In this episode of Stress-Free IEPTM, Frances Shefter speaks with Hannah Breckenridge, a Licensed Clinical Social Worker who specializes in helping people of all ages impacted by OCD & Anxiety using evidence-based treatments. She also has a sub-specialty working with parents and Autistic individuals that struggle with OCD & Anxiety.
Frances Shefter is an Education Attorney and Advocate who is committed to helping her clients have a Stress-Free IEP experience. In each podcast, Frances interviews inspiring people to share information, educate you, empower you and help you get the knowledge you need.
VOICEOVER ( 00:00:00): Welcome to Stress-Free IEPTM. You do not need to do it all alone with your host Frances Shefter, Principal of Shefter Law, she streams a show live on Facebook on Tuesdays at noon Eastern, get more details and catch prior episodes at www.ShefterLaw.com. The Stress-Free IEPTM video podcast is also posted on YouTube and LinkedIn and you can listen to episodes through Apple podcasts, Spotify, Google podcasts, Stitcher and more. Now, here’s the host of Stress-Free IEPTM Frances Shefter.
FRANCES ( 00:00:38): Hello, everyone and welcome to episode number 18. I just looked it up to because I was curious, we are actually on episode number 18 and today’s special guest is Hannah Breckenridge who is a licensed clinical social worker that specializes in helping people of all ages that are impacted by OCD and anxiety. She uses evidence based treatment for her to assist her clients and she also has a subspecialty working with parents and autistic individuals that struggle with OCD and anxiety. Her company, OCD DC, provides telehealth services and visits for Maryland, DC and Virginia. Hannah, welcome to the show.
HANNAH ( 00:01:26): Thank you so much for having me. I’m so excited to be here.
FRANCES ( 00:01:28): Uh, so I want to start with because I, some people might not know what is OCD. So, can you, what does it stand for? What is it?
HANNAH ( 00:01:37): That’s, uh, that is a good place to start. Um, so OCD, uh, stands for obsessive compulsive disorder. Um, I think a lot of us hear that term maybe thrown around colloquially, you know. Oh, I’m so OCD. Um, because I, I don’t know, I like to keep my room neat or something like that. And while OCD can show up in terms of the, the compulsions can look like um you know, sort of uh sort of arranging and rearranging and that sort of thing that does not, you know, classify one as having obsessive compulsive disorder. So, the big things that we’re looking for, if we were um going to be looking to diagnose somebody with OCD would be obsessions, meaning unwanted or intrusive thoughts or images, sometimes they’re also experienced as urges. And uh those thoughts, those images, those urges tend to create a significant amount of distress, right, in the individual um because of the, the, the intrusive nature or the unwanted nature. And because there’s so much distress, right? I mean, I think humans uh as we, as we sort of just normally do, right? We’re like, oh, I would like to get rid of that. Um And so, and so then come in the compulsions, right? And those are the ones I think that people might be a little bit more aware of because they’re more visible. Um, the compulsions. Um, well, sometimes more visible, um, the compulsions can range anything from, uh, you know, something that, ok, you might, you might see among, uh, like washing your hands or, you know, uh, touching things repeatedly, maybe having to repeat things, um, asking for reassurance, um avoiding. And those are all ones that we could observe, right? Those are kind of, they tend to call them the explicit compulsions. Um But there are also a number of mental compulsions as well. And, and that is one that, that, that category of compulsions can be overlooked so easily. And so sometimes you’ll hear people in the OCD world, they’ll refer to themselves as having pure O or purely obsessional type of OCD. And typically what they’re referring to is um is that they only have mental compulsions, right? So they might not have these explicit observable compulsions. So mental compulsions can range as well, right? So there are ones that are pretty straightforward, like um oh, I need to say this word a certain amount of times I need to pray this certain way. I need to, you know, et cetera, et cetera, et cetera um to, you know, slightly less concrete and um but still compulsion uh like uh let’s say you have a thought of what if I, you know, just take this knife and stab somebody, right? You know, it’s kind of a scary thought, a little distressing, especially if that is not in your, you know, uh, what you want to be, right? Um, and so you might, you could do a compulsion of, like, you could, I don’t know, avoid all knives. You could, uh, you know, there are a number of physical compulsions that you can do because of that. Um You could also have mental compulsions like um uh for example, and this is, these are the ones that might be slightly uh harder to catch. Sometimes I find um would be like, um, well, you essentially are arguing with yourself. I call it ping ponging sometimes, right? You have that thought and then you’re like, you know, well, I, I couldn’t do that. I could never do that. I’m not that type of person, you know, and there’s sort of this like urgency to it, right? Like, you know, oh no, no, no, no, no, like that’s not me. Um I would never hurt a fly but, you know, but it ping pongs because what happens after the compulsion is that it may or may not bring some temporary relief. That the important thing is that we perceive that it’s going to bring relief. Um So, um but it actually ends up just reinforcing the content and the um the content of the obsession in the first place and reinforcing uh that we should continue to do this cycle next time this comes up because this must be a very important issue. We treated it as if it was very important. And we also kind of taught ourselves that like, hey, it, we maybe aren’t as strong as we think we are. We maybe can’t handle as much as we think we can, like, we can’t handle those scary thoughts. Um So there are a number of uh functions at play. But with the ping ponging, what happens often is the, you know, let’s say with that money, you’re like, oh no, no, no, I’m not that type of person. Uh I’ve never heard a fly and then, you know, pings, ping pongs back to the obsession where it’s like, well, but that one time you did step on an ant. So, you know. Right. And then it’s, then you like the…
FRANCES ( 00:07:07): The devil and the devil and the angel on your shoulders.
HANNAH ( 00:07:11): Exactly. Exactly. I mean, um I know in my own lived experience, uh I used to when I was little, I would call it like World War Three, right? Like World War Three is just happening in my brain constantly because I’m having these things that were fairly, these, these thoughts or these experiences that were fairly intrusive and not wanted. And I was spending all of my time trying to get them out of my head. Right. I did not want them in there. Um And so it was just like a constant battleground. Yeah, so, uh so yeah, so that is, those are the two, you know, when we’re talking about OCD, right? Like those are the two things we’re looking for. We also though need to see that this has a significant impact in a major area of some life, right? So this is, this is not just a quirk, right? Or a, you know, thing that I occasionally do every once in a while, but it really doesn’t cause me any problems, right? No, this, this is, this is significantly impacting somebody’s life,
FRANCES ( 00:08:16): Right? Um Thank you so much. I, you know, like I know OCD, I’ve heard OCD but I’ve never heard it fully explained like that and I’m sure our listeners are glad, like, because it’s just, it’s such a different level and I never even thought of how much we don’t see and that’s like our silent disabilities, you know, that we don’t see. Um And so I think you said something once to me about um that it, it looks different in neurotypical and neurodivergent kids. So, like, I don’t know because at first my brain goes, is this a neuro, does this make a child neurodivergent or not? And what does that look like?
