Understanding OCD in Kids and Adults

[00:00:00] Adelina Brisbois, LMFT: You went and you did the thing, and a couple years later have really found your way in our community as the guy.

[00:00:08] Andrew Cohen, LMFT: So what ends up happening is our body starts perceiving those obsessions or those thoughts or experiences as a threat. When that happens, we're designed to fight or run away from that threat.

[00:00:18] Andrew Cohen, LMFT: I always say like OCD and anxiety disorders are resilience killers. Oh right. And confidence killers. Because you know, you have these worries and doubts. You do a behavior to try to prevent them. You never get the chance to learn that you can handle the feelings or the situations whenever they might run and makes, makes you

[00:00:32] Adelina Brisbois, LMFT: easier your Yeah.

[00:00:33] Adelina Brisbois, LMFT: Confidence. It

[00:00:34] Andrew Cohen, LMFT: makes you believe that

you

[00:00:34] Adelina Brisbois, LMFT: don't have a chance to be confident.

[00:00:36] Andrew Cohen, LMFT: Yeah.

[00:00:37] Narrator: Welcome to look for the Helpers, A podcast by Engage Therapy in Agora Hills, California. Hosted by Adelina Brisboy Licensed Marriage and Family Therapist and her husband, Dr. Blake Brisboy, licensed psychologist. Thanks for being here.

[00:00:57] Adelina Brisbois, LMFT: Good morning, Andrew.

[00:00:58] Andrew Cohen, LMFT: Good morning.

[00:00:58] Adelina Brisbois, LMFT: Welcome to our podcast.

[00:01:00] Andrew Cohen, LMFT: Thank you. So excited

[00:01:01] Adelina Brisbois, LMFT: to be here. I'm, I'm really glad you're here.

[00:01:02] Andrew Cohen, LMFT: Yeah.

[00:01:03] Adelina Brisbois, LMFT: Um, so I'm gonna do my best to introduce you and then you, you'll tell us a little bit more about yourself Sure. And your personal journey. So you're Andrew Cohen. Yeah. You're a local clinician.

[00:01:13] Adelina Brisbois, LMFT: You and your wife Danielle, have opened an amazing practice called Cohen, OCD therapy.

[00:01:18] Andrew Cohen, LMFT: Yeah.

[00:01:18] Adelina Brisbois, LMFT: Uh, because you and Danielle specialize in obsessive compulsive disorder and anxiety disorders.

[00:01:24] Andrew Cohen, LMFT: Yep.

[00:01:25] Adelina Brisbois, LMFT: You guys work with youth and adults. Mm-hmm. And anybody who is needing that support

[00:01:30] Andrew Cohen, LMFT: age is five and up.

[00:01:31] Adelina Brisbois, LMFT: Five and up.

[00:01:32] Adelina Brisbois, LMFT: Yeah. Which is really awesome and unique. And, um, just a little background about how we know each other. Yeah. I knew you back in the day when you started at Engage as. Um, what was it? A, a, a program Program

[00:01:45] Andrew Cohen, LMFT: assistant, I guess. Program

[00:01:46] Adelina Brisbois, LMFT: assistant. Yeah. You did everything right. You, I remember you would drive people to program, you would go pick up stuff that we needed and then, um, you know, I watched you go to school, get your degree, and then eventually I was able to be your supervisor and that was really awesome.

[00:02:04] Adelina Brisbois, LMFT: So Good. And got to know you better that way clinically and personally. Um, and then I, I think your story from there really takes off. So I'd love for you to share more about it today.

[00:02:15] Andrew Cohen, LMFT: Sure.

[00:02:15] Adelina Brisbois, LMFT: Um, you now are an expert in the community in OCD, uh, so much so that you come and train our staff mm-hmm. In how to recognize and, you know.

[00:02:25] Adelina Brisbois, LMFT: Understand OCD better.

[00:02:27] Andrew Cohen, LMFT: Yeah.

[00:02:27] Adelina Brisbois, LMFT: So we're really grateful for that. Um, all of us have learned, including myself. Yeah. From you and Danielle as well. So lemme turn it over to you Sure. And tell us a little bit about your journey. Like how did you get here?

[00:02:39] Andrew Cohen, LMFT: Yeah.

[00:02:40] Adelina Brisbois, LMFT: What was your story?

[00:02:41] Andrew Cohen, LMFT: Absolutely. Um, well thank you everyone for having me.

[00:02:44] Andrew Cohen, LMFT: I'm so excited and I hope the listeners get a lot out of this today. Um, yeah. So I mean, I've, you know, been passionate about being a therapist for a while. Um, I've always dealt with, you know, now looking back, knowing OC that it was OCD, you know, I would just call it anxiety at the time. Mm-hmm. A lot of worries.

[00:03:02] Andrew Cohen, LMFT: Um, and, you know, I went to therapy, you know, around 15 years old for a lot of this anxiety, and through that journey I became passionate, um, you know, about becoming a therapist and helping others. Um, you know, my OCDI think showed up. Now looking back around seven, eight years old and, you know, really kind of, I, I, I named my OCD Bitman.

[00:03:23] Andrew Cohen, LMFT: Um, so Bittman's kind of, uh, you know, been with me through this journey, if you will. Mm-hmm. And let's see. I mean, I was in talk therapy for a while. Went, uh, you know, to, to, it's all good. I was in talk therapy for a while, just throughout high school and, and kind of into col into college. And, you know, my anxiety now looking back, knowing OCD really kind of hit a peak when I was at my last, uh, year at UCLA.

[00:03:54] Andrew Cohen, LMFT: And, um, you know, it really became extremely debilitating. I, you know, was bombarded with, you know, we'll kind of go into what OCD is I'm sure, in a little bit. Yeah. But, you know,

[00:04:03] Adelina Brisbois, LMFT: well, you can tell us.

[00:04:04] Andrew Cohen, LMFT: Yeah, I'll, I'll go into the definitions and all that, but a lot of my worries or obsessions were around. You know, morality and if I'm a good person or not, and needed to confess a lot of like, thoughts that I was having.

[00:04:16] Andrew Cohen, LMFT: And it was just very consuming. And um, you know, luckily I was with a therapist at the time who I think recognized, she's like, I think this is OCD and, you know, referred me to a specialist, a place called OCD Center, Los Angeles. And, um, you know, with a, an amazing clinician, Laurie Yoakum. And, uh, you know, she, this, you know, I don't know if this sounds dramatic, but it did save my life.

[00:04:39] Andrew Cohen, LMFT: You know, I was at a point where if things didn't change, I don't, I don't, I wouldn't be here right now. You know, it was tormenting. It was 24 7. It would infiltrate my dreams.

[00:04:49] Adelina Brisbois, LMFT: Oh man.

[00:04:50] Andrew Cohen, LMFT: You know, it's like you never even got a break break. You didn't get a break. You didn't get a break. You didn't get a break.

[00:04:54] Andrew Cohen, LMFT: And um, you know, I went and did some really intensive, uh, ERP exposure and response prevention type therapy. And I was going, you know, two hours a day, three days a week for a while. And it was, you know, individualized and really intense and difficult. You know, that's what really led me down the path of, okay, I wanna specialize in this.

[00:05:14] Andrew Cohen, LMFT: Mm-hmm. This was the first time I've experienced therapy where, you know, I left it being able to like actually have, you know, we always talk about tools and skills and mm-hmm. Stuff, but this was the first time I was able to actually like, apply this stuff into my life and

[00:05:29] Adelina Brisbois, LMFT: outside of the therapy.

[00:05:29] Andrew Cohen, LMFT: Yeah.

[00:05:30] Adelina Brisbois, LMFT: Like you felt relief for the first time it sounds like,

[00:05:33] Andrew Cohen, LMFT: and not just, so we'll talk about the relief piece of it. Not just like temporary relief. Like you do a compulsion and you feel better.

[00:05:38] Adelina Brisbois, LMFT: Oh, all right.

[00:05:39] Andrew Cohen, LMFT: And the worry comes back.

[00:05:40] Adelina Brisbois, LMFT: Right.

[00:05:40] Andrew Cohen, LMFT: But it was more like long lasting, like, I would say it was more like content.

[00:05:44] Adelina Brisbois, LMFT: Oh, okay. Which is a big deal.

[00:05:46] Andrew Cohen, LMFT: Yeah.

[00:05:46] Adelina Brisbois, LMFT: When someone is struggling with the loop.

[00:05:48] Andrew Cohen, LMFT: Yeah. Yeah. So, you know, I, I was able to finally step outside of that cycle. OCD gets you OCD anxiety gets you looped into, and being able to actually like, be able to see my mind for what it is versus, you know, it's, you know, it was all jerking me around, making me do all these things that I didn't want to have to do.

[00:06:05] Andrew Cohen, LMFT: And

[00:06:05] Adelina Brisbois, LMFT: Yeah.

[00:06:05] Andrew Cohen, LMFT: You know, it finally was a way to break free from it. So. You know, I, uh, yeah, that, that's what got me kind of really interested in working with it. When I went to grad school, I was, you know, working at Engage, driving people around, doing all that fun stuff. But the whole time in grad school, I was spending my time researching and reading on OCD Anxiety, ERP, um, I even went, you know, onto the I-O-C-D-F, the international OCD Foundation's website, and there's like a find a provider, you know, function on there and basically put in my zip code and emailed probably every provider within a 50 mile radius of like, Hey, I really wanna work with this.

[00:06:41] Andrew Cohen, LMFT: Like, you know, what do I need? Tell me what to do, you know, can I come in? And finally, I was able to find a place out in West Los Angeles called Renewed Freedom Center, um, where Dr. Jenny Yip runs it and she's incredible. Um, you know, and I worked there for, for I think three years and opened my own practice out here and continue to be highly involved in the OCD world.

[00:07:03] Andrew Cohen, LMFT: So, you know, trained through the international OCD Foundation. Do like the advanced consult groups with them. And I'm actually attending one

[00:07:11] Adelina Brisbois, LMFT: in

[00:07:11] Andrew Cohen, LMFT: October. Yeah, in two weeks I think. Yeah. In an advanced pediatric one. I'm so excited. They're so much fun. Um, and yeah, I'm just very passionate about this. I, you know, I love to do podcasts like this to share about this stuff and, uh, provide trainings to folks like you and other treatment centers.

[00:07:27] Andrew Cohen, LMFT: And I've, you know, I, I very much value It is really cool being able to sit here and have this conversation with you.

[00:07:34] Adelina Brisbois, LMFT: It is

[00:07:34] Andrew Cohen, LMFT: really cool. It's, it's like, I mean, what, when, when was that? Like 2018? 2019?

[00:07:41] Adelina Brisbois, LMFT: Yeah. No, like probably 2017. So almost 10 years. Yeah. Right.

[00:07:47] Andrew Cohen, LMFT: Wow.

[00:07:47] Adelina Brisbois, LMFT: Yeah,

[00:07:48] Andrew Cohen, LMFT: yeah, yeah. Whoa.

[00:07:50] Adelina Brisbois, LMFT: Well, maybe, maybe it was 2016, you know, something like that.

[00:07:52] Andrew Cohen, LMFT: No, I definitely started in 2016 with Engage.

[00:07:55] Adelina Brisbois, LMFT: Right.

[00:07:55] Andrew Cohen, LMFT: But when you actually became my supervisor, I think 20 17, 20 18. Yeah. Yeah. Oh my.

[00:07:59] Adelina Brisbois, LMFT: I know, but

[00:08:00] Andrew Cohen, LMFT: that's just. Wow.

[00:08:01] Adelina Brisbois, LMFT: In a way it feels like a long time, but in another way it, it really doesn't.

[00:08:04] Andrew Cohen, LMFT: Yeah.

[00:08:05] Adelina Brisbois, LMFT: It doesn't feel like, you know, that long ago. No. But, um, it has been.

[00:08:10] Adelina Brisbois, LMFT: And when you, when I think about the work you've done and the, the journey you've been on Yeah. Like, when you say you love training, I can, I know that. Yeah. Because I've seen you do it. Yeah. And you, you like, you light up.

[00:08:20] Andrew Cohen, LMFT: Yeah.

[00:08:20] Adelina Brisbois, LMFT: Like you turn into an Andrew that is really cool to watch. Mm-hmm. Because you feel, it's so clear that it's so, you're so passionate about it.

[00:08:30] Adelina Brisbois, LMFT: And I now I understand more about why.

[00:08:33] Andrew Cohen, LMFT: Yeah. '

[00:08:33] Adelina Brisbois, LMFT: cause it's really coming from a place of, it's personal.

[00:08:36] Andrew Cohen, LMFT: Oh, very.

[00:08:37] Adelina Brisbois, LMFT: And I'll say, I was always interested. I, I was always kind of understanding that ERP exposure, prevent

[00:08:44] Andrew Cohen, LMFT: response prevention.

[00:08:45] Adelina Brisbois, LMFT: Uh, thank you. Exposure. Exposure, response, prevention, what it was. And is the treatment for OCDI knew that.

[00:08:50] Adelina Brisbois, LMFT: Yeah.

[00:08:51] Andrew Cohen, LMFT: Yeah.

[00:08:51] Adelina Brisbois, LMFT: But it also became a little personal for us. In our family. We had a family member that was struggling. Luckily not to the extent. Yeah. I think we were able to get knowledgeable and get resources quickly.

[00:09:04] Andrew Cohen, LMFT: Yeah.

[00:09:05] Adelina Brisbois, LMFT: But I'm so grateful that I, that I had that. Yeah. I mean, most parents don't get that.

[00:09:10] Andrew Cohen, LMFT: Mm-hmm.

[00:09:10] Adelina Brisbois, LMFT: And most people can't recognize it quickly. And you know, you mentioned that you had a therapist that was able to say like, I think this is OCD. Yeah. It got you on the right track. Yeah. And so our hope is that more therapists, I'm sure your hope as well Yeah. Is that more therapists have enough knowledge

[00:09:26] Andrew Cohen, LMFT: Totally.

[00:09:26] Adelina Brisbois, LMFT: To recognize and say, Hmm, this might be OCD.

[00:09:29] Andrew Cohen, LMFT: Yeah.

[00:09:30] Adelina Brisbois, LMFT: Let's check this out.

[00:09:31] Andrew Cohen, LMFT: Totally.

[00:09:31] Adelina Brisbois, LMFT: And not miss it.

[00:09:32] Andrew Cohen, LMFT: Yeah.

[00:09:32] Adelina Brisbois, LMFT: Because the more time that goes by that we miss it. We're, we're, we're letting people down.

[00:09:38] Andrew Cohen, LMFT: Yeah.

[00:09:38] Adelina Brisbois, LMFT: And we're also missing opportunities for people to have, you know. I don't, I don't wanna say relief 'cause you, you made a good point.

[00:09:45] Adelina Brisbois, LMFT: No,

[00:09:45] Andrew Cohen, LMFT: lemme say like, long-term relief, you know, like, like from this hope. Yeah. That's

[00:09:49] Adelina Brisbois, LMFT: really what it we're talking

[00:09:50] Andrew Cohen, LMFT: about. Yeah. Yeah.

[00:09:51] Adelina Brisbois, LMFT: Is a hope that Absolutely. This can go away. And from your story, it sounds like you were really motivated because you were in pain.

[00:09:58] Andrew Cohen, LMFT: Very much so. Very.

[00:10:00] Adelina Brisbois, LMFT: Do you find that that's the case with a lot of the people that come to you, that they're done with it?

[00:10:05] Adelina Brisbois, LMFT: Or is it kind of a mixed bag?

