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Lessons Learned: Mistakes in Clinical Work
Episode Overview:
This episode explores the concept of clinical vulnerability with Dr. Emily Bailey, a professor at Oglethorpe University and expert in anxiety and OCD. Join us as we discuss the importance of making mistakes, the art of exposure therapy, and how clinicians can best support their patients through open communication and personalized treatment.
Key Insights:
- Clinicians are human: Therapists make mistakes, and it's important for both clinicians and patients to recognize this. Growth comes from acknowledging mistakes and learning from them.
- The art of exposure therapy: Exposure and response prevention (ERP) therapy is not a rigid, cookie-cutter approach. It requires creativity, rapport building, and trust between therapist and client.
- Responding with urgency reinforces anxiety: Responding immediately to patient emails or calls can reinforce unhealthy patterns. Setting boundaries around communication is crucial for both the clinician's well-being and the patient's growth.
- The importance of processing: Sometimes, patients need to process their emotions before jumping into exposures. Recognizing when to pause and address underlying issues is key to effective treatment.
- Saying "I don't know" builds trust: It's okay for clinicians to admit when they don't have all the answers. Exploring solutions together fosters a stronger therapeutic relationship.
- Avoiding hard conversations is detrimental: Addressing comorbid disorders and other treatment interfering behaviors, even if challenging, is vital for a patient's long-term recovery.
- Referrals are a graduation: If a clinician isn't the right fit, they should refer the patient to someone who can better meet their needs. This is a positive step towards effective treatment, not a failure.
- Treating the whole person: Effective treatment addresses the individual's entire context, not just their symptoms. This includes family dynamics, life stressors, and any other relevant factors.
Notable Quotes:
- "It's almost like an art. There's a science to it, but there's this creative piece of treating anxiety and OCD..." - Dr. Emily Bailey
- "If you focus on being right, you can guarantee you're gonna be wrong." - Dr. Elizabeth McIngvale
- "The only mistakes that are made are the ones we don't learn from." - Cali Werner
Timestamps:
- [00:00:00] Introduction + Guest Introduction
- [00:06:09] Anxious moments + Marathon pacing anxieties
- [00:13:49] Clinical mistakes + Learning from experiences
- [00:20:11] Ethical boundaries in communication
- [00:25:06] Meeting clients where they are at + Not being rigid in treatment
- [00:32:28] Importance of the right treatment + Ethical referrals
- [00:41:03] Projection in clinical practice
- [00:47:45] Summarizing key takeaways
- [00:54:05] Where to find Dr. Bailey + Future episode topics
Guest Links:
- atlantaocdandanxietytreatment.com
- Oglethorpe University
Call to Action:
- Subscribe to The Anxiety Society Podcast on your favorite platform + leave a review! Connect with us on Instagram @theanxietysocietypod to explore more content, submit questions, & join our community! Let's change our relationship with anxiety, together!
Transcript
Welcome to the Anxiety Society Podcast.
Speaker A:We're your hosts, Dr.
Speaker A:Elizabeth Mackinbell and.
Speaker B:Cali Werner, both therapists and individuals that have navigated our own anxiety journeys.
Speaker B:Have you ever wondered how we became a society that is so defined by anxiety?
Speaker A:Tune in as we discuss, learn, and dive into what anxiety is, how we perpetuate it, and we can stop it.
Speaker B:This podcast will be real, raw and unfiltered, just like the anxiety that plagues so many of us.
Speaker B:We are here to push boundaries, challenge the status quo, and deep dive into topics that are sure to make you uncomfortable.
Speaker A:If you're ready to step outside of your comfort zone and explore the unfiltered truth that will help you change your entire relationship with anxiety and get back to living your life, you're in the right place.
Speaker B:This is the Anxiety Society podcast.
Speaker B:We live it and we contribute to it, and together we can change it.
Speaker A:And there's one thing that I need from you.
Speaker C:Can you come through?
Speaker A:Welcome back to the Anxiety Society Podcast.
Speaker A:Today's episode is going to be about clinical vulnerability.
Speaker A:We're going to share lessons learned in clinical practice and talk a lot about how we've grown as clinicians and why and taught.
Speaker A:And hopefully this will be a lot of different discussion points that both you can relate to, but you're going to learn from.
Speaker A:And we're so excited because we have a guest on today's show, and I'm going to let Callie introduce Dr.
Speaker A:Emily Bailey.
Speaker B:Dr.
Speaker B:Emily Bailey is an incredible clinician with her psyde.
Speaker B:She is a professor at Emory Oglethorpe, Oglethorpe University.
Speaker B:That's a mouthful.
Speaker B:I would not have gotten that.
Speaker B:Anyways, Oglethorpe, she knows statistics very well, is amazing at them.
Speaker B:The only reason why I'm getting through my dissertation and yeah, has a heart of gold.
Speaker B:She used to work at OCD Institute, now does private practice, and is a great individual to know in the field of OCD and anxiety.
Speaker C:Thank you.
Speaker A:And she works again at OCD Institute.
Speaker B:Yeah, doing our research for us.
Speaker C:I came back, I couldn't get enough of them.
Speaker A:Well, we're excited.
Speaker A:And Emily, tell us a little bit about just like, your background and what brought you to the field in general, but also the field of anxiety and OCD specifically.
Speaker A:Oh, my gosh.
Speaker C:I, you know, I've always been interested in anxiety.
Speaker C:I really initially was interested in trauma.
Speaker C:Still am interested in trauma.
Speaker C:There's a lot of comorbidity there.
Speaker C:But when I entered my graduates program, my doctoral program, I just found a love for anxiety disorders and related disorders.
Speaker C:Such as ocd.
Speaker C:I started out at Virtually Better, where I did a lot of virtual reality training for social anxiety Disorder, Fear of Planes, different phobias as well.
Speaker C:And then following that, I really transitioned in my postdoc to wanting to specialize in OCD and related anxiety disorders.
Speaker C:So I just found such a passion, and you can see so much progress so quickly, and really, it changes somebody's life so much.
Speaker C:And I think that's what drew me to it as well, is you could see such significant change in such a short time if you appropriately treated them.
Speaker C:So.
Speaker B:Yeah.
Speaker B:And all that to say we got to this point where we can confidently speak about OCD and anxiety treatment by making mistakes along the way.
Speaker A:Totally.
Speaker A:And I think that I love hearing you say that, just because, you know, so many of us that are in the anxiety field, we literally love this work.
Speaker A:Right.
Speaker A:Like, it's not a job.
Speaker A:I always tell people, if treating anxiety or OCD is a job, it's not gonna work out for you.
Speaker A:You're gonna get burnt out.
Speaker A:You're not gonna find that.
Speaker A:But those of us that are here and love it, we truly feel that way, where it's like, yes, it's challenging, but we get to watch people's life change.
Speaker A:And the reality is that we know with appropriate treatment, people's life really can change, and we know that treatment works.
Speaker A:So I'm so excited that you love it.
Speaker C:Yeah.
Speaker C:And honestly, it's almost like an art.
Speaker C:Right.
Speaker C:There's a science to it, but there's this creative piece of treating anxiety and OCD where you get to come up with awesome exposures that are so individualized.
Speaker C:And I think that brings the fun to it, where it's like, how can I be creative this time?
Speaker C:How can I take it up one more notch?
Speaker A:And I love you sharing that, because I think a lot of clinicians who don't treat anxiety and OCD think of, like, cognitive behavioral therapy and the intervention we do for anxiety as being super rigid and being this, like, you know, protocol treatment where those of us that do it, we're like, what are you talking about?
Speaker A:It's all about, like, building rapport with a client, like, having a great working relationship with them, trusting them.
Speaker A:Them trusting you.
Speaker A:And, like, you guys get to do this work, but you're laughing.
Speaker A:It's filled with love.
Speaker A:It's exciting.
Speaker A:It's empathetic.
Speaker A:It's not this, like, rigid, cruel treatment process.
Speaker C:And actually, that's kind of one of the mistakes that I made going into the field right when I was Like a very new clinician.
Speaker C:I was like, oh, gosh, I have to do this in a very rigid way.
Speaker C:It's a cookie cutter way.
Speaker C:This is how you treat anxiety and ocd.
Speaker C:And I think that's honestly one of my biggest learning moments is that, yes, ebp, erp, it's so important, but we sometimes miss the individual when we only focus on the treatment.
Speaker C:And there's so many outcomes that I think I could have made so much better and helped with my patient if I had just paused and been like, this is an individual processing moment versus, no, no.
Speaker C:We have to rigidly stick to the ERP because this is the gold standard treatment.
