you have any weird methods to keep OCD beneath your heel?

For (lots!) more about OCD and ERP, click here.

Image credit: Josh Rokman

A War in the Mind

war in my mindI remember the Sunday mornings in church when my mind was a war zone.

An intrusive thought would show itself, and with my Pure-O compulsions, I’d mentally bat it down (usually with repetitive prayer).  I was a ninja with my compulsion moves, but OCD was just as fast and furious.  Back and forth, back and forth, like a relentless game of Whac-a-Mole.

And no one knew.

All these happy people around me, worshiping God, taking in the sermon, happy and safe in their suburban church sanctuary– and, for me, it was a battle field.

Pure-O: so invisible, so dark, so exhausting.

I praise God that those days are a part of my past.  If you want to learn how I survived (and WON) this war, click here.  Your mind doesn’t have to be a scary place.

For (lots!) more about OCD and ERP, go to jackieleasommers.com/OCD.

Image credit: unknown.