[00:10:06] Andrew Cohen, LMFT: It's such a mixed bag. It's such a mixed bag. I think, you know, it's funny, I remember after treatment, or not after treatment, but like after we were in treatment for a while with Laura, you know, I was doing a lot better. And she's like, I think she said something to the extent of like, you're one of the easiest patients I've had.

[00:10:25] Andrew Cohen, LMFT: Because I was just like, at this point where I was like, tell me what to do, please. Like, I just, I I need these to just stop, not mm-hmm. And you'll come to learn that you can't stop obsessions. Right. But I need these to stop being so dominating.

[00:10:37] Adelina Brisbois, LMFT: You needed to get on with your life, it sounds like. Yeah. You wanted to

[00:10:41] Andrew Cohen, LMFT: very much so.

[00:10:42] Andrew Cohen, LMFT: Do

[00:10:42] Adelina Brisbois, LMFT: more.

[00:10:42] Andrew Cohen, LMFT: Very much so. Like I knew there were things I wanted to do and I just wasn't able to do 'em at that point. And so I would say, do I have patients that come in like that? Absolutely. You know, it's the, the classic, like you get sick of ti sick and tired of being sick and tired.

[00:10:57] Adelina Brisbois, LMFT: Yeah.

[00:10:57] Andrew Cohen, LMFT: Type of place. I would say more on average, you're seeing patients who come in, in a mixed bag of like, yeah, I'm motivated, but I'm also terrified.

[00:11:06] Adelina Brisbois, LMFT: Mm-hmm.

[00:11:06] Andrew Cohen, LMFT: Right. I've, I've had this for a while and I do have these beliefs that this is protecting me or my family or

[00:11:12] Adelina Brisbois, LMFT: Right.

[00:11:12] Andrew Cohen, LMFT: Somewhat to a certain extent. So. There is a lot of kind of motivational work you have to do and kind of working on those underlying beliefs that you know, that they believe OCD and anxiety are keeping them safe.

[00:11:24] Andrew Cohen, LMFT: Um, so,

[00:11:25] Adelina Brisbois, LMFT: so will you tell us more about what OCD is?

[00:11:28] Andrew Cohen, LMFT: Yeah, I'm, '

[00:11:28] Adelina Brisbois, LMFT: cause that's, I think, let's not assume that you and I at this point kind of can pick up and know what we're talking about. But

[00:11:34] Andrew Cohen, LMFT: yeah,

[00:11:35] Adelina Brisbois, LMFT: let's start, let's start from the beginning.

[00:11:36] Andrew Cohen, LMFT: Totally. And yeah, I think that's a great idea. So OCD stands for Obsessive Compulsive Disorder.

[00:11:42] Andrew Cohen, LMFT: I like to think about it. There's two parts to it. You have obsessions and you have compulsions. And obsessions are any sort of unwanted, intrusive thought, image, video, urge, sensation, memory that pops into our brains and causes a bunch of distress. Um, mainly a lot of fear and anxiety, but just depending on the content of the obsessions, what the actual obsessions are, can be a lot of shame, guilt, anger, sadness, frustration.

[00:12:10] Andrew Cohen, LMFT: Now our body and our brains are built for survival and we have this built in fight or flight freeze response. And whenever our brain perceives a threat, we go into this happening is our body starts perceiving those obsessions or those thoughts or experiences as a threat. When that happens, we're designed to fight or run away from that threat.

[00:12:29] Andrew Cohen, LMFT: So this is where the compulsions come in. Compulsions are any sort of behaviors a person does to kind of fight or get rid of those obsessions, right? And compulsions can be both physical behaviors, so things you can see someone doing. Mm-hmm. Right? If I was looking at you, you know, you'll think of like stereotypical ocd, someone washing their hands or checking their door lock.

[00:12:49] Andrew Cohen, LMFT: But also in ooc D you'll see a lot of people like Googling excessively or seeking reassurance that, you know, whatever they're scared of isn't gonna happen. Which you'll also see in anxiety disorders as well. And then there's mental compulsions, right? Mental compulsions are those mental behaviors or processes that you can't see someone doing right?

[00:13:06] Andrew Cohen, LMFT: So this could be as simple as counting or praying or trying to think a positive thought to cancel out a negative thought. Mm-hmm. All the way up to mentally reviewing situations and going over and over something. And then something that I like to talk about is like rumination. It's like you're putting on a detective cap and trying to analyze why am I having this thought?

[00:13:24] Andrew Cohen, LMFT: What does this mean about me? Do I actually want this? And all this kind of stuff. And,

[00:13:28] Adelina Brisbois, LMFT: and those are invisible. Like, yeah,

[00:13:30] Andrew Cohen, LMFT: you

[00:13:30] Adelina Brisbois, LMFT: can't, you don't know that someone's doing that.

[00:13:32] Andrew Cohen, LMFT: So, so I think with me, you know, mine, yes. Looking back there are, there are for sure physical compulsions I did, but not like the stereotypical ones that you would think of in movies.

[00:13:43] Andrew Cohen, LMFT: But majority of mine were rumination, like completely ruminating, replaying events to see if I did something bad, um, to see if there was something I needed to confess to my partner at the time. And mm-hmm. You know, it just became. A nightmare. And it is a nightmare for people. So what ends up happening is you get kind of caught in this vicious cycle, we call it the vicious OCD and anxiety cycle, where, you know, something triggers you, it can be an obsession.

[00:14:08] Andrew Cohen, LMFT: Right? So let's just use like a classic example of OCD of somebody who's really scared of getting sick.

[00:14:15] Adelina Brisbois, LMFT: Mm-hmm.

[00:14:16] Andrew Cohen, LMFT: They touch, uh, you know,

[00:14:17] Adelina Brisbois, LMFT: a

[00:14:17] Andrew Cohen, LMFT: doorknob, a knob, right? And you know, they get this intrusive, unwanted thought of, oh my gosh, there could be blood on that and I can get some sort of infection and die.

[00:14:25] Andrew Cohen, LMFT: Mm-hmm. Right? Naturally, when we're hooked by that thought and we're fully fused with it, right? That's going to trigger a lot of fear. You think you're gonna die, like Yeah. If that's what's going on in your brain, who wouldn't get scared? Right? So then naturally they do, they'll go and wash their hands with soap and water.

[00:14:41] Andrew Cohen, LMFT: Right? Right. They'll feel a sense of temporary relief. Right. They'll get this, but then maybe they turn that faucet off with their clean hand, that dirty faucet, and then, oh my gosh, I just touched that dirty faucet with bean hand. There could be something. I'm getting really anxious. I can't handle this.

[00:14:56] Andrew Cohen, LMFT: I'm having this uncertainty, this doubt, this urgency. So I'm gonna wash my hands with soap and water. I'm gonna turn the faucet off with a paper towel so we're all good. But then they go open the bathroom door, you know, it's like, oh my God, I just touched the dirty bathroom door. And then it just goes around and around and around.

[00:15:12] Andrew Cohen, LMFT: Mm-hmm. And this is, you know, that's just a one very small example. Right. But this is a cycle that anybody with OCD and or anxiety disorders can very much relate to. Right? Right.

[00:15:23] Adelina Brisbois, LMFT: And when that's 24 7, it's not just like five minutes.

[00:15:26] Andrew Cohen, LMFT: No,

[00:15:26] Adelina Brisbois, LMFT: that's 24 7. It becomes exhausting and debilitating. And that's when people land in your office.

[00:15:33] Andrew Cohen, LMFT: Yes. Yes. And, uh,

[00:15:34] Adelina Brisbois, LMFT: because we're not talking about like, okay, you're at the doctor's office and you don't wanna get sick, so you wash

[00:15:39] Andrew Cohen, LMFT: your hands. Yeah, yeah. Right. There are, there are situations where it is absolutely appropriate,

[00:15:44] Adelina Brisbois, LMFT: right,

[00:15:44] Andrew Cohen, LMFT: to wash one's hands. Right. There's situations where it's not so appropriate.

[00:15:48] Andrew Cohen, LMFT: Right? Yes. Sitting in this office or you know, this podcast room. I don't need to wash my hands after touching this. Okay. Right.

[00:15:54] Adelina Brisbois, LMFT: But if this was like an operating room

[00:15:56] Andrew Cohen, LMFT: Yeah.

[00:15:56] Adelina Brisbois, LMFT: You would need to wash your hands.

[00:15:57] Andrew Cohen, LMFT: Yes. Most likely. If I was interacting with all of the equipment and there was blood everywhere Yeah.

[00:16:02] Andrew Cohen, LMFT: That would be appropriate.

[00:16:03] Adelina Brisbois, LMFT: Yeah.

[00:16:04] Andrew Cohen, LMFT: Right. Um, so yeah, you get caught in this vicious cycle, and I think obsessions are what we call ego dystonic. Right. And, and, and these are, you know, experiences that we have that are not in line with our morals and values. Um, you know, they are against who we are as, as, as, as a person we see ourselves.

[00:16:21] Andrew Cohen, LMFT: Um, and, you know, this is what makes 'em so distressing, um, because, you know, you may have, I always use the example of like a new mom or dad who has a, you know, a new baby mm-hmm. And you know, maybe the mom or dad's changing the baby, and then they have an intrusive thought of, oh, did I just inappropriately touch my child?

[00:16:40] Andrew Cohen, LMFT: Right. And that's a scary thought to have. Right. And you know, this is, this person, mind you, is in no way, shape, or form has any history of anything like wanting to do that.

[00:16:49] Adelina Brisbois, LMFT: It's an intrusive thought. It came out of nowhere. That's

[00:16:51] Andrew Cohen, LMFT: exactly right. But then what happens is the, you know, the person starts analyzing that thought, why did I have that thought?

[00:16:58] Andrew Cohen, LMFT: Or Why did this happen? Then ding, ding, ding. The, the brain lights up as, oh, that's a threat.

[00:17:03] Adelina Brisbois, LMFT: Mm-hmm.

[00:17:03] Andrew Cohen, LMFT: You know, we need to be on the lookout for that. So, you know, every, what happens is when we do compulsions, we're basically teaching our brain that those obsessions or those unwanted thoughts are actual threats.

[00:17:13] Andrew Cohen, LMFT: And then we never actually are giving ourselves the opportunity to learn that they aren't. Right.

[00:17:18] Adelina Brisbois, LMFT: Yeah.

[00:17:18] Andrew Cohen, LMFT: You can kinda let 'em go. Um, and something I think that's important to mention is, you know, intrusive thoughts are completely normal for humans to have. Right.

[00:17:28] Adelina Brisbois, LMFT: That's really important to mention.

[00:17:29] Andrew Cohen, LMFT: Yeah.

[00:17:29] Andrew Cohen, LMFT: Yeah.

[00:17:30] Adelina Brisbois, LMFT: Because I, I think people come in and feel like there's something wrong with that.

[00:17:33] Andrew Cohen, LMFT: Yeah. Yeah.

[00:17:34] Adelina Brisbois, LMFT: And sometimes intrusive thoughts take over, and that's, those are the ones that we wanna maybe look at more seriously. But

[00:17:40] Andrew Cohen, LMFT: yeah,

[00:17:40] Adelina Brisbois, LMFT: sometimes it's normal.

[00:17:41] Andrew Cohen, LMFT: It's, it's very, it's, it's some, it's very, very normal. And I think, you know, it's our brain's number one job is to protect us, right?

[00:17:48] Andrew Cohen, LMFT: Right. It's like this super computer problem solving machine that's like, what could possibly go wrong and how can we prevent that?

[00:17:53] Adelina Brisbois, LMFT: And it's automatic, automatic, we don't even like choose it.

[00:17:55] Andrew Cohen, LMFT: No, no. And the fact, the more we try to stop them, the more we have them,

[00:17:58] Adelina Brisbois, LMFT: because then now it's not automatic. We're

[00:18:00] Andrew Cohen, LMFT: Yeah.

[00:18:00] Andrew Cohen, LMFT: We're, we're actively engaging. So, you know, like driving here today, it's super normal as someone's driving to see someone on the, you know, walking on the side of the road to have a thought of, oh, what if I just hit them, right? Mm-hmm. You know, very, you know, common intrusive thought. The difference though is somebody with OCD might be like, why didn't I have that?

[00:18:18] Andrew Cohen, LMFT: What does that mean about, wait, do I really wanna do that? And they kind of get hooked by it. Right,

[00:18:22] Adelina Brisbois, LMFT: right.

[00:18:22] Andrew Cohen, LMFT: It

[00:18:22] Adelina Brisbois, LMFT: bakes you as opposed to it just coming in and going.

[00:18:24] Andrew Cohen, LMFT: Right, exactly. And kind of just like, 'cause normally you're just like, huh, interesting. And being able to move

[00:18:28] Adelina Brisbois, LMFT: on or like, oh, I gotta be careful to not hit them.

[00:18:30] Andrew Cohen, LMFT: Yeah. And then that's about it.

[00:18:32] Adelina Brisbois, LMFT: Yeah.

[00:18:32] Andrew Cohen, LMFT: Right. But then, you know, that's, that's your typical experience. But when someone has OCD or anxiety, you're more susceptible potentially to latching on,

[00:18:40] Adelina Brisbois, LMFT: and you're stuck.

[00:18:40] Andrew Cohen, LMFT: You're stuck, you're very stuck on certain ones.

[00:18:43] Adelina Brisbois, LMFT: Yeah.

[00:18:44] Andrew Cohen, LMFT: Um, and yeah, so, so that's what OCD is. I think one last thing with it is OCD used to be called a doubting disease because

[00:18:52] Adelina Brisbois, LMFT: Oh, really?

[00:18:53] Adelina Brisbois, LMFT: I haven't heard that before.

[00:18:54] Andrew Cohen, LMFT: Yeah, yeah, yeah. So OCD wants the person to be a hundred percent certain. Basically that whatever it is they're worried about won't happen or didn't happen or whatever it might be. Mm-hmm. Right? And the reality is, is can we ever be a hundred percent certain in life? Right? So you think of that Handwashing example, the person's washing their hands to feel a hundred percent certain they're not gonna get sick.

[00:19:14] Andrew Cohen, LMFT: It's not that they actually

[00:19:15] Adelina Brisbois, LMFT: are, but they feel it. It's like a, it's kind of like a, like a delusion.

[00:19:19] Andrew Cohen, LMFT: It is to a certain extent. Right. You, it's, it's, it's the opposite of acceptance of reality as it is because uncertainty is everywhere. We're sick

[00:19:27] Adelina Brisbois, LMFT: as if we can prevent something.

[00:19:29] Andrew Cohen, LMFT: Exactly right. And you know, I think a misconception is people with OCD and anxiety are really bad at handling uncertainty.

[00:19:36] Andrew Cohen, LMFT: That's not true. They're just not so great at the things that OCD latches onto. Right.

[00:19:40] Adelina Brisbois, LMFT: Wait, can you say that again? That was really helpful.

[00:19:42] Andrew Cohen, LMFT: Yeah. So, so. There's a misconception that people with OCD and anxiety are bad at handling uncertainty.

[00:19:49] Adelina Brisbois, LMFT: Right.

[00:19:50] Andrew Cohen, LMFT: That's not true. It's just the things that OCD and anxiety latches onto.

[00:19:54] Adelina Brisbois, LMFT: Okay. So why I think that's really helpful to repeat is that I've experienced where people who with OCD have OCD about something

[00:20:03] Andrew Cohen, LMFT: mm-hmm.

[00:20:03] Adelina Brisbois, LMFT: But really don't about something else.

[00:20:05] Andrew Cohen, LMFT: Exactly.

[00:20:06] Adelina Brisbois, LMFT: And I think that the family or the loved ones around get really confused. Mm-hmm. And maybe think, see you're just

[00:20:13] Andrew Cohen, LMFT: making this

up.