HANNAH ( 00:08:58): Yeah, that’s a really, really good question. I think there’s probably some debate over it. And partially because there is some debate over whether or not, um, whether or not OCD is one of those things, it’s essentially just a condition that you have throughout your life, right? Um, and, and different people with OCD might have different takes on this. Um, whether or not this is something that OK, I see this as a lifelong thing that is just kind of part of who I am. Um, I, I could imagine there being some resistance to um uh sort of the neuro divergent label just because so many people with OCD experience it as unwanted or intrusive, right? So they would be like, um no, like this is not a part of me. I don’t want anything to do with this, right? Um That makes sense. So, but I could say, you know, I could see it either way. So, uh you know, if we wanted to maybe phrase it and we sort of um uh um I don’t know, try to try to figure out a way to, you know. Yeah, I, so I think generally, right? Um OCD and when I say generally, I do have a rule of thumb that if you like it, it’s not OCD, right? If you like thinking about blah, blah, blah, blah, blah, then it’s probably not OCD, right? That’s not what we’re talking about. Now. It does get into a debate over, you know, uh there are individuals with differing levels of insight uh you know, as to whether or not, you know, like they may for example, know that they are in distress and know that they are um really struggling but maybe not be able to kind of put the pieces together as to why that is and be able to identify that like, oh, wait a second. It’s my brain doing this thing, right? It’s not so, so sometimes that does take some time to kind of put that together. But to get back to your question about, you know, um individuals that might be neurodivergent versus neurotypical and especially we’re talking about kids. Um There, first of all, there are, there are lots of overlaps, right? You know, we might, we might expect some of the same things to come up in OCD that you would see um uh in, you know, autism or ADHD or, you know, uh a number of conditions. Um So some of those things and I’m sure that if folks have experience with those, they could imagine, right? Some of that, like rigidity in certain conditions could be seen in OCD. We would absolutely, you know, not be surprised at all, right? If there’s some rigidity around things. Repetitive behaviors also might be something that we see. Sensitivity to your environment, also something we might see in OCD and in, you know, some of these other um groups and then sometimes also fixed interest, right? I mean, if you have OCD and you are, I mean, obsession, it’s repetitive, right? You know, it’s over and over and over again. Um again, you would see those in both those conditions, I think where sometimes we will see um uh the difference in experiences come in is that oftentimes with my uh with my neurodivergent clients, there are sort of other things at play as well. So it’s like, you know, OK. yes, there’s, there’s OCD plus this other stuff. So, um sometimes the distress tolerance level is just, you know, a little bit lower and part of that has to do with, you know, um the maybe uh uh some of the executive functioning skills maybe aren’t there to help support that. Um And that would be, have to be a consideration, right, when we’re thinking about the treatment. Because if, if you don’t have kind of that base level of, you know, being able, base level, being able to sort of regulate strong emotions as they come up, then, you know, that might be something we need to kind of lay that foundation for before we, you know, fully jump to OCD treatment. But the other thing that sometimes will differ a little bit is insight level. I think that an insight is essentially when we’re talking about do you know right, that what, what you are experiencing like or, or, or that what you maybe like your compulsion, right. That it doesn’t make sense. Right? Like why you’re having to avoid all the cracks or, you know, something bad is gonna happen to your family? Right. Do you recognize that? That’s not that there’s a logical leap from point A to point B and that it’s not reasonable for you then to avoid all the cracks. Um, so if you have, you know, low to no insight, you know, like I said, that’s when we have to really start uh putting those pieces together and say, like kind of be investigators and put our, our um our uh you know, Sherlock Holmes hats on and try to get to the bottom of it so we can see and make those connections that, oh, you know what, it’s not just this random overwhelming feeling that came up, it is all of this stuff behind it, you know.
FRANCES ( 00:15:03): it’s, you know, I’m listening to you and I love what you’re saying because it’s where I, I’ve been turning lately is that I hate these labels. You know, people talk, like, especially with autism now that it’s the ASD – autism spectrum disorder – that there’s low level and there’s high functioning and that’s not what it is. The brain works differently and you excel at some things and might be lower at other things. And for me, especially because there’s the overlap because there’s overlap with OCD and autism, there’s overlap with ADHD and autism, anxiety comes out in a lot of these situations and it’s kind of let’s, let’s stuff the round person in a square hole, you know, and it just like all of our brains work differently. And why is it because it’s not what somebody defined as normal, considered neurodivergent right now, it’s like our brain works differently. And so for like, what I’m thinking with OCD, like it’s not, I mean, I guess it is a treatment but like, what do you do? Like, how do you help somebody with OCD when it is getting involved in their life to the extent that they’re having functioning difficulties?
HANNAH ( 00:16:16): Yeah. Yeah. Um, that’s a really good question and I mean, the good news is that as far as um, treatments go for, you know, sort of, uh mental health conditions, we have some really good tools in our tool belt. And um that is really good news uh for the number of people who are struggling with it. And, um, I think that, you know, also just, just to sort of validate where some people might be that it often feels pretty hopeless, right? I mean, if you are, you are plagued by intrusive or unwanted thoughts, if you are feeling like you essentially have to go do these things right, in order to just maintain, in order to not even just maintain but like prevent horrible things from happening. Um, it’s exhausting and so I think a lot of times when people come to me, like that’s where they’re at. They’re like, I am done. This is, this is awful. I hate having to follow the rules of OCD. I want to live my own life, right. And, and really tune into it when you’re talking about sort of those different, you know, strengths that people might have. Right. Like, often people have these, you know, these amazing strengths or these interests or these things they would much rather be doing than dealing with OCD. Um And so that’s where the treatment comes in. And so in the world of OCD, the overarching um umbrella of um of, of treatments all falls under the, the sort of cognitive behavioral framework. Now, they may sort of, depending on which one specifically you are using, uh pull from, you know, pull different components from, you know, maybe a third, for example, acceptance and commitment therapy is one of those, one of those approaches that works well with OCD and has a very robust uh uh evidence base behind it. Um And sometimes that’s, it’s considered sort of a third wave of therapy, meaning it came after CVT and is, is different in some significant ways. But also draws from some of the, the fundamental ideas behind it. So acceptance and commitment therapy is one um that was one that really emphasizes um mindfulness and emphasizes uh essentially living life in spite of any feelings, right? You know, or any internal experiences that we might be going, right? They, they, they emphasize moving towards the things that you value rather than listening to whatever noise right is happening in here. Um uh uh Exposure response prevention is also, you know, probably at the top of, of most therapists that, that specifically treat OCD it’s probably like at the top of their list. And I think probably to some extent, almost every therapist sort of will integrate it, right? You know, if they specialize in this area, um which is exactly what it sounds like, right? It’s, it’s, it’s um exposure, meaning we essentially practice it, we purposely maybe put ourselves in situations that are a little bit, you know, are gonna bring up some of that discomfort, bring up some of that anxiety and response prevention, meaning that we practice not doing the compulsion in response. Um And so that is, um like I said to different degrees, people integrate that. And that does as a side note, um that is where it can get really interesting um with some of my neurodivergent clients, right? Because there are, there are specific things that I might work with, um, a neurotypical client on that depending on, you know, um if, if, you know, if the client identifies as, you know, I don’t know, autistic or, or whatever, you know, that, that we might have to, uh, you know, evaluate if that’s the right fit for them, right? Depending on, on their preferences. Um um But exposure and response prevention uh is uh can be a really, really good tool and can be very empowering, right? You know, you’re sort of flipping the narrative on, on OCD a little bit saying like, no, no, no, no, no, I am in charge here. Not you, like I do this.
FRANCES ( 00:21:07): Interesting, it just sounds like like a lot of times people hear a disability or mental illness or something and it’s like everybody’s treated the same. Oh, just give them this medication, give him this type of therapy. But it sounds like for OCD, there’s more than that, there’s different treatments, but it also depends on how the client wants to be, you know, to live with the OCD type.
