Ask the Experts with Dr. Liz McIngvale & Chris Trondsen, LMFT!

[00:00:13]Liz, I see you twice this month. That's crazy.

[00:00:16]>> I know. We went from like Well, no, you saw me more than that at the conference.

[00:00:20]>> Oh, yeah. Yeah, because I saw you at the conference, too.

[00:00:23]>> I know. I feel like we went from like we never see each other and we're sad to like this month we've gotten to see each other like five times.

[00:00:31]>> I know. It was funny because I was talking to Amy Maraskin and she's like I had a list of people I wanted to spend more time with and I didn't get to see as much as I wanted to and I was thinking about like all the people there was because the way the conference was stacked there were some people because it was on multiple floors that I saw like on the way to the airport. Um, but I was super happy that I got to see you so much because I was like there's certain people. I'm glad we did that dinner with Algra and Ethan and Katie because um I didn't get to see them like the rest I saw Algra a lot but the Ethan and Katie I really only saw at our dinner. So I'm just excited I got to see so much of you and that you're here today. I hate doing this by myself because I feel like I'm talking to myself. So I'm always happy when I have a co-host. So I'm so excited to talk to me instead of to yourself. Well, >> yes. And I was telling you my light went out so I only have this backup light and it makes me look orange. So I'm sorry everybody. Um I need to get a second light in case that happens again. So >> um I'm excited to be here and I feel really like energized with conference conversations. So you know lots to chat about. But hi to everybody. Please tell us who you are and where you're calling from and in the or joining from. I guess this is not a call-in line but we could do a radio show. That'd be fun um in the comment section. But if you were at the conference or you were able to watch any of the conference live, I would love to hear about some of the like take-home messages you got or some of the things you're thinking about or talking about because that's just part of my that's one of my favorite things about the conference is I tend to come back and I'm like in my head for a couple weeks of like what I was hearing and what I was learning and like where the field is and also where our community is and then figuring out how to help better serve our community in ways that make sense.

[00:02:10]So anyway, glad y'all are here. Yes, I I felt um energized. I was uh did the live stream last week, but it was with Kimberly and she wasn't able to go. So, I'm glad that we're talking about it now with you because you were there. But I was saying I I posted in the in the clinicians Facebook group. I mean, I think one of the things I loved about the conference is it felt like a return to science. It felt like a return to evidence. I think when you're like social media online everywhere, you're seeing so many people post um you know about get better quick or treatment this or whatever and it's just a lot of like non-evidence-based AI using programs.

[00:02:47]There's people pushing different treatments as front line when it's not.

[00:02:51]So, I think it was just like a great place to kind of reconnect and hear so many people get better. I think that's the second thing besides obviously um hearing messaging backed by science. I don't know about you Liz, but there were so many people that I met who were like I saw them at one point um where they were like came up to me and they're like this is my first conference. I'm really struggling to like speaking or they were there like facilitating a support group and I'm like wow just three years ago you were here as like an attendee struggling and now you're like helping run some of the content. So I just think a lot of times people that I talk to from around the globe just feel helpless and I think at the conference I was like no there's a lot of people besides Liz and myself that are getting better you know it's not just us two.

[00:03:36]>> Yeah. I think it was a return to science in the sense that I feel like we, you know, as a community, but also as a society kind of like got really skeptical of science for a long time.

[00:03:45]And I feel like we're getting like we also had information overload, right? We didn't really have access to AI and like the same social media influencers and all the things in the mental health space that exploded these past five years. And I feel like a lot of us got kind of lost in like what's right, what's wrong, what makes sense, what isn't, who do we trust, how do we know if we trust someone, like what does it look like? Um, and I feel like we are seeing things level set a little bit, which is really nice when you see that start to happen of like, okay, like here's what we know is true. Here's what's what we call like anecdotal evidence, like Dr. Bramwoods talked a lot about at the plenary which is like personal experience which is very useful but like shouldn't be looked at as like fact and research because it isn't right. It's a personal experience versus you know research and outcomes and data and science and all the things that should really help us make informed decisions around our care. Um, but what I also liked, I'm curious if you because this is what I want to talk a lot about today, if you felt this, is I feel like we were we are trending more towards freedom language. And I was just like so excited to feel like there was a lot of times where I feel like our community started to kind of accept OCD as this like chronic disorder and you're always going to struggle. And it it felt a little bit for a while, at least for me, that like people were speaking about treatment and outcomes in kind of this bleak way, like, oh, ERP doesn't always work. People can't always get better. Like, you're just going to learn to be able to function better, better manage your symptoms. Um, and it's just so nice to hear people come back to like, not only does ERP work, it's one of the most effective mental health interventions that exists, and the outcomes are actually amazing. And like why are we talking so bad about an intervention that has such incredible outcomes and with ERP you actually can and should expect that you can get to freedom. And I just I love us getting back to this much more hopeful exciting message versus this kind of like doom and gloom longterm long-term diagnostic language.

[00:05:55]>> Yeah. I don't know if you remember so um Shannon Shai was the keynote the year before me and that it was my mom and myself but the year after there was a woman from Australia and I remember in the keynote she really talked about this she said you know I got better to a point that I almost don't feel like I have OCD like my symptoms are completely managed and we have to change the language and you've been saying it a lot too but I'll never forget like the backlash she got I saw her on my way out of the conference and I remember she just saying kind things about my mom and But I asked her how she felt about our keynote and she's like, "I've gotten so many people that are like, you're giving false hopes. People can't get fully better. It's a chronic disorder. They're always going to have to manage it." And she got attacked and she's like, "I'm never coming back again." And and I've never seen her again. And for everybody watching this, >> how sad is that?

[00:06:42]>> Yeah. For everybody watching, this was like 17 years ago, I think, at this point. So, it wasn't recent. But I don't feel like her message would be treated the same way today. Like you said, I felt like with the keynote, I felt like with presentations I went to, I feel like with the the kind of direction that you're helping lead our our field in, it's like people are getting better. And it's not like managing symptoms. That's what I heard a lot, too. It's not like you're going to struggle every day, but you're going to struggle better. It's a lot of people that were saying like, I got really good treatment. I saw Sean um I didn't see him talk this time. I've spoken with him, but Sean who got better at OCDI with you guys and him talking about his recovery and just, you know, hearing people talk about it like I've gotten my life back. Like I came there's a young adult that I spoke with um he became really close with Kyle and I spoke with him at his first conference.