[00:20:14] Adelina Brisbois, LMFT: You're just making this up, or you're just doing this for attention, like. You're so worried about getting sick from the hand washing or whatever. Yeah. But you'll like kiss your dog on the lips.

[00:20:23] Andrew Cohen, LMFT: Yeah.

[00:20:23] Adelina Brisbois, LMFT: You know, like Totally. Or, or your room's a mess.

[00:20:26] Andrew Cohen, LMFT: Mm-hmm.

[00:20:26] Adelina Brisbois, LMFT: But you are so worried about, you know, your locker being perfect, whatever.

[00:20:30] Adelina Brisbois, LMFT: It, maybe it's, and it's confusing to outside.

[00:20:33] Andrew Cohen, LMFT: Yeah.

[00:20:34] Adelina Brisbois, LMFT: So, I, I really think that's an important piece to elaborate

[00:20:37] Andrew Cohen, LMFT: Totally.

[00:20:37] Adelina Brisbois, LMFT: With the family members.

[00:20:38] Andrew Cohen, LMFT: Oh, absolutely. And we can talk about family accommodation. Let's do that. We definitely talk about that too. But going to your, your point of, you know, it's really hard when you're trying to take a logical approach to looking at ooc D

[00:20:50] Adelina Brisbois, LMFT: because it's not logical.

[00:20:51] Andrew Cohen, LMFT: Because it's not Right. Inherently, when we're in that fight or flight response, you know, a number of things physiologically change in our bodies to prepare us to fight runway. You know, our heart rate increases dramatically. Our breathing intensifies, our digestion shuts down. But most importantly, that logical part of our brain, that prefrontal cortex pretty much gone.

[00:21:09] Andrew Cohen, LMFT: Right. And for good reason. 'cause it uses a lot of energy and we need that energy going to our muscles to survive. To survive. Right. I, the example I always use with clients to just kind of really solidify this is, you know, if, imagine there was a fire outside the door, right? Right. Like literally right there.

[00:21:24] Andrew Cohen, LMFT: Would we sit here and try to logic and be like, Hey, Adelina, like what should we do? Lets

[00:21:28] Adelina Brisbois, LMFT: really, is there really a fire outside?

[00:21:30] Andrew Cohen, LMFT: Yeah. Let's really figure this out. Like, no, we'd be dead if we did that. Right?

[00:21:33] Adelina Brisbois, LMFT: We have to get out.

[00:21:33] Andrew Cohen, LMFT: We'd have to just get out. And it's really hard because when someone's experiencing an OCD episode or an anxiety episode to the outside observer, you're like.

[00:21:43] Andrew Cohen, LMFT: Dude, we're just sitting in class right now.

[00:21:45] Adelina Brisbois, LMFT: Mm-hmm.

[00:21:46] Andrew Cohen, LMFT: Or like, we're in, we're in our house in a very safe community, like what is going on? But inside like that brain is perceiving some sort of threat.

[00:21:54] Adelina Brisbois, LMFT: Mm-hmm.

[00:21:54] Andrew Cohen, LMFT: And our brain can't tell the difference sometimes.

[00:21:56] Adelina Brisbois, LMFT: Right.

[00:21:56] Andrew Cohen, LMFT: Right. And that's, that's what's so hard about this stuff.

[00:21:59] Andrew Cohen, LMFT: And you know, that anxiety, we, one is feeling is a hundred percent real and a hundred percent valid. Now, is it out of, you know, out of proportion to the context. Sure.

[00:22:07] Adelina Brisbois, LMFT: Right.

[00:22:08] Andrew Cohen, LMFT: But the brain doesn't know that in those moments.

[00:22:10] Adelina Brisbois, LMFT: So then what happens if you're like, you're the parent or a loved one of the person who's in this very illogical fear Yeah.

[00:22:17] Adelina Brisbois, LMFT: Or state of rumination.

[00:22:18] Andrew Cohen, LMFT: Yeah. '

[00:22:19] Adelina Brisbois, LMFT: cause I, I think that we, when we love somebody, like I've seen this with parents, they really want their kid to not be afraid.

[00:22:26] Andrew Cohen, LMFT: Who wouldn't?

[00:22:27] Adelina Brisbois, LMFT: Yeah. It's like their job. It's natural, like number one job.

[00:22:29] Andrew Cohen, LMFT: It's a natural parenting instinct. Right?

[00:22:31] Adelina Brisbois, LMFT: Yeah. So they try to explain why they're, why they are safe.

[00:22:34] Adelina Brisbois, LMFT: Mm-hmm. And um, you know what, why that's not true or not gonna happen mm-hmm. Or whatever. And then actually it feels like it makes it worse. Yep. And you taught me something about accommodation.

[00:22:46] Andrew Cohen, LMFT: Mm-hmm.

[00:22:47] Adelina Brisbois, LMFT: I'd love for you to explain that a little bit. Sure. I think that's really helpful for people to know about.

[00:22:51] Andrew Cohen, LMFT: Absolutely. So, basically, accommodations, well, lemme just rephrase this. Accommodations aren't inherently a negative or bad thing, right? Accommodations.

[00:23:00] Adelina Brisbois, LMFT: What are accommodations

[00:23:00] Andrew Cohen, LMFT: first all, what are accommodations towards? Yeah. So in the, a context of OCD accommodations are like actions or things people do to try to help the person with OCD feel better,

[00:23:11] Adelina Brisbois, LMFT: right?

[00:23:11] Adelina Brisbois, LMFT: In the, and just in that

[00:23:11] Andrew Cohen, LMFT: moment, right? In that exact moment. So, you know, say a kid's really, really scared that they hit someone with their car, right? Because there's like, you know, common ones like hit and run OCD where, oh my God, did I, did I hit something? And they wanna go check. You know, a parent may give them reassurance in that moment of saying, no, you didn't hit someone with your car.

[00:23:31] Andrew Cohen, LMFT: Right. They may feel a little bit better temporarily, however, OCD, the doubting disease likes to say, but did I tell 'em all the information? Like how do they really know? And then they'll ask for reassurance again. Yeah. And then the parent will try to logic and rationalize and walk them through, give more.

[00:23:47] Andrew Cohen, LMFT: Yes. And give more reassurance. Right. And what it does, maybe temporarily sometimes is, you know, softens the intensity of OCD, but ultimately it serves the same kind of function or purpose, if you will, that compulsions do. And that perpetuates the cycle.

[00:24:03] Adelina Brisbois, LMFT: But now someone else is doing the compulsion for you.

[00:24:06] Adelina Brisbois, LMFT: You basically

[00:24:06] Andrew Cohen, LMFT: Yep. Yep. So they, you know, OCD doesn't just impact the person who has it. It really does bring in loved ones, family members, therapists, teachers, whatever it might be. Mm-hmm. Um, so this is a crucial component when you're working with OCD and anxiety is to assess and, you know, work on removing these accommodations and.

[00:24:26] Andrew Cohen, LMFT: Teaching parents and loved ones to respond in more supportive ways. Right.

[00:24:30] Adelina Brisbois, LMFT: Which I think is really hard to do.

[00:24:32] Andrew Cohen, LMFT: It is so hard to do because your fight or flight gets going too.

[00:24:35] Adelina Brisbois, LMFT: Yeah. And it's not instinctual. No. Like when your, when your person is scared and you are, you wanna reassure them. Yeah. That's like kind of like an instinctual thing.

[00:24:44] Andrew Cohen, LMFT: It it is a thousand percent and humans aren't the only animals that do that.

[00:24:49] Adelina Brisbois, LMFT: Really?

[00:24:50] Andrew Cohen, LMFT: Yeah. There's been studies on accommodation and like primates and stuff like that. Really interesting. That also Yeah. Will like, you know, soothe their, their, their loved ones when they're feeling uncomfortable and anxious.

[00:25:00] Andrew Cohen, LMFT: Right. It's very normal. Which, yeah.

[00:25:01] Adelina Brisbois, LMFT: It's a good thing.

[00:25:02] Andrew Cohen, LMFT: It's a really good

[00:25:03] Adelina Brisbois, LMFT: thing. Except when it's with,

[00:25:05] Andrew Cohen, LMFT: except when OCD and anxiety come in and hijack the situation. Yeah. Right. So parenting somebody or being, you know, with a partner who has OCD anxiety, it's difficult because you kind of have to learn how to go against your gut instincts at times.

[00:25:20] Andrew Cohen, LMFT: Right.

[00:25:21] Adelina Brisbois, LMFT: I have an example about this.

[00:25:22] Andrew Cohen, LMFT: Yeah.

[00:25:23] Adelina Brisbois, LMFT: That I'd love to share. Yeah. So you came and trained our staff?

[00:25:26] Andrew Cohen, LMFT: Yeah.

[00:25:26] Adelina Brisbois, LMFT: Um, it must've been in the spring.

[00:25:28] Andrew Cohen, LMFT: Yeah, I think so.

[00:25:29] Adelina Brisbois, LMFT: And so you, it was like fresh, like you had just come maybe like a few days prior to us taking a flight.

[00:25:34] Andrew Cohen, LMFT: Yeah.

[00:25:35] Adelina Brisbois, LMFT: And we hadn't flown in a really long time.

[00:25:37] Andrew Cohen, LMFT: Yeah.

[00:25:38] Adelina Brisbois, LMFT: Blake and I actually, it was the first time our, our daughter had ever been on a plane.

[00:25:42] Andrew Cohen, LMFT: Wow.

[00:25:43] Adelina Brisbois, LMFT: Yeah. That's a whole nother thing in and of itself. She actually did fine.

[00:25:47] Andrew Cohen, LMFT: Good.

[00:25:47] Adelina Brisbois, LMFT: I was struggling though.

[00:25:48] Andrew Cohen, LMFT: You on the other end?

[00:25:50] Adelina Brisbois, LMFT: You? Yeah. Yeah. 'cause we had a flight back in like 2017. That was really a bad flight.

[00:25:54] Andrew Cohen, LMFT: Hmm.

[00:25:55] Adelina Brisbois, LMFT: Um, and so it kind of stayed with me.

[00:25:56] Andrew Cohen, LMFT: Yeah.

[00:25:57] Adelina Brisbois, LMFT: It it's been a long time.

[00:25:58] Andrew Cohen, LMFT: Yeah.

[00:25:59] Adelina Brisbois, LMFT: But I haven't flown enough. So anyway, all that to say we're in, we're in the air.

[00:26:04] Andrew Cohen, LMFT: Yeah.

[00:26:04] Adelina Brisbois, LMFT: Turbulence is minimal.

[00:26:06] Andrew Cohen, LMFT: Yeah, yeah,

[00:26:06] Adelina Brisbois, LMFT: yeah. But for me, 'cause I think I felt very vulnerable. Totally. I had my two babies with me, my, my, my family, you know, I'm like, you are very vulnerable up here.

[00:26:14] Andrew Cohen, LMFT: Totally. And

[00:26:15] Adelina Brisbois, LMFT: I'm just spinning. I'm like, not okay on

[00:26:18] Andrew Cohen, LMFT: all these different things.

[00:26:19] Adelina Brisbois, LMFT: Ruminating my body exactly what you described. My body was having a reaction. Yeah. I was feeling like I had a panic. I was about to have a panic attack. And I keep looking at Blake for reassurance. You know, 'cause he's the person I look to for reassurance.

Yeah.

[00:26:31] Andrew Cohen, LMFT: Yeah. Which is totally natural.

[00:26:32] Adelina Brisbois, LMFT: Yeah. And at first couple times he gave me like a, you know, we're okay. Yeah. You know, but then all of a sudden he quoted you and he pissed me off. 'cause he was like, I'm gonna stop reassuring you now and 'cause you said something to me, to us in the training, which was thinking about it isn't gonna change the outcome.

[00:26:52] Andrew Cohen, LMFT: Hmm.

[00:26:53] Adelina Brisbois, LMFT: Something like that.

[00:26:54] Andrew Cohen, LMFT: Yeah. Something to the extent of like, well ruminating isn't gonna actually stop the plane from crashing.

[00:26:58] Adelina Brisbois, LMFT: Yes.

[00:26:58] Andrew Cohen, LMFT: It's gonna like,

[00:26:59] Adelina Brisbois, LMFT: you're not

[00:26:59] Andrew Cohen, LMFT: that powerful crash. It's not gonna Yeah. It's gonna crash. It's gonna crash.

[00:27:01] Adelina Brisbois, LMFT: Yeah. And, and you thinking about it won't stop it. So anyway, he quoted you.

[00:27:04] Adelina Brisbois, LMFT: Yeah.

[00:27:05] Andrew Cohen, LMFT: And

[00:27:05] Adelina Brisbois, LMFT: I was like, oh my, I was so angry. Yes. I was so mad because all I wanted Yeah. Was for him to keep reassuring me.

[00:27:13] Andrew Cohen, LMFT: Yeah.

[00:27:14] Adelina Brisbois, LMFT: Because that would've felt good.

[00:27:15] Andrew Cohen, LMFT: Yeah.

[00:27:16] Adelina Brisbois, LMFT: But he stopped. And I will say, while I was very, very, very uncomfortable for the rest of the flight,

[00:27:22] Andrew Cohen, LMFT: yeah,

[00:27:22] Adelina Brisbois, LMFT: I can, I can be, if I'm being honest.

[00:27:25] Andrew Cohen, LMFT: Yeah.

[00:27:25] Adelina Brisbois, LMFT: It did make me lean back onto thinking about is not gonna change the outcome.

[00:27:30] Andrew Cohen, LMFT: Yeah.

[00:27:31] Adelina Brisbois, LMFT: And I kept repeating that to myself, thinking about every time it would come in, I, I'd say thinking about it is not gonna change the outcome.

[00:27:36] Andrew Cohen, LMFT: Yeah.

[00:27:37] Adelina Brisbois, LMFT: Until we landed. And then I was like, okay, we're

[00:27:40] Andrew Cohen, LMFT: here, we're we're good.

[00:27:41] Andrew Cohen, LMFT: We, we landed, we're here, we're in Boston.

[00:27:43] Adelina Brisbois, LMFT: And on the way back I was, I still struggled, but I was way better.

[00:27:47] Andrew Cohen, LMFT: Good.

[00:27:48] Adelina Brisbois, LMFT: And, and you know, we're flying more and, and yeah. Getting,

[00:27:50] Andrew Cohen, LMFT: you're getting your reps in your exposures in.

[00:27:52] Adelina Brisbois, LMFT: Yes. But, but I, it was the first time that I had experienced that. I mean, I was so angry.

[00:27:58] Andrew Cohen, LMFT: Mm-hmm.

[00:27:58] Adelina Brisbois, LMFT: And it made me have so much empathy. For, and this is like a mini version. Yeah. Like I wouldn't say I have this grand phobia of flying. Like it hasn't stopped me. Like I go, you know what I mean? So I'm not trying to compare myself, but I had,

[00:28:11] Andrew Cohen, LMFT: you gotta look into the world of what it is. Like.

[00:28:13] Adelina Brisbois, LMFT: Yes. I had a lived experience of how angry and disappointed I was that my loved one wasn't giving me

[00:28:19] Andrew Cohen, LMFT: Yeah.

[00:28:19] Adelina Brisbois, LMFT: The reassurance. Yeah. And imagine, so I was trying to imagine if this was every day, all the time.

[00:28:25] Andrew Cohen, LMFT: Yeah.

[00:28:25] Adelina Brisbois, LMFT: How hard it would be, first of all, for him or anyone to always resist.

[00:28:31] Andrew Cohen, LMFT: Oh my God.