HANNAH ( 00:21:32): Yeah, you know, I think, I think that that might somewhat uh I would, I would say, you know, I think most folks that specialize in treating OCD, they probably, they’re drawing from ERP (Exposure and Response Prevention), they’re probably, maybe not. There are maybe some very hard liner ERPers out there. Um But there might also be um uh folks that are integrating ACT (Acceptance and Commitment Therapy) more. Um There are also and these are all sort of like theoretical orientations, right? So, so they’re, is even within each of these, like quite a bit of overlap, it’s just a, you know, we’re all going towards the same goal of getting this client back to their life and, and their life on their terms, you know, um, it’s just different ways of getting there. And so, um, you know, there’s also, uh there’s, there’s some, you know, emerging evidence for, um, uh something called inferential based treatment which adds a really strong cognitive component to some of these other approaches that were maybe more behaviorally based. And again, it’s, it’s sort of adding into the mix. Um And, you know, I think that, um there are, there are definitely, there are gonna be certain therapists, right? Who maybe lean more in this direction or who lean more in that direction. I, just based on the work that I do, right? I mean, I see uh individuals with all different kinds of like, you know, uh skill levels and, and, you know, in, in working, um uh just working with the folks that I work with, I just find that I really do have to personalize, you know, that all within the context of like, you know, this is, you know, what we have, what the evidence supports, right? Um But, uh, but I find that, you know, no one person is the same, they’re not gonna, they’re not gonna be the exact same.
FRANCES ( 00:23:41): Yeah, it’s interesting because what you said it perfectly, the way I was thinking is that getting a person back to the way they want to live their life. And I think that’s the individual part, like, it’s not like, oh, you all have to live life like this, it’s how you, as an individual want to live your life and let’s figure out how to make it happen.
HANNAH ( 00:24:02): Yeah. Definitely. Definitely. And I think that’s, that’s been a little bit of, um, a little bit of a shift, you know, maybe in the past, like, 10, 15 years where I think probably 10, 15 years ago you would probably find quite a few more, very hard line ERP, right. And, and, and, and I’m not saying this in a, in a, you know, right when I came out of school that still was kind of, you know, the thing, right. Um, and so I think all of us are kind of growing as we, as we listen and understand that there are, there is more than one way to get to where we’re going. Um, and, and that not every way is going to fit for every person. Yeah.
FRANCES ( 00:24:51): And I know you say you work with kids through adults and it’s got to look very different. Um, like how, like I, I would see adults have more insight of what’s going on. How do you help kids that are having OCD, that it’s impacting like their education, school, home life?
HANNAH ( 00:25:11): Yeah. No, that’s a really good question. Um, and, yeah, I think on some level adults do tend to have a little more insight. Um, not always. Right. Um, everybody, everybody’s different. Um, but, uh, I think one of the things that can be that we might see with kids is it may be that they recognize that there’s something that they don’t like about what’s going on. Right. Um, but like you said, they may not be able to put those pieces together about like why that is. So, so like in younger kids, um, it’s a little more common for us to see things like we’ll see compulsions and you’ll be like, well, what are you worried is gonna happen if you don’t do that? Right. And they’ll sort of be like, hm, you know, or, or like, I don’t know, it get this bad feeling or, you know, it might be a more generalized experience maybe without the very, sometimes there are, right? And this is not to, to, um, to say this is the way for everybody but, uh, it might be a little less concrete, um, in how they’re experiencing it. They may not have a, you know, well, if this, then this, right explicitly,
FRANCES ( 00:26:30): They don’t know the why yet.
HANNAH ( 00:26:33): They, they may not know the why yet. Right. Or, or frankly, they’re just not at a sort of developmental level where their brain has come up with the why yet.
FRANCES ( 00:26:45): Right, the frontal lobe is not fully there.
HANNAH ( 00:26:46): We haven’t, we haven’t gotten there. Um, uh, which in that case, right? We just have to be mindful of that and the why and that in that case is that I don’t like being uncomfortable. Right. I don’t like this feeling. Um, and so it, it can be general, we can, we can keep it kind of general in that sense and still apply what we’re talking about, you know. Um, and, and often there, there’s even this, you know, so there’s that feeling, oftentimes there are even these, um, these thoughts or beliefs around those feelings, like, um, something like, well, if I don’t do this, then this feeling is never going away, right. Which, that is a scary thought, right? Like I wouldn’t want that. Um, yeah. Um, so, so, yeah, it, it, it, um, it can look a little different and as far as applying the concepts, there are certain concepts that I think are really, like, stick really well with kids and there are other ones that it, you just have to have, be a certain, you know, cognitive level to be able to, um understand, right. Um, and so sometimes we have to, to get to some of those other concepts we have to, um, you know, work on that foundation first, you know, like, ok, um, here this is, this is the feeling that I’m feeling and here’s how I know that I’m feeling that feeling because I’m sweaty and because I’m, you know, tense and because I feel like my stomach just dropped out of my butt and, you know, like, like all those, um, those sometimes we have to like start there, you know, as opposed to, you know, sometimes adults will, they’ll be able to say, like, look, I, I am feeling incredibly uncomfortable and anxious and, you know, be able to say exactly why that is
FRANCES ( 00:28:54): right. So, I mean, so the show it’s Stress-Free IEPTM and I’m thinking along the lines, I don’t think OCD would qualify for a disability for an IEP. But it can be like, if a child, if a child qualifies under something else. Are there things that you can think of that the schools can do to help a child that has OCD?
HANNAH ( 00:29:16): Absolutely. Um So one thing that I think is just really important is that um uh when we, especially in some of the acute cases where, you know, the kid is really struggling, um we, we are often hoping to have a team approach, right? Because, because there’s, there’s, it is really hard if say I am seeing somebody like once a week or, you know, 45-50 minutes and, you know, to be able for that person to be able to apply that outside a session. And that’s for an adult, you know, like that is um very hard when it comes to different contexts. So I think, you know, being willing to be part of that team can be really important and I always am encouraging, you know, when I have, uh uh when I have minors right. I’m always encouraging uh parents uh to, to uh sort of integrate me with, you know, any school personnel, right? That might be part of this team. Um You know, I, I, I don’t force people, right? But I always always, I always say, right, that there are definitely benefits to signing a release so that we can talk. Um So, uh so just being willing to come to the table and be part of that team is step number one. You know, you don’t necessarily have to have all of the answers per se, right? Like there, there doesn’t have to be like a, you know, oh, I know exactly what to do in this situation, but that’s where the individual therapist could come in and be very helpful, like specifically with each kid because it can look so incredibly different, you know, with each individual. And so what might be involved in the process is that, you know, sometimes in, over the course of um sometimes in the OCD community, the term ‘accommodations’ can, can kind of be like a dirty word a little bit because you think about that cycle again, right? We’re, we’re trying to not to, we don’t want to support that anymore than it needs to be supported, right? Um And so the uh that being said, and, and this is uh maybe kind of one of my own opinions on this matter is that, that is definitely the case. Um, and if I am, if I uh think that a client needs accommodations, I tend to encourage, at least when we’re talking to the kid, right, that we are framing this as something that’s like kind of a temporary thing, at least with regards to OCD, you know, um, that we’re going to, you know, what, we’re gonna figure out how to, you know, if you’re taking an ERP approach, we’re gonna figure out how to, like, face our fears and, you know, we’re gonna be brave and figure this out with, you know, with Miss Hannah and then we’ll maybe work on it in school, you know, that sort of thing. But we frame it as something where we’re like, oh, maybe we won’t need this in a couple of years. Which can be nice, right? Um uh you know.
FRANCES ( 00:32:42): Which usually I don’t say that with IEPs that like this is not something, but there are certain situations like with executive functioning that yes, you’re gonna always have executive functioning issues, however you can learn how to deal with it and, and, and put your own systems in place that you don’t necessarily need that support anymore.
