Latest / hol+ with Dr. Taz MD | The Future of Medicine is Holistic / Living With OCD: The Hidden Cycle, Family Accommodation, and How to Break Free with Melissa Mose, LMFT
Transcript
- [00:00:00] Dr. Taz: Okay. Real talk. I get the best dms from you guys after each [00:00:05] episode. So before we start, if you've been listening and you're thinking, that's [00:00:10] me, go ahead and send me a quick message on Instagram at Dr. Taaz md. [00:00:15] I love hearing what resonates, what you're struggling with and what you want more of. [00:00:20] That's how whole plus stays real in the conversation. [00:00:22] Dr. Taz: And it's not just a lecture. Let's [00:00:25] jump in. [00:00:25] Melissa Mose, LMFT: Does OCD go undiagnosed for long periods of time in both kids and adults? [00:00:30] That's the sad part. The, the statistic for a while was 11 to 17 years was the [00:00:35] average. [00:00:35] Dr. Taz: Oh my [00:00:35] Melissa Mose, LMFT: gosh. And in about the last 10 years, that's improved. But it's [00:00:40] still like on the 11 year end of things because it masquerades. [00:00:43] Melissa Mose, LMFT: Yeah. And anybody who [00:00:45] works with OCD has clients who have come. To us after [00:00:50] decades of being in therapy that didn't work. [00:00:52] Dr. Taz: Wow. When one person in a [00:00:55] family struggles with OCD, everyone feels the ripple effects, the [00:01:00] anxiety, the routines, the endless reassurance loops that quietly take over their [00:01:05] daily life. [00:01:05] Dr. Taz: My guest today, Melissa mos, LMFT, is a therapist, educator and [00:01:10] author of the book, internal Family Systems Therapy for OCDA. [00:01:15] Clinician's Guide. In it, she integrates the compassionate parts based lens of Internal Family [00:01:20] Systems with the proven science of exposure and response prevention to [00:01:25] create a more rational relational healing approach to OCD treatment. [00:01:29] Melissa Mose, LMFT: So [00:01:30] talk therapy, you can sit and just do reassurance with your client for years [00:01:34] Dr. Taz: and it goes [00:01:35] nowhere. [00:01:35] Melissa Mose, LMFT: Yeah. And they really like you and you really do make you know [00:01:38] Dr. Taz: good connection. [00:01:39] Melissa Mose, LMFT: Yeah. Right, right. It feels [00:01:40] better when they feel better when they leave. But it's a compulsion and it's repetitive and nothing moves, [00:01:44] Dr. Taz: [00:01:45] right? [00:01:45] Dr. Taz: So we are subconsciously doing things to accommodate to the people within [00:01:50] our family that may have OCD. Is that a good thing or a bad thing? [00:01:53] Melissa Mose, LMFT: With OCD? It's a [00:01:55] negative feedback loop, meaning, yeah, the compulsion works, [00:02:00] right, calms everything down in the short term. But what it does is it [00:02:05] makes it more likely for there to be the similar obsession and need in the future. [00:02:09] Melissa Mose, LMFT: So the brain [00:02:10] says, Hey, that worked. Let's do that again. And the, the ritual happens again, or [00:02:15] the question happens again. And so every time we do a compulsion for our [00:02:20] family member, we're making their OCD worse, right? So in that sense, [00:02:25] it's not good. [00:02:26] Dr. Taz: Melissa's work shows that recovery isn't just about symptom [00:02:30] reduction. [00:02:30] Dr. Taz: It's about building new relationships, both with our loved ones and with the parts of [00:02:35] ourselves that try to protect us from fear and uncertainty. Please join me in [00:02:40] welcoming Melissa to the show. Melissa, I'm so glad that you're here today. I have spent [00:02:45] a lot of time in practice. We have a pretty big team at Whole Plus as well. [00:02:48] Dr. Taz: We see all kinds of [00:02:50] patients with all kinds of different diagnoses, but I think the key is that we do see the whole [00:02:55] family and one of the things that I am. Personally very passionate about, and I would say my [00:03:00] team is as well, is that we have understood that healing happens within families and [00:03:05] family systems. [00:03:05] Dr. Taz: And we could do these beautiful treatment plans for, you know, the [00:03:10] mom or a child or even the dad. But if it's not integrated within the [00:03:15] family, the results and the success are only so much. So I know you spent a lot of time looking at [00:03:20] internal family systems, so I, I would love to hear how you, you know, have [00:03:25] stumbled upon that, how you feel about that, you know, and kind of how that fits [00:03:30] into really what's your area of expertise, which is OCD or Obsessive compulsive [00:03:35] disorder. [00:03:35] Dr. Taz: And we definitely wanna spend some time talking about that as well. 'cause we see that, I almost feel like that's on the [00:03:40] rise, but we can get into that in just a second. But talk about the family, the family dynamic. What does it [00:03:45] mean to have an internal family system of healing and your work in that space?[00:03:50] [00:03:50] Melissa Mose, LMFT: Okay, great. Well, thank you so much for having me because it's a near and dear to my heart [00:03:55] topic as well. Um, my 30 years of being a therapist has, has [00:04:00] taken wildly different courses at various different times. I started out sort of [00:04:05] more psychodynamic, but my training was all in family systems. So my very first [00:04:10] internship, my very first 15 years really of being a clinician [00:04:15] was working with teens and families. [00:04:17] Melissa Mose, LMFT: So we'd commonly have that [00:04:20] feeling of, of doing great deep work in session. Kid goes home, [00:04:25] the normal dynamics happen at home, and things, things just fall apart. [00:04:29] Dr. Taz: Right. [00:04:29] Melissa Mose, LMFT: [00:04:30] So, uh, Richard Schwartz, who was the developer of Internal Family [00:04:35] Systems, uh, was a regular family systems therapist. [00:04:39] Dr. Taz: Okay. [00:04:39] Melissa Mose, LMFT: And so [00:04:40] his training was all in systems dynamics and so he, [00:04:45] he. [00:04:45] Melissa Mose, LMFT: When he began to listen to his clients in a different way and understand about [00:04:50] multiplicity, which is normal. And, and he really created a [00:04:55] beautiful system for kind of understanding the internal landscape, internal [00:05:00] conflict, uh, in very common language that people can understand. [00:05:05] So, um, what he brought, and I'll get to that in a minute, but what he brought to it was [00:05:10] his family systems experience. [00:05:11] Melissa Mose, LMFT: Mm-hmm. Where if somebody's dominating the conversation in the [00:05:15] room [00:05:15] Dr. Taz: right, [00:05:16] Melissa Mose, LMFT: and the child isn't getting to speak, you might ask that [00:05:20] person to go wait in the waiting room. So when he began working with [00:05:25] parts on the inside of a person, he tried it and he said. Do you see? [00:05:30] Do you think that really loud, critical part of, you could maybe just go wait on the side for a [00:05:35] minute and to his surprise it worked. [00:05:38] Melissa Mose, LMFT: So, [00:05:40] um, the two pieces