[00:07:32]Um just kind of pulled him aside and he was like not going to talks. He didn't think he was going to get better and then this year he's like uh on the flyer and he did talks with the young adults and he's talking to people like I got better. So I agree with you. I mean just to think that 15 16 years ago somebody our keynote almost got shunned for saying that people can live with freedom and because of your work and because of other people's work and because of people getting better and sharing the message now it's like yes you can have freedom and you can really really thrive. And I'll never forget last thing um I'll never forget when I was in graduate school my professor who went over the DSM which has all the different diagnosis but went over the treatment for it. She didn't even know OCD super well. She didn't know I knew OCD well, but she I remember when we were going over OCD, she talked about exposure with response prevention and she said, "Of all the treatments for any of these diagnosis in the book, this one has the most effective outcomes." So to hear that from multiple places is just inspiring.

[00:08:30]>> Yeah, it really is. And it's one of those things that I think, you know, I I think that it it's like always this tough diad of our OCD community is so amazing, but we have to be careful that we're as a community making sure we're talking about freedom and hope and actually kind of getting people a little bit out of the community. And I don't mean it in that way, but like one of the things I spoke a little bit about at the plenary is that if we are identifying with OCD as being a part of us and it becomes a part of our identity versus, oh, OCD is something that I'm dealing with or I've dealt with and I'm going to overcome, but it's not a part of us. we actually can see treatment as something that can move us through our OCD diagnosis versus our OCD diagnosis being something that is always going to play this big role in our life.

[00:09:22]>> Yeah. I mean, I like what Amy is saying right here is like for a lot of us like we don't even reach like when people ask me am I cured, I get that question probably more than anything and I always just tell people like I don't meet diagnostic criteria for OCD anymore.

[00:09:36]Like if I do let's say the uh Yale Brown obsessivempulsive scale, I'm not going to sca I'm not going to score seven which is the minimum to mean that you have mild OCD. People are getting better. Amy is an example of this, right? Getting better. And I agree. I mean some clinicians the way that people talk and I think it's people in our community too just talk about it as management. And I think that that is going to I don't know about you, Liz, but if I was new to this uh diagnosis and I heard that you're going to only be able to manage it for the rest of your life, I'm going to walk away very very discouraged because I'm going to feel like, well, what's the point of working hard if all I can do at best is manage something on a consistent basis. It sounds exhausting.

[00:10:18]>> Yep. Yep. And and it's exhausting. Um, and I think that it's the message that a lot of us were not just told and sold, but like believed for a long time, you know, and so I do think that the advocate community, myself included, like we contributed a lot to that early on because we really were it was like, oh, if you're managing, you're doing well, you know, and anyway, it's just it was exciting for me to feel like the language is shifting and people are really receiving these messages of hope.

[00:10:48]And I was just so proud of the conference because we I think 50% of attendees were first-time guests and I just that got me really excited too that like people are accessing treatment and we have a huge group of folks who are like learning for the first time, you know, which is awesome for all of us to see and hear.

[00:11:03]>> Yeah, it seems like people really liked it. Peter said they weren't there this year, but they'll be at New York next year. So, yes, we're going to be in New York City next year. But the takeaways is community, true family, um, and a lot of more hope than when they were first struggling with a misdiagnosis in the 70s. Um, you know, my mom said that too.

[00:11:20]My mom went to I didn't go the first year I got diagnosed finally of OCD. I couldn't go to the I mean, I was barely functioning, so I couldn't go to the conference. My mom went and I remember when she came back, she told me she didn't tell me then, but she's told me recently like there weren't stories of people getting better. There wasn't a lot of hope. Um, but that's what she says she likes is like now when she goes to the conferences, she hears so many messages of hope. So with my clients that are, you know, did get diagnosed or misdiagnosed in the 70s and 80s, they're like, "Yeah, the the mindset about mental health, specifically OCD was so different and now it's so much more positive, which is great."

[00:11:57]>> Yeah.

[00:11:59]>> The highlights for uh Arty was the BDD track. Yes. And there was a lot of uh interest from clinicians. We had a really good crowd in that track. I I was excited about that. Um new resources and hope. Um yeah, there's definitely there was talks on BFRBs hoarding. Like there's a lot of good stuff on our uh co um our uh related disorders as well, which I think was really cool. Um Amy says we have to keep spreading the word that freedom is is possible. Um yeah and Ash says you know OCD can be so black or white can be so frilling to accept all come and go but when you practice the skills it becomes second nature. Can you talk about you talk a lot about like OCD as a lifestyle and I talked about that at our family group this past weekend and people were kind of asking um about that more in detail. So when people talk about like freedom as a lifestyle, treatment as a lifestyle, what does that mean?

[00:12:52]Yeah, I think it it means living your life. You know, it's such a good question because I think what I what a lot of people would have said 10 years ago is well, it means that you have to do ERP every day, right? You have to live your life learning to live with anxiety and uncertainty. And my answer is like absolutely not. Right? When we've done treatment and we've done it all the way and we've done our core fear work, we can get to a place where not only does our OCD and anxiety not impact our daily life, but like we also have freedom. We we have clarity. We the way we do ERP every day is we actually just live our life. I definitely don't have to in any given day sit back and say, "What ERP am I doing today?" And I'm I'm lucky to say that and I know that and it takes time to get there. I'm not trying to minimize that, right? But treatment should get you to a place where daily ERP means living your life. It means living your life freely. It means OCD and anxiety making no decisions for you, dictating none of your life anymore. And that's what ERP becomes. It just becomes that you're living your life. It doesn't feel like it's this dedicated treatment regimen that you have to sit back and do.

[00:13:55]>> Yeah. The other thing I want to ask you, Ash kind of talked about, so Ash did interviews at the conference for the OCD blog. Hey Ash. Um, and people talking about like connection, safe and safety.

[00:14:07]I don't know how you feel as somebody with OCD, but how does it feel different when you're there around other people with OCD versus like your everyday life?

[00:14:15]I mean, obviously at at work you're around it, but like with your friends, with your family, like do you feel because I have my opinions, but how how do you feel when you're there?

[00:14:24]>> Yeah, it's interesting. I mean, definitely I think community and connection is why many of us keep going, right? Especially if you no longer necessarily are going like I go now as a professional, but if I was going as someone with lived experience, I wouldn't necessarily need to be going for treatment because I'm not in that place in my life anymore. But like for connection and community, it would make sense. Um, and I think I guess I'm just curious what the word safety really means and you know because it can mean so much to different people. But I do think that like a therapeutic community and a community with individuals that you can connect with is or should inherently feel more safe, right? Like it should feel like a safer space. It should feel like a place where you can be yourself, where you can talk openly.