HANNAH ( 00:33:02): Right. Right. And, and that, that’s not to say that, you know, you, as the parent or the school needs to be like, OK, we’re like, now we’re moving all of these uh in like a formal sense. Right. Because, you know, you never know. Right. Like we have a, you could be dealing with harm OCD over here and then, you know, I don’t know, here come sexually intrusive thoughts coming down the pipeline. Right. You know, and, and then we needed those and it’s good to have them in place. Um, so, so that’s not to say, but I think when we’re, we’re, um, talking about it with, you know, with the kid framing it as something that like, you know, what we are gonna make progress on this, right? And, and all with the hope that, you know, maybe we don’t need them all the time, maybe we don’t, you know, maybe that’s something, so that can be important. Um The other important role for the school is just another set of eyes because with all of the different OCD themes, even though, um, you know, it can be, uh pretty pervasive and that it, it affects, you know, all of these different areas of life. It might affect different areas of your life in different ways, you know. So for example, let’s say you had, um, you know, sexually intrusive thoughts, right? Well, at home that might be something where, um, you know, oh man, I’m really afraid to watch, you know, the TV, because you never know what’s gonna come up and then maybe that will like result in me having a thought that I don’t like and then blah, blah, blah, blah, blah. Um but, you know, at school, maybe it’s a totally different trigger, maybe it’s, you know, I don’t know, uh, something that’s, that’s that we didn’t even see coming. Right. Um, and so that can be really important. Um, and, uh, so that’s why it would be important to have multiple sort of sources that we are gathering information from so that we can.
FRANCES ( 00:35:04): Yeah, it’s, you know, it’s an IEP team, team is the key word in that. And I say that often because people are like, well, I don’t want to bring an attorney because it will look adversarial. And I always tell them it’s like attorneys don’t always have to be adversarial. There are some that, that’s how they come in, but that’s not my style. I come in as an advocate, as a team. Let’s all work together. The focus is the child. Now, don’t get me wrong. I’ll get adversarial when I need to. But they, the start is for the team, you know, the team to work together because if we’re not the skills we’re teaching, like even the skills we’re teaching at school. If outside therapists and service providers don’t know, it’s just the child is like, ok, so I need to behave this way at school and this way with my therapist and service providers and this way at home and it’s not all blended together of one whole person.
HANNAH ( 00:35:58): Yeah, that, that is actually ends up being a huge issue. Especially with OCD because there’s um not, not only can certain forms of therapy be not helpful, they actually can feed the beast, you know, a little bit and, and a lot of times, you know, in like a school setting, for example, you know, you have to uh you know, a lot of the interventions that are in place, you know, you kind of have to, you know, be ready to serve, you know, this person plus this person plus this person, right? And so some of the things are a little more general. The only problem is is that sometimes those specific general things, right, can if we weren’t thoughtful about it or careful about it, turn into a compulsion in and of itself, right? So let’s say, let’s say that, you know, oh, ok. Well, um this person has a, um you know, this kid was taught deep breathing, this has happened number times, taught deep breathing and not that there’s anything wrong with deep breathing, but we want to frame it, you know, the right way. Um that now suddenly they feel like any time they’re anxious, you know, or they have an intrusive thought. Well, now they’ve got to deep breathe like five slow times and if it didn’t feel right, then maybe they gotta do it again, you know, so you can imagine it getting kind of sticky like that. And, you know, I agree, I’ve been in those situations, a number of situations where we’ve, um, met with the school. And I even, I love doing, um, like school observations too because, you know, sometimes, uh, sometimes the teachers got a lot to do. Right. And like, they’re not able to, they’re like, I know something’s going on. I just don’t know what it is. Um, but, you know, the, what I have found in taking that kind of team based approach is that, you know, the, the teacher is able to, uh, you know, uh might be able to share stuff with me that I, I had no idea about, right? You know, that I, I don’t know, for example, in the AP US history exam there are, it’s very writing heavy. Well, that’s important for my client, right? Who, who, you know, every time they see a blank page is just in, you know, avoidance mode, you know. So that’s important and, and likewise, you know, if you have, um, a teacher may or may not know what to do if, say you have a kid with OCD in your class who’s asking repetitive questions over and over and over again. How do you respond to that? You know? Um, and, and in an easy way, right? That’s not gonna be an extensive, you know, uh thing that’s taking all of your time and attention away from the other kids.
FRANCES ( 00:38:55): And that’s discreet, right? Exactly. Yeah. Um Yeah. No, god this has been so fascinating. It’s just, you know, it’s so funny because it’s just, you know, I started doing the show to provide information for parents and for families and I’m learning so much about all of this because, you know, like, yes, I have the education background. I have the special ed. I’ve been the attorney and all that, but it’s just not, I don’t have the psychological side. I don’t have, you know, the service provider side. And I love learning all this so that we can look at our children and help. So, like, what’s the next best step? Like, what can parents do that want more information like how to reach you or what they can do to help their child?
HANNAH ( 00:39:34): Yeah, definitely. Um Well, if, if they would like to reach me, they can do so through my website, which is, you know, https://www.ocd-dc.com/. And there’s a contact form. What did you say? Oh, the link will be on the show? Great. Um So they can reach me there. The other thing to check out is the IOCDF, the International OCD Foundation. They’re kind of the, they’re kind of the preeminent OCD nonprofit. They do a lot of advocacy work, a lot of education around OCD. They have, they host OCD Con every year, which is a thing and very exciting for those of us in this area. Um, and so, um, they have both an in-person one which this year I think it’s in, um, San Francisco. And they also have a virtual one every year. So, even if you can’t attend in person, um, and then they’ll also have certain things like, um, you know, OCD camp for kids. Right. Uh, that’s maybe like, um, a couple hours over the weekend or, you know, so there are a lot of resources there. The other really good thing about the um the IOCDF is that you can find a therapist or you can find a psychologist or you can find a psychiatrist or, you know, that sort of thing through their directory listing which, you know, uh they’re um uh you know, I think if you’re a member, you essentially, you know, get, get a free listing and everything. But um so there, there may be folks on there, you know, who um uh who maybe are, you know, don’t specialize as much, but if you specialize, you almost certainly have an IOCDF directory listing. Um If that makes sense.
FRANCES ( 00:41:33): No, that’s no, it totally makes sense. I get it.
HANNAH ( 00:41:35): And they also have a resource that they launched fairly recently. It’s um uh I think it’s called like Anxiety in the Classroom or something like that. It’s sort of like a sister site that um that talks about anxiety and OCD how it can show up in the classroom. I think they may even have some resources specifically for, for educators or for administrators or parents, you know, all different parties and, you know, that might be part of the team.
FRANCES ( 00:42:02): That is awesome. I love that there’s so much support about it now. You know, because back in my day when I went to school, it was all like, swept under the rug. Like, no, no, no, you don’t want people to know this and now it’s just, there’s international, there’s national groups that you can go and help and it’s so fabulous and so supportive. Um I loved having you on the show. Thank you so much for teaching me, teaching, you know, the audience talking about OCD. This has just been a full day of learning. It’s been awesome. Thank you.
HANNAH ( 00:42:34): Yeah. Thank you so much for having me. I obviously can talk about OCD until, you know, until I uh fall over. So.
FRANCES ( 00:42:42): Oh, and it’s great. It’s all relevant information. Yeah.
HANNAH ( 00:42:46): Yeah. Thanks so much.
VOICEOVER ( 00:42:48): You’ve been listening to Stress-Free IEPTM. With your host Frances Shefter. Remember you do not need to do it all alone. You can reach Frances through ShefterLaw.com where prior episodes are also posted. Thank you for your positive reviews, comments and sharing the show with others through YouTube, LinkedIn, Apple Podcast, Spotify, Google Podcasts, Stitcher and more.