[00:28:32] Adelina Brisbois, LMFT: Yeah. You know, this was just like a little, you know, tidbit.

[00:28:35] Andrew Cohen, LMFT: Tidbit if you will, for,

[00:28:36] Adelina Brisbois, LMFT: yeah.

[00:28:36] Andrew Cohen, LMFT: Yeah.

[00:28:37] Adelina Brisbois, LMFT: So anyway, I just wanted to share that, 'cause it, it, it stood out to me and it, it, it helps me to understand that.

[00:28:45] Adelina Brisbois, LMFT: Families, especially parents, I think must really, you know, you work with kids as young as five you said?

[00:28:50] Andrew Cohen, LMFT: Oh yeah. Oh yeah.

[00:28:51] Adelina Brisbois, LMFT: So tell us about that. What's that like? 'cause I think it's totally different when you got a little one.

[00:28:55] Andrew Cohen, LMFT: Yeah. Yeah. So look like, like you said, it's, it's, it's biologically programmed when within us as parents to reassure to care, keep our style children safe, all of that kind of stuff.

[00:29:07] Andrew Cohen, LMFT: And that's not inherently a negative thing. Right. In situations. So going back to the idea of like, accommodations aren't just a negative word, right? Right. And acom, it's technically an accommodation when you drive your five-year-old to kindergarten.

[00:29:20] Adelina Brisbois, LMFT: Sure.

[00:29:20] Andrew Cohen, LMFT: Right. But that's because. They can't drive because they're five, and that would actually be very dangerous.

[00:29:25] Andrew Cohen, LMFT: Right. You don't also send your 5-year-old by themselves to the grocery store to shop. Right. That's just not something that would be safe and appropriate. Right. However, in the anxiety OCD context of situations, you may have a 17-year-old kid who has their license, they're capable of driving. Mm-hmm. But they're all having these intrusive thoughts of, what if I hit someone with my car?

[00:29:44] Andrew Cohen, LMFT: So they've avoided it altogether. So now mom and dad are there shofar

[00:29:48] Adelina Brisbois, LMFT: yes.

[00:29:49] Andrew Cohen, LMFT: If you'll

[00:29:49] Adelina Brisbois, LMFT: Right.

[00:29:50] Andrew Cohen, LMFT: Shofar.

[00:29:50] Adelina Brisbois, LMFT: And now they don't have to drive and be uncomfortable and do,

[00:29:52] Andrew Cohen, LMFT: yes.

[00:29:53] Adelina Brisbois, LMFT: Yeah.

[00:29:53] Andrew Cohen, LMFT: Yeah. And so yes, they are experiencing this temporary relief, but it's really a double-edged sword because. You know, covertly overtly, you're overtly, you're basically saying, you know, like, okay, you're, you're safe, but covertly you're sending this message that, you know what, honey?

[00:30:08] Andrew Cohen, LMFT: I don't think you're strong enough to handle these feelings.

[00:30:10] Adelina Brisbois, LMFT: If I didn't drive you, you would actually not be safe.

[00:30:13] Andrew Cohen, LMFT: Yes, exactly. Very well put. Very well put. So,

[00:30:17] Adelina Brisbois, LMFT: but you're not saying that.

[00:30:18] Andrew Cohen, LMFT: No,

[00:30:18] Adelina Brisbois, LMFT: but it's, it's just the message that the person could receive. Yes. And probably is receiving conversation

[00:30:22] Andrew Cohen, LMFT: under Yeah.

[00:30:23] Andrew Cohen, LMFT: And, and repeatedly o repeated over and over and over and over again. Right. I always say like, OCD and anxiety disorders are resilience killers.

[00:30:31] Adelina Brisbois, LMFT: Oh,

[00:30:31] Andrew Cohen, LMFT: right. And confidence killers. Because you know, you have these worries and doubts. You do a behavior to try to prevent them. You never get the chance to learn that You can handle the feelings or the situations, whatever they might

[00:30:42] Adelina Brisbois, LMFT: arise.

[00:30:43] Andrew Cohen, LMFT: And it gives your

[00:30:43] Adelina Brisbois, LMFT: Yeah. Confidence.

[00:30:43] Andrew Cohen, LMFT: It makes you believe

[00:30:44] Adelina Brisbois, LMFT: that you don't have a chance to be confident.

[00:30:46] Andrew Cohen, LMFT: Yeah. You have no chance to actually learn resiliency. Right. And this is something when I'm working with kiddos and parents especially, is talking to them about, you know, what, what are some of the roles a parent's supposed to take on, you know?

[00:30:58] Andrew Cohen, LMFT: And typically the usual is, you know, love your kid. Yeah. Provide for them.

[00:31:01] Narrator: Of course, of

[00:31:02] Andrew Cohen, LMFT: course. Like the, the, the, but, but ultimately at the end of the day, parents' jobs are to, you know, create a resilient person who can survive without them.

[00:31:11] Adelina Brisbois, LMFT: Right,

[00:31:12] Andrew Cohen, LMFT: right. Yes. To be able to thrive on their own eventually.

[00:31:16] Andrew Cohen, LMFT: Circle of life. Yeah. Yeah. That's just,

[00:31:18] Adelina Brisbois, LMFT: that's what you want for your kids, even though it's hard at certain, uh, stages to let go.

[00:31:22] Andrew Cohen, LMFT: Totally. But even like this morning, I, I took my 2-year-old, he woke up and he was in his little sleep sack and, you know, I was, he, he's working on taking his clothes off and unzipping and stuff and there was an instinct in me to just go and do it for him.

[00:31:35] Andrew Cohen, LMFT: Right. But I was like, you know, hold on, this is actually, and he did it himself. Did it take like eight minutes? Yes. But you know, and how would

[00:31:41] Adelina Brisbois, LMFT: he learn?

[00:31:42] Andrew Cohen, LMFT: How would he learn? And it was really cute. He was so proud of himself. He was hopping all around and you know, it's like, that was awesome bud. Yes. So those moments, whenever we jump into like a accommodate or do something for our kid, we're potentially robbing them of the opportunities to learn that they can do it themselves.

[00:31:57] Andrew Cohen, LMFT: Yeah. Make sense?

[00:31:58] Adelina Brisbois, LMFT: It does. So I have a question about that.

[00:31:59] Andrew Cohen, LMFT: Yeah.

[00:32:00] Adelina Brisbois, LMFT: How often do you see like the parents' OCD coming in. Often

[00:32:07] Andrew Cohen, LMFT: Yes. That was was the reaction to Yeah. Yeah. Yeah. So OCD and anxiety, right? We know there's, you know, genetic kind of factors to it. Um, so there's a, there's a good chance a parent or a family member has it, right?

[00:32:19] Andrew Cohen, LMFT: And, and what causes OCD? There's no like one thing.

[00:32:22] Adelina Brisbois, LMFT: Mm-hmm.

[00:32:22] Andrew Cohen, LMFT: Um, you know, and we, and so kind of a, a couple of things. Environmental factors like stressors and those kind of things. And, you know, seeing how parents or loved ones deal with anxiety. We can also have a genetic predisposition. So if, yeah. If you do have an anxious parent and every time they're faced with anxiety, they have this urgency and they need to like get rid of it quickly.

[00:32:40] Adelina Brisbois, LMFT: Mm-hmm.

[00:32:41] Andrew Cohen, LMFT: That kid, its, you can pick up on that.

[00:32:42] Adelina Brisbois, LMFT: Yeah.

[00:32:43] Andrew Cohen, LMFT: Right.

[00:32:43] Adelina Brisbois, LMFT: Well, I just wonder too if like the parents OCD sometimes gets in the way of the treatment of the kids. Like did the parent also have to get the treatment?

[00:32:55] Andrew Cohen, LMFT: Yes.

[00:32:55] Adelina Brisbois, LMFT: Yeah.

[00:32:56] Andrew Cohen, LMFT: Yeah. So I've definitely had a lot of cases. This was more so when I was working at the, the treatment center.

[00:33:01] Andrew Cohen, LMFT: 'cause we were working with like. Extremely. I mean, it still happens to this day with my practice, but you know, you'd have such anxious parents that would have all their own obsessions of, if I don't accommodate my son, I'm a bad mom.

[00:33:11] Adelina Brisbois, LMFT: Right, right, right. That's exactly what, and

[00:33:13] Andrew Cohen, LMFT: yeah, go ahead. Sorry.

[00:33:14] Adelina Brisbois, LMFT: No, that's what I was thinking.

[00:33:15] Adelina Brisbois, LMFT: That it, I feel like one begets the other.

[00:33:18] Andrew Cohen, LMFT: Mm-hmm. And, and it almost, it really can create like codependence, if you will too. It's just a whole other Yeah. A whole other kind of discussion, um, where it's like the, the mom or nurse or dad feels like they can't survive without the kid. The kid feels like they can't survive without, you know, and

[00:33:33] Adelina Brisbois, LMFT: it's Right because it's, that's literally what their brains are thinking.

[00:33:35] Andrew Cohen, LMFT: Yeah. Mm-hmm. And it's, it's running every, it's running the show.

[00:33:38] Adelina Brisbois, LMFT: So what do you do? You treat, you have to treat the parent with o, with the ERP.

[00:33:41] Andrew Cohen, LMFT: So a lot of times, you know, with. It's a, it's a gentle approach

[00:33:46] Adelina Brisbois, LMFT: because,

[00:33:46] Andrew Cohen, LMFT: you know, well,

[00:33:47] Adelina Brisbois, LMFT: it always has to be. Yes. Yeah. You, that's what you do so well. Yeah. Is that you, you're very gentle and like humanistic in your approach?

[00:33:54] Andrew Cohen, LMFT: Well, because it is, I mean, it's, it's hard.

[00:33:55] Adelina Brisbois, LMFT: Yes.

[00:33:56] Andrew Cohen, LMFT: Those alarm bells are going off.

[00:33:57] Adelina Brisbois, LMFT: Yeah. It's easy for us to sit here and chat. Yeah. This is like people's lives. Oh yeah. And they're struggling.

[00:34:01] Andrew Cohen, LMFT: Very much so. Very much so. So, you know, when we're working with like kids and even, I typically, even when I'm working with like 13, 14, sometimes 15 year olds, I'm having parents typically in session because I want them to see how I respond to their kid.

[00:34:16] Andrew Cohen, LMFT: 'cause their kid comes in, is like, am I gonna die? I just felt this thing in my throat. Am I gonna die?

[00:34:20] Adelina Brisbois, LMFT: Right?

[00:34:21] Andrew Cohen, LMFT: And you can see the parents starting to get anxious and wanting to reassure. And I kind of just sit there and like, yeah. Does my heart rate go up? And I kind of feel uncomfortable. Sure. Because

[00:34:28] Adelina Brisbois, LMFT: you're human.

[00:34:29] Andrew Cohen, LMFT: Because I'm human and like that's a, ugh, that's not comfortable. Um, but I'm able to sit there and kind of coach the parents through like, all right, look, this is, you know, I, I have a lot of my clients named their ocd. So let's just say this OCDs named Chuck. It sounds, it's like, oh, it looks like Chuck's entered the room here.

[00:34:45] Andrew Cohen, LMFT: You know, it sounds like Chuck is wanting that certainty and reassurance. Um, and coaching parents on, you know, we can validate like, yeah, this is hard to have these thoughts and feelings. Right? But you know what, I'm not gonna answer this 'cause I love you and you can get through this. You can handle these feelings.

[00:34:58] Adelina Brisbois, LMFT: That's back to the confidence.

[00:34:59] Andrew Cohen, LMFT: Yeah. Right. Supportive statements. It's, it's something from, um, the space. Supportive parenting for anxious childhood emotions, which is an amazing treatment, um, that was designed for parents and loved ones

[00:35:10] Adelina Brisbois, LMFT: space. S-S-P-A-C-S-C-E.

[00:35:13] Andrew Cohen, LMFT: Yeah. Um, where, you know, you want to instill, you wanna validate what they're feeling because.

[00:35:18] Andrew Cohen, LMFT: That fight or flight's going off, right? They are feeling that those alarm bells are ringing. But then you don't wanna just jump in and reassure and say, oh, that bad thing's not gonna happen. Because to be honest, do we know

[00:35:28] Adelina Brisbois, LMFT: exactly

[00:35:28] Andrew Cohen, LMFT: like that kid could be dying,

[00:35:30] Adelina Brisbois, LMFT: right?

[00:35:30] Andrew Cohen, LMFT: He might drop dead in two seconds.

[00:35:32] Andrew Cohen, LMFT: Hopefully not.

[00:35:33] Adelina Brisbois, LMFT: Yes,

[00:35:33] Andrew Cohen, LMFT: but most likely won't. Um, but you're, so, you're, you're, you're validating. But then instilling confidence is basically saying like, you know, this is hard. I get it. I see this. And you know what? You are really strong. You can handle hard things.

[00:35:45] Adelina Brisbois, LMFT: And Chuck is here, and Yeah. Chuck, what do we do with Chuck?

[00:35:48] Adelina Brisbois, LMFT: Can you, first of all, yeah. What do we do with Chuck there? What

[00:35:51] Andrew Cohen, LMFT: do

[00:35:51] Adelina Brisbois, LMFT: we

[00:35:51] Andrew Cohen, LMFT: do? Yeah. What do we do with Chuck? So it's a whole, you know, in addition to ERP, well this is kind of in, this is involved in ERP. Basically we want to help the clients get from a resistance and struggle stance with their thoughts and feelings to a much more acceptance, willingness stance.

[00:36:06] Andrew Cohen, LMFT: Okay. Right. So, kind of slowly coaching the client, a lot of psychoeducation about our thoughts and feelings and they're not dangerous and all that fun stuff, but a lot of like. Interventions of, of practicing acceptance and willingness of like, oh, hey Chuck, I see you're here. Like, thanks for stopping by.

[00:36:20] Andrew Cohen, LMFT: And almost even getting to the place of like, you know what? Come, come take a seat on my shoulder. Right?

[00:36:24] Adelina Brisbois, LMFT: If you're welcome,

[00:36:25] Andrew Cohen, LMFT: you could, you are. Yeah.

[00:36:25] Adelina Brisbois, LMFT: You can be part of me.

[00:36:26] Andrew Cohen, LMFT: Absolutely. But

[00:36:26] Adelina Brisbois, LMFT: you're not all of me.

[00:36:27] Andrew Cohen, LMFT: You're not. No, you're, you're not me actually. You're not me. You're not me. You are a, you know, my brain is doing some stuff and I'm myself, right?

[00:36:34] Andrew Cohen, LMFT: This is just kind of a part that's chatting away and trying to protect me. It's just, no, not such a great job. So, like, for example, as we've been sitting here in this podcast, you know, hopefully I've seen, I've seen, um, present, but like I've had intrusive thoughts, right? Biman has been like, oh, your career's gonna end.

[00:36:51] Andrew Cohen, LMFT: You know, they called you an OCD expert. Are you really an expert? Are you a specialist? What would even d determine? You know? And I could sit here and start arguing with that, right?

[00:37:00] Adelina Brisbois, LMFT: With Bitman.

[00:37:00] Andrew Cohen, LMFT: With Bitman, right? But like, then I won't be able to actually engage in this really important, you know, values-based.

[00:37:08] Andrew Cohen, LMFT: Uh, what's it called? Activity that I really want to do and spread awareness and help people who are dealing with this. So it's kind of like, it's almost like it's, you know, it's almost like pull up a chair bit and like, come sit and

[00:37:17] Adelina Brisbois, LMFT: come on Bitman. Join

[00:37:19] Andrew Cohen, LMFT: the conversation. Join the conversation. You can be here.

