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. 

Dear Diary

Dear Diary,

I love the writing rhythm I’m in right now. It feels good to sit down nearly every night and hammer through something. It’s been quite varied: some nights I will sweep through two chapters and others I will spend all evening on just 250 words. It all feels good. I am just now running into the part of my story that I have the least experience with; I am trying to tap into raw emotions over situations I’ve never been in. It’s intimidating, to say the least. But I keep rotating between my desk and my prayer journal.

I just binge-watched Stranger Things on Netflix and quite enjoyed it. (And I don’t even enjoy being scared … but I do love a good psychological thriller.)

Waiting for my copy of Melina Marchetta’s new book Tell the Truth, Shame the Devil to arrive. In the meantime, I re-read Saving Francesca and its companion novel The Piper’s Son. (P.S. Salt Novel, my current work-in-progress, was born out of The Piper’s Son + a “what if.”)

Jacob Wetterling’s remains were found on a farm in Paynesville, MN. His abduction hit way too close to home for those of us who grew up in central Minnesota, and this has been a question that people my age have had for most of our lives. I remember when he was abducted in 1989. I was seven years old, and St. Joseph, where he was taken, is only about 20 miles from where I lived. Paynesville, where he was found nearly 27 years later, is about the same distance. The man who led them to the body was living in Annandale, just 11 miles from my parents’ house. This case has changed both MN and national laws, and while it is a heartbreaking ending to this decades-long mystery, I hope it will somehow bring the family some closure.

I am sleeping much better (and with NO sleep aids)! The insomnia doctor I’ve been meeting with is the kindest, gentlest, sweetest man. I am so grateful for the way he has thoughtfully pursued answers to my long-standing issues with sleep.

Work has been insanely busy– due in part to the last-minute closing of another private school in Minnesota (we ended up with maybe 8 or so of their students transferring to UNW and registering late) and in part to the implementation of new software in my office. But I feel good. I feel like I’m doing some of my best recruiting I’ve done in years. I am overflowing with creative ideas. It’s like a dam burst.

I’m thinking ahead to next month– which includes OCD Awareness Week– and planning to meet with the OCD Twin Cities team to plan a special event for it. (Anyone have ideas?)

My parents’ dog had puppies! Five purebred German shepherds– four chubby dark-colored male pups and one little all-white girl pup. In all our batches of puppies over the years (to different dogs), we’ve never had a purebred white shepherd before!

puppies

Well, I’d better get back to the manuscript. It’s being fussy.

Love,
Jackie

P.S. What’s going on in your worlds? I always love to hear from you, friends.