Stress Free IEP™ with Frances Shefter and Hannah Breckenridge
In this episode of Stress-Free IEPTM, Frances Shefter speaks with Hannah Breckenridge, a Licensed Clinical Social Worker who specializes in helping people of all ages impacted by OCD & Anxiety using evidence-based treatments. She also has a sub-specialty working with parents and Autistic individuals that struggle with OCD & Anxiety.
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Stress-Free IEPTM:
Frances Shefter is an Education Attorney and Advocate who is committed to helping her clients have a Stress-Free IEP experience. In each podcast, Frances interviews inspiring people to share information, educate you, empower you and help you get the knowledge you need.
Watch more episodes of Stress-FreeTM on YouTube.
Connect and learn more from your host, Frances Shefter:
VOICEOVER ( 00:00:00): Welcome to Stress-Free IEPTM. You do not need to do it all alone with your host Frances Shefter, Principal of Shefter Law, she streams a show live on Facebook on Tuesdays at noon Eastern, get more details and catch prior episodes at www.ShefterLaw.com. The Stress-Free IEPTM video podcast is also posted on YouTube and LinkedIn and you can listen to episodes through Apple podcasts, Spotify, Google podcasts, Stitcher and more. Now, here’s the host of Stress-Free IEPTM Frances Shefter.
FRANCES ( 00:00:38): Hello, everyone and welcome to episode number 18. I just looked it up to because I was curious, we are actually on episode number 18 and today’s special guest is Hannah Breckenridge who is a licensed clinical social worker that specializes in helping people of all ages that are impacted by OCD and anxiety. She uses evidence based treatment for her to assist her clients and she also has a subspecialty working with parents and autistic individuals that struggle with OCD and anxiety. Her company, OCD DC, provides telehealth services and visits for Maryland, DC and Virginia. Hannah, welcome to the show.
HANNAH ( 00:01:26): Thank you so much for having me. I’m so excited to be here.
FRANCES ( 00:01:28): Uh, so I want to start with because I, some people might not know what is OCD. So, can you, what does it stand for? What is it?
HANNAH ( 00:01:37): That’s, uh, that is a good place to start. Um, so OCD, uh, stands for obsessive compulsive disorder. Um, I think a lot of us hear that term maybe thrown around colloquially, you know. Oh, I’m so OCD. Um, because I, I don’t know, I like to keep my room neat or something like that. And while OCD can show up in terms of the, the compulsions can look like um you know, sort of uh sort of arranging and rearranging and that sort of thing that does not, you know, classify one as having obsessive compulsive disorder. So, the big things that we’re looking for, if we were um going to be looking to diagnose somebody with OCD would be obsessions, meaning unwanted or intrusive thoughts or images, sometimes they’re also experienced as urges. And uh those thoughts, those images, those urges tend to create a significant amount of distress, right, in the individual um because of the, the, the intrusive nature or the unwanted nature. And because there’s so much distress, right? I mean, I think humans uh as we, as we sort of just normally do, right? We’re like, oh, I would like to get rid of that. Um And so, and so then come in the compulsions, right? And those are the ones I think that people might be a little bit more aware of because they’re more visible. Um, the compulsions. Um, well, sometimes more visible, um, the compulsions can range anything from, uh, you know, something that, ok, you might, you might see among, uh, like washing your hands or, you know, uh, touching things repeatedly, maybe having to repeat things, um, asking for reassurance, um avoiding. And those are all ones that we could observe, right? Those are kind of, they tend to call them the explicit compulsions. Um But there are also a number of mental compulsions as well. And, and that is one that, that, that category of compulsions can be overlooked so easily. And so sometimes you’ll hear people in the OCD world, they’ll refer to themselves as having pure O or purely obsessional type of OCD. And typically what they’re referring to is um is that they only have mental compulsions, right? So they might not have these explicit observable compulsions. So mental compulsions can range as well, right? So there are ones that are pretty straightforward, like um oh, I need to say this word a certain amount of times I need to pray this certain way. I need to, you know, et cetera, et cetera, et cetera um to, you know, slightly less concrete and um but still compulsion uh like uh let’s say you have a thought of what if I, you know, just take this knife and stab somebody, right? You know, it’s kind of a scary thought, a little distressing, especially if that is not in your, you know, uh, what you want to be, right? Um, and so you might, you could do a compulsion of, like, you could, I don’t know, avoid all knives. You could, uh, you know, there are a number of physical compulsions that you can do because of that. Um You could also have mental compulsions like um uh for example, and this is, these are the ones that might be slightly uh harder to catch. Sometimes I find um would be like, um, well, you essentially are arguing with yourself. I call it ping ponging sometimes, right? You have that thought and then you’re like, you know, well, I, I couldn’t do that. I could never do that. I’m not that type of person, you know, and there’s sort of this like urgency to it, right? Like, you know, oh no, no, no, no, no, like that’s not me. Um I would never hurt a fly but, you know, but it ping pongs because what happens after the compulsion is that it may or may not bring some temporary relief. That the important thing is that we perceive that it’s going to bring relief. Um So, um but it actually ends up just reinforcing the content and the um the content of the obsession in the first place and reinforcing uh that we should continue to do this cycle next time this comes up because this must be a very important issue. We treated it as if it was very important. And we also kind of taught ourselves that like, hey, it, we maybe aren’t as strong as we think we are. We maybe can’t handle as much as we think we can, like, we can’t handle those scary thoughts. Um So there are a number of uh functions at play. But with the ping ponging, what happens often is the, you know, let’s say with that money, you’re like, oh no, no, no, I’m not that type of person. Uh I’ve never heard a fly and then, you know, pings, ping pongs back to the obsession where it’s like, well, but that one time you did step on an ant. So, you know. Right. And then it’s, then you like the…
FRANCES ( 00:07:07): The devil and the devil and the angel on your shoulders.
HANNAH ( 00:07:11): Exactly. Exactly. I mean, um I know in my own lived experience, uh I used to when I was little, I would call it like World War Three, right? Like World War Three is just happening in my brain constantly because I’m having these things that were fairly, these, these thoughts or these experiences that were fairly intrusive and not wanted. And I was spending all of my time trying to get them out of my head. Right. I did not want them in there. Um And so it was just like a constant battleground. Yeah, so, uh so yeah, so that is, those are the two, you know, when we’re talking about OCD, right? Like those are the two things we’re looking for. We also though need to see that this has a significant impact in a major area of some life, right? So this is, this is not just a quirk, right? Or a, you know, thing that I occasionally do every once in a while, but it really doesn’t cause me any problems, right? No, this, this is, this is significantly impacting somebody’s life,
FRANCES ( 00:08:16): Right? Um Thank you so much. I, you know, like I know OCD, I’ve heard OCD but I’ve never heard it fully explained like that and I’m sure our listeners are glad, like, because it’s just, it’s such a different level and I never even thought of how much we don’t see and that’s like our silent disabilities, you know, that we don’t see. Um And so I think you said something once to me about um that it, it looks different in neurotypical and neurodivergent kids. So, like, I don’t know because at first my brain goes, is this a neuro, does this make a child neurodivergent or not? And what does that look like?