[00:37:20] Andrew Cohen, LMFT: You know, I can see you there, but I'm just gonna choose not to actively engage with you. Right.

[00:37:25] Adelina Brisbois, LMFT: So what do you think it is about I love this.

[00:37:27] Andrew Cohen, LMFT: Yeah.

[00:37:27] Adelina Brisbois, LMFT: I love this intervention, this part of the intervention.

[00:37:30] Andrew Cohen, LMFT: Yeah.

[00:37:30] Adelina Brisbois, LMFT: Um, you know, Blake and I are trained by a Violet Oak lander. She's a gestalt play therapist. Yeah.

Yeah.

[00:37:35] Adelina Brisbois, LMFT: And so much about her work is the parts mm-hmm. Like the different parts of you and owning all the parts. Yeah. And you don't have to like all of them for them to all be part of you. So No, they

[00:37:46] Andrew Cohen, LMFT: are there,

[00:37:46] Adelina Brisbois, LMFT: but they're all there and they're, they all have, they're all welcome. Uh, even if you don't like some of them Totally moments.

[00:37:52] Adelina Brisbois, LMFT: Totally. But they're there to help you anyway. It reminds me a lot of the work that we do in, in, in that way sim, it's similar

[00:37:59] Andrew Cohen, LMFT: for sure.

[00:38:00] Adelina Brisbois, LMFT: What do you think works about that? For OCD.

[00:38:04] Andrew Cohen, LMFT: Yeah, so basically going back to that fight or flight response, right? That that survival response of escape get rid of.

[00:38:11] Adelina Brisbois, LMFT: Mm-hmm.

[00:38:11] Andrew Cohen, LMFT: That's really good when there's actual external threats. Uhhuh, right? So if there is, say you're walking your dog and there's a coyote, you know, you cross the street and you go the other way and that threat is gone.

[00:38:22] Adelina Brisbois, LMFT: Mm-hmm.

[00:38:22] Andrew Cohen, LMFT: What happens though is with OCD and anxiety disorders, we start perceiving our thoughts, our feelings, our sensations, our memories, all these, we call it like our private experiences or inner events.

[00:38:33] Andrew Cohen, LMFT: Right. We start perceiving those as threats. Can you really escape or run away Right from yourself?

[00:38:38] Adelina Brisbois, LMFT: Right. That's the, okay. Yeah. Oh, so you externalize it so that you can have some space to run away?

[00:38:44] Andrew Cohen, LMFT: Yeah. Well, no, no, not not to run away. Away.

[00:38:46] Adelina Brisbois, LMFT: You don't run

[00:38:46] Andrew Cohen, LMFT: away, you don't wanna run away from it. It's, it's,

but

[00:38:47] Adelina Brisbois, LMFT: you're separate,

[00:38:48] Andrew Cohen, LMFT: you're, you are being able to take a step back, if you will, and observe like, oh look, my brain is throwing this stuff at me.

[00:38:55] Andrew Cohen, LMFT: I've been doing all these behaviors, these away moves, if you will, trying to distract myself, compulsions sometimes, like drinking drugs, whatever it might be, to not experience them. Right. When we do that, we get that temporary relief, but we're cheap. We're never getting ourselves the opportunity to learn.

[00:39:10] Andrew Cohen, LMFT: They aren't threats. Mm-hmm. Right. So ERP essentially is, let's open up and, and, and lean into, and breathe into, if you will, these inner experiences, these thoughts. We don't want to have that are we deem as threats, feelings, all that kind of stuff. 'cause then we get to actually experience that they aren't, they don't hurt us.

[00:39:27] Adelina Brisbois, LMFT: Oh, I see.

[00:39:28] Andrew Cohen, LMFT: Right. So it's, it's all about our, that, that brain perceiving those thoughts and feelings as threats when they're not

[00:39:34] Adelina Brisbois, LMFT: right. And then experiencing it and not dying

[00:39:37] Andrew Cohen, LMFT: basically.

[00:39:38] Adelina Brisbois, LMFT: And learning that it's. Then it wasn't

[00:39:40] Andrew Cohen, LMFT: exactly right. Now that doesn't mean that there aren't emotions and or thoughts that are unpleasant or that we don't want.

[00:39:47] Andrew Cohen, LMFT: Right. Human. It's, it's hard being a human. Right. We, uh, you know, if we live long enough, we're gonna experience some extremely great moments.

[00:39:54] Adelina Brisbois, LMFT: Totally.

[00:39:55] Andrew Cohen, LMFT: Some horribly,

[00:39:56] Adelina Brisbois, LMFT: yeah.

[00:39:57] Andrew Cohen, LMFT: Horribly tragic moments. You know, like I just, I lost my aunt this past weekend and it was just, it sucks. It really sucks, you know? And cancer sucks, but, you know, I was, I was having to really practice what I preached to my clients.

[00:40:11] Andrew Cohen, LMFT: I, you know, was there a part, were there parts of me that were wanting to really run away and distract from the sadness? Sure. Mm-hmm. You know, and also I was trying my best and being compassionate with myself and allowing myself to actually experience the sadness and create space for it. While at the same time practicing kind of like some gratitude of being with my family in this and being able to connect and, you know, celebrate for life, if you will.

[00:40:33] Andrew Cohen, LMFT: All of that can exist. Right. And a lot of times with OCD. There's a whole bunch of like underlying beliefs of people with OCD that I can't have a good time if these obsessions are here. You know, I can't be present, I can't do whatever it is. If I'm having these worries and anxiety, I can't. And it's, it's really about teaching clients that you can coexist with it all and we get to choose where we, you know, put our attention.

[00:40:53] Andrew Cohen, LMFT: Mm-hmm. Right. Almost like a, like, spotlight.

[00:40:58] Adelina Brisbois, LMFT: So is it kinda like both and like both can exist?

[00:41:01] Andrew Cohen, LMFT: Mm-hmm.

[00:41:01] Adelina Brisbois, LMFT: And you can still

[00:41:02] Andrew Cohen, LMFT: Yeah.

[00:41:03] Adelina Brisbois, LMFT: Go on.

[00:41:03] Andrew Cohen, LMFT: Because the reality is they do exist,

[00:41:06] Adelina Brisbois, LMFT: right?

[00:41:06] Andrew Cohen, LMFT: Both do exist in, in the struggle mode and the get rid of mode and the compulsion avoidance mode. It's denial of reality as it is.

[00:41:13] Andrew Cohen, LMFT: You're, you're, you're trying to get rid of something that's there and trying to pretend like it's not Yeah. And you're putting all this energy and attention on it, right. Versus No, I'm accepting that these thoughts and feelings are here. You know, it doesn't mean I like them or want them. Right. Or agree with the content of them.

[00:41:28] Adelina Brisbois, LMFT: Right.

[00:41:28] Andrew Cohen, LMFT: Right. It's, they're, they're here right now and I get to choose what I do in this moment,

[00:41:34] Adelina Brisbois, LMFT: you know?

[00:41:35] Andrew Cohen, LMFT: Does that, does that make sense? I know it could be a little like heady and a little confusing, but

[00:41:39] Adelina Brisbois, LMFT: Well, it makes sense to me.

[00:41:40] Andrew Cohen, LMFT: Yeah.

[00:41:40] Adelina Brisbois, LMFT: I think I follow It's, it's, but it is confusing.

[00:41:43] Andrew Cohen, LMFT: It can

[00:41:43] Adelina Brisbois, LMFT: be like, it's like a lot of this because you can't see it.

[00:41:46] Andrew Cohen, LMFT: Yeah.

[00:41:47] Adelina Brisbois, LMFT: Sometimes.

[00:41:47] Andrew Cohen, LMFT: Yeah.

[00:41:48] Adelina Brisbois, LMFT: I know. Some of, some of it you can't see, like, like in movies, right? I think people colloquially very much say, oh, I have ooc D or they have Ooc D because it's so, um, simplified

[00:41:58] Andrew Cohen, LMFT: mm-hmm.

[00:41:58] Adelina Brisbois, LMFT: In the media.

[00:41:59] Andrew Cohen, LMFT: Yeah.

[00:42:00] Adelina Brisbois, LMFT: Like people think, yeah. I don't, it's not Ooc D because they, yeah. They don't wash their hands, don't.

[00:42:05] Adelina Brisbois, LMFT: Move things perfectly or whatever. There's so many diff You taught me, you taught all of us at Engage. Like there's actually so many different forms

[00:42:14] Andrew Cohen, LMFT: Yeah.

[00:42:14] Adelina Brisbois, LMFT: That are so tricky.

[00:42:15] Andrew Cohen, LMFT: Yeah. Yeah.

[00:42:16] Adelina Brisbois, LMFT: And now that I know what I know, I see more and I so does, so does our team.

[00:42:20] Andrew Cohen, LMFT: Yeah.

[00:42:21] Adelina Brisbois, LMFT: Like we'll be sitting there and, uh, I'll, I'll see how, you know, my colleagues are thinking differently Yeah.

[00:42:27] Adelina Brisbois, LMFT: About what's showing up in the

[00:42:29] Andrew Cohen, LMFT: conceptualizing and stuff. That's

[00:42:30] Adelina Brisbois, LMFT: awesome.

[00:42:30] Andrew Cohen, LMFT: Yeah.

[00:42:31] Adelina Brisbois, LMFT: That we would've totally missed because it just looks like, oh, this person's just really anxious.

[00:42:34] Andrew Cohen, LMFT: Yes.

[00:42:35] Adelina Brisbois, LMFT: But then when you start to really listen to the, the nuances mm-hmm. Of how it's a spiral in a loop and they're stuck.

[00:42:43] Andrew Cohen, LMFT: Mm-hmm.

[00:42:43] Andrew Cohen, LMFT: Mm-hmm.

[00:42:43] Adelina Brisbois, LMFT: It's the stuckness that I think when you feel as the clinician or as the parent, that you should cue you Yeah,

[00:42:50] Andrew Cohen, LMFT: yeah, yeah.

[00:42:50] Adelina Brisbois, LMFT: To be curious and wonder if perhaps there's more going on.

[00:42:54] Andrew Cohen, LMFT: Sure.

[00:42:54] Adelina Brisbois, LMFT: And then another thing you told me too. A long time ago is that sometimes typical interventions for anxiety can actually exacerbate

[00:43:04] Andrew Cohen, LMFT: Yeah.

[00:43:04] Adelina Brisbois, LMFT: For cd. Yeah. Can you say a little bit about that? I, I found that a so helpful

[00:43:08] Andrew Cohen, LMFT: Yeah.

[00:43:09] Adelina Brisbois, LMFT: And, and kind of fascinating.

[00:43:11] Andrew Cohen, LMFT: Yeah. Yeah. Absolutely. So, you know, a lot of, like, you know, in therapy, cognitive behavioral therapy, there can be this thing of like cognitive restructuring where you go and you challenge or look for the evidence for a thought being true or not true, or the accuracy of it.

[00:43:25] Andrew Cohen, LMFT: Um, this can very easily turn into compulsions because inherently, you know, say someone has an intrusive thought that, you know, uh, they're, they're in their kitchen with their family and they're, they're cutting a. You know, some mistake and they have an intrusive thought of, I could take this and stab my mom.

[00:43:42] Adelina Brisbois, LMFT: Mm-hmm.

[00:43:42] Andrew Cohen, LMFT: Right? Um, you know, our natural instinct is gonna be to fight with that thought. I don't want to do that because I'm a good person. And you know what? I would never do that. But then OCD chimes back in with Yeah. But you never know anything's possible. Right. But then you argue back with like, no, because I've never actually hurt anyone.

[00:43:57] Andrew Cohen, LMFT: But this could be the first time you do. Right. Why do

[00:43:59] Adelina Brisbois, LMFT: you have that thought then?

[00:44:01] Andrew Cohen, LMFT: Yeah. Why do you have that thought? What does it mean about you? Right. And inherently, you're already trying to argue the evidence in those moments. Mm-hmm. So those traditional CBT interventions of like looking for evidence for evidence against, can very easily feed into it.

[00:44:16] Andrew Cohen, LMFT: I still teach those kinds of tools with the caveat that, and this is kind of like the, the really, really important piece of it. It's not to gain certainty. Right.

[00:44:27] Adelina Brisbois, LMFT: Oh, okay. That's the

[00:44:28] Andrew Cohen, LMFT: difference. Right. That's, that is, that is the huge component there where people will use these interventions to be like, no, for sure not.

[00:44:33] Andrew Cohen, LMFT: I'm not gonna stab 'em. And realistically they're, they're not.

[00:44:37] Adelina Brisbois, LMFT: Mm-hmm.

[00:44:38] Andrew Cohen, LMFT: But ooc D you can be 99.999999% certain. It's not enough. It's not enough, right. Not, okay.

[00:44:44] Adelina Brisbois, LMFT: So it's not for certainty. So what is it for?

[00:44:46] Andrew Cohen, LMFT: It's really to help them, you know, going back to how I said earlier in the podcast, how people handle uncertainty just fine.

[00:44:53] Adelina Brisbois, LMFT: Right.

[00:44:53] Andrew Cohen, LMFT: Just the things are o cd latches onto, it's to be able to help their mind get there. I use the example with my clients all the time of like, you know, if they drive of, of, you know, is your car in the parking lot?

[00:45:06] Adelina Brisbois, LMFT: Oh yeah, yeah,

[00:45:06] Andrew Cohen, LMFT: right. I did that I think at the training and everyone's like, yeah, it is.

[00:45:10] Andrew Cohen, LMFT: Absolutely. And I'm like, well, can you hear it? Can you see it? You know, what are you, you know, and they're like, no, we can't. So is there a chance something happened? Well, yeah, there's a chance it got stolen or towed, whatever. Then I ask like, but are you spending all waking hours trying to make sure your car is in the parking lot to be certain?

[00:45:27] Andrew Cohen, LMFT: They're not, and I ask like, what would your life look like if that's what you were doing? They wouldn't have a life because that's all they would be doing. So it's inherently learning how to teach them, look, is it possible that your car is stolen? Anything's possible. Right, right. Given the actual circumstances though, that we're in, we're in a safe neighborhood, you haven't heard any alarms, there hasn't been previous break-ins and all that kind of stuff, you're, you're probably okay and you can come back to what's important.

[00:45:53] Andrew Cohen, LMFT: So using like cognitive restructuring in that sense of like, look, you know, that thought is telling me this, like, given the situation I'm currently in, given know, we're, we're, we're, we're most likely okay to, to, to ignore this, if you will, and kind of leave this, you know, that's one of the ways to kind of use it, but it really can be misused very, very easily.

[00:46:14] Andrew Cohen, LMFT: Um,

[00:46:15] Adelina Brisbois, LMFT: yeah. And I think if a, if a clinician doesn't know that,

[00:46:18] Andrew Cohen, LMFT: yeah,

[00:46:18] Adelina Brisbois, LMFT: they might accidentally, oh, not, not intending to, but might accidentally. Um, feed an ooc d and, and this is the part that I find really, like I struggle with, is that you may not even know it.

[00:46:30] Andrew Cohen, LMFT: Totally.

[00:46:31] Adelina Brisbois, LMFT: Totally. Because it would, it would require the person sitting in front of you to explain that to you.

[00:46:36] Andrew Cohen, LMFT: Yep.

[00:46:36] Adelina Brisbois, LMFT: And they, I think mostly maybe don't even realize it.

[00:46:39] Andrew Cohen, LMFT: Yeah.

[00:46:39] Adelina Brisbois, LMFT: Or would it ever say it because it's protecting them or whatever it may be.

[00:46:44] Andrew Cohen, LMFT: Well, well, and I, and I really like to think like, I mean, I really do believe everyone, the clinicians have their best intentions, you know, best, you know, they wanna help.