that are really important is that we see the inner [00:05:45] landscape as a multiplicity, and it's really intuitive because we [00:05:50] all know the experience of part of me wants to go work out and part of me [00:05:55] wants to sit on the couch. Right? [00:05:56] Dr. Taz: Right. [00:05:56] Melissa Mose, LMFT: Or I'm so mean to myself. People [00:06:00] say that all the time. [00:06:00] Dr. Taz: Yeah. [00:06:01] Melissa Mose, LMFT: So who's the I and who's the myself. Right. [00:06:05] Already we're at a multiplicity. Uh, it works really well with OCD where [00:06:10] people are constantly saying, my brain's telling me to do this, but I know I don't have to. Or, [00:06:15] you know, we call it the bully in your brain. So, um. [00:06:20] After I switched my career and began working in OCD entirely. [00:06:24] Melissa Mose, LMFT: So [00:06:25] the last 15 years I've specialized in that. Um, the training [00:06:30] was fabulous. I learned amazing treatment modalities, [00:06:35] um, and, and the OCD community very well aware of the role of family accommodation, which I'm sure we'll get to, [00:06:40] but [00:06:40] Dr. Taz: Right. [00:06:40] Melissa Mose, LMFT: Um, IFS wasn't, is not a part of that [00:06:45] landscape. Right. They're, they know what works and they have gold standard treatments and [00:06:50] that's what you do. [00:06:51] Melissa Mose, LMFT: But because I've spent so much time as a clinician before [00:06:55] specializing, you know, you go in the room, you bring your whole self. And all [00:07:00] your tools and I found myself using not just my family systems [00:07:05] experience, but the internal family systems training that I had. [00:07:09] Dr. Taz: So is in, so [00:07:10] for somebody like me who's not familiar mm-hmm. [00:07:11] Dr. Taz: With any of this, so is Internal Family Systems, is it more about you, the [00:07:15] individual and everything inside your landscape? Mm-hmm. Meaning your thoughts, [00:07:20] your feelings, you know, your different emotions and learning to separate that [00:07:25] out? Or does it also apply to the external family, like who you're living with and things [00:07:30] like that? [00:07:30] Melissa Mose, LMFT: Yeah. There, there's an awareness of internal and external, right? The [00:07:35] external constraints, um, are important, but primarily what [00:07:40] Internal Family Systems is focused on is the parts of you and how they interact, [00:07:45] how they blend, meaning take you over, uh, how [00:07:50] they step back constantly throughout a day. [00:07:52] Dr. Taz: Mm-hmm. [00:07:53] Melissa Mose, LMFT: Uh. And that's [00:07:55] how we interact with the world. It's not that parts aren't bad and they're, you don't wanna get rid of even [00:08:00] bad parts. [00:08:00] Dr. Taz: Right. [00:08:01] Melissa Mose, LMFT: Dick Schwartz is known for saying there are no bad parts. It has a good [00:08:05] intention. It's going about it in a way that's rather extreme. So it's about shifting your [00:08:10] awareness inside and becoming aware of various different parts of you that are [00:08:15] like states of mind that are familiar. [00:08:18] Melissa Mose, LMFT: Right. Like a [00:08:20] people pleasing pattern. [00:08:21] Dr. Taz: Mm-hmm. [00:08:21] Melissa Mose, LMFT: Um, thoughts and feelings show up as parts too. [00:08:25] Um, not always, you know, images or urges. Anything you can [00:08:30] experience on the inside that kind of drives what you do. [00:08:33] Dr. Taz: Mm-hmm. [00:08:34] Melissa Mose, LMFT: Um, [00:08:35] is, is sort of one form of consciousness that we call parts. [00:08:40] [00:08:40] Dr. Taz: Gotcha. [00:08:41] Melissa Mose, LMFT: There's also a self, and self [00:08:45] is really what's there when parts aren't taking over. [00:08:48] Melissa Mose, LMFT: Right. It's just your awareness. [00:08:50] It's the you who can be aware that you have parts. And that's [00:08:55] an important state of mind or or place to be able to access because [00:09:00] that's where healing happens. That's where we can be open and curious and not [00:09:05] judge and push away and struggle with our parts. [00:09:07] Dr. Taz: Gotcha. [00:09:08] Melissa Mose, LMFT: So there are [00:09:10] parts that have categories. [00:09:12] Melissa Mose, LMFT: They typically function in certain ways that [00:09:15] are. You know, useful, not useful. They get into [00:09:20] struggles, they polarize, they, um, have alliances, team up [00:09:25] together, you know, certain parts. Pinch hit for one another, you know, a lot [00:09:29] Dr. Taz: [00:09:30] going on. [00:09:30] Melissa Mose, LMFT: Yeah. In the human [00:09:30] Dr. Taz: body. [00:09:31] Melissa Mose, LMFT: Exactly. So it's like a whole family. It really, they do operate really just like a [00:09:35] family system inside. [00:09:35] Melissa Mose, LMFT: So, [00:09:36] Dr. Taz: so you were talking about the, your internal landscape and how, [00:09:40] how you have different things probably at different times that act as the parent or the [00:09:45] child mm-hmm. Or the friend or the bully or Yeah. You know, the motivator [00:09:50] or the cheerleader, but they're all within us. Yeah. Essentially at the end of, at the end of the day, [00:09:55] when we think about OCD, okay. [00:09:56] Dr. Taz: Mm-hmm. Obsessive compulsive disorder, which we know affects [00:10:00] children and we know affects adolescents. Mm-hmm. And definitely affects adults too. [00:10:05] What do we not understand about it? When we see maybe something on TV or in a [00:10:10] movie or things like that. Like what, what is OCD? How do you truly define it [00:10:15] and what's maybe the biggest misconception around it? [00:10:18] Melissa Mose, LMFT: Right. So the biggest [00:10:20] misconception, I think, is that it, it stops at wash and check the familiar [00:10:25] kinds of O-C-D-O-C-D is actually very complex and it can [00:10:30] attach to pretty much anything. Um, and it can be very subtle. So, [00:10:35] um, hoping to raise some awareness about that so people recognize it sooner, [00:10:38] Dr. Taz: right? [00:10:39] Melissa Mose, LMFT: Um, but, [00:10:40] but what it really is, is it's a combination of obsessions and [00:10:45] compulsions. [00:10:45] Melissa Mose, LMFT: No big surprise there, [00:10:46] Dr. Taz: right? [00:10:47] Melissa Mose, LMFT: They operate in a loop where [00:10:50] obsessions stir up things, right? They sound the alarm, they alert the [00:10:55] system. Um, they, their function is to make sure [00:11:00] nothing bad happens, but the, their method is sound, the alarm scan for [00:11:05] data. Compare things, make sure you're on guard. So there's the, the one side that's a really [00:11:10] alerting energy and then compulsions come in and fix it. [00:11:14] Melissa Mose, LMFT: And [00:11:15] so compulsions can be the normal rituals that we see. Uh, this is [00:11:19] Dr. Taz: where [00:11:20] the hand washing, [00:11:21] Melissa Mose, LMFT: hand [00:11:21] Dr. Taz: stereotype, the door checking, that's [00:11:24] Melissa Mose, LMFT: the stereotype. Flipping [00:11:25] switches going in and out rooms, right? [00:11:26] Dr. Taz: Yeah. [00:11:26] Melissa Mose, LMFT: Anything physical we're a little more familiar [00:11:30] with because we can see it. But they're also mental rituals where people will [00:11:35] review conversations over in their head or if they say something that's [00:11:40] feels bad or off, they'll unsay it or they'll repeat things over and [00:11:45] over. [00:11:45] Melissa Mose, LMFT: They'll try and have a good thought and get rid of a bad thought. There's all mental [00:11:50] rituals are happening all the time for people and it's, uh, that can be a real struggle. [00:11:55] Um. Reassurance Seeking is the one that really involves the family [00:12:00] because it's, it involves the family members in doing compulsions with and [00:12:05] for the person with OCD. [00:12:07] Melissa Mose, LMFT: So it might be asking a question [00:12:10] over and over and over again for hours on the extreme end. [00:12:13] Dr. Taz: Mm-hmm. [00:12:14] Melissa Mose, LMFT: Um, [00:12:15] sometimes it's, um, more subtle, like it's a statement or a confession. Oh, I [00:12:20] was really mad at so and so today. I, I had this thought, I wish, you know, [00:12:25] whatever and to see if mom reacts in the car. Right. And if mom doesn't [00:12:30] get all upset, then I feel better. [00:12:32] Melissa Mose, LMFT: So there's subtle ways to get reassurance. [00:12:35] Um, and [00:12:36] Dr. Taz: so when they're making, so when somebody in your family's making these statements or has these [00:12:40] habits that they're doing over and over again [00:12:42] Melissa Mose, LMFT: mm-hmm. [00:12:43] Dr. Taz: Correction is not the first. [00:12:45] Thing to do. Right. Right. It's more reassurance is the first thing to do, is what I'm [00:12:50] hearing you say. [00:12:50] Melissa Mose, LMFT: Well, naturally we reassure. [00:12:52] Dr. Taz: Mm-hmm. [00:12:53] Melissa Mose, LMFT: Right. Naturally. [00:12:55] Um, whether it's, um, avoidance, which is another kind of compulsion, actually just [00:13:00] stay out of it mm-hmm. Out of anything that's gonna stir stuff up. But as, as family members. [00:13:05] We know if we're at all attuned, we know when somebody's agitated or [00:13:10] upset, [00:13:10] Dr. Taz: right? [00:13:11] Melissa Mose, LMFT: And as parents, of course, we want to help our children, [00:13:14] Dr. Taz: right? [00:13:14] Melissa Mose, LMFT: [00:13:15] We want to make sure they, you know, feel good and can function. [00:13:20] And so we tend to be reassuring, and that's not a bad thing. I want it [00:13:25] being re being a reassuring presence is not a bad thing. Answering a question for the [00:13:30] sake of giving information is not a bad thing. [00:13:32] Melissa Mose, LMFT: But when somebody already has the [00:13:35] information and they're asking you just to reassure them, [00:13:38] Dr. Taz: mm, [00:13:39] Melissa Mose, LMFT: this is okay, [00:13:40] right? Yes. Okay. You know, these kinds of questions or questions that don't have any [00:13:45] answers, like, you know. Safety questions or is there gonna be an earthquake? [00:13:49] Dr. Taz: [00:13:50] Right. [00:13:50] Melissa Mose, LMFT: Right, [00:13:50] Dr. Taz: right. [00:13:50] Melissa Mose, LMFT: And, and as parents, you know, it's bedtime, of course you're gonna say like, [00:13:55] no, there's not gonna be an earthquake. [00:13:56] Melissa Mose, LMFT: Right. Well, we don't really know that. So it's, it's questions that [00:14:00] are repetitive and they're not about getting the information. [00:14:04] Dr. Taz: How does a [00:14:05] parent or a partner become a part of this sort of OCD cycle in maybe [00:14:10] a non-productive way Right. Without realizing it? Like, what, what's happening there? [00:14:14] Melissa Mose, LMFT: Well, [00:14:15] it's, it's so natural and I wanna say that, you know, even as a mental health [00:14:20] professional [00:14:20] Dr. Taz: mm-hmm. [00:14:20] Melissa Mose, LMFT: Right? I did everything quote unquote wrong at first when I really [00:14:25] didn't know what was going on with my daughter because. You know, sometimes there's more than [00:14:30] one kid or everybody has to get out the door, [00:14:32] Dr. Taz: right? [00:14:32] Melissa Mose, LMFT: And, and so you wanna smooth things over. [00:14:35] And so sometimes a, a question will come up, or, [00:14:40] um, it's just easier if I open the door for her, right? [00:14:44] Melissa Mose, LMFT: Or it's [00:14:45] just easier if I answer the question or, um, she, I know how [00:14:50] agitated she gets, right? So it might be simple things like I, I learn through [00:14:55] experience that everything's smoother. If I don't bring up this topic, I learn through [00:15:00] experience. It's better if I leave the house late last, so nobody feels like [00:15:05] responsible for leaving the stove on or right. [00:15:07] Melissa Mose, LMFT: Nobody wants to go back in and check. Um, we just [00:15:10] naturally learn how to make things go smoothly. And when that happens [00:15:15] and you start to notice, you're doing it over and over, you start to notice there are things that you're [00:15:20] doing for your child. That you wouldn't do for your other child, for instance. [00:15:24] Melissa Mose, LMFT: Right. Or your [00:15:25] partner, um, that you wouldn't wanna do. Right. You might be, [00:15:30] but you're just doing it to prevent or to reduce anxiety. That's an, [00:15:35] that's an accommodation. [00:15:36] Dr. Taz: Gotcha.[00:15:40] [00:15:45] [00:15:50] [00:15:50] Melissa Mose, LMFT: Well, it's a complicated question. I mean, it's bad for OCD, right? Right. [00:15:55] Because with OCD it's a negative feedback loop. [00:15:58] Dr. Taz: Ah, meaning, yeah. [00:15:59] Melissa Mose, LMFT: The [00:16:00] compulsion works, right. Calms everything down. In the short [00:16:05] term, but what it does is it makes it more likely for there to be the similar [00:16:10] obsession and need in the future. [00:16:11] Melissa Mose, LMFT: So the brain says, Hey, that worked. Let's do that again. [00:16:15] And the, the ritual happens again, or the question happens again. And so every [00:16:20] time we do a compulsion for our family member, we're making their OCD worse. [00:16:25] Right? So in that sense, it's not good. Right? It, there are really high [00:16:30] correlations between high accommodation and low treatment. [00:16:33] Melissa Mose, LMFT: You know, we're poor [00:16:35] treatment gains. So it does make OCD worse. Now, I wanna say to parents, [00:16:40] it doesn't mean it's your fault, right? Right. We're doing the best that we can, but what we do [00:16:45] matters. There are programs that actually treat just the parents and [00:16:50] the kid with OCD gets better. I've done it any number of times. [00:16:53] Dr. Taz: Mm. [00:16:54] Melissa Mose, LMFT: Because we [00:16:55] can just by changing our own behavior. Not reinforce [00:17:00] patterns that make a, make a big difference. So, [00:17:01] Dr. Taz: so what are you noticing? Like what, what are three [00:17:05] things for parents listening or even partners listening mm-hmm. That three [00:17:10] accommodations we may be doing within our home [00:17:13] Melissa Mose, LMFT: mm-hmm. [00:17:13] Dr. Taz: That we don't even