HANNAH ( 00:08:58): Yeah, that’s a really, really good question. I think there’s probably some debate over it. And partially because there is some debate over whether or not, um, whether or not OCD is one of those things, it’s essentially just a condition that you have throughout your life, right? Um, and, and different people with OCD might have different takes on this. Um, whether or not this is something that OK, I see this as a lifelong thing that is just kind of part of who I am. Um, I, I could imagine there being some resistance to um uh sort of the neuro divergent label just because so many people with OCD experience it as unwanted or intrusive, right? So they would be like, um no, like this is not a part of me. I don’t want anything to do with this, right? Um That makes sense. So, but I could say, you know, I could see it either way. So, uh you know, if we wanted to maybe phrase it and we sort of um uh um I don’t know, try to try to figure out a way to, you know. Yeah, I, so I think generally, right? Um OCD and when I say generally, I do have a rule of thumb that if you like it, it’s not OCD, right? If you like thinking about blah, blah, blah, blah, blah, then it’s probably not OCD, right? That’s not what we’re talking about. Now. It does get into a debate over, you know, uh there are individuals with differing levels of insight uh you know, as to whether or not, you know, like they may for example, know that they are in distress and know that they are um really struggling but maybe not be able to kind of put the pieces together as to why that is and be able to identify that like, oh, wait a second. It’s my brain doing this thing, right? It’s not so, so sometimes that does take some time to kind of put that together. But to get back to your question about, you know, um individuals that might be neurodivergent versus neurotypical and especially we’re talking about kids. Um There, first of all, there are, there are lots of overlaps, right? You know, we might, we might expect some of the same things to come up in OCD that you would see um uh in, you know, autism or ADHD or, you know, uh a number of conditions. Um So some of those things and I’m sure that if folks have experience with those, they could imagine, right? Some of that, like rigidity in certain conditions could be seen in OCD. We would absolutely, you know, not be surprised at all, right? If there’s some rigidity around things. Repetitive behaviors also might be something that we see. Sensitivity to your environment, also something we might see in OCD and in, you know, some of these other um groups and then sometimes also fixed interest, right? I mean, if you have OCD and you are, I mean, obsession, it’s repetitive, right? You know, it’s over and over and over again. Um again, you would see those in both those conditions, I think where sometimes we will see um uh the difference in experiences come in is that oftentimes with my uh with my neurodivergent clients, there are sort of other things at play as well. So it’s like, you know, OK. yes, there’s, there’s OCD plus this other stuff. So, um sometimes the distress tolerance level is just, you know, a little bit lower and part of that has to do with, you know, um the maybe uh uh some of the executive functioning skills maybe aren’t there to help support that. Um And that would be, have to be a consideration, right, when we’re thinking about the treatment. Because if, if you don’t have kind of that base level of, you know, being able, base level, being able to sort of regulate strong emotions as they come up, then, you know, that might be something we need to kind of lay that foundation for before we, you know, fully jump to OCD treatment. But the other thing that sometimes will differ a little bit is insight level. I think that an insight is essentially when we’re talking about do you know right, that what, what you are experiencing like or, or, or that what you maybe like your compulsion, right. That it doesn’t make sense. Right? Like why you’re having to avoid all the cracks or, you know, something bad is gonna happen to your family? Right. Do you recognize that? That’s not that there’s a logical leap from point A to point B and that it’s not reasonable for you then to avoid all the cracks. Um, so if you have, you know, low to no insight, you know, like I said, that’s when we have to really start uh putting those pieces together and say, like kind of be investigators and put our, our um our uh you know, Sherlock Holmes hats on and try to get to the bottom of it so we can see and make those connections that, oh, you know what, it’s not just this random overwhelming feeling that came up, it is all of this stuff behind it, you know.
FRANCES ( 00:15:03): it’s, you know, I’m listening to you and I love what you’re saying because it’s where I, I’ve been turning lately is that I hate these labels. You know, people talk, like, especially with autism now that it’s the ASD – autism spectrum disorder – that there’s low level and there’s high functioning and that’s not what it is. The brain works differently and you excel at some things and might be lower at other things. And for me, especially because there’s the overlap because there’s overlap with OCD and autism, there’s overlap with ADHD and autism, anxiety comes out in a lot of these situations and it’s kind of let’s, let’s stuff the round person in a square hole, you know, and it just like all of our brains work differently. And why is it because it’s not what somebody defined as normal, considered neurodivergent right now, it’s like our brain works differently. And so for like, what I’m thinking with OCD, like it’s not, I mean, I guess it is a treatment but like, what do you do? Like, how do you help somebody with OCD when it is getting involved in their life to the extent that they’re having functioning difficulties?
HANNAH ( 00:16:16): Yeah. Yeah. Um, that’s a really good question and I mean, the good news is that as far as um, treatments go for, you know, sort of, uh mental health conditions, we have some really good tools in our tool belt. And um that is really good news uh for the number of people who are struggling with it. And, um, I think that, you know, also just, just to sort of validate where some people might be that it often feels pretty hopeless, right? I mean, if you are, you are plagued by intrusive or unwanted thoughts, if you are feeling like you essentially have to go do these things right, in order to just maintain, in order to not even just maintain but like prevent horrible things from happening. Um, it’s exhausting and so I think a lot of times when people come to me, like that’s where they’re at. They’re like, I am done. This is, this is awful. I hate having to follow the rules of OCD. I want to live my own life, right. And, and really tune into it when you’re talking about sort of those different, you know, strengths that people might have. Right. Like, often people have these, you know, these amazing strengths or these interests or these things they would much rather be doing than dealing with OCD. Um And so that’s where the treatment comes in. And so in the world of OCD, the overarching um umbrella of um of, of treatments all falls under the, the sort of cognitive behavioral framework. Now, they may sort of, depending on which one specifically you are using, uh pull from, you know, pull different components from, you know, maybe a third, for example, acceptance and commitment therapy is one of those, one of those approaches that works well with OCD and has a very robust uh uh evidence base behind it. Um And sometimes that’s, it’s considered sort of a third wave of therapy, meaning it came after CVT and is, is different in some significant ways. But also draws from some of the, the fundamental ideas behind it. So acceptance and commitment therapy is one um that was one that really emphasizes um mindfulness and emphasizes uh essentially living life in spite of any feelings, right? You know, or any internal experiences that we might be going, right? They, they, they emphasize moving towards the things that you value rather than listening to whatever noise right is happening in here. Um uh uh Exposure response prevention is also, you know, probably at the top of, of most therapists that, that specifically treat OCD it’s probably like at the top of their list. And I think probably to some extent, almost every therapist sort of will integrate it, right? You know, if they specialize in this area, um which is exactly what it sounds like, right? It’s, it’s, it’s um exposure, meaning we essentially practice it, we purposely maybe put ourselves in situations that are a little bit, you know, are gonna bring up some of that discomfort, bring up some of that anxiety and response prevention, meaning that we practice not doing the compulsion in response. Um And so that is, um like I said to different degrees, people integrate that. And that does as a side note, um that is where it can get really interesting um with some of my neurodivergent clients, right? Because there are, there are specific things that I might work with, um, a neurotypical client on that depending on, you know, um if, if, you know, if the client identifies as, you know, I don’t know, autistic or, or whatever, you know, that, that we might have to, uh, you know, evaluate if that’s the right fit for them, right? Depending on, on their preferences. Um um But exposure and response prevention uh is uh can be a really, really good tool and can be very empowering, right? You know, you’re sort of flipping the narrative on, on OCD a little bit saying like, no, no, no, no, no, I am in charge here. Not you, like I do this.
FRANCES ( 00:21:07): Interesting, it just sounds like like a lot of times people hear a disability or mental illness or something and it’s like everybody’s treated the same. Oh, just give them this medication, give him this type of therapy. But it sounds like for OCD, there’s more than that, there’s different treatments, but it also depends on how the client wants to be, you know, to live with the OCD type.