[00:15:06]um where people are going to understand concepts like sexual orientation, OCD, POCD, and things that like you might not know how to talk about freely among your friends. Um I will say to be candid, I don't talk a lot about OCD in my life besides at work because it's a part of my work, but like it's not part of my life. So I don't actually talk about OCD much at home or with my friends.

[00:15:29]Obviously, if they ask or they want questions or they have concerns, I find myself talking a lot about anxiety because a lot of my friends are in stages of having kids and like they want to ask questions about how to deal with anxiety or I see anxiety in my own kids that I'm dealing with. Um, but because I'm not personally struggling at that level anymore, I don't have the need to feel like I need to be able to talk openly about my OCD in my own personal life. Um, I don't know if that makes sense. So, like I definitely understand where it comes from. And for me, like I I can't say it shows up every day because I don't I don't actually want to be talking about my OCD outside of work just because I'm like it's not a part of my life anymore. It doesn't define any of my life. It doesn't need to take up more space.

[00:16:12]>> No, I totally get it. And it's the same for me. I don't talk about it outside of like, you know, work. But I think what's so nice about being in the community, kind of like what Ash is saying, is like, you know, I I met my uh boyfriend's um all his friends. They had a big event on Sunday and I was talking about the work I do, but I don't think when I talk about the work and this is no judgment on them. This is the same with like my everyday friends, right?

[00:16:35]Like I don't think people get how detrimental this disorder can be at its rawest form. Like when people are first getting diagnosed, they've been struggling for years in silence. And so it's like I always kind of think and I know I shouldn't compare, but I always think like if I sat around in a group and I was like, "Oh, I'm a cancer surgeon, right? Like I take out cancerous tumors." Like people are going to be like, "Oh my god, like your clients, you know, probably are in dust bed." And they bounce back. But when I talk about what I do, people are always just like, "Oh, okay." Like, you know, they have the idea that I have people that are kind of stressed out. They come sit on my couch and we talk about their stress and then they they kind of, you know, move past it. And I'm like, "No, I mean, I'm working with clients that haven't left their house in 10 years.

[00:17:16]I've left with working with clients that lost their marriage, lost custody to their kids, like they're, you know, living paycheck to paycheck because they had to quit their job. Like, this is such severity. And I think that's what I always like about the conference is like in different presentations when people are giving case studies or when you know we're talking in front of parents that are talking about like how struggling their kids are. It like just reminds me that people can go from such lows to like thriving and presenting at the conferences years later. And I just wish I could somehow I I just wish that there was an understanding in the general public just how much our our um community is struggling and why like this work is so important because I just want the world to understand, you know, just kind of what I do and I just don't know how to explain it in a way that people are like, "Oh, I really get it."

[00:18:06]So that's why I like going to the conference because I think people are all like, "Hey, this is tough and you know, we've overcome something so difficult." So I just always like being around my people. That's how I always feel at the conference.

[00:18:16]>> Yeah. Yeah. No, I agree. And it's people get it. They understand it. There definitely is this shared and lived understanding of like the detrimental impact the disorder can have. They, you know, what happens if it's untreated, the desire to help people get to treatment and get better because we know how severe it is. So, yeah, all of that.

[00:18:35]Totally. and same Ash about kind of just it becomes a safe place for people to like have or talk about anxiety and it not be something that is um maybe like ignored or stigmatized.

[00:18:46]>> Yeah. Can you talk a little bit about what Amy's mentioning about like what's the function of the behavior? I think that also ties in with like core fear work. Um I I think this also ties in a lot I think um you know at the conference but beyond this happened at the family group as well is like their loved one will show like different symptoms. maybe they have co-occurring autism or generalized anxiety etc. So why is it important to kind of understand the function of those like surface compulsive behaviors and why is it uh important to dig deeper and really look at at at core fears?

[00:19:19]>> Yeah. Um it's a great question. So I actually like put this now on our group board as I just write WTF and people laugh but it's really true like I want us to constantly when we're doing clinical work as clinicians but also as patients be thinking about what is the function right WTF it's easy to remember but like what's the function of my behavior and this question can be in treatment when people will say things like well how do I know if I'm leaning in and like approaching my fear or if I'm distracting myself it's like well what's the function of moving on is the function of moving on to try to suppress the thought and you know not have to think about it in which you're actually still giving it power because you're telling your brain and body it's dangerous or is the function of moving on like hey I've already addressed this and like sitting here thinking about it more isn't helpful I'm going to go do something else even though I feel anxious in which case that's a really helpful behavior and so you know I think sometimes it's it happens all the time here where people will come to me and say this is my exposure how do I do respons like you know and they want they want me to come up with some sort sort of like treatment guideline handbook for them that like for every single trigger this is exactly what you do. And my answer is always like, "Well, I don't know what you should do." And they're like, "What do you mean? You're supposed to be able to tell me." I'm like, "Well, it's different for everybody." But also, the same behavior I do could be a ritual for Chris. It could be helpful for someone else. It could be right. And so, like anything can again, it's what is the function of it in your life, right?

[00:20:44]Is the function to try to reduce anxiety, decrease urgency, make me feel better, in which case we shouldn't be doing it or is the function it actually like helps me approach my anxiety, distress, and move through it. Right?

[00:20:56]Again, conceptually we want to be thinking bigger picture. How do we get to freedom? We we teach ourselves that anxiety is not dangerous. We approach our fears. We don't avoid, right? We we really accept and lean in and and send the message to our brain and our body that these things aren't going to control me. I'm not going to be afraid of them, you know. So anyway, yeah, I love the question. I think it's really important to ask and it also is important for clinicians to be asking because not all behaviors are OCD. Even if a prov patient presents to you with OCD, sometimes there's clear OCD behaviors. Sometimes there's OCD.

[00:21:29]There's behaviors that you're not sure if they're OCD and sometimes there's some that definitely aren't. We need to understand the function of all the behaviors, right? autis autism behaviors can look like OCD, but actually when you understand the function, it's actually like functional and helpful for that person. They they need a system. They're not willing to totally get rid of the behavior. And so our treatment looks different, right? We're not necessarily trying to totally extinguish the behavior. for trying to make it more productive, less time consuming, more functional in their life because it's better understood in their autism diagnosis than if that behavior is better understood as a clear OCD behavior in which we need to extinguish the behavior completely. We need to approach the fear completely. Right? So we have to really be asking, thinking and understanding the full function of every behavior someone does and the impact and role it plays in their own functioning and health. And I think it also adds to preventing that sort of whack-a-ole experience that a lot of people have because if somebody's always chasing those surface level problems, there's some reason that somebody is driven to that. So if somebody at work, for instance, is constantly monitoring like how their boss reacts to them or making sure that their emails are sent with no grammar uh problems, staying late or on the weekends to overwork, they're always going to be doing different surface level things at the office if they're afraid of losing their job. But working with the client to really understand like what is your core fear? Nobody wants to lose their job and everybody takes certain parameters to prevent that. But why is this consuming?