realize we're [00:17:15] doing. [00:17:15] Dr. Taz: I don't know if there's like tactical examples you can give and I would, I would do both for a [00:17:20] parent and for a partner too. Yeah. Because I know there are partners with OCD, [00:17:25] you know, and that can be a dynamic as well, you know? [00:17:29] Melissa Mose, LMFT: [00:17:30] Right. But, right. Yeah. So with, with kids, uh, it, it is [00:17:35] oftentimes question answering over and over. [00:17:37] Melissa Mose, LMFT: Um. Serving [00:17:40] this particular food on that particular dish to avoid the temper tantrum, uh, laying [00:17:45] clothes out in a certain way. [00:17:46] Dr. Taz: Mm. [00:17:47] Melissa Mose, LMFT: Uh, washing extra loads of laundry, [00:17:50] uh, sneaks up on you. Right, right. You don't realize, like, why are all these like things in the, [00:17:55] in the laundry basket? Well, [00:17:56] Dr. Taz: right. [00:17:57] Melissa Mose, LMFT: Um, they've been removed and put on the floor and then they can't [00:18:00] be worn until it just, that sense of urgency is kind of a tip off. [00:18:04] Melissa Mose, LMFT: But for [00:18:05] kids, it might be particular foods, it might be clothing items, [00:18:10] might be that they, um, I have to wash my hands [00:18:15] before I touch your stuff. You know, those kinds of things. Uh, [00:18:20] so I'm trying to give examples of both the. The sort of the reassurance ones and the ones [00:18:25] where it's outright, outright rituals, [00:18:27] Dr. Taz: right. [00:18:27] Melissa Mose, LMFT: Participating, buying more soap [00:18:29] Dr. Taz: Mm. [00:18:29] Melissa Mose, LMFT: [00:18:30] You know, keeps running out. You, you don't even even know it at first. Right. It's like, why, why are they using so much [00:18:35] soap? [00:18:35] Dr. Taz: Right. [00:18:35] Melissa Mose, LMFT: Yeah. And then you realize, okay, I'm, I'm funding their OCD. [00:18:39] Dr. Taz: Gotcha. [00:18:39] Melissa Mose, LMFT: [00:18:40] Right. Okay. Um, opening cabinets for people. So with, with partners, I've seen it [00:18:45] end up being, well, there are certain people I just, we don't have over, we can't [00:18:50] entertain or, or we don't entertain at all. [00:18:51] Dr. Taz: It's making [00:18:52] Melissa Mose, LMFT: accommodations [00:18:52] Dr. Taz: for them. [00:18:53] Melissa Mose, LMFT: Yeah. Because it's such [00:18:55] a disruption to the, the world and the way everything has to be. Or, well, when [00:19:00] I turn off the TV, I know that to put the remote in the right place, or I get up and put the [00:19:05] pillows back. Um, or sometimes, um, you know, [00:19:10] spouses might. Work less, and so people accommodate by working more.[00:19:15] [00:19:15] Melissa Mose, LMFT: Or one partner, uh, has to be the one responsible for giving [00:19:20] medication to the children because it's too triggering for the other one. Wow. [00:19:23] Dr. Taz: Yeah. [00:19:23] Melissa Mose, LMFT: Yeah. [00:19:23] Dr. Taz: Are, are [00:19:25] there ways, well, first of all, let me ask one question. Does OCD go undiagnosed for long periods of [00:19:30] time? Yes. In both kids and adults. [00:19:31] Melissa Mose, LMFT: That's the sad part. [00:19:32] Melissa Mose, LMFT: Yeah. I, I, yeah. It, the, the [00:19:35] statistic for a while was 11 to 17 years was the average. [00:19:38] Dr. Taz: Oh my [00:19:38] Melissa Mose, LMFT: gosh. [00:19:40] Yeah. And in about the last 10 years, that's improved, but it's still like on the 11 year end [00:19:45] of things because it, it masquerades. Yeah. Anybody who works with OCD has [00:19:50] clients who have come to us after decades of being [00:19:55] in therapy. [00:19:55] Melissa Mose, LMFT: That didn't work. [00:19:56] Dr. Taz: Wow. [00:19:57] Melissa Mose, LMFT: So, talk therapy, you can [00:20:00] sit and just do reassurance with your client for years and [00:20:02] Dr. Taz: it goes nowhere. [00:20:03] Melissa Mose, LMFT: Yeah. And they really like you and [00:20:05] you really do make, you know, [00:20:06] Dr. Taz: a good connection. [00:20:07] Melissa Mose, LMFT: Yeah. It feels better when they feel better when they leave, [00:20:10] but it's a compulsion and it's repetitive and nothing moves. [00:20:13] Dr. Taz: Right. What [00:20:15] then, you know, I'm thinking again about the family and about relationships. You [00:20:20] know, how can somebody, you know. Like, have a quick [00:20:25] checklist of like, oh my gosh, you have OCD, or I think you have OCD. [00:20:30] Mm-hmm. And let's go try to get some help, you know, rather than being like, okay, [00:20:35] let's, let's make this this way. [00:20:36] Dr. Taz: Mm-hmm. So and so doesn't get upset or mm-hmm. Let me change, you know, [00:20:40] my behavior or what I wanna do so that this person's happy. You know? What's, is [00:20:45] there a, like a quick, like warning signs, triggers, checklist that a, a parent or [00:20:50] a partner could have in their mind to be like, ah, [00:20:53] Melissa Mose, LMFT: mm-hmm. [00:20:53] Dr. Taz: I see what's [00:20:55] really going on here. [00:20:55] Melissa Mose, LMFT: Right, right. Well, noticing when things start to take longer than they [00:21:00] used to, or they should, you know, showers are longer, homework takes forever. Getting [00:21:05] dressed is something, so you, you might find yourself, uh, noticing that we're late more of the [00:21:10] time. [00:21:10] Dr. Taz: Mm-hmm. [00:21:10] Melissa Mose, LMFT: Um. It's also, um, rigidity. [00:21:15] [00:21:15] Dr. Taz: Hmm. [00:21:15] Melissa Mose, LMFT: Uh, and, you know, not that this masque, this can masquerade, this can be multiple different [00:21:20] things, but you know, it has to be this way, can't be that way. [00:21:23] Melissa Mose, LMFT: And so lots of [00:21:25] agitation or keeping things separate, not wanting school things, [00:21:30] uh, in the bedroom, you know, those, those kinds of things that they look a little odd or they don't seem [00:21:35] connected with anything logical. Um, but you also see repetitive [00:21:40] things. You'll, you'll notice, um, behaviors are going in and out of doors, little signs [00:21:45] like that. [00:21:45] Melissa Mose, LMFT: And if it's in, you know, starting to get bigger, that's when, [00:21:50] when to pay attention. But mainly, I would say to, to really try and find the [00:21:55] curiosity so that it's, you know, it can be very frustrating, [00:21:58] Dr. Taz: right? [00:21:59] Melissa Mose, LMFT: To be [00:22:00] waiting for somebody who is taking their socks off and putting them back on again, or getting [00:22:05] totally undressed so that they could put the clothes on the right way. [00:22:07] Dr. Taz: Right. [00:22:07] Melissa Mose, LMFT: And, you know, those kinds of [00:22:10] things. They don't wanna be doing either. And I hear it sadly, [00:22:15] called manipulation. You know, they, they, they just, they're just manipulating you because [00:22:20] they want, they don't wanna go to school or, and, and it's really not, [00:22:25] OCD is agonizing for the person who's experiencing it. [00:22:28] Melissa Mose, LMFT: So when we [00:22:30] can, as, as the family member, just try and lead with some [00:22:35] curiosity, like, what's going on for you and, and how, you know, like, [00:22:40] can we just like explore it? Like, tell me more. [00:22:42] Dr. Taz: Right. [00:22:42] Melissa Mose, LMFT: You know, I think is really important because a [00:22:45] lot of OCD has to do with thoughts that are taboo, they're [00:22:50] intrusive and they're horrifying. [00:22:51] Dr. Taz: Mm. [00:22:52] Melissa Mose, LMFT: And this is the type of OCD we don't see. [00:22:55] So you might, this is another one. It might appear that your [00:23:00] family member is just sort of spacing out and, and like tuning out. [00:23:04] Dr. Taz: Yeah. [00:23:05] [00:23:05] Melissa Mose, LMFT: And. Because they may be trying to undo a thought that popped into their head that was really [00:23:10] atrocious. Right? [00:23:10] Dr. Taz: Like [00:23:10] Melissa Mose, LMFT: a lot of people will get really violent images or really inappropriate [00:23:15] sexual images, and they, they're terrifying because they don't know it's OCD.