HANNAH ( 00:21:32): Yeah, you know, I think, I think that that might somewhat uh I would, I would say, you know, I think most folks that specialize in treating OCD, they probably, they’re drawing from ERP (Exposure and Response Prevention), they’re probably, maybe not. There are maybe some very hard liner ERPers out there. Um But there might also be um uh folks that are integrating ACT (Acceptance and Commitment Therapy) more. Um There are also and these are all sort of like theoretical orientations, right? So, so they’re, is even within each of these, like quite a bit of overlap, it’s just a, you know, we’re all going towards the same goal of getting this client back to their life and, and their life on their terms, you know, um, it’s just different ways of getting there. And so, um, you know, there’s also, uh there’s, there’s some, you know, emerging evidence for, um, uh something called inferential based treatment which adds a really strong cognitive component to some of these other approaches that were maybe more behaviorally based. And again, it’s, it’s sort of adding into the mix. Um And, you know, I think that, um there are, there are definitely, there are gonna be certain therapists, right? Who maybe lean more in this direction or who lean more in that direction. I, just based on the work that I do, right? I mean, I see uh individuals with all different kinds of like, you know, uh skill levels and, and, you know, in, in working, um uh just working with the folks that I work with, I just find that I really do have to personalize, you know, that all within the context of like, you know, this is, you know, what we have, what the evidence supports, right? Um But, uh, but I find that, you know, no one person is the same, they’re not gonna, they’re not gonna be the exact same.
FRANCES ( 00:23:41): Yeah, it’s interesting because what you said it perfectly, the way I was thinking is that getting a person back to the way they want to live their life. And I think that’s the individual part, like, it’s not like, oh, you all have to live life like this, it’s how you, as an individual want to live your life and let’s figure out how to make it happen.
HANNAH ( 00:24:02): Yeah. Definitely. Definitely. And I think that’s, that’s been a little bit of, um, a little bit of a shift, you know, maybe in the past, like, 10, 15 years where I think probably 10, 15 years ago you would probably find quite a few more, very hard line ERP, right. And, and, and, and I’m not saying this in a, in a, you know, right when I came out of school that still was kind of, you know, the thing, right. Um, and so I think all of us are kind of growing as we, as we listen and understand that there are, there is more than one way to get to where we’re going. Um, and, and that not every way is going to fit for every person. Yeah.
FRANCES ( 00:24:51): And I know you say you work with kids through adults and it’s got to look very different. Um, like how, like I, I would see adults have more insight of what’s going on. How do you help kids that are having OCD, that it’s impacting like their education, school, home life?
HANNAH ( 00:25:11): Yeah. No, that’s a really good question. Um, and, yeah, I think on some level adults do tend to have a little more insight. Um, not always. Right. Um, everybody, everybody’s different. Um, but, uh, I think one of the things that can be that we might see with kids is it may be that they recognize that there’s something that they don’t like about what’s going on. Right. Um, but like you said, they may not be able to put those pieces together about like why that is. So, so like in younger kids, um, it’s a little more common for us to see things like we’ll see compulsions and you’ll be like, well, what are you worried is gonna happen if you don’t do that? Right. And they’ll sort of be like, hm, you know, or, or like, I don’t know, it get this bad feeling or, you know, it might be a more generalized experience maybe without the very, sometimes there are, right? And this is not to, to, um, to say this is the way for everybody but, uh, it might be a little less concrete, um, in how they’re experiencing it. They may not have a, you know, well, if this, then this, right explicitly,
FRANCES ( 00:26:30): They don’t know the why yet.
HANNAH ( 00:26:33): They, they may not know the why yet. Right. Or, or frankly, they’re just not at a sort of developmental level where their brain has come up with the why yet.
FRANCES ( 00:26:45): Right, the frontal lobe is not fully there.
HANNAH ( 00:26:46): We haven’t, we haven’t gotten there. Um, uh, which in that case, right? We just have to be mindful of that and the why and that in that case is that I don’t like being uncomfortable. Right. I don’t like this feeling. Um, and so it, it can be general, we can, we can keep it kind of general in that sense and still apply what we’re talking about, you know. Um, and, and often there, there’s even this, you know, so there’s that feeling, oftentimes there are even these, um, these thoughts or beliefs around those feelings, like, um, something like, well, if I don’t do this, then this feeling is never going away, right. Which, that is a scary thought, right? Like I wouldn’t want that. Um, yeah. Um, so, so, yeah, it, it, it, um, it can look a little different and as far as applying the concepts, there are certain concepts that I think are really, like, stick really well with kids and there are other ones that it, you just have to have, be a certain, you know, cognitive level to be able to, um understand, right. Um, and so sometimes we have to, to get to some of those other concepts we have to, um, you know, work on that foundation first, you know, like, ok, um, here this is, this is the feeling that I’m feeling and here’s how I know that I’m feeling that feeling because I’m sweaty and because I’m, you know, tense and because I feel like my stomach just dropped out of my butt and, you know, like, like all those, um, those sometimes we have to like start there, you know, as opposed to, you know, sometimes adults will, they’ll be able to say, like, look, I, I am feeling incredibly uncomfortable and anxious and, you know, be able to say exactly why that is
FRANCES ( 00:28:54): right. So, I mean, so the show it’s Stress-Free IEPTM and I’m thinking along the lines, I don’t think OCD would qualify for a disability for an IEP. But it can be like, if a child, if a child qualifies under something else. Are there things that you can think of that the schools can do to help a child that has OCD?
HANNAH ( 00:29:16): Absolutely. Um So one thing that I think is just really important is that um uh when we, especially in some of the acute cases where, you know, the kid is really struggling, um we, we are often hoping to have a team approach, right? Because, because there’s, there’s, it is really hard if say I am seeing somebody like once a week or, you know, 45-50 minutes and, you know, to be able for that person to be able to apply that outside a session. And that’s for an adult, you know, like that is um very hard when it comes to different contexts. So I think, you know, being willing to be part of that team can be really important and I always am encouraging, you know, when I have, uh uh when I have minors right. I’m always encouraging uh parents uh to, to uh sort of integrate me with, you know, any school personnel, right? That might be part of this team. Um You know, I, I, I don’t force people, right? But I always always, I always say, right, that there are definitely benefits to signing a release so that we can talk. Um So, uh so just being willing to come to the table and be part of that team is step number one. You know, you don’t necessarily have to have all of the answers per se, right? Like there, there doesn’t have to be like a, you know, oh, I know exactly what to do in this situation, but that’s where the individual therapist could come in and be very helpful, like specifically with each kid because it can look so incredibly different, you know, with each individual. And so what might be involved in the process is that, you know, sometimes in, over the course of um sometimes in the OCD community, the term ‘accommodations’ can, can kind of be like a dirty word a little bit because you think about that cycle again, right? We’re, we’re trying to not to, we don’t want to support that anymore than it needs to be supported, right? Um And so the uh that being said, and, and this is uh maybe kind of one of my own opinions on this matter is that, that is definitely the case. Um, and if I am, if I uh think that a client needs accommodations, I tend to encourage, at least when we’re talking to the kid, right, that we are framing this as something that’s like kind of a temporary thing, at least with regards to OCD, you know, um, that we’re going to, you know, what, we’re gonna figure out how to, you know, if you’re taking an ERP approach, we’re gonna figure out how to, like, face our fears and, you know, we’re gonna be brave and figure this out with, you know, with Miss Hannah and then we’ll maybe work on it in school, you know, that sort of thing. But we frame it as something where we’re like, oh, maybe we won’t need this in a couple of years. Which can be nice, right? Um uh you know.
FRANCES ( 00:32:42): Which usually I don’t say that with IEPs that like this is not something, but there are certain situations like with executive functioning that yes, you’re gonna always have executive functioning issues, however you can learn how to deal with it and, and, and put your own systems in place that you don’t necessarily need that support anymore.