Speaker C:So I'm even thinking of, like, social anxiety disorder.
Speaker C:I had this patient pretty recently who during the holidays, I was like, it's a perfect time to, you know, get exposed to your family and like, some of the people that you're not as close to, let's use the holidays as an opportunity.
Speaker C:And I remember their face changed and they were like, no.
Speaker C:And initially I was like, this is resistance to treatment.
Speaker C:Right.
Speaker C:And I almost took it an approach that was like, no, you're resisting our treatment.
Speaker C:Like, this is the right way to do it.
Speaker C:This makes sense given your presentation.
Speaker C:But from what I've learned, I paused and I explored rather than just being like, no, you have to do this.
Speaker C:Which is what I used to do, where I was like, no, no, no, this makes complete sense.
Speaker C:You're still doing it.
Speaker A:Right.
Speaker B:Which is a perfect preview, sneak peek of what we are going to dive into more.
Speaker B:But before we do that, we've got to start with our anxious moments.
Speaker A:Ooh.
Speaker C:Yeah.
Speaker B:And so maybe anxious moments could be mistakes that we've made in maybe since we're going to be talking about those vulnerabilities.
Speaker B:Or it can be an anxious moment that's happened over the past week or so.
Speaker B:And I can go first since I usually put others on the spot.
Speaker B:My anxious moment is I decided to be a pacer in the Houston marathon on a whim and decided a little late, and I'm kind of going a little bit of a faster pace than what I really wanted.
Speaker B:I started getting a little tickle in my throat a couple of days ago, and Emily, who flew in yesterday, came in and the second she saw me, she goes, you're sick.
Speaker B:And I was like, I'm not sick.
Speaker B:It's just like a little bit of allergies, Right?
Speaker B:Yeah.
Speaker B:As the days went on, I do not feel bad.
Speaker B:And so that is kind of the hard part.
Speaker B:But I am definitely congested.
Speaker B:You can probably hear it in my voice.
Speaker A:I noticed yesterday, but I was not going to say anything because I was like, oh, she is running the marathon.
Speaker A:This is probably not going to be a fun thing for me to bring up right now.
Speaker B:Yeah, I've kind of been in denial about it.
Speaker B:And the time that I'm running is a little faster than I would like.
Speaker B:And so, yeah, I'm just, like, nervous and anxious and can't wait for it to be over.
Speaker A:Well, you told me walking down, I was like, how are you feeling about the marathon?
Speaker A:You're like, I feel like I'm in denial that I'm actually sick right now.
Speaker A:And I'm like, yeah, that makes sense.
Speaker C:I can see that.
Speaker C:She just keeps saying, it's allergies.
Speaker C:It's allergies.
Speaker C:I'm like, not quite.
Speaker B:Maybe I can wish it into happening, but I have heard from my athlete that they might want to change their pace time.
Speaker B:And normally I'd be like, no, you can do this.
Speaker B:And I'm like, yeah, let's think about it.
Speaker A:Like, whatever you think makes sense.
Speaker A:If we need to do a four.
Speaker B:Hour, we are fine with that.
Speaker A:Whatever you want.
Speaker C:Yeah, those you want.
Speaker A:Yeah.
Speaker B:I'm probably going to share how that went in our next episode, but that's mine.
Speaker A:I have a question, Cali.
Speaker A:So you get signed up to pace this marathon at a pace you weren't necessarily training for.
Speaker A:Right now.
Speaker A:We all know you can do it, but let's pretend that, like, halfway through the marathon, you're like, I can't maintain this speed.
Speaker A:What do you.
Speaker A:How do you tell your, like, what do you tell yourself?
Speaker A:How do you make yourself do something that it doesn't feel like you can do?
Speaker A:Because for me, when I.
Speaker A:I'm like, I can't do this.
Speaker A:I just stop straight up and exercise.
Speaker A:I'm like, oh, this hurts.
Speaker A:This doesn't feel right.
Speaker A:I'm done.
Speaker B:I think it's a lot of the same strategies you use in erp.
Speaker B:I've done hard things before.
Speaker B:I can do this too.
Speaker B:That's such a cliche.
Speaker B:Cheesy answer.
Speaker B:But I also have a lot of people pleasing tendencies.
Speaker B:And so when it's involving someone else, I think that's an extra motivator of, like, gosh, they're not going to get to finish if I don't finish with them because it's a blind athlete.
Speaker B:Um, and so just, you know, thinking about that extra pressure kind of helps me a little bit.
Speaker B:But, yeah, I also think I've I've struggled a lot with rigidity around those things.
Speaker B:And so as soon as you started to say that, my mind went into this defense mechanism of that's not an option.
Speaker A:That's how, well, that's probably how you get through it is you tell yourself that's not an option, where for me, it's always an option.
Speaker A:Stopping exercising, never off the table.
Speaker A:Yeah.
Speaker A:Emily, anxious moment.
Speaker C:Oh, gosh.
Speaker C:I, I, I have to say it was yesterday when I was traveling.
Speaker C:I was warned in advance that people are getting sick.
Speaker C:And usually I have zero health anxiety.
Speaker C:I'm not worried about it at all yet I'm sitting next to you.
Speaker C:I'm not worried about getting sick at all.
Speaker C:But all of a sudden, everyone around me started coughing at the same time.
Speaker C:And I'm telling you, I don't wear masks.
Speaker C:I'm like very fine out in public ever since COVID and I put my mask on for the first time since pretty much Covid.
Speaker C:And I was just really worried because they were right next to me.
Speaker C:And then the person that I was most worried about or concerned about was right in the aisle behind me and.
Speaker A:They ended up sitting.
Speaker B:Yeah, coppers are annoying.
Speaker B:Like when, when you have, especially on.
Speaker A:A flight and you're like, I can't escape this at all.
Speaker B:Yeah.
Speaker B:And on flights, I don't know, you kind of just get grossed out anyways.
Speaker A:So you're so close.
Speaker A:Do you all remember during that peak of COVID if you ever had like, wrong pipe or anything happened where it was like a cough that wasn't even a real cough, but everyone would just stare at you were so anxious of like, I swear I'm not sick.
Speaker A:Like, I just drank this coffee and went down the wrong side.
Speaker B:Yeah.
Speaker B:Well, even now, right?
Speaker B:Like, I, I'm like, it's just a little congestion.
Speaker B:I don't feel bad or anything, but I'm still anxious for other people.
Speaker B:Like, are they anxious because I have a little bit of a runny nose?
Speaker B:So.
Speaker A:Well, I get this all the time.
Speaker A:Being this pregnant is, I feel like everybody is like, I won't come near you.
Speaker A:And I'm like, I don't, I'm fine.
Speaker A:Like, I live at home with a two and a three year old.
Speaker A:Like, I'm exposed to every cold and illness that is known to man every day.
Speaker A:So don't worry about me.
Speaker A:But it's funny, people, I think too, you get like hyper responsibility around people that you're more anxious about than yourself.
Speaker A:Right.
Speaker A:Like, we can handle ourselves being sick.
Speaker B:Right?
Speaker A:Right.
Speaker A:My anxious Moment.
Speaker A:I don't know.
Speaker A:I think that.
Speaker A:I think I'm starting to get anxious about the babies.
Speaker B:Oh, just now.
Speaker C:Just now.
Speaker C:I know.
Speaker A:So I actually.
Speaker A:I'm a weird person.
Speaker A:I know this, but I actually really enjoy labor.
Speaker A:Like, I.
Speaker A:Both of my kids, like, I bird them within 10 minutes.
Speaker A:Like, I only pushed for less than 10 minutes.
Speaker A:It was a really, like, exciting, great process.
Speaker A:I also have, like, the most incredible doctor, and she does certain things that, like, really make a big difference.
Speaker A:I think so.
Speaker A:Like, that I think I just.
Speaker A:In my mind, I've been telling myself that all labor and delivery is gonna be that same way.
Speaker A:And people have started to freak me out about twins.
Speaker A:Like, everybody gives you an opinion, everybody tells you something.
Speaker A:And so, like, last night I was researching just, like, what to expect and what are the differences.
Speaker A:And just because it's higher risk, I think now I'm starting to get more in my head about it where, honestly, I'd rather be ignorant, because what does it matter, like, how much I read?
Speaker A:I'm not a doctor.
Speaker A:I'm gonna know what happened and do it anyways, and they're gonna figure it out and tell me what to do when the time comes.
Speaker A:Like, it's not like, if I read more, I'm more prepared.
Speaker A:It's gonna make a difference.
Speaker B:Right.
Speaker A:But just trying to get to that place of.
Speaker A:I think I'm also, like, most anxious for my kids just because they're asking a lot of questions and they're excited.