[00:23:20] [00:23:20] Melissa Mose, LMFT: So real gentleness and, and just noticing [00:23:25] lots of time in the head, um, [00:23:27] Dr. Taz: is a sign, [00:23:28] Melissa Mose, LMFT: is a sign. [00:23:28] Dr. Taz: Interesting. [00:23:30] What is the current standard of treatment for OCD, whether again, kid or [00:23:35] adult, like what, what's sort of established as like, you know, how do you, okay, let's say you're [00:23:40] suspicious of it. You think you might have it or somebody that you love has it, what's the, [00:23:45] what's standard treatment? [00:23:46] Melissa Mose, LMFT: Yeah. It, it, and this is important because for, for [00:23:50] decades ever, well, until about 40 years ago, I think OCD was considered untreatable. [00:23:54] Dr. Taz: [00:23:55] Really? [00:23:55] Melissa Mose, LMFT: Yeah. [00:23:56] Dr. Taz: Wow. It was [00:23:57] Melissa Mose, LMFT: the, it was people were, that's just your [00:23:58] Dr. Taz: personality. [00:24:00] [00:24:00] Melissa Mose, LMFT: Yeah. It's psychotic. Even people were put in institutions and just sort of left because [00:24:05] nobody could, could help. [00:24:06] Melissa Mose, LMFT: So it's really important that the thing that helped, the [00:24:10] very first treatment that helped was exposure and response prevention therapy. [00:24:14] Dr. Taz: Mm-hmm. [00:24:14] Melissa Mose, LMFT: So [00:24:15] exposure, um, was being done in the way of like, [00:24:20] habituation, you know, like Pavlov dogs. Right. And, you know, like we all, we all sort of [00:24:25] settle down. Our nervous system settles down for a while. [00:24:27] Melissa Mose, LMFT: But the, the important critical [00:24:30] element was the response prevention or the ritual prevention. So if you expose [00:24:35] the client or the person to the scary thing, touch the doorknob to be [00:24:40] like, you know, [00:24:40] Dr. Taz: right. [00:24:41] Melissa Mose, LMFT: Easy example. And then you don't allow them, [00:24:45] or they choose. 'cause it's always gotta be willing, uh, they choose not to wash. [00:24:49] Dr. Taz: Mm-hmm. [00:24:50] [00:24:50] Melissa Mose, LMFT: What will happen is just like if you walk in a dark room. Your eyes adjust. [00:24:55] Right? Or you walk in a house that smells funny, you know, you get used to it [00:25:00] in the very same way. Anxiety will go down on its own eventually. [00:25:05] And by having that experience of anxiety going down, the brain learns [00:25:10] something new. [00:25:10] Melissa Mose, LMFT: Like, I can tolerate this, I can be with it, and it [00:25:15] won't be, it won't last forever and ruin my day. [00:25:18] Dr. Taz: Gotcha. [00:25:19] Melissa Mose, LMFT: So unless they [00:25:20] have that experience, the, the reinforcement of the compulsion is just too powerful. [00:25:25] So exposure and response prevention is really important and really works. And, [00:25:30] um, I'm a big fan. I used ERP. [00:25:33] Melissa Mose, LMFT: There are other [00:25:35] methods out there now that are more cognitive therapy. [00:25:38] Dr. Taz: Mm-hmm. Like CBT, like [00:25:40] cognitive behavioral therapy. [00:25:40] Melissa Mose, LMFT: Yeah. Like infra. And there's inference based. CBT is sort of another way of looking [00:25:45] at it, but, but really nothing has the research. That ERP [00:25:50] has and the true gold standard is ERP plus medication. [00:25:54] Dr. Taz: So exposure [00:25:55] response therapy. Yeah. Plus medication. [00:25:56] Melissa Mose, LMFT: That's right. [00:25:57] Dr. Taz: And what medications? [00:25:59] Melissa Mose, LMFT: Typically [00:26:00] it's an SSRI, it's a, it's a Zoloft, or, you know, one of those types of [00:26:05] medi medications that help and, um, and, and they really do, they really work. [00:26:10] And it's different for every person. Right. Right. I think a lot of people don't wanna go that route until it gets [00:26:15] more extreme. [00:26:15] Melissa Mose, LMFT: But, you know, OCD, and this is another thing, people don't always know [00:26:20] OCD can be disabling. [00:26:21] Dr. Taz: Mm-hmm. [00:26:21] Melissa Mose, LMFT: You know, people don't leave the house, people don't shower, [00:26:25] people, you know, don't eat food, um, or wipe until they bleed. [00:26:29] Dr. Taz: [00:26:30] Right. [00:26:30] Melissa Mose, LMFT: It's really excruciating. And it, it can really ruin a life. [00:26:34] Dr. Taz: So the [00:26:35] combination, so I'm curious, what does the research say about medication alone with an ssri [00:26:39] Melissa Mose, LMFT: [00:26:40] mm-hmm. [00:26:40] Dr. Taz: Versus the exposure response therapy alone? Mm-hmm. Versus both together. Is there. [00:26:45] [00:26:45] Melissa Mose, LMFT: Yeah, there's [00:26:45] Dr. Taz: some data on all of [00:26:46] Melissa Mose, LMFT: that there. There's data. I don't think I have the numbers in my head. Yeah. But you know, [00:26:50] yes. There's data that, and it, and it depends on the person. If you have somebody who's responding well to [00:26:55] SSRIs, that may be all they need. [00:26:58] Melissa Mose, LMFT: They have a pretty mild form of [00:27:00] OCD and it seems to get better enough that they're functioning and that's all they wanna do. [00:27:05] Um, vice versa, some people don't wanna do medication 'cause that [00:27:10] just has a certain resonance for them. Right. Or, um, and so they just do [00:27:15] ERP and it may be harder for them. Right. [00:27:17] Melissa Mose, LMFT: Because part of what the medication combination [00:27:20] does is make it a little easier to lean into the tough work. [00:27:23] Dr. Taz: Mm. [00:27:23] Melissa Mose, LMFT: To lean into having the [00:27:25] difficult experience. Gotcha. [00:27:26] Dr. Taz: Yeah. [00:27:26] Melissa Mose, LMFT: And then ideally, I, I think ideally you can [00:27:30] then stop the medication, but some people are like, I wanna do this without that. And they [00:27:35] try and it's effective. [00:27:37] Melissa Mose, LMFT: And then, you know, for those, it, it [00:27:40] combine, it, it, it definitely works better [00:27:42] Dr. Taz: if it's combined. [00:27:43] Melissa Mose, LMFT: If it's combined. [00:27:43] Dr. Taz: And what's the [00:27:45] treatment