[00:23:02]Why is why is this everything that you do on a daily basis and like I worked with a client once that had seen like four or five therapists and he was like you know I go see a therapist I'm able to kind of like extinguish those surface behaviors but they just come back in a different form. And when we looked at him, the pattern always came back to this idea that if he was to lose his his job, he wouldn't have anything else that he um was important because that was kind of his life and he'd leave his family disappointed in him and they'd become homeless and he'd live on the street. And like when we really address those core fears, he's like, I don't even believe any of that crap. Like I'm so much more than my job. Like I we have so much savings. I could always get another job. And he's like, I've I've just he's like, it's so obvious now that I'm sitting here talking about the core fear, but nobody's ever spent a session or two on that. So, I've always just been so fixated on like emails and like making sure I sent something and like, you know, seeking reassurance how I'm doing. And so, it was easier once understanding the core fear to see all these behaviors as part of that. and he took way more of a leap of faith in the treatment to really prevent himself from rereading emails or asking his boss a certain set of reassurance questions because he's like now I know what I'm scared of and I'm not even really scared of that. So I think that's why it's so important to understand as well is sometimes people don't even know why they're doing all the behaviors that they feel inclined to do.

[00:24:25]>> That's right. That's right. Couldn't have said it better. So what did you learn Chris? What were some of your favorite things or like some of your big takeaways or things you're bringing back into practice? All of the above.

[00:24:34]>> Yeah. Yeah, I think um you know one of the talks that I was part of I got asked to be part of because some people couldn't make the panel. It was like an ethics uh conversation about working with marginalized groups and there was a presenter that talked about um she works with a lot of students and so encouraging the students to talk to their uh school counselors about OCD and having them understand it and that way you know the counselors are starting to learn about it and also when they need certain resources. but she had worked with a a a patient that was black, like a a client that was black, and when she opened up about her harm OCD, the school like called the police and she got arrested and it was like just a horrible experience. And it was just a good reminder that like different people's experience with OCD is different and different clients experiences, not always race, but it could be sort of like, you know, where they grow up, what they live with. There was another panelist talking about or somebody in the audience talking about how like, you know, she's been working with a lot of Catholic uh Latino clients and like a lot of them um don't feel like treatment is the right thing. It's more about faith. So, it's just it just is a good reminder. I think one of the things that I came up in is that like OCD is OCD and you treat it the same for everyone. But it's always just a good reminder at these conferences that because of different reasons, OCD is different for everyone. And that treatment, I think you guys do it well at your your location, is like treatment needs to be tailored for the specific person, even if it's nothing to do with their identities, but just who they are as a person or co-occurring disorders. So, I think I took that as one of the big takeaways, is like you really have to make sure the client is getting the treatment tailored best for them. And then I think second, which I kind of knew but hearing it more in the research space of like a lot of times the reason ERP quote unquote fails is somebody's been diagnosed with only OCD for so long but they really have autism, uh ADHD, BDD, uh gender dysphoria, they have um you know other Yeah. BPD, right? They have other things. And so, um, it reminds me as a clinician, like if I'm starting to see other signs of other things, like, you know, it's important to talk to the client and say, "This is what I'm noticing, and I think we need to get you, um, some psychological testing just to see if there's something else going on. If it's something out of my scope, or if it's in my scope, this is also happening." And that may be why you're not finding any kind of freedom from treatment. Yeah, it's and that's what one of the things I love about the conference is I think as a clinician or even an individual lived experience like the first couple years you go you're getting this like not to say basic but you're getting your like really important foundational knowledge and skills that's like critical but then you start to like get more advanced right so like I'm hearing you say Chris now like the conference for you really helps clarify some more advanced stuff and things that maybe even as a clinician that you're like okay yeah I need to keep that in mind now or this in mind because I know for me as a clinician early on I was more apt to like put things into OCD boxes versus like really saying like huh what else could be going on and you know because I maybe wasn't as comfortable or I didn't understand these differentials as much and I've seen a lot more of that at the conference lately these talks on like differential diagnosis and patients talking about it I think we used to have excuse me but we used to have advocacy that focused solely on OCD and now like there was an amazing presentation with patients and providers on comorbid bipolar and OCD. There was amazing ones on BPD and like like just it's really great to see people also talking about hey yes I have OCD but like here's what a coorbidity looks like both clinically but also individually as well and talking about that and and sharing that message because I think it's interesting sometimes I feel like there's still some stigma in coorbidities and it's like people want to overidentify with o all of my symptoms being OCD excuse me but what we know is that that's actually really detrimental because like you said, it doesn't get you the right help.

[00:28:37]>> Yeah. And and this wasn't really out of the conference. This was at last month's family group with with uh Kimberly Quinland. But the other thing is like when people have co-occurring disorders, seeing a therapist once a week for 45 to 50 minutes isn't cutting it. If your OCD is already severe enough, but then in addition, you also have these other co-occurring disorders. You know, I don't know, and maybe you can talk to this, like there's still such like an avoidance or stigma, like Kimberly and I were kind of talking about at the meeting, like there's still such a stigma of like if you go to a higher level care, it's because you failed or you're bad or it's a punishment. And it's like, no, if somebody's experiencing three different disorders, they're barely able to function. Like, you need a treatment team. One person seeing you once a week, it just feels like you're putting a band-aid on a broken dam. It's just not enough.

[00:29:28]Agreed. You >> talk about like a treatment team at a higher level like why it's important to have like diagnostic crit I mean assessment working with a psychiatrist.

[00:29:36]>> Oh my gosh. And for us like it's it's such a complex treatment team but like for us it's on our on-site anyone who's in our PHP or residential.

[00:29:46]It's a day program or a residential level of care. They get a family therapist their individual therapist and their psychiatrist. And that team is working really closely together to understand like okay like what happens in the family system and what does that behavior tell us about the presentation what happens with medication and what does that tell us about the presentation what's happening in session but what's interesting is it's not just that in a residential program we also have 24-hour observation in a day program we get eight hours a day of observation you would not believe the amount of like collateral and also clinical shifts we make based on behavioral observation that we're getting hours and hours during a day, right? So it's like yes it's it's the specific clinical team is really important but also any additional like time and collateral and behavioral observation we get of patients helps us better understand them how they operate how they move through the world how learning works for them and the way they're going to better tolerate ERP or their current distress tolerance skills when they're in the middle of an exposure that they're doing on their own or other things that show up. You know, it's just it's so much more than what like a lot of patients will first come to our program and they're like, "Well, I want to see my individual therapist more." And I'm like, "I get that." And I I like it makes sense why you would want to do that, but actually like no one ingredient in an intensive level of care is what like is helping. It's the combination of everything. It's the group work, it's the individual work, it's us getting to observe you during all of that and see what's getting in the way. What are treatment interfering behaviors? What where is OCD? what are things you don't need to do anymore because you can do that well, right?