Speaker A:But I also know it's gonna be a big change for them.
Speaker A:And so anyway, just on my mind of figuring out, like, there's no right answer, but how do you make sure everybody moves through it in a healthy way?
Speaker B:Yeah.
Speaker B:Well, and also, just.
Speaker B:I'm sure you got those same kinds of pieces of feedback for your first.
Speaker B:Right.
Speaker A:Totally.
Speaker B:And just people always have an opinion and their own experiences, but you handled it like a champ.
Speaker B:So I feel like your outcome.
Speaker A:It'll be fine.
Speaker A:I mean, I know it'll be fine no matter what.
Speaker A:And it's one of those things that is just anticipatory anxiety, which is what we treat and what we talk about.
Speaker A:Right.
Speaker A:Which is the worst part is the anxiety before.
Speaker A:But once an event happens, even if I end up needing a C section or things happen like, it's gonna be fine and it' It'll figure it out.
Speaker A:Right.
Speaker A:But worrying about it before, it doesn't.
Speaker B:And kind of any day.
Speaker B:Right.
Speaker B:Like, it could happen any day.
Speaker A:Yeah.
Speaker A:I think that's.
Speaker A:There's, like, extra Fluid.
Speaker A:There's some things that have made my risk of preterm labor go up that I think.
Speaker A:I think that's where I have more anxiety is I wish somebody could just tell you, oh, you're going to go into labor in the next two weeks, or, no, you're totally fine.
Speaker A:You don't need to worry about it.
Speaker A:And they can't.
Speaker A:So it's just that, like, yeah, it could be tomorrow, could be three or four weeks.
Speaker C:Like, we don't uncertainty.
Speaker A:Yeah.
Speaker C:We need to.
Speaker A:Right.
Speaker A:Just keep going with it.
Speaker A:And so I will say, you guys, so many people say to me, like, why are you going to work right now?
Speaker A:You really should, like, be relaxing and you should be in.
Speaker A:Like, I don't do well at home.
Speaker B:Yeah, it's horrible.
Speaker A:I'm like, first of all, if I'm not at work and my kids are home, that's a lot harder for me being this pregnant, like, chasing two toddlers.
Speaker A:But second of all, like, just sitting at home with my thoughts and worrying about it, like, you think that's healthier structure, why do you stay busy?
Speaker B:I'm right with you.
Speaker B:Like, if I were also pregnant with twins, I would be dragging myself if I could to this.
Speaker B:Yeah.
Speaker B:But you're gonna.
Speaker B:Yeah.
Speaker B:I'm so excited.
Speaker B:It's gonna be really fun.
Speaker A:It's going to be fun.
Speaker A:Yeah.
Speaker A:From that angle, maybe we'll do like a podcast from the hospital.
Speaker A:I'll call in or something.
Speaker B:Yeah.
Speaker B:FaceTime.
Speaker A:Perfect.
Speaker B:Well, okay, we're going to jump back into the topic that we got a sneak peek of and dive into some clinical mistakes that we've made along the way and how those mistakes have made us better clinicians in the field.
Speaker B:Because I think we all learn from those mistakes that we make.
Speaker B:Right.
Speaker B:And it's empowering and helpful to grow in those ways.
Speaker B:And if you think that you are a listener that is with clinician that doesn't make mistakes, you're thinking incorrectly.
Speaker B:Because we all have.
Speaker A:We all make mistakes.
Speaker A:Yeah.
Speaker A:And I think I'll start.
Speaker A:But I think that early on, when I first started my clinical work, my biggest anxiety was not knowing answers and feeling like I needed to know the answer, but also needed to know the right answer.
Speaker A:And I have learned how important it is both in that relationship you build with your patients and in general, to be able to say, like, I don't know the answer to that.
Speaker A:Like, let's figure that out together.
Speaker A:Like, why don't we look into that?
Speaker A:Or why don't I ask around and you can.
Speaker A:You Know, and the humility, like, yes, it's hard.
Speaker A:It's vulnerable as the clinician, when you're supposed to be the expert in the room to not know an answer yet.
Speaker A:It builds so much trust with your clients versus if you give them an answer that may not be true or that you don't actually know a lot of details around because you want to try to sound smarter, you want to make sure you have it all together.
Speaker A:And so, anyways, I think that was probably, and has been my biggest, like, one of my biggest lessons learned is that it's okay to not know, and it's okay to explore it together with your patients.
Speaker C:And at the end of the day, backtracking, saying something that's you think maybe the answer, and then backtracking is almost worse.
Speaker C:It's the worst process because you're like, you know, I said that thing and I thought I knew it.
Speaker C:So I'd rather just be upfront and just preach, I don't know.
Speaker C:And that's okay.
Speaker C:We'll figure it out together.
Speaker B:Yeah.
Speaker B:I think one of the things that I have really started to learn, even just now at this part of the journey, is that when I was getting supervision, there was a point where I really didn't trust my own clinical experience and felt like I needed to get approval from my supervisor.
Speaker B:Right.
Speaker B:And I'm seeing that now because I get to be a supervisor, which I think is so fun.
Speaker B:One of my favorite parts of the job.
Speaker B:But there's times where one of my supervisees might ask me a question and I'll say, but I know what you said.
Speaker B:You got this.
Speaker B:But it kind of made me think back to, well, I need that extra approval.
Speaker B:And so there's this period when you're going through that transition of kind of being supervised to being on your own, where you really have to learn to trust yourself.
Speaker C:Oh, yeah, yeah.
Speaker C:And honestly, doubt is so such a big part of that transition, and you have to build confidence in your supervisee in addition to yourself.
Speaker C:Right.
Speaker C:You know this, you got this.
Speaker C:I trust you, you're capable, and let's go.
Speaker B:Yeah, for sure.
Speaker A:100%.
Speaker A:And I think that that's actually was going to be my next.
Speaker A:Next thing that I've learned a lot about is that I feel like early on in supervision, I'll never Forget this with Dr.
Speaker A:Storch.
Speaker A:But, like, every time I would get anxious or triggered or be unsure if I said the right thing, I would literally run to his office as if it was urgent.
Speaker A:And I think that has been such A lesson learned for me around clinical skills is that if you don't know something or if you're unsure or even if your patient makes you uncomfortable or talks about something that, like, doesn't feel great, when you respond with urgency, you're actually now just responding to anxiety versus being able to, like, help them and give them good clinical tools.
Speaker A:And when we think about the skills and anxiety, right, where we're trying to teach our patients is not to treat things urgently, not to treat things as if.
Speaker A:But if we're doing the same on the back end, what is happening, right?
Speaker A:And I'm not building my own confidence in myself.
Speaker A:I'm becoming dependent on whoever's answering that question for me.
Speaker A:And of course, in our field, there's times things are urgent, right?
Speaker A:Someone's expressing suicidal ideation, like, there's certain things.
Speaker A:Yes, of course we need to respond urgently.
Speaker A:Someone's unsafe, like, those sort of things.
Speaker A:Yet for the most part, like, it's our job to explore, to unpack, and to be able to do it in a neutral, calm way.
Speaker A:But if inside we know we're going to go run to someone.
Speaker A:And so I was just talking about this here at the clinic is how can when we have even, like a patient issue arise, be less of, like, texting each other and hopping on calls and grabbing somebody, and instead go in calendars and schedule a meeting with the whole clinical team a few days or a week out and talk about it.
Speaker A:Then when we've had time to process, because you think about outside of the clinical world, how many times have you gotten in an argument that you way overreacted because you responded in that moment, versus if you're just like, okay, I'm gonna bookmark this, maybe I'll write down some thoughts of how I feel.
Speaker A:But like, let's talk about it in a couple days or let me approach it.
Speaker A:And when you wait, you're able to not just approach it with log, but you're able to work through it in such a healthier manner all the time.
Speaker B:All the time.
Speaker C:It's all about pausing, not reacting to that, and taking that time for yourself to understand and process your emotions related to the.
Speaker C:What just happened.
Speaker B:Yeah.
Speaker B:So I, as you were talking about urgency, maybe that's our first overall theme.
Speaker B:Like, when did we respond with a sense of urgency?
Speaker B:And I used to get emails from parents when I first started working with kids, and these parents usually would just kind of be telling on their kids.
Speaker A:It's a perfect example because, yeah, we all deal with this.
Speaker B:Yes, they would would be telling on their kids, which for listeners, it's kind of unhelpful, unproductive, because it breaks rapport.
Speaker B:Right.
Speaker B:We need the parent to be talking with you and the child so that you can address it because otherwise the kid will say, well, how do you know that?
