My Journey to Writing my Book

Developing this approach to treating OCD has been a highly integrative experience for me, drawing from many facets of both my personal and professional experience. I studied at Pacifica Graduate Institute because of its interdisciplinary and cutting-edge approach, and like many clinicians in the early ’90s, I was trained in psychoanalytically based talk therapy. But my first clinical experience as a brand-new 25-year-old therapy intern was at a residential treatment center for adolescents that plunged me into a crash course in trauma work and family systems therapy.

This work had almost nothing to do with the lovely archetypal theories I had written papers about. What it gave me, however, was invaluable experience in sitting with pain and making friends with fear. I found myself doing therapy on a bathroom floor and facilitating multi-family groups where angry teens throwing chairs was not uncommon. After becoming licensed, I continued to work with adolescents and their families and developed experience in treating a wide range of issues from substance abuse and eating disorders to educational and learning challenges, all in the context of family systems.

Introduction to OCD

Despite having doubt and fear as their nearly constant companions, roughly half of all individuals with obsessive compulsive disorder (OCD) are not getting the help they need (National Institute of Mental Health). They aren’t getting diagnosed early enough, they’re paying for years of therapy that isn’t helping, or they’re avoiding treatment entirely because they see it as too frightening. This dismal reality began to matter to me personally when my eight-year-old daughter suddenly became one of those people—and my five years of graduate school and 15 years of licensed clinical experience had not equipped me with the tools to help her. Unfortunately, the same was true for many of the therapists with whom she and I would meet in our search for help.

Obsessive compulsive disorder can be incredibly difficult to treat. Part of the challenge is that it is complex and multifaceted. Frequently it shows up in ways that don’t look familiar to clinicians unless they specialize in treating OCD, and the symptoms often shift and change, making a clear understanding of it even harder. In addition, even with the best intentions, clinicians can easily fall into specific OCD-related traps that may reinforce symptoms, making OCD worse over time instead of better. Further, research and experience show that OCD does not respond well to talk therapy, which is a predominant modality for many clinicians.

Driven by my passion to find a better way to support the healing of individuals with OCD as well as their families, I’ve concluded that therapists need a greater variety of effective tools to address some of the missing pieces in OCD treatment. My experience and research over the past decade have demonstrated that the experiential nature of Internal Family Systems (IFS) therapy makes it an ideal therapy model and a true asset in the treatment of OCD.

IFS and ERP are commonly thought to be diametrically opposed. In the course of my clinical work with clients struggling with OCD, however, I have used both modalities and have not actually found them in conflict at all. In fact, it’s my experience that IFS and ERP have some fundamental differences but work together effectively.

What Is Self-Led ERP?

While IFS therapy does not speak in the same language as CBT, each has roots in the same underground spring of mindful awareness and similarly facilitates an experiential process of differentiation internally among the parts of a person which may have distorted or outdated views and feelings, bringing into power the actual Self in the present world, who sees things clearly.

I began calling my approach to IFS therapy for OCD by the nickname Self-led ERP which stands for “Self-led encountering and relating to parts.” My twist on “ERP” came naturally and serendipitously as I began to see the exquisite correlations between traditional exposure therapy and parts work.

Treating the Doubting Disease

As therapists, we all encounter stuck places in our work and scary moments when we are not sure of our footing. It is reassuring to know that “As long as we stay in our Selves the client’s wisdom will emerge” (Schwartz & Sweezy, 2020, p. 182). but the progressive and extreme nature of OCD protectors can stir up parts of us that take us out of that healing space. OCD is called the doubting disease, after all.