[00:31:24]Like it's it's there's so much that comes together to make the treatment work outside of just like oh your family session or your individual session or your psychiatrist. Although those three are also very important to be collaborating and chatting because they have different backgrounds. You know, our psychiatrist understands meta interactions and what it might mean and what it might lend to much differently than the behavioral therapist does. And the family therapist can get collateral from historicals and information from family that's really useful in a case. Like, you know, it's a it's a huge combined effort that we work together to best help and serve our patients.

[00:32:01]>> Yeah. I always think back to my own care and how much like I wish I would have been able to get a higher level of care at the time and just kind of work on some things and it just meant that after I finished my OCD therapy, I had to do some other therapy, right? I had to do BDD therapy then after that and then there's stuff uh with with some family trauma that I went and saw a specialist on that. So, it would have been nice to do it all at once.

[00:32:22]>> Do it at once. But what I will tell you, Chris, sorry to tell you this is like I don't think there was good BDD res or comorbid trauma work back then. Like now, you know, for us, like BDD, I loved the presentation that like BDD is not OCD. Quit treating it like that because it's not and it has to be. And you would not believe the number of RES programs right now that still treat BDD the exact same as OCD. And I actually don't think that would have been useful, but like so you have to know what you're presenting with and is the program I'm going to equipped to really handle coorbidities?

[00:32:54]Do they have specialists in BDD, specialists in trauma, specialists in comorbid autism? like what are you know can they collaborate and work well with a team of you know so we we work really well with the Houston DBT center for our comorbid BPD cases if we need someone doing comprehensive DBT at the same time like what does that look like and what is available because to think that we can silo treatment that just really doesn't work for complex coorbidities >> no I mean I'm I'm working with a client right now that that was getting treatment for OCD and uh skinpicking and the therapist was treating skin picking like OCD and ERP wasn't working for skin picking. And so we started doing interventions for skin picking and she's doing a lot better. And the parents were just like, "How did this other therapist not know that they're two different disorders?" And I'm like, "Because it takes a lot, right? Like you you have to go beyond that initial OCD uh education that most people don't even get just to get education on uh related disorders and co-occurring disorders. So, I always tell people like I know it's hard um to to know you're getting good care, but really like coming to live streams like this, coming to different events and just seeing what are the treatment centers presenting, doing research, talking about the issue, like really the leaders in the field because you're going to get the most upto-date care and it's such a difference. Like you said, when somebody's getting everything is treated like OCD, nobody's getting better, but when they really get specific care, I got this question um asked I heard Oh, yeah. Before we move on, if you're a parent, if you're a clinician, if you're a patient, call the program and ask questions. Like, ask point of questions. Well, how do you treat BDD different? What does that look like? How do you treat BFRBs different?

[00:34:35]What does your treatment look like when someone has a coorbidity? If a program's not willing to sit and chat and talk to you about their interventions and what they do different, that should also be a red flag. So, just >> absolutely. Yeah. And if they get defensive, like I've had clients say that before, like, "Oh, I was talking to another therapist and she was getting defensive when I was asking about her credentials and her background." And I'm like, "Why? Most of us have those public anyways, but why would you get defensive?" Like, you know, so it's so important. Um, I heard this at the conference, but somebody uh messaged us.

[00:35:04]They the IOCF passed me this question.

[00:35:06]Somebody said, "Any favorite ways to respond to someone making an I'm so OCD" type comment.

[00:35:11]>> Yeah, it's a good question. Um, so I always am like thoughtful of when is a good and bad time to provide education.

[00:35:19]Like sometimes it is actually in a group setting um at a dinner table. I'm probably not going to, you know, try to educate someone and like shame them in that moment versus somebody who's saying it like obviously in a therapy office or in an individual time. I'm absolutely going to talk about like actually let's talk about what OCD is or is not. Um, but you know, I think you could you have to tailor your own like feedback based on the situation you're in in the social setting and just think about it of like can you if someone says I'm so OCD I'll be like oh in what way or what does that look like and then maybe they tell me and I'm like oh actually like that's not OCD that's just particular like OCD is a chronic disorder you know there's ways you can say it that it's like you know it's not at first assuming they don't know and instead being like tell me more about that and then being able to provide the education. Um, but it's tough. I also think this is where broad education on OCD not being an adjective, like what I'm so OCD perpetuates and why that language isn't good is really important because the more we can get the broad language out, other people might, you know, quit using it so flippantly. And but it's just, you know, you tailor it. But my favorite way is to like ask more, like, what do you mean by that? Like, oh, tell me in what way? Or, oh, actually, I I know a lot about OCD.

[00:36:34]Like, what what ways does it show up in your life? and then being able to say, "Oh, actually that doesn't sound as much like OCD. That sounds more like a characteristic or, you know, a preference." And um this is why OCD is very different than that.

[00:36:46]>> Yeah. Somebody made a good point at the conference. They're like, "We haven't had like like health uh uh conditions like married into like our lexicon."

[00:36:57]Like nobody's like, "Oh my god, I'm feeling so cancer today." Right? But people say all the time like, "Pay attention. Stop being so ADHD." or like, "God, I he's so bipolar. Like, he answered my call yesterday and didn't today." Or like, "Uh, I'm so OCD. I hate when they touch my, you know, my my package on the front door and put it in my room." Like, people just have made that kind of stuff as part of our vernacular. But you you don't hear that in physical stuff, right? Like somebody's not like, "Oh my god, like my my damaged spine. I feel like I'm crippled." Like people just don't say stuff like that. So, it's so weird that it's such like a part of like free, you know, people feel so free talking about it. Um, this question comes from Ardith.

[00:37:38]They said, "I'd love suggestions about how I can support my son and my family, why he's in denial, but he needs a higher level of care. I'm making progress, but he's not even ready for an IOP."

[00:37:47]>> Yeah. I mean, I I always tell people like I don't know if he's in outpatient, but you know, I really want the outpatient therapist to be having this conversation, too, just because it sometimes it feels very personal. It feels like we're being attacked or you're saying, "I'm not getting better."