Speaker B:And there's this, like, working team alliance and splitting happens.
Speaker A:So, yeah, we often will call it this, like, triangle of communication.
Speaker A:Right.
Speaker A:Where it's like the kid tells you one thing, the parent tells you another, and then you're stuck in the middle and the parent isn't willing to say it sometimes in front of the kid and they just want to give it to you for you to deal with.
Speaker A:But you're like, actually like, let's talk about that together.
Speaker A:Oftentimes when the parents are like, oh, no, no, thank you, or I don't.
Speaker B:Have time, I don't want to say.
Speaker A:Anything, well, then what do I do with this?
Speaker B:Yeah.
Speaker B:Yeah.
Speaker B:And so there were a few times where I would address in my initial intake with parents, like communication, we should all have that together.
Speaker B:There might be times where we meet individually, but not to go over things like that.
Speaker B:And I would still get those emails and I would get so mad that I would write out my response as soon as they sent the initial email.
Speaker B:Well, what do you think?
Speaker B:I like, what message did I send to them when I did that?
Speaker C:It's an emergency.
Speaker B:Yeah.
Speaker B:In fact, it is an emergency and we should be responding like this.
Speaker B:Like, how ridiculous.
Speaker B:And it took me a while to learn what schedule send was and that was a big mistake.
Speaker B:And it since has saved me and taught parents and kids more about using their own coping strategies.
Speaker A:So let's actually talk about that for a second.
Speaker A:So in the clinical field, there are ethics and boundaries we're supposed to abide by.
Speaker A:And I think this is really important for listeners to know that sometimes listeners think that their clinicians should be available to them 24 7.
Speaker A:And the reality is is that we actually should not for many reasons.
Speaker A:Number one, most of us are not a crisis hotline.
Speaker A:So if you are in cr, so you're feeling unsafe or suicidal, we want you to call 91 1, go to your local ER, call the suicide hotline.
Speaker A:We don't want you coming to us because we're not always available and like, that would not be a healthy resource.
Speaker A:Number two, anxiety, which is what we treat, right?
Speaker A:Anxiety and ocd.
Speaker A:It is not a crisis and it is not dangerous.
Speaker A:And that is the message we're trying to teach you through therapy.
Speaker A:So imagine If I'm trying to tell you, hey, anxiety doesn't have to be dangerous.
Speaker A:You don't have to respond to it as if it's dangerous.
Speaker A:Yet every time you're triggered, you email me and I respond within 30 seconds.
Speaker A:What message am I reinforcing?
Speaker A:I'm reinforcing that.
Speaker A:Oh, this is dangerous.
Speaker A:Oh, you do need me.
Speaker A:Oh, you can't work through this on your own.
Speaker A:And so I will say, though, when we get these emails and we don't respond, or we get phone calls and we don't respond immediately, it is still really hard for us because we're having to hold space and we feel guilty and we feel anxious, yet it's okay to have boundaries in place, right?
Speaker C:And that even applies outside of parents.
Speaker C:Like, I have some young adults who, who email me when a trigger happens and they're like, I need to talk about this now.
Speaker C:Give me some resources now.
Speaker C:And I have started in my intake to say, you know, it may take me 24 to 48 hours to respond, and I may not respond exactly to the thing that you're wanting me to.
Speaker C:If there's reassurance, if I feel like you're, you know, trying to figure something out and problem solve in an unhelpful way, we can wait till the next time I see you.
Speaker A:And sometimes, by the way, that is my response of like, let's talk about this on Wednesday when I see you.
Speaker A:And.
Speaker A:And then when a patient arrives, I'll unpack that.
Speaker A:Of like, why do you think I said that?
Speaker A:And they're like, oh, because like, I was in a really bad trigger and I actually already feel better about it.
Speaker A:And I'm like, look at that.
Speaker A:Like, you worked through this on your own instead of relying on me.
Speaker A:And at the end of the day, as clinicians, we don't want our patients to become codependent on us, right?
Speaker A:We want you to become your own clinician to rely on yourself.
Speaker A:And so we have to model that even though it's hard.
Speaker A:So a cardinal mistake, responding very quickly.
Speaker A:Yes, yes, yes.
Speaker A:Giving out your cell phone.
Speaker A:Oh, gosh, we've all done it, like, right?
Speaker A:Like at some point early on, it was like, oh, well, this family won't abuse it, or, oh, like, this isn't a big deal.
Speaker A:Or I will call them from my cell phone, you know, because they won't even notice or return the call.
Speaker A:And man, I have had to be so strict about that just because, again, it's not a client's fault if I give them my cell phone and Then they use it because really, I've sent the message that that's okay and that, like, I'm fine with that level of communication and flexibility.
Speaker A:But it is.
Speaker A:It becomes very daunting for us to feel like we need to be available 247 outside of our work hours.
Speaker A:Because you now have access to our phone number.
Speaker C:And does that not communicate it right.
Speaker C:Completely.
Speaker C:That you can contact me whenever you want.
Speaker C:There's.
Speaker C:There's no limits.
Speaker C:We almost would have to.
Speaker C:If we.
Speaker C:Which I don't.
Speaker C:But if we gave out our numbers, it's like we need to set parameters around it.
Speaker C:Like, you're running late, let me know.
Speaker C:But you can also communicate that over an email.
Speaker C:So why text or office line or whatever?
Speaker C:Yeah, yeah.
Speaker B:Too easily accessible for you to be able to grab that also.
Speaker B:And just important to know.
Speaker B:Okay, well, if I push the cell phone boundary while also helping patients.
Speaker B:Right.
Speaker B:Cause they can't just reach for that.
Speaker B:That grab it.
Speaker B:And.
Speaker A:And just the burnout for us, like the patients that I ever.
Speaker A:That I did do that for early on when I would make mistakes of being available all the time.
Speaker A:I feel like when they showed up in my session, I wasn't in the same empathetic space that I was for other.
Speaker A:With other patients because I already felt so drained by the amount of communication they needed for me in between sessions, you know, that it was just like.
Speaker A:Like, I've already talked to you 10 times.
Speaker A:Like, it just.
Speaker A:And that's not fair to them.
Speaker C:No.
Speaker B:I have some friends in the sports psychology field, and sports psychology is a bit different.
Speaker B:Like, you sometimes do go to the client's house and work with them in a different kind of setting, or you would go to their game and watch them in that kind of setting to support them.
Speaker B:So there's just some different parameters in place.
Speaker B:But a lot of them have the same phone number for their cell and for their clients.
Speaker B:And we were talking about how there's some burnout in those.
Speaker B:Those situations and how they can't separate between the two.
Speaker B:And I was like, I could never do that.
Speaker B:I have to have a separate cell phone for my work line and a separate phone for my personal line.
Speaker B:Because I want to see.
Speaker B:Even though they both ring to my cell, I want to see.
Speaker B:Is now a time to actually answer a patient call if I'm at a country music concert?
Speaker A:Right.
Speaker A:No.
Speaker C:And that's when it always happens, right?
Speaker C:Is when.
Speaker A:Yes.
Speaker C:We're just like sitting at a concert and then we get 12 missed calls.
Speaker A:You're on vacation.
Speaker A:And they're like, yeah, yeah, yeah.
Speaker B:It's just for my own well being.
Speaker B:Was not.
Speaker B:I like having two phones for two different things.
Speaker B:But in the world of mental health, I think we kind of all should.
Speaker A:Yeah, we have to be cautious.
Speaker A:So that's one of mine.
Speaker B:Yeah.
Speaker B:So let's jump more into your topic of being in this place where you feel sometimes we have to meet the clients where we're at and not go straight into this regimen.
Speaker B:ERP structure.
Speaker B:Right.
Speaker B:We should do X.
Speaker B:Yeah.
Speaker B:Because we talk about ERP and cognitive behavioral therapy, evidence based practice, EBP quite a bit.
Speaker B:And we do say that it's very structured, 12 to 18 sessions.
Speaker B:You notice a difference after a certain point in time.
Speaker B:And that's one of my mistakes too.
Speaker B:Emily and I were talking about on the way here, I had a really difficult case who butted heads with me a lot, was quite an arguer, Very stuck on their compulsions and why they weren't compulsions, but it was really inhibiting their entire life, their relationship with their family.
Speaker B:And I got way more firm than I normally would.
Speaker B:This was, was years ago, and I still think about this case, but they really pushed a button with me.
Speaker B:And I just remember kind of throwing my hands up and being like, I don't think treatment's for you right now.
Speaker B:Because I had been so, so frustrated.
Speaker B:And we were talking about, well, what was the mistake that I made there?