[00:46:53] Andrew Cohen, LMFT: Right. And it's just kind of a simple fact of, I think not knowing at that point, right, right. We're not taught this stuff in grad school.

[00:47:00] Adelina Brisbois, LMFT: I know. Why aren't we?

[00:47:02] Andrew Cohen, LMFT: I don't really know.

[00:47:03] Adelina Brisbois, LMFT: Let's change that. Let's if, if there's a way we can change that, we should, because. It's a disservice.

[00:47:09] Andrew Cohen, LMFT: It is

[00:47:09] Adelina Brisbois, LMFT: to our clients if we don't know.

[00:47:12] Adelina Brisbois, LMFT: 'cause we, we learn about all the other stuff. We learn about ccb T and dbt, you know, I mean, theories.

[00:47:16] Andrew Cohen, LMFT: It, it's even, it's funny though, 'cause like we do, but do we really learn that much?

[00:47:19] Adelina Brisbois, LMFT: That's true. We learn, but okay. At least we know that the other things

[00:47:22] Andrew Cohen, LMFT: exist.

[00:47:22] Adelina Brisbois, LMFT: Exist.

[00:47:23] Andrew Cohen, LMFT: Yeah. Yeah. That they're out

[00:47:24] Adelina Brisbois, LMFT: there, they're there to learn more about.

[00:47:26] Andrew Cohen, LMFT: Yeah.

[00:47:26] Adelina Brisbois, LMFT: I, I, and I haven't been in grad school in a very long time, so is it possible that they are teaching that?

[00:47:31] Andrew Cohen, LMFT: I mean, I wasn't taught, I mean, they, we, we learned in our DSM class, like a half of a class, what OCD was, but it wasn't, it was the, you know, professor talking about stereotypical OCD and didn't, the ERP was never mentioned, you know, anything.

[00:47:44] Adelina Brisbois, LMFT: Is it new? Is ERPA news?

[00:47:45] Andrew Cohen, LMFT: No, it's been around, I think since like the seventies.

[00:47:48] Adelina Brisbois, LMFT: So how, yeah, why is it, why doesn't have bigger? Let's,

[00:47:52] Andrew Cohen, LMFT: well, you want, I mean, this is a whole can of worms. We're opening here because

[00:47:55] Adelina Brisbois, LMFT: Yeah. What is it?

[00:47:55] Andrew Cohen, LMFT: Well, when you think, when you

[00:47:57] Adelina Brisbois, LMFT: hear Hope medicine,

[00:47:58] Andrew Cohen, LMFT: no. Well, maybe, I don't know. But exposure therapy, when you hear the word exposure therapy

[00:48:02] Adelina Brisbois, LMFT: Oh.

[00:48:03] Adelina Brisbois, LMFT: People don't wanna be uncomfortable.

[00:48:05] Andrew Cohen, LMFT: Yeah. Right. Exposure therapy has a lot of misconceptions

[00:48:09] Adelina Brisbois, LMFT: Okay.

[00:48:10] Andrew Cohen, LMFT: Behind it. Like, oh my God, God, it's traumatizing. It's, it's, it's mean, it's cruel. It's forcing patients to do these things.

[00:48:17] Adelina Brisbois, LMFT: Yes. That's true. People do think that.

[00:48:18] Andrew Cohen, LMFT: Yeah. And I have to, so much of my work in the beginning with clients is breaking down those barriers of like, no exposure.

[00:48:26] Andrew Cohen, LMFT: Therapy is the most compassionate thing you can do for yourself because it's those slow, slow, and we're not forcing people to do things they're not willing to do. We are looking at what's important to them, their values

[00:48:36] Adelina Brisbois, LMFT: Yes. And

[00:48:37] Andrew Cohen, LMFT: guiding exposures through that.

[00:48:39] Adelina Brisbois, LMFT: Right.

[00:48:39] Andrew Cohen, LMFT: You know?

[00:48:40] Adelina Brisbois, LMFT: Yeah. But I think back in the day, or at least again, based on the media

[00:48:43] Andrew Cohen, LMFT: Yeah.

[00:48:43] Adelina Brisbois, LMFT: I, you're right. Some people think like you're afraid of a snake, you need to go hold a snake.

[00:48:47] Andrew Cohen, LMFT: Yeah. We're gonna immerse, we're gonna fear factor it.

[00:48:49] Adelina Brisbois, LMFT: Yes. Fear factor. Exactly. Yeah. Whereas that's not at all what it's, well

[00:48:52] Andrew Cohen, LMFT: that's, that's, that's the sexy version of exposure therapy.

[00:48:55] Adelina Brisbois, LMFT: Right. That's because it makes people watch a show.

[00:48:57] Adelina Brisbois, LMFT: Exactly. And it's like, yeah. Yeah. You're right. It's, uh, entertaining.

It's

[00:49:01] Andrew Cohen, LMFT: way more entertaining than, you know, just kind of like touching something like this or

[00:49:04] Adelina Brisbois, LMFT: looking at a picture.

[00:49:05] Andrew Cohen, LMFT: Yes.

[00:49:06] Adelina Brisbois, LMFT: A snake. Or even saying the word snake. Yeah. Like, it could be, you start really light so that it's never out of someone's comfort zone, but it's enough challenge.

[00:49:15] Andrew Cohen, LMFT: Well, it's, it's a ch it's, it's like, I, it's honestly, I think the working out analogy is so perfect. Mm-hmm. With it. Like, if you've never ran in your life and you ask someone to run a marathon,

[00:49:24] Adelina Brisbois, LMFT: right. They're gonna,

[00:49:25] Andrew Cohen, LMFT: yeah. It's

[00:49:25] Adelina Brisbois, LMFT: not gonna

[00:49:25] Andrew Cohen, LMFT: work. Good luck.

[00:49:26] Adelina Brisbois, LMFT: Yeah.

[00:49:26] Andrew Cohen, LMFT: But like, if they've never run in their life and you ask them to run, you know, 0.3 miles, maybe that's a bit more possible.

[00:49:32] Andrew Cohen, LMFT: Are they gonna sweat, is their heart rate gonna increase? Yes. Yes. And that's good.

[00:49:35] Adelina Brisbois, LMFT: That's the point. 'cause then they, it kind of builds your tolerance to then the next le level and Exactly.

[00:49:39] Andrew Cohen, LMFT: And you work your way up.

[00:49:40] Adelina Brisbois, LMFT: Right? Yeah. That's a, that's a good analogy. We, we do get, I will say. I don't know if I've told you this, but we do sometimes get resistance from families when we refer to you.

[00:49:49] Andrew Cohen, LMFT: I'm sure it's, I'm sure.

[00:49:51] Adelina Brisbois, LMFT: And we have to do some psychoeducation and teach and say No, no, it's, it's actually not what you're thinking.

[00:49:56] Andrew Cohen, LMFT: Yeah.

[00:49:56] Adelina Brisbois, LMFT: Um, but also sometimes the person who's suffering says, you're gonna take this thing away from me. I don't want comp to take it away from me, so I don't wanna do it.

[00:50:04] Andrew Cohen, LMFT: Yeah.

[00:50:05] Adelina Brisbois, LMFT: And it's not until they get motivated or get it gets serious enough that they'll go.

[00:50:10] Andrew Cohen, LMFT: Totally.

[00:50:11] Adelina Brisbois, LMFT: But that's the part that I think we've seen as a little bit of a struggle.

[00:50:14] Andrew Cohen, LMFT: Well, what I think to kind of, I dunno counter that if you will, but there are some clients that I've seen for, you know, sometimes we don't even start ERP for at least a month, month and a half, sometimes even two months if they're not there.

[00:50:27] Adelina Brisbois, LMFT: Mm-hmm. You're just getting them ready.

[00:50:28] Andrew Cohen, LMFT: We're, yes, we are working on a lot of acceptance strategies, mindfulness strategies, a lot of motivational interviewing. Um, you know, I'm, I'm very, I love acts, so a lot of creative hopelessness kind of exercises to help them learn like. Their ways aren't sustainable.

[00:50:42] Andrew Cohen, LMFT: Right. To help them get to that conclusion,

[00:50:44] Adelina Brisbois, LMFT: to then have motivation to do it true on their own. Like

[00:50:47] Andrew Cohen, LMFT: Yeah. '

[00:50:47] Adelina Brisbois, LMFT: cause they have to do it. No one else can do it. And that's the other thing, yeah. I think is important for families to hear.

[00:50:52] Andrew Cohen, LMFT: Mm.

[00:50:52] Adelina Brisbois, LMFT: Right. Is that the family can't do the e RRP four?

[00:50:55] Andrew Cohen, LMFT: Well, yes and no. So like this is where space comes in.

[00:50:58] Adelina Brisbois, LMFT: Okay.

[00:50:59] Andrew Cohen, LMFT: Right. So if it,

[00:51:00] Adelina Brisbois, LMFT: I don't know much about space.

[00:51:01] Andrew Cohen, LMFT: Yeah. So tell me, tell me about it. Um, so basically it's all about removing the accommodations that family members are doing. Um, accommodations are, you know, pages and pages long, typically when you, when you go and look and what accommodations are happening with families.

[00:51:17] Andrew Cohen, LMFT: Mm-hmm. So what you're doing in this sense is you're working if the client, I have like three cases right now where I'm not even seeing a patient or the client, I'm seeing the parents. Mm-hmm. And we are going through and, and charting all these different accommodations they're doing. For their kid. Right.

[00:51:31] Adelina Brisbois, LMFT: And does the kid know that the parent's doing this?

[00:51:33] Andrew Cohen, LMFT: So yes, we make an announcement, we give 'em a letter basically saying, you know, mom and dad love you very much. You know, you're an amazing kid. You know, and, and we also see how much this OCD and or anxiety is debilitating for you. So mom and I are working with, you know, Andrew Cohen, and, you know, stay tuned.

[00:51:49] Andrew Cohen, LMFT: We'll be letting you know, kind of some changes are coming. Right. And we love you.

[00:51:52] Adelina Brisbois, LMFT: Okay.

[00:51:53] Andrew Cohen, LMFT: Right. Um, so every time we pick an accommodation to remove, we're making an announcement to the kid. It's not, it's not a discussion. Right.

[00:52:01] Adelina Brisbois, LMFT: It's an announcement.

[00:52:01] Andrew Cohen, LMFT: It's an announcement. I

[00:52:02] Adelina Brisbois, LMFT: noticed you said the word

[00:52:03] Andrew Cohen, LMFT: announcement.

[00:52:03] Andrew Cohen, LMFT: Yeah. It's an announcement. It's a unilateral decision from the parents, the kid. Because ultimately if the kid's not willing, the parents don't have to be slave to OCD and anxiety.

[00:52:11] Adelina Brisbois, LMFT: Right?

[00:52:12] Andrew Cohen, LMFT: Right.

[00:52:12] Adelina Brisbois, LMFT: Because then it becomes this. Negotiation that's not going anywhere.

[00:52:15] Andrew Cohen, LMFT: Exactly. Exactly. Now, I much prefer if the kiddo is willing to participate in treatment.

[00:52:21] Andrew Cohen, LMFT: Yes, of course. And we can come to that together. Yeah. However, what I find a lot with space when I do this is, yes, it starts out a lot with just parents. But then once accommodations start getting removed, the kids or young adults or whoever it may be, kinda start to realize, oh my God, like OCD really is debilitating for me.

[00:52:38] Andrew Cohen, LMFT: 'cause I've had so many, like, um, you know, intakes where a kid comes in, I'm doing, you know, my assessments with them, talking about OCD, they're like, no, it doesn't bother me at all. I'm

[00:52:47] Adelina Brisbois, LMFT: fine.

[00:52:47] Andrew Cohen, LMFT: I'm, I am so good. Everything's great. Yeah. I'm able to go to school. I'm able to play with friends. I'm able to do this.

[00:52:53] Andrew Cohen, LMFT: Then you bring the parents in, you look up the accommodation scale, it's like, you know, huge everything. They're doing everything for the kid. They're getting the clothes prepared. They're texting their friends for them. They're doing the homework behind the scenes, they're doing all this kind of stuff, pulling it all literally.

[00:53:07] Andrew Cohen, LMFT: And unfortunately, like this, understandably so, creates a lot of. Attention in the house. A lot of resentment builds also to the, to the, uh, client because it's like, oh my God, we're doing all this for you. Right. So, um, I forgot kind of what we got on that topic, but with space, I guess we are, we are working

[00:53:24] Adelina Brisbois, LMFT: Oh, I was saying about the parents and how like they, like their role.

[00:53:30] Adelina Brisbois, LMFT: I guess. So you, you're,

[00:53:32] Andrew Cohen, LMFT: you, you, there is hope if your kid is not willing to, so like say you do have a client who really is, they're just not there. We work with parents on that.

[00:53:40] Adelina Brisbois, LMFT: That's so good to know. I actually didn't know that.

[00:53:42] Andrew Cohen, LMFT: Yeah.

[00:53:43] Adelina Brisbois, LMFT: Um, it would still be my first call. Yeah. And I guess you would just do that, but I That's good to know.

[00:53:48] Andrew Cohen, LMFT: Yeah. No, and it's, it's, it's, it's been a game. I mean, it's a game changer because, you know, a lot of times how many, you know, it's like, oh, my kid's not willing to do treatment. It's hopeless. Like it's a lost cause. Oh. You have to wait for them to be ready. But there are. Behaviors that parents are doing that are potentially facilitating no change.

[00:54:03] Adelina Brisbois, LMFT: Yeah.

[00:54:04] Andrew Cohen, LMFT: Right. Whereas,

[00:54:05] Adelina Brisbois, LMFT: and you're not blaming the parents, you're, it's not their fault. It, you're just helping them to get out of it.

[00:54:10] Andrew Cohen, LMFT: Well, it's, it's, you know, and I I phrase this, it, it, it's all coming from this very deep love and, and not wanting to see your kids suffer and it's, you know, it isn't their fault.

[00:54:20] Adelina Brisbois, LMFT: Yeah.

[00:54:20] Andrew Cohen, LMFT: But I, I like to phrase it as like, you know, you didn't cause this, but you can be a huge part in solving this.

[00:54:27] Adelina Brisbois, LMFT: Yeah.

[00:54:27] Andrew Cohen, LMFT: Right.

[00:54:28] Adelina Brisbois, LMFT: I have a question for you actually. I think I've asked you in, in offline, but

[00:54:33] Andrew Cohen, LMFT: Yeah.

[00:54:33] Adelina Brisbois, LMFT: Um, do you what, tell us what you know about pans and pandas.

[00:54:37] Andrew Cohen, LMFT: Yeah.

[00:54:38] Adelina Brisbois, LMFT: Because I think that's another thing that therapists dunno enough about

[00:54:42] Andrew Cohen, LMFT: Yeah.

[00:54:42] Adelina Brisbois, LMFT: And it crosses over largely Yeah. In the OCD world.

[00:54:45] Andrew Cohen, LMFT: Yeah. So, um, I'm gonna totally butcher the pronunciation of, uh, these conditions, but pans I believe is pediatric acute neuropsych. Something, oh God, I'm blanking on it. Basically what they are are infections that, that go through the blood that, that like, like sicknesses, people get, you know, strep throat or other kind of infections.

[00:55:05] Andrew Cohen, LMFT: The virus. The virus of sorts. Yeah. A virus that, that can cross the blood brain barrier and kind of impact parts of the brain where OCD kinda lives. And a lot of times you'll see parents come in with kiddos and they're like, my kid went to bed and they woke up the next day, or like very quickly soon after a completely different kid, you know, in debilitating OCD symptoms.