[00:38:02]When it comes from family versus when it's a clinician, like it is our job. We are trained. We should be able to have a very clear, candid conversation of why why we want you to go to a higher level of care and why that actually is going to help you and why doing what we're doing is hurting you and like not useful. Um, the other thing is, you know, I don't I can't speak for other programs, so I can only speak for ours, but like myself, clinicians, we're happy to hop on calls anytime. We do this all the time. Chris knows this. I do this with Chris sometimes, too. But like when a patient I I had a long phone call with a mom this morning, but we I'm happy to hop on calls with people who are wanting to even just learn more. And you can pitch it as like, oh, like I actually know somebody who's at a residential program or I have like we also have patients and parents that'll talk to other patients and parents that are, you know, considering like some of our alumni that love to do that and that's a part of their advocacy and mission is to talk about what it actually is and destigmatize some of the myths, but also help them understand why it can help and save their life. Um, but it doesn't have to mean, oh, you're having a conversation to go there, right? It can just be, hey, why don't you talk to someone about who's who's been to residential or who's been to a higher level of care and see what it was like?

[00:39:10]Like, I wonder if some of the things that you're worried about might actually not be things you need to be as worried about sort of thing.

[00:39:16]>> Yeah. Like I I've had patients and a patient will be talking to you soon. Um, and it's a lot of the things that they say I know and I think I hope it's better from you, but I know that it's not true. I think there's a lot of times when clients are afraid of a higher level of care, specifically residential, they really picture like the 1970s psychiatric hospitals, and I'm like, I get that those are like, you know, cool to have in a movie, but that's not what we're doing anymore, like 60 years later, right? So, um, I think it's important to learn. The other thing, I wouldn't always suggest this, but the other thing, if a client is absolutely 100% unwilling to go to a higher level of care, starting with a clinician who goes in knowing that this client, because that's the thing that's so key is going in, I've worked with clients before that are going to be doing an IOP, PHP, or residential. And I go in working with them like, hey, we're going to do this to get you ready for the higher level of care. Some clinicians, for whatever reason, um even if they're working with a a severe case case of OCD, don't always um have their clients go to a higher level of care when needed. But sometimes, you know, going to like weekly sessions with a clinician who's really working to get your son ready for a higher level of care can be helpful. It's always going to be better if they can go straight to that residential because just like in surgery, right? Like if you have a broken leg, you're not going to go home and put icy hot on it for months till you go get surgery, right? You get surgery first and then repair after. So I hope people can go straight, but if they're absolutely dragging their feet, sometimes working with a clinician that's well informed on higher levels of care to get them ready for it can sometimes be helpful. I work with clients that are afraid to go to residentials because they don't want to be around that many people and we work on like going to places in public. They get comfortable with that and then they're ready for a residential. Yeah, I just wrote a note that like we need to do a section on our website about like what REZ really is and like testimonials and talk about it and help because I I get this question all the time that I'm like we need better material and I feel like that doesn't really exist. There's not a lot of good like educational material on destigmatizing uh you know residential and and talking about what it really is and why it's useful and that sort of thing. So, >> no, it would be great for you guys to do that. Like a miss thing because everybody thinks like it's going to be like prison. No autonomy. Everything's going to be taken away. I'm gonna have to be wearing like scrubs. Like, you know, I'm going to be forced to like wake up at 2 am and do. I mean, it's just like things that I personally know.

[00:41:40]Um, but I think having it in that way for for those of us, we could just like send them a link and be like, this is what it really is.

[00:41:46]>> I'm on it.

[00:41:47]>> Yes. Uh the question was, "Has a therapist ever told you during ERP sessions you have to challenge every urge or intrusive thought? Keep your willpower strong against every obsession that pops in your head and resist the compulsions." Or have they told you the opposite? You don't need to resist the thoughts. You have to accept them while resisting the compulsions. Um I would say these approaches can be uh misunderstood. So, basically just putting up the question like when somebody's actively doing ERP, let's say somebody is um they've left the church because every time they're at the church, if they have an intrusive thought that they feel is blasphemous, they feel super uncomfortable in the church and they feel worse because they're like, "Oh, I'm having these thoughts in church versus at least at home, I'm not in a in a holy place."

[00:42:30]What should that person be doing like while they're actively back in the church when they're having thoughts?

[00:42:35]What do what do you um feel is the best thing for for people to be doing mentally when they're doing an exposure?

[00:42:42]>> Yeah, I actually don't know. Um because again, WTF, what's the function? So, you know, it's interesting because I could take both approaches. I could say actually like for some of my patients, I do want them purposely approaching all their thoughts because when they don't approach their thoughts, it's because it's actually because they're avoiding them or because they don't want to think about them and that's actually keeping them alive. For some of my patients, approaching every single thought becomes a ritual and can like become a part of their OCD and I actually want them to kind of choose to do nothing about them and let it be there. And so again, this is where we go back to it really depends, right? It's what what are we using it for? If we're using the kind of I don't need to approach this thought as a way to avoid thinking about the thought or as a way to kind of not have to be distressed, that's a problem. But if we're like approaching every single thought and it's becoming like compulsive and it's becoming unhelpful and keeping us stuck, that's also a problem. So again, you can see where this is why treatment conceptually is like easy to understand, but in practice it's nuanced, you know, just because we at the end of the day like every single person's treatment has to look different. And you know only you or you and your provider maybe together will really know the difference of like is this helping you or is this keeping you stuck? And so what I always ask instead of WTF, which I do ask, is is it keeping you stuck or is it letting you have freedom from the thought? Like is whatever you're doing, does the thought keep showing up? Does the thought continue to be distressing? If so, then like we need to do something different.

[00:44:20]If you do this and it's really decreasing the fear and you're noticing that the thought is coming with less frequency, less intensity, and it's no longer really triggering, then great, it's working. Keep doing it, you know.

[00:44:30]So, it just depends. It really does.

[00:44:33]>> Yeah. I would always say like the biggest thing I tell people too is you want to make sure that your mental response is in congruence with what you're trying to learn. And so, from basically like an exposure, there's a lot of learning that happens in addition to just the behavioral component. And so I tell clients like if you are at church in the an analogy I gave and the whole entire time you're in your head like I hate this. Why did my therapist do this?

[00:44:57]Oh my god, I'm going to hell. This is bad. I never want to do this again. Then sure that's not the right thing to do.

[00:45:02]But yeah, just like you said it's so different from everyone um what they're trying to do. I know for me a lot of times just in my personal experience it was really just like telling my brain like I'm doing this and we're going to see if I can survive this and then we'll learn at the other end. I'll learn something from it and I'd go do it and I'm like wow I was able to handle it.