Speaker B:And I think it was that maybe they needed some more processing before we jumped into all of this exposure.
Speaker A:Yeah, yeah, yeah.
Speaker A:And I think that, you know, so historically, cognitive behavioral therapy is a very goal oriented treatment.
Speaker A:When you learn about CBT and you're taught cbt, you're taught that it is short term, is time limited, it's goal oriented.
Speaker A:And so I think clinicians, especially young clinicians who start in the field have this thought process that like, this has to be fast paced and I have to.
Speaker A:We can't process.
Speaker A:This is not talk therapy.
Speaker A:We come in, we have goals and we meet those and you kind of get out.
Speaker A:And that's just not reality when a patient's sitting across from you.
Speaker C:No.
Speaker C:And there's things that there's.
Speaker C:That's gonna have to be processed, even if it's not anxiety and OCD related.
Speaker C:I think that really involves just putting some limitations and parameters on this relationship that should have very small boundaries and parameters.
Speaker C:Right.
Speaker C:Parameters that make sense for professionals.
Speaker C:But in, in the, you know, therapy room, we need to be able to discuss anything that comes up.
Speaker C:Anything that's Distressing to our patients.
Speaker C:Sometimes that means pausing and not doing ERP for a session.
Speaker C:Sometimes that means stepping back and recognizing is willingness less.
Speaker C:Do we need to do some motivational interviewing?
Speaker C:Do we need to process what the stuck point is?
Speaker C:Because I had this issue where I.
Speaker C:I started framing it all as, they're resistant, they're resistant, they're resistant.
Speaker C:And that really made me have a different perspective of my patient, and it made me just so burnt out because it felt like I was arguing or that I was trying to defend my case, that this is OCD and this is what we do to treat it.
Speaker A:And, like, you're not helping yourself.
Speaker A:Why do you not want to get better?
Speaker A:Like, you start thinking all these things because you're like, the treatment's right in front of you.
Speaker A:You just don't want to do it.
Speaker C:Yeah.
Speaker C:And I'm like, they're human.
Speaker A:They're not ready.
Speaker C:Take the humanness out of this.
Speaker C:And the therapeutic experience is so difficult.
Speaker C:It's challenging, it's vulnerable.
Speaker C:Sometimes you need to pause and process that because it can feel like a failure.
Speaker C:If I'm telling them they're resistant, they're feeling like they're failing.
Speaker C:And I don't want my patients to feel like a failure because they're hesitant or because there needs to be more to process.
Speaker A:And the reality is, is that so many of our patients show up and they're just not ready or life happens.
Speaker A:Right.
Speaker A:Like, I think about just imagine in my own therapy process when my dad had open heart surgery recently, or I'm, you know, have a baby, and I'm, like, dealing with life transitions.
Speaker A:If my therapist would be like, oh, sorry, we can't talk about that, because that's not ocd.
Speaker A:It'd be like, wait, what?
Speaker A:You know, where the reality is, is that you have to meet your patients where they are.
Speaker A:And sometimes, yeah, hopefully.
Speaker A:Now, again, I do think when we're doing ERP and OCD work, if we notice that every week it's something else so that we're avoiding doing OCD treatment, we want to talk to our patients about that.
Speaker A:We to be able to say, hey, I'm noticing that every time we're planning to do an exposure, something comes up and we kind of get sidetracked.
Speaker A:So how about we, like, set aside time for exposures and time for processing?
Speaker A:Like, there's ways to do both.
Speaker A:So it doesn't mean you have to do one or the other all the time.
Speaker A:Yet I do think at the same time, like, we're dealing with individuals who have human experiences and who deal with life stressors and who live in this world we live in where there's anxiety and stress and war and things that are super triggering.
Speaker A:And if it, if we just are like, oh, yeah, I can't talk about that.
Speaker A:This isn't a space.
Speaker C:Right.
Speaker A:Who are we actually treating?
Speaker A:Like, are we treating the person or just the one problem?
Speaker B:I was just gonna say the, the thing that I think is also so kind of important to think about is this is often patient's first time in their.
Speaker B:Right.
Speaker B:And if they have a bad first experience, they're not coming back.
Speaker B:They're not coming back and they're not.
Speaker C:Gonna get the help they need.
Speaker C:They're not gonna live a high quality life.
Speaker C:And we can't separate someone's symptoms, someone's diagnosis from their contact context.
Speaker C:Right.
Speaker C:The culture, the environment that they live in, we can't take that away because that is a huge component of treatment.
Speaker A:Yes.
Speaker C:What happens with OCD if we have three stressors that week, we're probably not going to be as adherent to response prevention.
Speaker C:Right.
Speaker C:We're probably going to feel higher levels of anxiety or distress.
Speaker C:That is relevant and that's relevant for our patients to be able to notice as well.
Speaker B:Yeah.
Speaker A:I just want to say real quick, like a lot of times people will ask, you know, what is your treatment?
Speaker A:How's your treatment different?
Speaker A:At ocdi, which, you know, we're one of the, the handful of residential programs that treat OCD and anxiety specifically in the country compared to some other programs.
Speaker A:And one of my biggest things I talk about is that we treat the whole person.
Speaker A:So if someone shows up and they have trauma, they've got OCD and they've got depression, we're not looking at them and saying, okay, well, you're going to be here for 10 to 12 weeks, we're going to treat your OCD.
Speaker A:Here's your OCD worksheets.
Speaker A:Go for it.
Speaker A:Which by the way, is unfortunately what a lot of programs do do.
Speaker A:Instead, we're figuring out everything that's going on because guess what, I bet they're interrelated and I bet I can't treat one without the other exasperating or vice versa.
Speaker A:And we need to figure out how to treat it together.
Speaker A:And sometimes we're referring you out within the first week or two because we're saying, hey, this other issue, substance use disorder, personality disorder, whatever is going on is actually more primary than anxiety or OCD right now.
Speaker A:And we feel that if we started anxiety and OCD treatment, you're gonna get stuck because this is gonna be a treatment interfering behavior.
Speaker A:And I wanna talk about that for a second because I think that has been one of my biggest lessons learned, is that it is okay to tell a patient you're not the right treatment program or provider for them.
Speaker A:And it's fact made you anxious.
Speaker A:But in fact, it's so ethical, you know, And I will tell y'all, one of our clinicians here about a year ago said to me, she said, you know, Liz, I've worked at a lot of places that always would say, they don't take patients money if they can't help them.
Speaker A:And she was like, but I never experienced it.
Speaker A:They always made patients, like, stay there certain length of time, and they kept them there no matter what.
Speaker A:And they would justify like, oh, but we're still helping them in this arena, or it's okay.
Speaker A:And she, like, you guys are the first program I've ever been at where, like, if you're not the right fit, you were referring people out immediately.
Speaker A:And I think part of that is because we don't run a program based on profits.
Speaker A:We run a program based on people.
Speaker A:Right.
Speaker A:And we, a lot of us have lived experience.
Speaker A:And so for us, we know what it's like.
Speaker A:I went to clinicians who played Candyland with me for years, and my OCD got worse, and they had no idea what they were doing.
Speaker A:And it's a horrible experience.
Speaker A:It makes you believe treatment doesn't work.
Speaker A:It makes you, like, it exhausts your financial resources.
Speaker A:Right.
Speaker A:All these things happen that not willing to fall into that.
Speaker A:And so I think it's really important as a listener to two things.
Speaker A:But, like, if treatment's not working, talk to your provider about that instead of continuing to try something that you're not seeing work.
Speaker A:But second of all, if a provider is telling you, hey, we think there's something else going on, and we think that needs to be addressed actually.
Speaker A:Like, even though of course that's hard to hear, and that's often not what patients want, when they had their mind made up that, like, we're going to this program and it's going to help us, or I have this diagnosis, yet at the same time, have a lot of respect that they're willing to say that to you.
Speaker B:Yeah.
Speaker B:I always tell patients, look at it like you've graduated, We've gotten more information on how to help you get better.
Speaker B:And so if you're being referred to someone else, that's a graduation, right?
Speaker A:Yeah.
Speaker A:I mean, think about A medical workup.
Speaker A:Right.
Speaker A:Like, if you go to a doctor with certain symptoms, convince you of a certain diagnosis, but after the medical workup, they're like, actually, this is your diagnosis, and this is the treatment that's gonna help you.
Speaker A:Wouldn't you much rather know that than be treating something incorrectly and not get better?
Speaker B:Yeah.
Speaker B:I was gonna share one of my biggest pet peeves, and I'm glad you spoke first.
Speaker B:Cause I think it ties hand in hand with what goes on in the field and referring out lately.