course like? Is this something they have to do for a year, for 90 days? Like, [00:27:50] or is it variable? [00:27:51] Melissa Mose, LMFT: Yeah, it, it is variable, but, but people who, who really work in [00:27:55] the OCD clinics really feel like there shouldn't be anything that can't, you can't make a big [00:28:00] difference in a few months. [00:28:01] Dr. Taz: A few months. [00:28:01] Melissa Mose, LMFT: Yeah. [00:28:02] Dr. Taz: Gotcha. [00:28:02] Melissa Mose, LMFT: And it, it does work quickly. It's [00:28:05] a really compassionate treatment. I think it gets kind of a, a bad wrap out [00:28:10] there because it's, it's portrayed in the media is looking toilet seats and [00:28:13] Dr. Taz: Right. [00:28:14] Melissa Mose, LMFT: Really horrible. So, [00:28:15] you know, fear factor kinds of things. And it's, it's really not with a good clinician, you know, you're, [00:28:20] you're being, you're being encouraged and are you willing to try something new? [00:28:24] Melissa Mose, LMFT: And how would [00:28:25] it be? So, you know, those, um, yeah, I think it, it works [00:28:30] quickly and it's very compassionate. And [00:28:32] Dr. Taz: do you see OCD coexisting with [00:28:35] other. Conditions or diagnoses or diseases. For example, in clinic we see a lot of [00:28:40] pans or pandas, the pia, pediatric autoimmune neuro encephalitis. [00:28:45] We see a lot of that often triggered by a virus or a big [00:28:50] stressor or a bacteria or something like that. [00:28:51] Dr. Taz: And then turning into this autoimmune type [00:28:55] scenario that then becomes, or presents itself, I should say, as [00:29:00] OCD in some of the patients. Um. We have patients with eating disorders [00:29:05] and, you know, I'm curious like of that connection mm-hmm. And does that change [00:29:10] treatment? What's the chemistry happening there? [00:29:12] Dr. Taz: Is there something that we, as clinicians are missing? Are [00:29:15] there other como, you know, comorbidities that we don't know about or we're not thinking about? [00:29:20] So, you know, comment for a second on, on some of that. [00:29:22] Melissa Mose, LMFT: Yes. [00:29:23] Dr. Taz: That's heavy. That's a [00:29:25] heavy, that's a heavy category. [00:29:26] Melissa Mose, LMFT: Let's do a conference. Yeah. [00:29:27] Dr. Taz: Yes. Pretty much, right? [00:29:28] Dr. Taz: I [00:29:29] Melissa Mose, LMFT: mean it really is. Yeah. [00:29:30] Because yes, it overlaps with all kinds of different things and the, the pans and pandas [00:29:35] piece is really key. Uh, especially to bring the family, you know, families need to be [00:29:40] involved in those situations. Um, and that was, that was really what sparked my turn [00:29:45] into, into OCD treatment. [00:29:47] Dr. Taz: Yeah. [00:29:47] Melissa Mose, LMFT: Was my daughter's experience after a strep [00:29:50] infection. Yeah. So sudden onset. Really severe and really terrifying, right? [00:29:55] Because it comes outta nowhere. So it's great that there's more awareness to neuroinflammation [00:30:00] as something that can cause these symptoms. Um, and eating disorders actually [00:30:05] for some reason co-occur with pans and pandas kids quite a bit. [00:30:09] Melissa Mose, LMFT: The food tends to [00:30:10] be the object of, um, the obsessions and the fear. Um, [00:30:15] so eating disorders [00:30:20] can, can look like O-C-D-O-C-D can look like eating disorders. They can [00:30:25] actually be function one another and, and really intricate, intricately related. And [00:30:30] you would do different treatment if it were OCD than if it were [00:30:35] pure eating disorder. [00:30:35] Melissa Mose, LMFT: So a lot of times, you know, the a i avoidant, [00:30:40] restrictive food intake. Disorder. Yeah. Mm-hmm. Um, that's one that [00:30:45] happens a lot because it's not a, and for people who have OCD that looks kind of eating [00:30:50] disorder ish, [00:30:50] Dr. Taz: right? [00:30:51] Melissa Mose, LMFT: They're obsessions aren't really about their body, how they look, they're, it [00:30:55] really is more about, I don't like things that are that [00:31:00] texture. Yeah. [00:31:00] Melissa Mose, LMFT: That, you know, I don't like eating in these places. It has, it has a [00:31:05] obsessive compulsive quality to it and, [00:31:07] Dr. Taz: well, it's a big wellness. And movement [00:31:10] risk, right. Where people are now, like, I'm not gonna go anywhere that serves seed oils. Mm-hmm. [00:31:15] Or I'm not going to eat anything with sugar. I'm not gonna eat anything with, you know, [00:31:20] I mean I've actually had patients that we've tried to like reverse. [00:31:23] Dr. Taz: This was early in the practice, but we've tried to [00:31:25] reverse neuroinflammation in different ways. And honestly looking back may have made things [00:31:30] worse because it triggered like orthorexia in them, right. Where they became obsessive compulsive. Mm-hmm. About like the [00:31:35] ingredient in every single thing to the point that they're food restricting and food restricting and food [00:31:40] restricting and next thing you know is turned into an eating disorder. [00:31:42] Dr. Taz: You know? [00:31:43] Melissa Mose, LMFT: And then that gets into the whole lifestyle [00:31:45] piece, right. Of wanting to have the right mindset. [00:31:47] Dr. Taz: Right. [00:31:47] Melissa Mose, LMFT: Right. And I can't get out of bed until I get in the right [00:31:50] mindset. [00:31:50] Dr. Taz: Right. [00:31:50] Melissa Mose, LMFT: And they're watching, [00:31:51] Dr. Taz: yeah. [00:31:51] Melissa Mose, LMFT: You know, influencers, you're gonna protect [00:31:52] Dr. Taz: my piece. [00:31:54] Melissa Mose, LMFT: Yeah, exactly. Like, [00:31:55] exactly. Got got it. And so then that's really it. [00:31:57] Melissa Mose, LMFT: Quite a head trip, right? Am I in the right mindset? Can I move [00:32:00] forward? What is it? How's it gonna, so, um, because you can hyper focus on pretty much [00:32:05] anything, [00:32:05] Dr. Taz: right? [00:32:05] Melissa Mose, LMFT: Yeah. So it's the balancing act of, you know, teasing apart [00:32:10] what's sweat because, um, you know, it also co-occur with trauma. [00:32:15] Um, autism, [00:32:17] Dr. Taz: yes. [00:32:17] Melissa Mose, LMFT: Right? [00:32:18] Melissa Mose, LMFT: That's another one where [00:32:20] it can, there can, they can both be there, right? Or one can look like the other, uh, a [00:32:25] DH adhd. So [00:32:25] Dr. Taz: just sorry to interrupt. Yeah. [00:32:26] Melissa Mose, LMFT: Does trauma trigger OCD? Well, trauma doesn't [00:32:30] cause OCD we're pretty, you know, solid and wanna be very clear about that, right? It can trigger an [00:32:35] onset in somebody who is maybe genetically predisposed, maybe also [00:32:40] has some other co-occurring thing, like a, like the inflammation. [00:32:43] Melissa Mose, LMFT: Um, but [00:32:45] OCD can get. Kind of wrapped up in a traumatic [00:32:50] experience and serve as a protective mechanism and get [00:32:55] reinforced. So when both are there, it's really complicated. Um, but [00:33:00] we do, yeah, we, we do sort of, I. It's not just trauma causing [00:33:05] OCD [00:33:05] Dr. Taz: in, how is OCD related to A DHD or, uh, attention [00:33:10] deficit syndrome? [00:33:10] Melissa Mose, LMFT: Yeah. It tends, it's, there's this triad, uh, you know, especially in kids, right? Yeah. [00:33:15] OCD [00:33:15] Dr. Taz: well, I talk about the triangle all the time for everything. I'm like, it's always three. There's always, there's always three, [00:33:20] there's always a triangle. That's So your goal is to figure out your triangle. [00:33:22] Melissa Mose, LMFT: Exactly. Exactly. [00:33:24] Melissa Mose, LMFT: Yeah. So [00:33:25] O-C-D-A-D-H-D and Tourette syndrome. [00:33:28] Dr. Taz: Right? [00:33:28] Melissa Mose, LMFT: Right. So with the tics in, [00:33:30] in young kids, and yeah, that does complicate things also a little bit because [00:33:35] sometimes A DHD medications can increase trigger anxiety and cause [00:33:40] those kinds of things. So, um, also they get misdiagnosed. Um, [00:33:45] I've, the, a number of kids that I've worked with were diagnosed with A DHD [00:33:50] because they're staring out the window. [00:33:51] Melissa Mose, LMFT: They're inattentive. [00:33:52] Dr. Taz: Right. [00:33:53] Melissa Mose, LMFT: And teachers don't realize they're [00:33:55] inattentive because they're trying to replace the bad thought they just had with the good thought. And things have to be [00:34:00] just right before they can take the math book out. And so, uh, [00:34:05] yeah, the, the co-occurring, they do find that people with [00:34:10] OCD have a much higher incident of other co-occurring disorders, and so [00:34:15] we do have to be careful about how we [00:34:16] Dr. Taz: is OCD born in a, in.[00:34:20] [00:34:20] Dr. Taz: Can, let me phrase this correctly, is OCD born in [00:34:25] conditions where there is chronic inflammation? [00:34:27] Melissa Mose, LMFT: I am beginning to believe we're, [00:34:30] we're gonna find out more and more that, that's true. Um, I think that [00:34:35] that's what the pans and pandas [00:34:36] Dr. Taz: right. [00:34:37] Melissa Mose, LMFT: You know, like cases that were more extreme kind [00:34:40] of led us to discover. [00:34:41] Melissa Mose, LMFT: Uh, and also when people get sick, [00:34:45] their OCD spikes. [00:34:46] Dr. Taz: Mm. [00:34:47] Melissa Mose, LMFT: Um, it spikes with hormones. That's why you [00:34:50] see all the perinatal OCD. So, you know, there's all kinds of What [00:34:54] Dr. Taz: about like [00:34:55] perimenopause and menopause? [00:34:56] Melissa Mose, LMFT: Yeah. I think that can, [00:34:57] Dr. Taz: that will trigger it as well. [00:34:58] Melissa Mose, LMFT: You, you don't see that as [00:35:00] much because it's a decline in hormones. [00:35:02] Melissa Mose, LMFT: Right. Rather than the, a spike, the surge that happens hormones, you know, [00:35:05] but, but I, working with teenage girls, I, you know, it's like, or you know. [00:35:10] Young women, you always see, well, it's, you know, week before my period and my [00:35:15] OCD is going crazy. So it's very standard to recognize that it's biochemically [00:35:20] based and And induced. [00:35:21] Melissa Mose, LMFT: And triggered. Yeah. [00:35:22] Dr. Taz: So is the solution for somebody like that, [00:35:25] if anyone's listening to us and they notice these symptoms worsen like maybe the week before your cycle, [00:35:30] or they're worsening when you ovulate, like at a spike, right? Mm-hmm. When you have that surge, [00:35:35] or you might be pregnant and having a surge of progesterone or doing IVF and getting a surge of [00:35:40] hormones. [00:35:40] Dr. Taz: Mm-hmm. Mm-hmm. So for any of of those folks, if they're noticing that, that's when they're [00:35:45] OCD flares and it's not constant necessarily, what is their treatment [00:35:50] strategy to manage that? [00:35:51] Melissa Mose, LMFT: You know, that's a tough one because there, there are probably a lot [00:35:55] of things out there Yeah. In the way of, you know, supplements or [00:36:00] anti-inflammatories, the anti-inflammatory diet. [00:36:01] Dr. Taz: Mm-hmm. [00:36:02] Melissa Mose, LMFT: There, there are probably things out there that would [00:36:05] be helpful, and I'm not an expert on those things, but. I also know that it [00:36:10] really depends on the person, you know, what kind of energy, effort, and ability they have to [00:36:15] utilize those kinds of auxiliary treatment methods to [00:36:20] optimize their functioning. [00:36:21] Melissa Mose, LMFT: I think a lot of, for me, the way I work because of the [00:36:25] internal family systems approach [00:36:26] Dr. Taz: mm-hmm. [00:36:27] Melissa Mose, LMFT: Is to notice again that [00:36:30] parts are, you know, your parts are really active right now. [00:36:33] Dr. Taz: Right. [00:36:33] Melissa Mose, LMFT: And, and [00:36:35] helping people learn the, the skill of unblending so they can say [00:36:40] a part of me's freaking out right now and I just need to focus on getting my kids to school [00:36:45] rather than, I'm so anxious I can't function, rather than identifying with the [00:36:50] feelings. [00:36:50] Melissa Mose, LMFT: So [00:36:51] Dr. Taz: are you concerned that when you look at Gen Z. For example. [00:36:54] Melissa Mose, LMFT: Mm-hmm. [00:36:55] [00:36:55] Dr. Taz: Um, that there's a little bit of parking or [00:37:00] hyper fixating on the fact that there is a mental health issue. Mm-hmm. [00:37:05] In fact, I think I saw a survey recently that said 75% of Gen Z [00:37:10] women girls report that they have some mental health something. [00:37:13] Dr. Taz: Right. And. [00:37:15] There's a TikTok trend going around recently of like all [00:37:20] these young women, girls and younger women, like, yeah. You know, well, here's [00:37:25] my mental health cocktail, and like, downing like a bunch of whatever. Right. You know? Are, [00:37:30] are you concerned that there's this hyper fixation just around that and [00:37:35] not an understanding that we gotta keep moving? [00:37:36] Dr. Taz: Like, right. You know, this is not a reason to stop what you're doing, to [00:37:40] quit what you're doing. You gotta keep moving through it, you know? Right. Um, especially for somebody who's practiced [00:37:45] for 15, 16 years. [00:37:46] Melissa Mose, LMFT: Right, right. So yes. I, and, and I have to say, [00:37:50] I, I love Gen Gen ZI have a [00:37:52] Dr. Taz: Gen ZI have, they're in my home, trust [00:37:55] me. [00:37:55] Dr. Taz: Yeah, [00:37:55] Melissa Mose, LMFT: yeah, yeah. Their sense of humor and the view of the world, it cracks me up. They're great and [00:38:00] yes, they're like, love me. A good diagnosis. I've heard that one. Right? Yeah. [00:38:03] Dr. Taz: Uhhuh. [00:38:03] Melissa Mose, LMFT: And so that's great. [00:38:05] Um. Can't, you know, like anything else, right? It's like it's functional until it [00:38:10] stops being helpful anymore, I think in a certain way. [00:38:13] Melissa Mose, LMFT: Um, open [00:38:15] awareness, inclusion, it's easier to talk about these things, [00:38:18] Dr. Taz: right. [00:38:19] Melissa Mose, LMFT: Is great. [00:38:19] Dr. Taz: [00:38:20] Right. [00:38:20] Melissa Mose, LMFT: I am