Episode #15: Finding your Village

Hello everyone! I am excited to share this months podcast, as we are joined by what I call a CBT SUPERSTAR, Sara Vicendese.  Sara is a Licensed Marriage and Family Therapist who specializes in Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) in addition to traditional PsychoDynamic therapy. This podcast is based on the phrase, "It takes a village to raise a child".   This phrase is used often to explain the importance of community when raising a thriving and successful child.  We believe that you can create your own "micro-village" to help you along with your recovery. Today we talk about ways to create YOUR "Village" (in whatever form you think is helpful) to help you with your on personal recovery.  We discuss how to find the correct treatment, access the most helpful resources and how to include your family members, friends or partners in your recovery, in a healthy and helpful way. Below is a basic layout of our conversation.  Enjoy!!!

 Today we talk about ways to create YOUR "Village".  What is the most effective form of treatment for OCD, and how do I find a therapist who provides it?

Sara talks about the difference between Cognitive-Behavioral Therapy (CBT) including Exposure and Response Prevention (ERP) and psychodynamic “talk” therapy, specifically focusing on:

• How to interview your therapist: what questions to ask, how to ask them, and the importance of interviewing therapists without assuming that everyone with a degree is going to be the right fit.
• How to know what kind of therapy you’re in.

How do you find a good ERP Therapist

• Check out IOCDF.org for a list of therapists who are trained in CBT and Exposure and Response Prevention (ERP).
• Once in contact with a therapist, ask if they know what ERP is?
• Ask what books they rely on when treating OCD? (This might allow you to screen them for their knowledge)
• Ask if they have they worked with OCD before and for how long? Where did they get their training

How do you know your current therapy is or isn’t working?

Sara writes, “A lot of dynamic therapists will stress that things can “get worse before they get better,” encouraging clients to wait months – or even years – to see the benefits of their work. It’s true that in any therapy, including ERP, you will likely feel worse before you start to feel better…but if months go by and you aren’t experiencing any reduction in symptoms OR if you notice – at any time – that you are getting significantly worse, it is likely time to move on.”

What advice do you have for those who cannot find an ERP therapist in their area? Or, for those who can only afford a therapist in-network who does not know about ERP?

• There are some awesome workbooks out there for OCD. (Mindfulness Workbook for OCD, The OCD Workbook, Trichotillomania: An ACT-enhanced Behavior Therapy Approach Workbook)
• Ask your non-ERP therapist to read these workbooks (depending on your symptoms) ahead of time and go through them together in session.
• There are also so awesome online forums (Yahoo groups are GREAT) or online resources such as IOCDF.org, OCD stories etc (See my resources page for more info)
• Also consider the potential for Skype or teletherapy (always ask the therapist if they are legally allowed to see you from the state they are licensed in, depending on where you life)

 What advice do you have for those who want to start ERP treatment, but currently have a non-ERP therapist?

Sara writes: “There are really two options here; you can leave your current therapist and start with an ERP therapist, OR you can explore the potential of seeing both at the same time.” Sara discusses the importance of collaboration and making sure that both therapists are in regular touch with each other – to prevent each therapist from working against each other. Sara encouraged therapists to coordinate care and maintain the effectiveness of both.

What advice do YOU give to the family members of those who are struggling with mental health issues such as Obsessive Compulsive Disorder (OCD) and Body Focused Repetitive Behaviors (BFRB's) or Eating disorders?

Living with, and loving, someone with these disorders can be extremely challenging and it’s critical that all members of the family are as healthy as possible for everyone to thrive. Jon Hershfield’s book is great in this situation, as psycho-education is so important. Sara discusses the importance of involving family in treatment as appropriate (assuming family is supportive and including them wouldn’t be detrimental to treatment). Sara also discussed how she often recommends that family members seek out their own support – either through support groups or personal therapy. Kimberley discusses to use of the Family Accommodation Scale (FAC) to identify ways the family are accommodating the OCD compulsions. Click here for a link to the Family Accommodation Scale.

Is there a kind of therapy can benefit the spouse or parent or family member of someone with OCD or other anxiety disorder, or a BFRB?

Individual therapy (and/or support groups) for the family member can be very successful. In addition, there is great benefits from continuing to be educated about the loved ones disorder and get consultation on the best ways to support them though their recovery process.

What can a sufferer do when their family member or friend is not supportive of their recovery?

This is a tough, but important, question. Being unsupportive can take many different forms, from simply not understanding / participating in treatment to (on the other extreme end) working against treatment or purposely interfering with it. Someone who is not supportive of treatment is someone who is, in some way, colluding with the illness. Maybe recovery would mean that their life will be more difficult for them, or perhaps the treatment itself is hard to tolerate. Sara discusses how she often see families where more than one member is suffering from the disorder – however, only one is diagnosed and in treatment. If one partner is going through ERP, that can stress the relationship if the other partner has similar undiagnosed issues. Sometimes people aren’t supportive of recovery because it is hard at first and requires more energy/work than they are willing to put in. I can think of an example where a parent consistently disrupted treatment for their child because they didn’t want to see them in distress and the increased anxiety in the household during exposures made them uncomfortable. A highly anxious parent may have as much trouble with their child’s exposures as the child – for their own reasons. In most cases, most people get on board given enough time and education. That said, we are faced with tough decisions if our loved ones / friends interfere with treatment. Again, it is important that loved ones be brought into treatment, encouraging them to get their own support, and even the option of moving on from the relationship if it is keeping the sufferer stuck. Sara Vicendese has a private practice in Westwood, CA.  Learn more about Sara on her website at http://saravicendese.com/ You may also see the unedited video interview here