[00:45:20]Nothing bad happened and once again it was a lie from OCD. But I think like you said it's really just understanding like what is the automatic kind of thoughts that they're mental compulsions they're doing and really working on what are they hoping to achieve from those and how can we get them on the treatment side versus the compulsion side.

[00:45:37]>> Yeah. And remembering the goal is to not care. Like the goal is I don't care if I have this thought. I don't care if I'm distressed. I don't care what it means or says or the fear. Right. And that is so so important just because I think that a lot of people get really stuck on um what do I do like how like tell me exactly and it's like again like I don't like I don't know what you do because I don't know what like how this work like what makes sense what doesn't blah blah blah blah um but one of the things that I was actually talking about with someone recently is I was doing we were doing a lunch and learn we do a lot of these in our community and they were saying they were like well sometimes times I think scripulosity and other things can be a little bit harder to treat because when we treat patients with say contamination if they do the exposure you know they they see that they don't get sick they know that it's okay and like you know it it becomes like it's it makes sense for them they get more clarity um versus scrupulosity is a little different cuz like there's no way for us to know if we're going to go to heaven like right or what's going to happen because that's not something we can like see happen within a time frame or you know during treatment and I'm actually going to really disagree agree with this just because again if we're holding on to like let me see if this comes true. Let me only do this as a behavioral experiment. So okay, I'm willing to have these bad thoughts about my mom as long as something doesn't happen to my mom or as long as you know as long as I get to know she's okay or she's safe. You guys like that is like that we're missing the point. Does that make sense? like we're missing the entire point of treatment if we're still waiting to see if something happens.

[00:47:14]Like to me, a contamination exposure should actually be the exact same as a sculosity exposure because the goal isn't do you get sick or not. The goal is you don't care anymore. You're able to let go and have clarity that like well even if I did get sick, whatever, I would deal with it versus I'll do this as long as I don't get sick. Why?

[00:47:33]Because if that's what's happening, that's what's going to keep happening for every trigger. So, you're not actually going to have freedom from your illness. You're just going to be using ERP constantly to survive and to do behavioral experiments. I want you to use ERP where you get to a place where you no longer have triggers. You just have thoughts, right? Like, there's no such thing as an intrusive thought for you anymore because it's just a thought.

[00:47:55]Like, it it was only intrusive because you were responding to it. Not, oh, I keep having every intrusive thought and I have to do ERP and then I have to see what happens. That we're missing the point of treatment. So again, are we really understanding and thinking about and practicing treatment wholly, which means like we don't care. We're letting go. We're we're understanding the function of any of our behaviors. And if any of them are reinforcing the cycle, we really know why and what that means and and how to address that and change it.

[00:48:24]>> Yeah. And I think the reason what you're saying is important, too, is because sometimes, you know, we we were talking about this in my group last night.

[00:48:30]there's a a person that is uh you know is is working up to going somewhere public without a mask because there are COVID fears and what I was reminding people because people are like you should do it and then you'll learn and I'm like but guess what people do get sick right it might not be co it might be the flu etc the point of treatment isn't to always prove if something's going to happen or not because things do happen it's reminding yourself that if something were to happen that wasn't great you could still land on your feet you can still overcome it and that you are stronger than you know So the the goal of treatment isn't to learn how to, you know, if the the the percentage or probability of things happening, it's also, hey, if something happens, I could still land on my feet and be super successful regardless.

[00:49:13]>> Yeah. Exactly. Exactly. And just, you know, the more you do treatment as a patient, but as a clinician, too, but like even as a patient, the more the concepts make sense. It's like one of the things Ryan, our clinical director, always says and I love is he's like the more you understand ERP, you can't think of any other better treatment for OCD because it like it makes so much sense of like what we're trying to teach you and like the goals and what happens, you know? So anyway, um okay, let's go through lots of questions. I know we only have six more minutes. Um do I know any providers or clinics that accept Medicaid and Medicare? Baylor College of Medicine, I believe, does here in Houston and they are virtual. Um, they do have virtual options, so I would reach out to them. You can just Google BCM's OCD clinic. Um, I feel what Chris said. Lots of people saying, um, happy and meaningful disability pride month.

[00:50:07]Love all the feedback.

[00:50:11]There was this question. Um, uh, let me get it. It was, "How do you know if it's ADHD, mild cognitive impairment, or OCD?" Um, if you're having problems concentrating, there's always some background noise in your head.

[00:50:25]>> Yeah, great question. And so, what I would say is I want you to get a full comprehensive assessment first because we can't treat OCD if someone really is unsure if there's coorbidities or what else might be going on. So I want you to get what I would like is like a full psychological assessment where we rule out and understand if there is any cognitive impairment what that means how that impacts the way you learn. If you have a diagnosis of AD ADD or ADHD what that means and where those symptoms are if you have OCD we want to get diagnostic clarity first. Once you have that then we need to treat OCD as OCD you know so once we have clarity like I I have a lot of patients but like patients who will go through injuries right and it's like the doctor is very clear on this is what the injury is this is what my recommendations are the rest is anxiety now we're going to treat the rest as anxiety and OCD we're not going to keep going back for second opinions but we want to get that clarity first so that we know what to treat when and how and then be able to dive into the effective treatment for each Yeah, Elizabeth says that she's at the point now where she actually gets excited to do exposures. Um, how do other people because that's where we are and we want people to get So, what is kind of like a way that you see people actually getting excited and looking forward to doing exposures?

[00:51:41]>> Yeah. I mean, this is the goal of any new learning that happens, you know, in your life. When you are terrified to ride a bike, but you figure it out, you're so excited. And every time you get to go ride, it's even though it's still maybe challenging at the beginning, it's exciting and then it becomes second nature, right? You have the saying of like it's like riding a bike. Um OCD should be the same way, right? It should be scary and hard up front, but once you do it a couple times, you should feel empowered. It should feel almost euphoric. It should feel so exciting because you get not just to have relief from your anxiety and OCD through ERP, but also you start to get your life back. You're like, "Gh, it doesn't have to control me anymore.

[00:52:19]It doesn't I don't have to keep living this way. Um, and we love we're huge fans here at OCDI as are most programs of like gamifying OCD. Make it fun. Make it exciting. It doesn't need to be boring, right? OCD should treatment can include Chris talks about this. Going out in public, eating together, doing stuff that you enjoy. It's not exposure should be real world, real life, values based. They should they should be fun.