Speaker B:I've talked to you about how I get a lot of consultations now of, like, can we meet to talk about OCD anxiety?
Speaker B:And I love consulting with people that are already in the field.
Speaker B:I have a really hard time with someone reaching out to me, saying, I know they're not an OCD provider.
Speaker B:Hey, do you have 30 minutes for me to talk to you about my patient that has ocd?
Speaker B:I want to just make sure that I'm doing things correctly.
Speaker B:And.
Speaker B:And I'm like, but you don't have any training in OCD.
Speaker B:You haven't taught OCD.
Speaker B:That's not something I can do.
Speaker B:We talk about OCD, do that in 30 minutes.
Speaker B:Right?
Speaker C:It's a little bit more complex than that.
Speaker B:Yeah.
Speaker B:Well, and it's kind of.
Speaker B:Not only is it a disservice to the patient, but it's kind of a disservice to us that treat OCD and anxiety in the field.
Speaker B:Right.
Speaker B:That we do specifically focus on the anxiety, specific diagnoses.
Speaker B:And if that's not a part of the wheelhouse, we're referring out.
Speaker B:And so.
Speaker B:Yeah, I think that happens way more often than I would like to admit.
Speaker B:And it's kind of infuriating 100%.
Speaker A:So.
Speaker A:Yeah.
Speaker A:So lesson learned for me is that it is okay to say we're not the right fit.
Speaker A:And.
Speaker A:And I.
Speaker A:And it's hard.
Speaker A:Right.
Speaker A:Especially because sometimes people seek you out because they really want you to treat them, they trust you.
Speaker A:And so you feel like you're letting them down by saying, I'm not the right person for you.
Speaker A:Yet at the same time, what I will always say is that six months, a year later, those patients often will come back and thank you.
Speaker A:Because no one else was willing to do that for them and kept seeing them even though they weren't.
Speaker A:They weren't getting better.
Speaker C:Yeah.
Speaker C:Say no.
Speaker A:Yeah.
Speaker A:It's hard for all, but it's good.
Speaker A:Yeah.
Speaker A:So let's talk for a second about maybe, like, a specific clinical moment.
Speaker A:Moment or lesson that you feel like, has allowed you to grow clinically.
Speaker B:I think I've had some moments where I just felt like I was spinning with a patient that was either kind of treatment resistant or had some difficulty with regulating their emotions.
Speaker B:But they also had anxiety and ocd and we weren't getting anywhere with the exposure work.
Speaker B:And for a long time, I think I would put that on, what am I doing incorrectly?
Speaker B:Instead of, okay, I understand what this is.
Speaker B:This is like, they need some emotion regulation skills.
Speaker B:They need to go to dialectical behavior therapy first.
Speaker B:And so instead of continuing to try to flip through all these cards, recognizing that's not actually the right form of treatment, and I need to give them to some DBT and they, it's the best thing ever when they respond.
Speaker B:And like you said, the family reaches out a few months later and says thank you.
Speaker B:That was needed.
Speaker B:When at first they were a little bit discouraged because they had been therapists shopping for someone that would give their kid a response.
Speaker B:So that's the first one that comes to mind.
Speaker B:And while others go, I'm going to think of something more specific.
Speaker A:I'll go, I feel like I really avoided.
Speaker A:So when I had patients that would have a comorbid personality disorder or maybe even like borderline substance use disorder, certain disorders that I felt like were a little bit harder to talk to the family and individual about.
Speaker A:In particular, if I felt like, oh, telling them about this diagnosis might make them really upset with me or might trigger them, I would find myself avoiding it and I would find myself justifying, like, oh, but they do also have anxiety or ocd.
Speaker A:I'll treat that.
Speaker A:It's okay.
Speaker A:And I remember about a year ago here, clinically we had like a.
Speaker A:We do a bunch of case conceptualizations with the team and we said, like, why is it that when we recognize personality disorder symptoms or certain symptoms, we're not talking openly about it with the patients?
Speaker A:And most of the clinicians responses were like, well, number one, we don't know what to do with it.
Speaker A:Like, we don't know if, like, we notice they have this.
Speaker A:They may have this going on, but like, we don't know what to tell them or what to do.
Speaker A:So it feels like it's not going to be a super helpful conversation.
Speaker A:But also they were like, we're worried about the response.
Speaker A:Response.
Speaker A:Certain diagnoses we get worried about.
Speaker A:If we give that, will a patient be resistant to it?
Speaker A:Will they be against it?
Speaker A:What will happen?
Speaker A:It's easier to not rock that boat sometimes.
Speaker A:And our.
Speaker A:In conclusion, as we continue to Talk about it was like, yeah, but the injustice around the ability for them to truly get well is way too significant to not talk to them about it.
Speaker A:Right.
Speaker A:We can't let our own anxiety stop us from having a hard conversation with patients that we know long term.
Speaker A:Like I always tell people it will be so detrimental for a patient to have dual diagnosis, but come here thinking they have one diagnosis and leave thinking they still only have one.
Speaker A:How much more beneficial for them if we're at least.
Speaker A:Even if we can't treat the other one because it's not our specialty, if we can at least talk to them about it and allow them to recognize where their OCD and anxiety is versus differentiation, interpersonal difficulties, or this is my substance use disorder.
Speaker A:This is whatever else is going on that allows them to know that they need specific treatment for that and they can get better.
Speaker A:And so I think early on I just really avoided hard conversations because I was anxious about it.
Speaker A:I didn't want to have them, I didn't want to deal with them.
Speaker A:They're not fun, right?
Speaker A:Yet.
Speaker A:What I have learned time and time again is that they are so much easier the sooner you have them.
Speaker A:So as soon as you start to recognize treatment interfering behaviors or these different.
Speaker A:The more you can talk about it immediately and say, I'm seeing this.
Speaker A:Let's talk about this.
Speaker A:This, let's start to.
Speaker A:Let's pull out the diagnostic statistical manual.
Speaker A:Let's read about this.
Speaker A:Patients actually not just appreciate it, but oftentimes it validates them, right?
Speaker A:Because they're like, you were trying to put me in a box here.
Speaker A:And it.
Speaker A:I, I always felt like I never fit totally in that box.
Speaker C:You know, this brings up a thought for me is I just recently had this experience where a parent of a patient of mine really wanted them to have an OCD anxiety diagnosis.
Speaker C:And I was seeing more than an OCD anxiety diagnosis.
Speaker C:Spoke about it obviously with the parent of like, I think there may be something more.
Speaker C:Did, did the assessment, it was something more.
Speaker C:And they were trying to forbid me from telling the patient who was underage.
Speaker A:I've had this a lot.
Speaker C:It, first of all, it just like crushed me because this person didn't feel understood by anyone.
Speaker C:They were struggling, they didn't understand why.
Speaker C:They kept saying, why am I not like other people?
Speaker C:And this was the reason.
Speaker C:Like, this, this diagnosis explained it all.
Speaker C:Preventing someone from understanding themselves is more than a disservice.
Speaker C:It could harm someone totally.
Speaker A:And I see this all the time, by the way, with like autism spectrum disorder and different Disorders where parents feel like there's more stigma there.
Speaker A:Right.
Speaker A:I don't.
Speaker A:I want my kid to have this diagnosis versus that one because it'll be easier for them.
Speaker A:It's like.
Speaker A:But it's not easier for that individual who doesn't feel like that fits for them.
Speaker A:Right.
Speaker A:And they still don't understand themselves appropriately.
Speaker C:And if they're not getting better.
Speaker C:Right.
Speaker C:It's like, the treatment's not going to work for that diagnosis.
Speaker C:This treatment that I give ERP is not going to work for the separate diagnosis that I'm finding.
Speaker A:Well, I cannot tell you all the amount of phone calls I get from parents.
Speaker A:Kind of like, I can go on a rant about it, but where they're trying to fit their kid into this anxiety and OCD box, and they'll tell me the symptoms and I'll say, okay, well, like, this sounds like this could be.
Speaker A:But honestly, these are.
Speaker A:Sound like it's better to find as autism or better defined as, you know, this ADHD or whatever's going on, or you, you know, and so many times the parents are just.
Speaker A:They don't want to hear it, and they go down this route and two years later, they've explored every treatment, intervention except the one that would actually work for what their kid's dealing with.
Speaker C:Stigma.
Speaker A:And I mean, it's so sad because it's like, man, now they probably have additional diagnoses that have come up.
Speaker A:They've got an emerging personality disorder potentially at this point now, too, or whatever else could be going on because of untreated mental health conditions.
Speaker A:And I just.
Speaker A:I mean, I get it, right?