[00:55:25] Andrew Cohen, LMFT: But not only that, a lot of times there's extreme emotional dysregulation, you know, anger or ability, just huge mood swings on those kinds of things. Um, and you know, whenever a kiddo comes in, you know, uh, I did an intake kind of recently I think where they were talking about like, oh, he is had like 10 strep infections like in the past year.

[00:55:46] Andrew Cohen, LMFT: You know, it's like, okay, well let's go.

[00:55:48] Adelina Brisbois, LMFT: That'll cue you.

[00:55:49] Andrew Cohen, LMFT: Yeah. Something if there's, but when his

[00:55:50] Adelina Brisbois, LMFT: parents don't make that linked.

[00:55:52] Andrew Cohen, LMFT: If that, that he's been sick. Well that's I, when I assess you ask. Yes, yes. When I'm assessing, I'll, I'll ask about like symptom onset, like how quickly did this happen? Was this like over years?

[00:56:01] Andrew Cohen, LMFT: Was this like overnight? That'll kind of gear me towards is this pans, is it not? Also if there's a lot more comorbidities too, you know, maybe more irritability and things like that, we'll look at potentially that. So, you know, you have to get kind of evaluated by a pediatrician. Um, you also have to be careful.

[00:56:18] Andrew Cohen, LMFT: You go to, 'cause there's some pediatricians that don't believe pans and pandas exist. Um, it's controversial in that world. Um,

[00:56:25] Adelina Brisbois, LMFT: do you know why

[00:56:26] Andrew Cohen, LMFT: I, honestly, that would be a good question for my brother.

[00:56:30] Adelina Brisbois, LMFT: Yeah.

[00:56:30] Andrew Cohen, LMFT: I, I, I, I don't know why.

[00:56:33] Adelina Brisbois, LMFT: I mean, I've asked, I've asked a couple pediatricians myself.

[00:56:36] Andrew Cohen, LMFT: Yeah.

[00:56:36] Adelina Brisbois, LMFT: And I, I don't know that I have an answer

[00:56:38] Andrew Cohen, LMFT: Yeah.

[00:56:38] Adelina Brisbois, LMFT: To why, but I Something about the research on it.

[00:56:41] Andrew Cohen, LMFT: Mm.

[00:56:42] Adelina Brisbois, LMFT: Something about the research on it being doubted.

[00:56:45] Andrew Cohen, LMFT: Okay. And so like the, like the, the, the, like the setup of the trials and all that kind of stuff, like the,

[00:56:49] Adelina Brisbois, LMFT: I don't know the details, but something like that.

[00:56:51] Andrew Cohen, LMFT: Okay.

[00:56:52] Adelina Brisbois, LMFT: And it's just too bad, I think.

[00:56:55] Andrew Cohen, LMFT: Yeah, yeah.

[00:56:55] Andrew Cohen, LMFT: Well, because I think, you know, it's funny, I was at, um, so the I-O-C-D-F does what's called the Behavior Therapy Training Institute, BTTI. Okay. So I was in one of those trainings and one of the psychiatrists there talked about, you know, she does believe PANS is real, you know, as a thing. However she thinks.

[00:57:13] Andrew Cohen, LMFT: Overly diagnosed.

[00:57:14] Adelina Brisbois, LMFT: Oh, okay.

[00:57:14] Andrew Cohen, LMFT: Yeah. Okay. So like a lot of times people will jump to like, oh, so

[00:57:17] Adelina Brisbois, LMFT: there's a resistance maybe? Like, let's not, everything's not pain.

[00:57:20] Andrew Cohen, LMFT: Not pain. Exactly. Right. So I think there's skepticism. SD same

[00:57:23] Adelina Brisbois, LMFT: thing.

[00:57:23] Andrew Cohen, LMFT: Yes, exactly. Or everyone's, you know, autistic or whatever it might be. So I think there's that component to it.

[00:57:29] Andrew Cohen, LMFT: But that's, I, I'm actually my brother's coming out today. I'm gonna talk to him about it,

[00:57:34] Adelina Brisbois, LMFT: see what he says, because I, I think in med school, you know, we were talking, I mean, they don't teach us in grad school. Yeah,

[00:57:40] Andrew Cohen, LMFT: no.

[00:57:40] Adelina Brisbois, LMFT: And, and it sounds like they don't really maybe teach it in med school either. That doesn't mean that.

[00:57:45] Adelina Brisbois, LMFT: It doesn't exist.

[00:57:45] Andrew Cohen, LMFT: Absolutely.

[00:57:46] Adelina Brisbois, LMFT: Absolutely. And I think clinicians tend to be the first line of noticing.

[00:57:50] Andrew Cohen, LMFT: Mm-hmm.

[00:57:51] Adelina Brisbois, LMFT: Because of the sudden,

[00:57:52] Andrew Cohen, LMFT: the sudden aspect of it. Yes, absolutely. And, and so, so treatment, you're still gonna be doing ERP, right? Yeah. So like from the, the, the behavioral therapy component of things, not much different, but you do need to get, you know, that underlying infection treated, um, and, and figuring that kind of stuff out.

[00:58:07] Andrew Cohen, LMFT: And there's something called like IV ig, I think it's, they're like, it's like IV treatments.

[00:58:11] Adelina Brisbois, LMFT: Mm-hmm. That's for more intense cases.

[00:58:13] Andrew Cohen, LMFT: Yeah. And it's, it's not covered by insurance. It's very expensive. And I think that's also where the controversial lies too, is like

[00:58:18] Adelina Brisbois, LMFT: Right.

[00:58:18] Andrew Cohen, LMFT: Does it work? Yeah.

[00:58:19] Adelina Brisbois, LMFT: Yeah.

[00:58:19] Andrew Cohen, LMFT: Does it actually work or help?

[00:58:21] Andrew Cohen, LMFT: Um, you know, I think there's cases where it has, there's cases where it hasn't and people are spending thousands of dollars. So it's,

[00:58:26] Adelina Brisbois, LMFT: and I think that it's also, I think there's also a component of autoimmune, um. Disease in there. And I think autoimmune diseases in general, just there's not a lot of information about

[00:58:38] Andrew Cohen, LMFT: it.

[00:58:38] Andrew Cohen, LMFT: Yeah, that's fair. And I mean, I, I, I, I, you know, it's part, I mean, I have, I'm gonna preface, I'm, I'm not a medical doctor, you know, it's so

[00:58:45] Adelina Brisbois, LMFT: hard to either my, and I don't, I just kind of know what I have figured out over time. But, you know, we're, we're gonna be talking to a couple pediatricians on here.

[00:58:52] Andrew Cohen, LMFT: Yes, yes.

[00:58:53] Andrew Cohen, LMFT: That would be amazing. Please, please get, you know, I don't wanna be like RFK junior over here and, and claim things without any actual,

[00:58:59] Adelina Brisbois, LMFT: I mean, we don't know that. The fact is that there's a lot of things that we don't know about.

[00:59:04] Andrew Cohen, LMFT: Yeah.

[00:59:05] Adelina Brisbois, LMFT: And this is just one of them. Yeah. But the reason I wanted to ask you about it is 'cause of the, um.

[00:59:10] Adelina Brisbois, LMFT: Because of the treatment.

[00:59:11] Andrew Cohen, LMFT: Yeah. Yeah.

[00:59:11] Adelina Brisbois, LMFT: So the treatment is the same

[00:59:12] Andrew Cohen, LMFT: from my perspective. From your perspective from ERP? Yeah. You're, you're looking at now because there's other comorbidities potentially, you know, like, like higher irritability and those kinds of things. There might be more other therapies that need to be thrown into mixed DBT emotional regulation kind of skills.

[00:59:26] Adelina Brisbois, LMFT: Right.

[00:59:27] Andrew Cohen, LMFT: Um,

so

[00:59:27] Adelina Brisbois, LMFT: in addition to,

[00:59:28] Andrew Cohen, LMFT: in addition to the ERP? Yes, absolutely. And sometimes, you know, because ERP is inherently can be dysregulating, so sometimes we need to get them like a base layer, if you will, of better strategies to manage big feelings before we even dive into ERP. Right.

[00:59:46] Adelina Brisbois, LMFT: Yeah. And I think that, um, again, so like you get rid of the infection, right?

[00:59:50] Andrew Cohen, LMFT: Yeah.

[00:59:50] Adelina Brisbois, LMFT: Um, and then you do ERP, and then what Does it go away?

[00:59:55] Andrew Cohen, LMFT: Well, so I think the, the thing is, is, you know, if they get sick just throughout their lives, it can kind of flare up.

[01:00:02] Adelina Brisbois, LMFT: Got it.

[01:00:02] Andrew Cohen, LMFT: Right. Well,

[01:00:03] Adelina Brisbois, LMFT: and that's the autoimmune part.

[01:00:04] Andrew Cohen, LMFT: Yeah. I, I, I think, yeah, maybe. I'm not, I'm not really, yeah. I'm not totally sure how on that backend it works like that, but I mean, it makes sense.

[01:00:12] Adelina Brisbois, LMFT: Yeah. You know, because there's a flare Yeah. There's an, there's an inflammation or a flare of that thing. Yeah. I, I agree. I'm also not a doctor.

[01:00:18] Andrew Cohen, LMFT: Yeah.

[01:00:18] Adelina Brisbois, LMFT: But I, it's unfortunately, I've, I feel like, um, in helping a lot of my clients and actually my friends,

[01:00:24] Andrew Cohen, LMFT: yeah.

[01:00:25] Adelina Brisbois, LMFT: I've become sort of knowledgeable about this.

[01:00:28] Andrew Cohen, LMFT: Totally.

[01:00:28] Adelina Brisbois, LMFT: But, but I will say there's not like this article I can go read 'cause there's not ton, a ton of them.

[01:00:33] Andrew Cohen, LMFT: Yeah.

[01:00:33] Adelina Brisbois, LMFT: And I wish there were,

[01:00:34] Andrew Cohen, LMFT: yeah, I mean there's, you know, the I-O-C-D-F has good information on pans. I think there's like the pans pandas network.org or something like that.

[01:00:41] Adelina Brisbois, LMFT: Yes.

[01:00:41] Andrew Cohen, LMFT: That's, that's a good resource.

[01:00:43] Andrew Cohen, LMFT: Um.

[01:00:44] Adelina Brisbois, LMFT: I'm gonna, we're gonna put all this in the show notes

[01:00:47] Andrew Cohen, LMFT: Oh, perfect.

[01:00:47] Adelina Brisbois, LMFT: So that people can reference it Yeah. If they'd like. But, um, yeah, I think that's what really got me more, uh, tuned in to, to OCD. Yeah. And to, um, and to ERP.

[01:00:59] Andrew Cohen, LMFT: Absolutely.

[01:00:59] Adelina Brisbois, LMFT: Because we, we work with kids, we work with young kids. And, um, I, I think there is a huge difference when someone says that their child has always been this way.

[01:01:08] Andrew Cohen, LMFT: Mm-hmm.

[01:01:08] Adelina Brisbois, LMFT: From, from the beginning. Yeah. You know, there was like little pieces,

[01:01:12] Andrew Cohen, LMFT: like Yeah.

[01:01:12] Adelina Brisbois, LMFT: Versus someone who is completely functioning No, no struggles. And then all of a sudden, and I think it, there's like an age range, like it's like five to like 10 or something that mm-hmm. Um,

[01:01:25] Andrew Cohen, LMFT: honestly, that, that I'm not totally sure about.

[01:01:27] Adelina Brisbois, LMFT: Okay. That's a good guess. I'll. You know, who is actually really knowledgeable about this? Melissa mos. Melissa mos. Yes. Yes. And Tanya Altman too,

[01:01:36] Andrew Cohen, LMFT: with,

[01:01:36] Adelina Brisbois, LMFT: she's a pediatrician.

[01:01:37] Andrew Cohen, LMFT: Okay.

[01:01:37] Adelina Brisbois, LMFT: Yeah. I to connect with her, she's great. And she, she taught us a lot about this.

[01:01:41] Andrew Cohen, LMFT: Oh, awesome.

[01:01:42] Adelina Brisbois, LMFT: Yeah. Back at like, actually in like 2018.

[01:01:44] Andrew Cohen, LMFT: Okay.

[01:01:44] Adelina Brisbois, LMFT: She, she taught us about the, and maybe even earlier than that.

[01:01:47] Andrew Cohen, LMFT: Yeah.

[01:01:48] Adelina Brisbois, LMFT: Um, and because we work with kids, I think sometimes I think like, man, I, I love that you work with kids as young as five.

[01:01:54] Andrew Cohen, LMFT: Yeah.

[01:01:55] Adelina Brisbois, LMFT: Because I think a lot of people don't.

[01:01:57] Andrew Cohen, LMFT: Yeah.

[01:01:58] Adelina Brisbois, LMFT: And um, and I

[01:01:58] Andrew Cohen, LMFT: gotta be honest, when we're working with kids that young, the majority of it is parent accommodation work.

[01:02:03] Andrew Cohen, LMFT: Of

[01:02:03] Adelina Brisbois, LMFT: course. Always. But that should always be the case. Yeah. By the way, like, we work with kids that young Yeah. And play therapy. And we still include the parents Yes. In the, for the same reasons you described.

[01:02:11] Andrew Cohen, LMFT: Yeah. Yeah.

[01:02:12] Adelina Brisbois, LMFT: Um, but I just think in my career, like I think back,

[01:02:15] Andrew Cohen, LMFT: yeah.

[01:02:15] Adelina Brisbois, LMFT: And I'm like, man, how many times did I miss this?

[01:02:19] Adelina Brisbois, LMFT: How many times did I just not know? Yeah. Enough,

[01:02:22] Andrew Cohen, LMFT: yeah.

[01:02:22] Adelina Brisbois, LMFT: To help some kids that I was working with that now I wish I could go back I know. And, and redo that and help them more. But anyway.

[01:02:29] Andrew Cohen, LMFT: No, I mean, it's, it's, and it's, that's a, I'm talking about our minds. That's such an easy spiral to fall into if I, you know.

[01:02:35] Adelina Brisbois, LMFT: Sure. But what, what I do do is say, well teach people about it now.

[01:02:39] Andrew Cohen, LMFT: Yes. Yes.

[01:02:39] Adelina Brisbois, LMFT: Do what I can do to help more therapists know. That's why I wanted to ask you about

[01:02:43] Andrew Cohen, LMFT: it. No, it's great. And kind of going, I mean, that's going back to the Ooc D kind of thing. That's why I'm so passionate about teaching this stuff, too.

[01:02:50] Andrew Cohen, LMFT: 'cause I mean it

so

[01:02:51] Adelina Brisbois, LMFT: you don't miss it.

[01:02:51] Andrew Cohen, LMFT: Yeah. I mean, it takes an average of 14 to 17 years from symptom onset Whoa. To be diagnosed and getting the appropriate treatment. Yeah.

[01:02:59] Adelina Brisbois, LMFT: That's a long

[01:02:59] Andrew Cohen, LMFT: time. It's a, I mean, that's, that's a long time. So I started having symptoms at, yeah, I started having symptoms at six or seven.

[01:03:06] Andrew Cohen, LMFT: I got diagnosed at 23. I think I fall kinda right in that.

[01:03:09] Adelina Brisbois, LMFT: So what about your family and your family's lovely. I love your family so much.

[01:03:13] Andrew Cohen, LMFT: It's, they're so sweet.

[01:03:13] Adelina Brisbois, LMFT: Um, what, what's, I wonder what their experience was with like, with knowing, knowing that this was going on. Did they know all the whole time? 'cause it was in your mind.