HANNAH ( 00:33:02): Right. Right. And, and that, that’s not to say that, you know, you, as the parent or the school needs to be like, OK, we’re like, now we’re moving all of these uh in like a formal sense. Right. Because, you know, you never know. Right. Like we have a, you could be dealing with harm OCD over here and then, you know, I don’t know, here come sexually intrusive thoughts coming down the pipeline. Right. You know, and, and then we needed those and it’s good to have them in place. Um, so, so that’s not to say, but I think when we’re, we’re, um, talking about it with, you know, with the kid framing it as something that like, you know, what we are gonna make progress on this, right? And, and all with the hope that, you know, maybe we don’t need them all the time, maybe we don’t, you know, maybe that’s something, so that can be important. Um The other important role for the school is just another set of eyes because with all of the different OCD themes, even though, um, you know, it can be, uh pretty pervasive and that it, it affects, you know, all of these different areas of life. It might affect different areas of your life in different ways, you know. So for example, let’s say you had, um, you know, sexually intrusive thoughts, right? Well, at home that might be something where, um, you know, oh man, I’m really afraid to watch, you know, the TV, because you never know what’s gonna come up and then maybe that will like result in me having a thought that I don’t like and then blah, blah, blah, blah, blah. Um but, you know, at school, maybe it’s a totally different trigger, maybe it’s, you know, I don’t know, uh, something that’s, that’s that we didn’t even see coming. Right. Um, and so that can be really important. Um, and, uh, so that’s why it would be important to have multiple sort of sources that we are gathering information from so that we can.
FRANCES ( 00:35:04): Yeah, it’s, you know, it’s an IEP team, team is the key word in that. And I say that often because people are like, well, I don’t want to bring an attorney because it will look adversarial. And I always tell them it’s like attorneys don’t always have to be adversarial. There are some that, that’s how they come in, but that’s not my style. I come in as an advocate, as a team. Let’s all work together. The focus is the child. Now, don’t get me wrong. I’ll get adversarial when I need to. But they, the start is for the team, you know, the team to work together because if we’re not the skills we’re teaching, like even the skills we’re teaching at school. If outside therapists and service providers don’t know, it’s just the child is like, ok, so I need to behave this way at school and this way with my therapist and service providers and this way at home and it’s not all blended together of one whole person.
HANNAH ( 00:35:58): Yeah, that, that is actually ends up being a huge issue. Especially with OCD because there’s um not, not only can certain forms of therapy be not helpful, they actually can feed the beast, you know, a little bit and, and a lot of times, you know, in like a school setting, for example, you know, you have to uh you know, a lot of the interventions that are in place, you know, you kind of have to, you know, be ready to serve, you know, this person plus this person plus this person, right? And so some of the things are a little more general. The only problem is is that sometimes those specific general things, right, can if we weren’t thoughtful about it or careful about it, turn into a compulsion in and of itself, right? So let’s say, let’s say that, you know, oh, ok. Well, um this person has a, um you know, this kid was taught deep breathing, this has happened number times, taught deep breathing and not that there’s anything wrong with deep breathing, but we want to frame it, you know, the right way. Um that now suddenly they feel like any time they’re anxious, you know, or they have an intrusive thought. Well, now they’ve got to deep breathe like five slow times and if it didn’t feel right, then maybe they gotta do it again, you know, so you can imagine it getting kind of sticky like that. And, you know, I agree, I’ve been in those situations, a number of situations where we’ve, um, met with the school. And I even, I love doing, um, like school observations too because, you know, sometimes, uh, sometimes the teachers got a lot to do. Right. And like, they’re not able to, they’re like, I know something’s going on. I just don’t know what it is. Um, but, you know, the, what I have found in taking that kind of team based approach is that, you know, the, the teacher is able to, uh, you know, uh might be able to share stuff with me that I, I had no idea about, right? You know, that I, I don’t know, for example, in the AP US history exam there are, it’s very writing heavy. Well, that’s important for my client, right? Who, who, you know, every time they see a blank page is just in, you know, avoidance mode, you know. So that’s important and, and likewise, you know, if you have, um, a teacher may or may not know what to do if, say you have a kid with OCD in your class who’s asking repetitive questions over and over and over again. How do you respond to that? You know? Um, and, and in an easy way, right? That’s not gonna be an extensive, you know, uh thing that’s taking all of your time and attention away from the other kids.
FRANCES ( 00:38:55): And that’s discreet, right? Exactly. Yeah. Um Yeah. No, god this has been so fascinating. It’s just, you know, it’s so funny because it’s just, you know, I started doing the show to provide information for parents and for families and I’m learning so much about all of this because, you know, like, yes, I have the education background. I have the special ed. I’ve been the attorney and all that, but it’s just not, I don’t have the psychological side. I don’t have, you know, the service provider side. And I love learning all this so that we can look at our children and help. So, like, what’s the next best step? Like, what can parents do that want more information like how to reach you or what they can do to help their child?
HANNAH ( 00:39:34): Yeah, definitely. Um Well, if, if they would like to reach me, they can do so through my website, which is, you know, https://www.ocd-dc.com/. And there’s a contact form. What did you say? Oh, the link will be on the show? Great. Um So they can reach me there. The other thing to check out is the IOCDF, the International OCD Foundation. They’re kind of the, they’re kind of the preeminent OCD nonprofit. They do a lot of advocacy work, a lot of education around OCD. They have, they host OCD Con every year, which is a thing and very exciting for those of us in this area. Um, and so, um, they have both an in-person one which this year I think it’s in, um, San Francisco. And they also have a virtual one every year. So, even if you can’t attend in person, um, and then they’ll also have certain things like, um, you know, OCD camp for kids. Right. Uh, that’s maybe like, um, a couple hours over the weekend or, you know, so there are a lot of resources there. The other really good thing about the um the IOCDF is that you can find a therapist or you can find a psychologist or you can find a psychiatrist or, you know, that sort of thing through their directory listing which, you know, uh they’re um uh you know, I think if you’re a member, you essentially, you know, get, get a free listing and everything. But um so there, there may be folks on there, you know, who um uh who maybe are, you know, don’t specialize as much, but if you specialize, you almost certainly have an IOCDF directory listing. Um If that makes sense.
FRANCES ( 00:41:33): No, that’s no, it totally makes sense. I get it.
HANNAH ( 00:41:35): And they also have a resource that they launched fairly recently. It’s um uh I think it’s called like Anxiety in the Classroom or something like that. It’s sort of like a sister site that um that talks about anxiety and OCD how it can show up in the classroom. I think they may even have some resources specifically for, for educators or for administrators or parents, you know, all different parties and, you know, that might be part of the team.
FRANCES ( 00:42:02): That is awesome. I love that there’s so much support about it now. You know, because back in my day when I went to school, it was all like, swept under the rug. Like, no, no, no, you don’t want people to know this and now it’s just, there’s international, there’s national groups that you can go and help and it’s so fabulous and so supportive. Um I loved having you on the show. Thank you so much for teaching me, teaching, you know, the audience talking about OCD. This has just been a full day of learning. It’s been awesome. Thank you.
HANNAH ( 00:42:34): Yeah. Thank you so much for having me. I obviously can talk about OCD until, you know, until I uh fall over. So.
FRANCES ( 00:42:42): Oh, and it’s great. It’s all relevant information. Yeah.
HANNAH ( 00:42:46): Yeah. Thanks so much.
VOICEOVER ( 00:42:48): You’ve been listening to Stress-Free IEPTM. With your host Frances Shefter. Remember you do not need to do it all alone. You can reach Frances through ShefterLaw.com where prior episodes are also posted. Thank you for your positive reviews, comments and sharing the show with others through YouTube, LinkedIn, Apple Podcast, Spotify, Google Podcasts, Stitcher and more.
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