Speaker A:As a parent, you never want to hear anything's wrong with your kid.
Speaker A:Do you want your kids to be the best and be perfect and of course.
Speaker A:And can you recognize how much worse you're making it if you're letting your own anxiety, your own stigma get in the way of their treatment?
Speaker B:Yeah, I thought of mine.
Speaker B:It's a really good one, I think, but I might be biased.
Speaker B:What is it called when you put your own beliefs on to another patient?
Speaker A:Projection.
Speaker B:Projection.
Speaker B:Yeah.
Speaker B:I was not able to think of the word, probably because of all my congestion.
Speaker B:But I will never forget this experience I had where I definitely engaged in projection on one of my patients.
Speaker B:And I think that's in the clinical field such.
Speaker B:To me, it's like a word that gives me the ick.
Speaker B:Like, why would I engage in that behavior?
Speaker B:I'm such a better clinician than that.
Speaker B:But I didn't realize until after the fact that I had totally been projecting my own beliefs onto a client and this was years ago, but they had some family interpersonal conflict.
Speaker B:And the interpersonal conflict that was happening actually made me anxious.
Speaker B:And I recognized that I had some anxiety.
Speaker B:But I was trying to tell the client, this is what you need to do in this situation.
Speaker B:Instead of walking through with the client like, this is how you're feeling.
Speaker B:What are your value systems?
Speaker A:What do you want to do?
Speaker B:Exactly.
Speaker B:Exactly.
Speaker B:And I gave them some specific advice and I should not have.
Speaker B:I looked back and I actually debriefed it with my own therapist and she kind of walked through with me.
Speaker B:Why that maybe wasn't the only option in that situation.
Speaker B:And I've worked with this client since then and it's all been good.
Speaker B:But I still look back at, man, I thought I was too good for projection.
Speaker B:And I totally got stuck in the trap, totally total.
Speaker B:And then I ended up doing it.
Speaker A:And again, it's not like I think as clinicians it's important I see this with ocd.
Speaker A:So like with OCD treatment, OCD treatment, we hope, right.
Speaker A:Has really evolved over the years.
Speaker A:Yet at the core, the behavioral change and the behavioral components of ERP have stayed the same.
Speaker A:But now we're focusing a lot on values based ERP and how to do.
Speaker A:How to do justice based treatment and how to make sure we're incorporating values instead of just like, let's see if we can trigger you.
Speaker A:And I have found so many clinicians are anti this work because it makes them think that what we're telling them is that what they've been doing for 20 years is wrong.
Speaker A:And so they get very like, yeah, but ERP has worked and it's always worked.
Speaker A:And so, like, there's not any reason to say values based is better.
Speaker A:And my answer is like, you're probably right, right?
Speaker A:Like traditional ERP that maybe isn't as values based probably works just as well as values based erp.
Speaker A:The difference though is that one is much more ethical, Right.
Speaker A:One your clients are going to be a lot more bought into.
Speaker A:And one is just in a lens that has more empathy and has more love and care and is less rigid and that people are more willing to do.
Speaker C:Yeah.
Speaker A:And a lot of the negative pieces we hear about ERP or resistance to it would be, could be mitigated with values based erp.
Speaker A:But what I learned when I kept saying, like, why are these certain clinicians who by the way, are like, very well known, great clinicians, why are they resistant to this?
Speaker A:It really is because they hear it.
Speaker A:As you're saying, my first 20 years of my career, I was doing bad work.
Speaker A:And I think that's so important for us to talk about is that, like, just because you engaged in projection with a client doesn't mean you did something wrong.
Speaker A:It doesn't mean you're a bad clinician.
Speaker A:It doesn't mean you should just not do clinical work anymore.
Speaker A:It's, in fact, what makes you a great clinician is being able to say, wow, that happened.
Speaker B:I recognize that.
Speaker A:Can I make a change and can I do something different?
Speaker A:Right.
Speaker A:Like, I always talk about, about ERP I was doing with patients 10, 15 years ago is not the same ERP I would do.
Speaker A:That doesn't mean I'm embarrassed of the work that I did.
Speaker A:But it is really good for me to be able to say, yeah, I probably wouldn't do those same things.
Speaker A:I would do it differently.
Speaker A:And here's why.
Speaker C:It's kind of empowering to be able to see your own growth.
Speaker C:And I think that was a growth moment for you probably to recognize that.
Speaker C:And so reframing it kind of for ourselves as, yeah, we used to do it this way.
Speaker A:Way.
Speaker C:What's so bad about growing as a field and trying it out, Right?
Speaker C:Who knows where the field's going to be in 20 years from now?
Speaker A:Exactly.
Speaker A:Right, Exactly.
Speaker A:No, I couldn't agree more.
Speaker A:And I think that that's my takeaway from today is that clinicians are still humans and we still make.
Speaker A:We still make mistakes, right?
Speaker A:Like, we.
Speaker A:We don't do things perfectly.
Speaker A:And if you're a listener, I hope that you are working with a clinician, that you know that and that they're able to own that and to talk about that and to work through that with you and that they are not sitting there preten though, you know, your only problem with getting better is that, you know, you're not listening to me.
Speaker A:It's like, no, if someone's not getting better, we need to really figure out what's going on, what's holding them back, you know, and think about it.
Speaker A:Even in arguments, like, if Matt and I get in an argument, right, I can get really mad and say, like, this is ridiculous.
Speaker A:You should do this.
Speaker A:Or I can.
Speaker A:And maybe I do a lot of times, right?
Speaker A:But also I can sit back and say, okay, where is this coming from?
Speaker A:Why did he get triggered by the thing that I said?
Speaker A:And, like, can I have empathy for that, that.
Speaker A:And still have a discussion about how we move forward?
Speaker A:Right.
Speaker A:Like, both things can be true.
Speaker A:And we can all grow together versus it being unhealthy.
Speaker B:Yeah, there's that quote.
Speaker B:The only mistakes that are made are the ones we don't learn from.
Speaker A:Yeah.
Speaker C:Yes.
Speaker C:And I mean, if we're only focusing on being right as clinicians, we're going to not be effective.
Speaker A:We're going to be so wrong.
Speaker A:Yeah.
Speaker C:We're going to try wrong.
Speaker A:If you focus on being right, you can guarantee you're going to be wrong.
Speaker C:We're going to dig our heels up.
Speaker A:Yeah.
Speaker A:If you focus on the fact that, like, I'm going to make mistakes and what I always tell a patient, and I was actually just talking about this with one of our clinicians here, is that we can learn from every single person here.
Speaker A:It doesn't matter if you are a clinical psychologist, if you are a medical director, or if you are a residential counselor.
Speaker A:We all learn from each other.
Speaker A:And in fact, the way we best help our patients is our entire team and the knowledge we get from every single person.
Speaker A:And that's how the world should work, too.
Speaker A:Right?
Speaker A:It should.
Speaker A:Like, we're learning.
Speaker A:I tell my patients, like, we're gonna learn together.
Speaker A:Yeah.
Speaker A:There's gonna be things, like, on day one that I think are gonna make sense and we're gonna learn that isn't the right fit for you.
Speaker A:Or we need to be flexible with the way we approach treatment.
Speaker A:Or I might do something totally different with you than I would do with somebody who had a very similar presentation.
Speaker A:And that's okay.
Speaker A:Right?
Speaker A:That is what treatment should be about.
Speaker A:It should be about humanizing the process.
Speaker A:And I always call it, like, are we treating the whole picture or are we treating one semi symptom?
Speaker A:Because I can treat one symptom.
Speaker A:We all can.
Speaker A:And that's when mental health tends to feel like a game of whack a mole.
Speaker A:Right.
Speaker A:Where.
Speaker A:Okay, you're going symptom by symptom, and something's always popping up versus.
Speaker A:Oh, my clinician actually treated all of me.
Speaker A:Right.
Speaker A:They treated my ocd, my anxiety, but also my family dynamics, boundary setting, like, all these different things that all contribute and play a role to the way my symptoms appear in my life.
Speaker B:Yeah.
Speaker B:They met me where I was.
Speaker A:Yes.
Speaker B:I think that we should summarize kind of the key takeaways from today.
Speaker B:And the first one is a giveaway, and it's that all clinicians make mistakes.
Speaker B:And it's really important to know, like, if you are working with a clinician that's made a mistake, did they own up to it, or is it that they have not changed and continue to make that same mistake over and over.
Speaker B:That's where we start to question like, is this the right fit?
Speaker B:Right.
Speaker B:It's not that one mistake was made.
Speaker B:The clinician owned up to it.