[01:03:22] Andrew Cohen, LMFT: Yeah. I mean, they knew I was anxious, but also we're, you know, neurotic Jews. I think all of us are anxious. Um,

[01:03:29] Adelina Brisbois, LMFT: so you blended in?

[01:03:30] Andrew Cohen, LMFT: Yeah, I think we just fit in perfectly. My mom's always the one who's like, knock on wood, knock on wood. Knock on wood. Right. So, you know, talk about that learned component of it too.

[01:03:40] Andrew Cohen, LMFT: Um, but. What was I gonna say? My, I think I definitely, it started out more as like bad separation anxiety. Okay. I think they just kind of looked at it like, you know this,

[01:03:50] Adelina Brisbois, LMFT: Andrew loves us so much.

[01:03:52] Andrew Cohen, LMFT: Yes. And like he wants to sleep in the bed with us. And That's so sweet. You know, at 15 years old when you're neither wanting to sleep in the bed.

[01:03:59] Andrew Cohen, LMFT: That's also not the sweetest.

[01:04:00] Adelina Brisbois, LMFT: Right.

But

[01:04:01] Andrew Cohen, LMFT: I think it was, it was like I looked at and around that time, that's when I started going to therapy. But they didn't, they didn't, I didn't even know the extent of it really until, I think, like I said, that's that last year at UCLA when it just really hit the fan.

[01:04:16] Andrew Cohen, LMFT: Like everything was, I couldn't function. Right. Um, up until that point I was getting by, but there were so many compulsions that I was doing

[01:04:24] Adelina Brisbois, LMFT: to get by.

[01:04:24] Andrew Cohen, LMFT: Yes. But I didn't realize they were compulsions. I didn't know what I, I was just like, this is what I have to do to keep going. Right. Um, and then it just hit head.

[01:04:32] Andrew Cohen, LMFT: And I think at that point we were all like uhoh. Something's not right, you know?

[01:04:37] Adelina Brisbois, LMFT: So did your parents or your family say they were, they were worried about you and they said it? Or did you have to kind of come to them and say, you know what, I'm doing all this stuff that you don't even know about in my mind.

[01:04:48] Andrew Cohen, LMFT: So it's, I think it was more of externally, like, I was clearly not doing well. Okay. Like you can see just if you talk to me and all that kind of stuff. So they saw that. I don't even think I'd be able to like, explain or even have kind of the insight to realize what I was doing. In my mind it felt,

[01:05:03] Adelina Brisbois, LMFT: oh yeah, you

[01:05:03] Andrew Cohen, LMFT: did.

[01:05:03] Andrew Cohen, LMFT: It felt out of my control. Right.

[01:05:05] Adelina Brisbois, LMFT: It was, it was happening to you.

[01:05:07] Andrew Cohen, LMFT: Yes. Like

[01:05:07] Adelina Brisbois, LMFT: it felt like

[01:05:08] Andrew Cohen, LMFT: bombarded by these intrusive thoughts of, oh my God. It's like, for example, had a, you know, a serious girlfriend in, in college and I would get bombarded by like an intrusive thought of, oh, that girl might be prettier than this girl.

[01:05:18] Andrew Cohen, LMFT: Your your girlfriend. So you have to go confess that. Or you had this thought about another girl, that means you're a terrible person. You gotta go confess that. Right. So it, it just literally, it's, it's that process I just described. It didn't feel like that. It was literally just like being hit with a brick and like, I got hit with a thought and I just confessed.

[01:05:33] Andrew Cohen, LMFT: And

[01:05:33] Adelina Brisbois, LMFT: it was your reality.

[01:05:34] Andrew Cohen, LMFT: Yeah.

[01:05:35] Adelina Brisbois, LMFT: It was. Right. Now you can talk about it as separate from

[01:05:36] Andrew Cohen, LMFT: Yes.

[01:05:37] Adelina Brisbois, LMFT: You, but at the time you, it was, you were consumed with it

[01:05:40] Andrew Cohen, LMFT: consumed,

[01:05:40] Adelina Brisbois, LMFT: like how, what's the phrase that a fish doesn't know that they're in water?

[01:05:45] Andrew Cohen, LMFT: Yes.

[01:05:45] Adelina Brisbois, LMFT: Right. You're just

[01:05:45] Andrew Cohen, LMFT: in it, I guess in it. That's, that is your world.

[01:05:47] Adelina Brisbois, LMFT: It's their world. They don't know something different.

[01:05:48] Andrew Cohen, LMFT: Yeah. Yeah. So that was very just much, you know, every day, um, for a while. Um, so I think obviously they, they started seeing I wasn't doing well and you know, there were times where, you know, I would just have complete breakdowns and my girlfriend at the time would've to call my parents to come get me.

[01:06:05] Andrew Cohen, LMFT: Um, you know, my last week of college, I just remember trying to party as much as possible just to not have any sort of thoughts. And, uh, obviously that didn't, um, end well, uh, you know, 'cause. Sober up eventually.

[01:06:21] Adelina Brisbois, LMFT: Yeah. And they came and they came

[01:06:23] Andrew Cohen, LMFT: and then they came right back.

[01:06:23] Adelina Brisbois, LMFT: It didn't, it didn't drown.

[01:06:25] Adelina Brisbois, LMFT: Bitman,

[01:06:25] Andrew Cohen, LMFT: no. Bitman, uh, you know, there's the rebound effect. I like to describe it like, you know, when you try to do stuff like that, it's like trying to put a beach ball underneath the pool, you know, that's harder. The farther down you push it. That rebound effect

[01:06:36] Adelina Brisbois, LMFT: that's, you're so good at these metaphors that it really helps people

[01:06:40] Andrew Cohen, LMFT: Yeah.

[01:06:40] Adelina Brisbois, LMFT: To under at least me.

[01:06:41] Andrew Cohen, LMFT: Yeah.

[01:06:41] Adelina Brisbois, LMFT: To, to like have a visual

[01:06:43] Andrew Cohen, LMFT: understand it. Yeah. It's, it's, I mean that's why I love to act. That's why I love to act so much, to be honest too.

[01:06:47] Adelina Brisbois, LMFT: So they must be so proud of you.

[01:06:50] Andrew Cohen, LMFT: I think so. I mean, yeah. Know they are. They are. And it's, uh, you know, it's sweet. It's, it's cool. I think my parents, I, I love them to death.

[01:06:57] Andrew Cohen, LMFT: They, they are, I think the classic example of parents that just love their kid and were trying to do what they can now, looking back, did they reassure me a whole bunch and do that kind of stuff? Yeah. They didn't know. Yeah. They

[01:07:07] Adelina Brisbois, LMFT: were doing their best that

[01:07:07] Andrew Cohen, LMFT: they could do. Yeah, exactly. Yeah.

[01:07:09] Adelina Brisbois, LMFT: They know, do what they knew how to do.

[01:07:11] Andrew Cohen, LMFT: Yeah. And, and now, you know, my, my, my parents and my dad and, you know, they know more about this stuff and, you know, they're even with their own lives starting to try and, you know,

[01:07:21] Adelina Brisbois, LMFT: that's so cool. Work

[01:07:22] Andrew Cohen, LMFT: on it themselves. And I think that's really, you know, that's, you know, I, silver lining of all this is like

[01:07:29] Adelina Brisbois, LMFT: Yeah.

[01:07:30] Adelina Brisbois, LMFT: It it helped your whole system.

[01:07:31] Andrew Cohen, LMFT: Yeah. The whole family system. And, you know, I think my parents can be very proud. They got therapists, the doctor, you know, the teacher.

[01:07:38] Adelina Brisbois, LMFT: Yeah.

[01:07:39] Andrew Cohen, LMFT: Tutor

[01:07:39] Adelina Brisbois, LMFT: helpers.

[01:07:39] Andrew Cohen, LMFT: Helpers. A whole bunch of helpers. Whole bunch of helpers in the family. Yeah.

[01:07:42] Adelina Brisbois, LMFT: Yeah. All amazing human beings.

[01:07:45] Andrew Cohen, LMFT: Yeah. Yeah. Um, and I'm, yeah, very, you know, very lucky and blessed to have that.

[01:07:50] Andrew Cohen, LMFT: Um, it's really nice.

[01:07:52] Adelina Brisbois, LMFT: Yeah. I mean, really

[01:07:52] Andrew Cohen, LMFT: nice.

[01:07:53] Adelina Brisbois, LMFT: The reason I think they must be so proud of you is because I am so proud, and I am not your parent, but I, I really,

[01:08:01] Andrew Cohen, LMFT: I mean, you were, you were, what's it called? An essential step on the journey of it. I mean, engage was. I was there for, I mean, in total how many years?

[01:08:09] Adelina Brisbois, LMFT: Yeah. 'cause

[01:08:10] Andrew Cohen, LMFT: five, six years. And then worked in private practice there and

[01:08:13] Adelina Brisbois, LMFT: Yeah. And you did groups. Mm-hmm. I remember,

[01:08:16] Andrew Cohen, LMFT: yeah. It was the, the case man. No, what was it called? Yeah,

[01:08:18] Adelina Brisbois, LMFT: yeah. Called Position was, it was called Case Manager at the time.

[01:08:20] Andrew Cohen, LMFT: Yeah. Yeah.

[01:08:21] Adelina Brisbois, LMFT: But you know what? I didn't know that you had all this struggle underneath the hood.

[01:08:26] Adelina Brisbois, LMFT: Like, I really didn't, like you hit it pretty well,

[01:08:29] Andrew Cohen, LMFT: and, and most of us do.

[01:08:31] Adelina Brisbois, LMFT: Mm-hmm.

[01:08:31] Andrew Cohen, LMFT: Right? I don't know, you know, the ins and outs of your mind. Exactly what I'm going in Blake's mind. And it's,

[01:08:35] Adelina Brisbois, LMFT: it's a good reminder Yeah. That we don't know what people are dealing with. Like I would've never known this.

[01:08:40] Andrew Cohen, LMFT: Yeah.

[01:08:41] Adelina Brisbois, LMFT: And now that I know, I'm like, wow, you were doing stellar.

[01:08:45] Adelina Brisbois, LMFT: I mean, I thought you were doing great no matter what.

[01:08:47] Andrew Cohen, LMFT: Yeah. But Ben hugging,

[01:08:48] Adelina Brisbois, LMFT: knowing that Bitman was there and knowing your journey to get like, wow. It just makes it even more impressive. So it's a reminder to be kind to people.

[01:08:56] Andrew Cohen, LMFT: Yeah.

[01:08:57] Adelina Brisbois, LMFT: And you know, you don't know what they're dealing with.

[01:08:59] Andrew Cohen, LMFT: Totally.

[01:08:59] Adelina Brisbois, LMFT: Whether it's something like this or like a death in the family or just.

[01:09:03] Adelina Brisbois, LMFT: Worries about a loved one.

[01:09:05] Andrew Cohen, LMFT: Anything

[01:09:05] Adelina Brisbois, LMFT: you just never know.

[01:09:06] Andrew Cohen, LMFT: Yeah.

[01:09:07] Adelina Brisbois, LMFT: Um, and yeah, I, I, I think I just, I am, I always tell people about you. I try to introduce you to as many people as I can, because I want people to know you and have the resource in you. Yeah,

[01:09:21] Andrew Cohen, LMFT: yeah. Yeah.

[01:09:21] Adelina Brisbois, LMFT: Um, so anyway, thank you.

[01:09:24] Andrew Cohen, LMFT: No, I, I, for being here appreciate, you know, you guys having me and it really is cool coming here full circle.

[01:09:29] Andrew Cohen, LMFT: And, you know, I'd love to come back and talk about a bunch of different topics. Yeah. And, you know, any, any time. Um, so yeah, it's been great.

[01:09:37] Adelina Brisbois, LMFT: Sounds good. And, and tell Bitman thank you.

[01:09:39] Andrew Cohen, LMFT: Oh,

[01:09:40] Adelina Brisbois, LMFT: absolutely. Bar for letting us bark.

[01:09:41] Andrew Cohen, LMFT: Yes, yes, absolutely. Hey, you know, I, I owe kind of my livelihood to Bitman though, if you think about it.

[01:09:46] Andrew Cohen, LMFT: There

[01:09:46] Adelina Brisbois, LMFT: you go. Look at, look at all the stuff you've created because of Bitman. Yeah. Thank you, Bitman.

[01:09:50] Andrew Cohen, LMFT: Thank you. Bitman. Exactly.

[01:09:52] Adelina Brisbois, LMFT: Oh, and OCD therapy would not exist. It would not, if it wasn't forbid.

[01:09:56] Andrew Cohen, LMFT: No, it really wouldn't. I don't know what I would be doing.

[01:09:58] Adelina Brisbois, LMFT: Yeah. And you and you have trained other clinicians Yeah.

[01:10:01] Adelina Brisbois, LMFT: In the community.

[01:10:02] Andrew Cohen, LMFT: Yeah. And we got associates that work with us and we just, you know, hired a new one who, who's I'm training right now. And, you know, it's, it's, it's really, it's cool.

[01:10:10] Adelina Brisbois, LMFT: It is cool because if I know that someone was trained by you, it does gimme a certain amount of confidence in their training.

[01:10:17] Andrew Cohen, LMFT: Yeah.

[01:10:17] Adelina Brisbois, LMFT: I do think a lot of people in our field, unfortunately, like, consider themselves an expert. Yeah. 'cause they had an, an experience themselves. Yeah. You know, and I think that Yes. In a way

[01:10:29] Andrew Cohen, LMFT: that, that, that, that gives you like Yes. Personal knowledge of the

[01:10:32] Adelina Brisbois, LMFT: distance. Yeah. But it could also be very triggering.

[01:10:34] Andrew Cohen, LMFT: Yes.

[01:10:34] Adelina Brisbois, LMFT: You know, like, I know for myself, there are certain things that when I, if it comes up in my office Yeah. I'm wary of. Yeah. '

[01:10:40] Andrew Cohen, LMFT: cause

[01:10:41] Adelina Brisbois, LMFT: it's a little too personal

[01:10:42] Narrator: for me. Yeah.

[01:10:42] Adelina Brisbois, LMFT: Counter. Yeah. A lot of counter. Yeah. And I've seen people, um, sort of let that kind of take over. Yeah. It's really hard. You have to get really good consultation and supervision to not, you know, over identify.

[01:10:54] Andrew Cohen, LMFT: Absolutely.

[01:10:54] Adelina Brisbois, LMFT: But I think what, again, what you did is yes, you have your personal experience Yeah. And you have this really solid tool under your belt that you use. And then now you can train other people in it.

[01:11:05] Andrew Cohen, LMFT: Yeah, exactly. No, and it's, you know, when I, when I commit to something, I, I, I go in if you will, so, yeah.

[01:11:12] Andrew Cohen, LMFT: You know, we'll see. Uh, we'll see what the future brings.

[01:11:15] Adelina Brisbois, LMFT: Yeah. Let's

[01:11:15] Andrew Cohen, LMFT: see

[01:11:15] Adelina Brisbois, LMFT: what happens next.

[01:11:16] Andrew Cohen, LMFT: It's uncertain and we gotta,

[01:11:17] Adelina Brisbois, LMFT: all I know is that you're helping people.

[01:11:19] Andrew Cohen, LMFT: I like to

[01:11:20] Adelina Brisbois, LMFT: think so. Thank you. Thank you. Thank you for that. Absolutely. And thank you for helping us, and just thanks for being here today.

[01:11:25] Andrew Cohen, LMFT: Yeah. No.

[01:11:25] Andrew Cohen, LMFT: And you guys have made, I mean, talk about proud you guys created this whole thing, like this is just, it's awesome. You guys are a force to be reckoned with.