[00:52:43]Um, you should be kind of excited. So, I love that. That means you're doing treatment right. So, uh, great. really works for young clients. I I helped out because Denise unfortunately couldn't make it to the conference. So, I helped Susan Boaz and Meg um do a a middle school and it was gamifying exposures and so we did Uno and if you got a card that was like plus two, draw four, things like that. you could either draw cards or you could do an exposure or we did Jenga and like every time you pulled one out um you could do an exposure if you're if Jane like something fell and it was like kids that were not like privy to do exposure suddenly loved it as soon as like it was part of a game they're like I don't want to draw for I'm afraid of eating things with peanuts and she ate like a a granola bar with peanuts. So, but for adults too, like find something that you know you enjoy doing and make your exposures around that so you're like looking forward to it. It doesn't have to feel like torture. I tell people that all the time >> and it shouldn't, right? Like that's the big piece. It shouldn't it should feel like you're getting your life back, you know? It Yeah. Um Okay, Chris, we only have two minutes. So, um, I know you always love to throw up a bunch of questions, but I I think you can kind of see a lot of the questions where people are talking about just, you know, how long it can take to get to treatment, but also knowing there's great treatment, um, how to kind of lean in, accept uncertainty, all the stuff. So, final comments and thoughts you have.

[00:54:07]>> Yeah. No, I I think my final comment is just I hope people heard everything we talked about today. I really, you know, making sure that you find a provider that is really leading in the field or at least just somebody that really does this work. I think it's so important making sure that your assessment does kind of look at everything you're experiencing because I think we don't always know we have a co-occurring disorder and that's so important. Uh definitely recognizing that people are getting better and you're not in this uh journey so that you can kind of do symptoms less. You're getting into this journey so you can really kind of discover why were you put on this earth?

[00:54:41]What are you passionate about? Can you go after your goals? OCD doesn't have to be a part of our lives. And I think there was a discussion on the Facebook group because somebody was doing a training where they're saying like, you know, learn about your strengths from having OCD. Let's not identify with OCD.

[00:54:56]OCD is a mental health condition. It's not who we are at our core. It's a set of symptoms and behaviors that we can absolutely reduce and thrive from. So, um, I just don't want people to identify with OCD. It's not fun. We don't need that. um we have effective treatments and the harder you work at it, the more freedom you can get and eventually you can be like Liz, myself and others um that are thriving in life. And like Liz said, I don't talk about OCD outside of work very often because it just doesn't come up. I'm usually bitching about the cost of gas or traffic or taxes or something that's unfun. Um but OCD isn't like the topic a lot because it's just not something that's in my life a lot and you can get that way as well.

[00:55:35]>> I love that. Yeah, >> that that's it. You know, I think a message of hope. You know, I always love to end the live streams just saying like help and hope is always available. And I mean that when I say that, you know, whether it's OCD or coorbidities, there's always treatment available that can help you. And we just sometimes have to figure out the right one because maybe what we're doing hasn't been working because it's not the right level of care or it's not the right specific intervention or somebody who says they treat BDD doesn't or BFRB doesn't and we need to really adjust. But don't just if you're not getting better, don't think it's because you can't, you know, understand that we just need to make adjustments and we need to keep fighting and advocating to get you the right help so that you can get better because there is so much hope in this in recovery from the OCD from related disorders. Um, and I just I don't want people to ever lose sight of that, no matter how much you're struggling, even if that feels you feel really skeptical about that statement and that knowledge. Um, I will give a little plug, but tomorrow at OCDI Texas, we're doing a webinar with one of our past patients where he's going to come on and talk about his experience. Um, and he's going to talk really openly about his experience in residential and past treatment and what it's like. And so I always like to just share those because I think those are great opportunities. You can go to ocditex.com to learn more and join that webinar. But it's a it's a good opportunity to kind of learn and hear from somebody who understands different levels of care and what it was like and the difference it made. So, um, again, between so many organizations, Chris does such a great job with OCD SoCal's Family Support Group and, um, IOCDF, there's so many ways to just get good education, messages of hope and knowledge, and just keep searching for those. If you're a parent, send those to your kids. Someone asked earlier, how do I get my kid? Send him that link and maybe he'll watch it and not talk to you about it. And it doesn't have to feel pressured, but it might make a big difference if he's if you feel like I really want him to learn more about a level of care. So, you just never know what education can do for someone >> if they go there. Is there a specific place on the website or >> Yeah, you can go to there's a section on our website that's for like webinars and marketing, but I'm also going to try to do a popup on the homepage, but the webinars tomorrow and any of our webinars just like ICDFs, they're always recorded and put on our YouTube channel, too, so you can watch them later.

[00:57:50]>> Yeah, make sure to check that out. I think hearing if you're a family member or a loved one watching this and you know often what I hear is somebody sees a webinar of a person that has gone through the treatment um and it just feels comfortable knowing somebody else has done it and gotten better and so if you can make that or at least watch the recording definitely do that. Um lastly, all I'll say is if you um are looking for a clinician, please go to iocf.orgfindhelp.

[00:58:16]You can find Liz and I there. That's where I found my therapist many years ago. Oh my god, my therapist was at the conference. It was the second time I've se fourth time I've seen her since I did treatment. But it was cool to see her at the conference. So >> Oh, I love that. Mine, too. I got to spend a lot of time with him. It was fun.

[00:58:31]>> Oh, I do. I know your therapist. You don't have to say him out loud. But do I >> Oh, Thirstster was I didn't know that.

[00:58:37]>> Yeah, he was I didn't know that. Never mind.

[00:58:40]>> Yeah, he ran the OCD residential program at Mener. So, he was my first true clinician that really changed my life.

[00:58:46]Dr. Bjorgensson, who now for Yeah, >> I always like talking to him. We ran into each other and talked for a while because I went to Iceland and Norway and he a lot and he's from Iceland and he's great. He's amazing.

[00:58:57]>> Funny. Yeah, he's awesome. So, >> yeah. And if you're watching this, you're going to be at a point one day you'll go to the conference and run into your therapist and be like, I remember when. So, um, thank you everybody for joining us.

[00:59:08]>> I love being back. I will not be here the first Wednesday cuz I'll be out of town, but Ryan Jud, our clinical director, will be on. And Chris, I want to encourage y'all to talk all things about how treatment should look different for BDD and OCD and all the stuff because I know people love hearing that. So, >> yes. All right. Well, I am so excited to have you twice in one month on these live streams. You can always watch these back on IOCF's Facebook under reals if you're on your phone or lives if you're on the computer or on IOCF's YouTube channel. Thanks to Liz. Thanks to everybody that asked questions and we will see you next Wednesday at 12 Eastern every Wednesday here on Ask the Experts live streams. Thank you so much and make sure you head over to iocf.org for any kind of resources and help. Take care y'all. We'll see you next week.

[00:59:48]Bye.

[00:59:49]>> Bye guys.