Speaker B:And that's probably not, not a fit for me because you're not going to find a clinician that doesn't make mistakes along the way.
Speaker B:But it's really about what we do with those.
Speaker A:And the second piece I'll say is, as a clinician, can you own that you're going to make mistakes and can you be okay with them?
Speaker A:I had a recent incident where a patient had said that I said something and they really disagreed with the way I said or explained this particular diagnosis.
Speaker A:And my response was like, wow, if I really did say that, like that's totally fair feedback because I can see where that would feel really invalidating and I need to approach that.
Speaker A:That versus I didn't say that and I would never say that or I was right and you're wrong.
Speaker A:Like which one is going to be helpful and which one can we both learn and grow from?
Speaker B:Yeah, so true.
Speaker B:Third, I would say incorporating others family members in treatment with the right mindset.
Speaker B:Right.
Speaker B:Like making sure that we're not over enmeshing the family involvement in treatment.
Speaker B:Because as clinicians we're really working with the patient.
Speaker B:Like the patient is our patient and we, we have to kind of set some boundaries in order to protect their care, their clinical work and our clinical work with them and trust our gut in some of those situations.
Speaker B:But also schedule, send, schedule, send emails.
Speaker A:Yeah.
Speaker A:Don't respond with urgency.
Speaker C:And I think that just relates to just boundaries we have to set and how it's so easy as a young clinician to try and give, give, give all of yourself and realizing that it's healthier to set boundaries and take time for yourself.
Speaker A:Yep.
Speaker A:And that goes to my second piece.
Speaker A:Like set boundaries, but also share those boundaries up front.
Speaker A:Like talk to them, your patients, sessions, one about of course, confidentiality and the things you need to, but also about like response time and what they can expect.
Speaker A:And when you notice things, be direct.
Speaker A:Try to not skirt around what you're seeing as a clinician to try to protect your patient because that doesn't protect anyone.
Speaker A:That actually makes things much worse.
Speaker B:Yeah.
Speaker B:And if you are not a clinician listening more of a patient on the other side of it.
Speaker B:But don't be afraid if your clinician says, I think this level of care is actually what's needed and if they're changing something up.
Speaker B:I think sometimes we can get really defeated hearing, oh, wait, you're not the clinician for me.
Speaker B:When in reality, no, we've gathered more data to get you closer to an outcome that you need to have freedom from the mental illness that you're struggling with.
Speaker A:Yeah.
Speaker A:Be grateful for referrals and a clinician who's willing to look at it as, like, I'm going to refer because this is helpful versus I'm going to keep you on, because I can keep you on my caseload.
Speaker B:Right, Right.
Speaker B:And my last one for clinicians is you.
Speaker B:And this is me being not bitter, but just a little bit skewed, I guess.
Speaker B:But you can't become an OCD clinician in 30 minutes.
Speaker B:You just can't.
Speaker B:So if you're reaching out to me to do that, my answer's gonna be no.
Speaker B:But I will send you some great training programs to involve yourself in.
Speaker B:Just like I probably couldn't do what that clinician is doing in 30 minutes.
Speaker B:I know I would need to dedicate to some extensive training.
Speaker B:And so, yeah, refer out if that patient's needing some OCD treatment and get.
Speaker A:Intensive training if you want to treat new populations.
Speaker C:Yeah, exactly.
Speaker B:Truth.
Speaker A:I have one more, probably two more, but one for sure that I have is I really want us to be willing to learn and be willing to conceptualize in a way that we're open for growth.
Speaker A:Right.
Speaker A:So sometimes you can't do that right after you've had a certain case because it's too hard and it's too close, but down the road code.
Speaker A:Don't look at it as, oh, you're saying I've done treatment wrong, or you're saying I failed.
Speaker A:My clients look at it as like, wow, is there anything I can grow from or anything I could learn from or anything I could do differently now?
Speaker A:And I think that is just such an important place to be.
Speaker A:Right.
Speaker A:That as clinicians, we should be evolving.
Speaker A:If you have been practicing for 10, 20, 30 years and you're still doing the same exact treatment with the same exact protocols as when you left grad school, you should be wondering what's going on.
Speaker A:Right.
Speaker A:There should be some updates or changes to the way you conceptualize and understand the patient's approach in front of you.
Speaker B:I love that you said that because it makes me think about when I first came back to OCDI after being in grad school again and doing some private practice.
Speaker B:I had some intimidation around bringing some cases to our roundtable discussion in the back of my Mind I didn't want clinicians to think Cali really doesn't know the answer to that.
Speaker B:And so I had to build up some comfort.
Speaker B:And now of course I will bring any question that I have to our clinical team because it took some time to build that.
Speaker B:But if you are a clinician that's seeking case consultation and you feel like you can't do that, really ask yourself if it's not getting easier.
Speaker B:Is this something that I need to work on or do I need to find a clinical consultation group that I can actually share openly and, and learn and get positive feedback.
Speaker C:It should never be judgment when something is brought to case consult or when you're talking with other like minded individuals.
Speaker C:If you're like, I really actually don't know.
Speaker C:That should be a moment where everyone bands together and supports you because that's a growth moment.
Speaker C:And I think think here it does a great job at just like all of us collaborating, figuring it out because ultimately we want the same thing for the patient.
Speaker B:Yeah.
Speaker A:And so my biggest last pieces of feedback that I always think about, and I've talked about this before, is like if you had a wait list, would that patient still be on your caseload?
Speaker A:And number two, like don't be afraid to refer out because at the end of the day it is your job to best help your patient.
Speaker A:It is not your job to make them feel feel good.
Speaker A:And those are two different things.
Speaker A:Right.
Speaker A:And so I always think about it as like with anything, whether it's disclosure or treatment, am I doing this for me or for them?
Speaker A:But if it's ever come to a point that like I'm keeping them for me because I don't want to have a hard conversation or because I, I don't want to deal with making them anxious versus like they actually don't need me anymore.
Speaker A:Right.
Speaker A:You need to be thinking about that.
Speaker A:And for patients when we terminate, that's a good thing.
Speaker A:I think so many times our patients get upset like, well, why don't you want to see me anymore?
Speaker A:It's because we don't need to see you anymore because you've graduated, you don't need us.
Speaker A:You can do this independ and that's amazing.
Speaker B:Yeah.
Speaker A:Right.
Speaker A:I want my kids to stay babies forever, but it's like I also want them to grow up.
Speaker A:Right.
Speaker A:Like both can be true and it can be a really great thing.
Speaker B:Absolutely.
Speaker B:So, Dr.
Speaker B:Emily Bailey, if listeners want to find you, where do they go?
Speaker C:Well, they can go a lot of different places.
Speaker C:They can go to AtlantaOCD and anxietytreatment.com they can contact me probably through here as well, right?
Speaker C:Yes, definitely.
Speaker C:And they can also find me at Oglethorpe University.
Speaker C:Just look me up.
Speaker A:And Emily does and oversees our research here at ocdi.
Speaker A:So she is the person and the brains behind if what we're doing is working and how we make sure that we're on top of that, both clinically and sharing that with the public.
Speaker A:And so we'd love to have you on to do another episode on how to incorporate research into treatment in a way that makes sense.
Speaker A:And how do patients help understand what evidence based treatment even means?
Speaker A:I was on this rant with my sister last night because Instagram and I feel like social media has gone a little bit far lately into conspiracies.
Speaker A:And I feel like it's gotten so far into to like people diagnosing themselves and people going to these non experts now.
Speaker A:Right.
Speaker A:These non experts have bigger platforms than experts around treatment, diagnosis, and what to do.
Speaker A:And so I'm like, I need to start some sort of a.
Speaker A:Like, instead of this, do this, instead of this, do that, or this one.
Speaker A:This morning I was like, I feel like my constant quote should just be still erp, like considering celery Joes, still stick with erp, considering this, still stick with erp.
Speaker A:But like, you know, I think that so many times people hear research and science and in today's world, it's gotten a bit taboo and it's gotten like it's a bad thing versus being able to understand how can we incorporate that in a healthy way.
Speaker A:And again, even when we're using research and science, we're still treating that person right.
Speaker A:We can have research that tells us what intervention is going to be the best.
Speaker A:Yet we're also dealing with a human across from us that it needs to be tailored for them.
Speaker A:And so I would love to do another episode where we dive into that.
Speaker C:I would love it.
Speaker C:I nerd out about research.
Speaker C:So bring it on.
Speaker B:Amazing.
Speaker B:Thanks for being with us, Emily.
Speaker C:Thanks for having me.
Speaker B:This is the Anxiety Society.
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Speaker C:And there's one thing that I need from you.
Speaker C:Can you come through.