well aware that when I was a teenager, I probably had [00:38:25] some clinical anxiety around things. Right. Or social anxiety. Right. But I didn't, I didn't [00:38:30] think I even knew the word anxiety. I, I literally thought that I got excited [00:38:35] about taking the SAT. [00:38:36] Dr. Taz: Right. And [00:38:37] Melissa Mose, LMFT: I was just nervous probably, you know? Right. [00:38:40] So it was good for me to not know. That is my point. Yeah. You know? Yeah. And I think with, um, [00:38:45] with these kids, I, yeah, yeah. It can, it can be a rabbit hole, it can [00:38:50] be an excuse to opt out. [00:38:51] Dr. Taz: Yeah. [00:38:52] Melissa Mose, LMFT: And that is not healthy. Um, [00:38:55] and then identifying with the diagnosis and, um, so it's [00:39:00] unfortunate. [00:39:01] Melissa Mose, LMFT: It also, it's a [00:39:02] Dr. Taz: reality. [00:39:02] Melissa Mose, LMFT: Hopefully like, like other things, [00:39:05] you know, it gets extreme and then it comes kind of back into the fold when people start to [00:39:10] realize the other side of it [00:39:11] Dr. Taz: would a better message be. One that we could all spread [00:39:15] that, look, this is a disorder of inflammation. Mm-hmm.[00:39:20] [00:39:20] Dr. Taz: Neuroinflammation in particular, which actually has solutions. Mm-hmm. You know, and it's [00:39:25] not necessarily a part of your personality. 'cause I think that's the myth out there. Yeah. Like, oh, I [00:39:30] just have OCD, like Yeah. [00:39:31] Melissa Mose, LMFT: You [00:39:31] Dr. Taz: know what I mean? It's almost like a type, you know? Yeah. So instead of [00:39:35] like. Perpetuating that myth that OCD is, is integrated into your personality. [00:39:39] Dr. Taz: [00:39:40] It may actually be a symptom [00:39:41] Melissa Mose, LMFT: mm-hmm. [00:39:42] Dr. Taz: Of neuroinflammation. Right. And for that, there is a plan, [00:39:45] you know? [00:39:45] Melissa Mose, LMFT: Yeah. And, well, I think anything that reduces shame Yeah. Is important. And that [00:39:50] increases hope. I hear a lot OCD is untreatable, right? Mm-hmm. And it's not, not the case. And then [00:39:55] the other end of I'm so OCD, you know? [00:39:57] Melissa Mose, LMFT: Yeah. [00:39:57] Dr. Taz: Ooc [00:39:57] Melissa Mose, LMFT: D is not an adjective. If you actually have the [00:40:00] D part, it's wrecking your life. Right? So that's not anything. Right. Right. Right. [00:40:05] So I do, I really agree with you to, to focus on, we are a brain body system [00:40:10] and we come wired in a certain way and we have capacities and [00:40:15] we have, we have, you know, things that we're not as good at and our, you know, [00:40:20] like to see it as the body can be attended to in a way that's gonna minimize that. [00:40:24] Melissa Mose, LMFT: [00:40:25] And no, it's not a personality thing. [00:40:27] Dr. Taz: Yeah. I think that in itself is such an important [00:40:30] message. Does it look different in men? [00:40:32] Melissa Mose, LMFT: Oh, interesting. You know, in some very [00:40:35] major ways. No. Okay. You know, it's like, it's, I [00:40:40] mean, it may be, it, it appears at different times, you know, I, I get a lot of 11-year-old girls.[00:40:45] [00:40:45] Dr. Taz: Yeah. [00:40:45] Melissa Mose, LMFT: And, you know, the boys tend to be a little older or adolescent. Um, [00:40:50] but in terms of the fears and the, uh, you know, the [00:40:55] thoughts, the intrusive thoughts, I mean, intrusive thoughts seem to be very different or very much [00:41:00] the same. People don't wanna be, what if I'm a bad person? [00:41:03] Dr. Taz: Mm. [00:41:03] Melissa Mose, LMFT: Right. What if I'm [00:41:05] careless or I'm, or what if I'm a monster? [00:41:06] Melissa Mose, LMFT: What if I really want to hurt people? I wanna really call [00:41:10] attention that. That's a really common kind of OCD that we don't really talk about. [00:41:15] Like, and people are wandering around thinking, what if I really intended to bump her elbow when I [00:41:20] passed her on the street? What if I'm, you know, like, and it's, it's really debilitating, but [00:41:25] I see that in. [00:41:26] Melissa Mose, LMFT: Boys see that in girls. Um, I think the [00:41:30] subtypes, you know, OCD is the process underneath it. All right. It's the alert and then [00:41:35] the fix and the alert, and then the fix. And that's how we tell it from other things. [00:41:40] But the content of it, um, might occur more in [00:41:45] certain contexts than in others. Um, in religious [00:41:50] households. [00:41:50] Melissa Mose, LMFT: Mm-hmm. The scrupulosity piece, like, did I pray enough? Am I devout enough? [00:41:55] Whereas other places that might look more like morality and, you know, did I [00:42:00] cheat or did I represent myself accurately? So, so the, [00:42:05] the flavoring of the content might change. Um, but no, [00:42:10] it's pretty equal opportunity. It's pretty [00:42:11] Dr. Taz: consistent, yeah. [00:42:12] Dr. Taz: Across the board. Mm-hmm. Are there medications that worsen [00:42:15] OCD? [00:42:16] Melissa Mose, LMFT: It depend. It can depend. You know, again, medications are so. [00:42:20] [00:42:20] Dr. Taz: Tricky [00:42:21] Melissa Mose, LMFT: people specific. Yeah. Uh, but, you know, Ritalin can [00:42:25] definitely, you know, that, like we said, the A DHD medicines can, can worsen it. Um, I'm sure that [00:42:30] there are some that I'm not aware of. [00:42:31] Melissa Mose, LMFT: Mm-hmm. [00:42:31] Dr. Taz: But [00:42:32] Melissa Mose, LMFT: I think anything, you know, whenever you [00:42:35] notice I'm in a spike or you notice your family members in a spike, they may [00:42:40] not even realize it, but you've just seen them walk in and outta a room five, five times or whatever. [00:42:44] Dr. Taz: Right. [00:42:45] [00:42:45] Melissa Mose, LMFT: You know, you're not necessarily without being judgmental. Right. You want, you [00:42:50] wanna maybe call attention to it, but. [00:42:52] Melissa Mose, LMFT: But track what happened. [00:42:54] Dr. Taz: Mm-hmm. [00:42:54] Melissa Mose, LMFT: Like what are [00:42:55] the antecedents to this? Um, and so, and maybe, maybe if it is a [00:43:00] medication or if it is some sort of a substance or, or it's a [00:43:05] interaction, it's certain people right, that they hang out with or stress, you know, stress [00:43:10] can definitely make it worse. [00:43:11] Dr. Taz: Now, sometimes OCD is also worn as a badge of honor, right? [00:43:14] Dr. Taz: [00:43:15] Mm-hmm. I'm Type A, I'm OCD. [00:43:17] Melissa Mose, LMFT: Mm-hmm. [00:43:18] Dr. Taz: I am blah, blah, blah, blah, blah. Right. [00:43:20] Or because they're OCD, they were successful and able to do [00:43:25] X, Y, and Z. Yeah. Or we hear about, I think Steve Jobs or like some of these, you [00:43:30] know, figures in our culture and history that like you hear about like how they [00:43:35] worked or, you know, some of their habits and their rituals, and people [00:43:40] attribute that to being part of why they're successful, like, [00:43:43] Melissa Mose, LMFT: mm-hmm. [00:43:43] Dr. Taz: What's your thought there? [00:43:45] [00:43:45] Melissa Mose, LMFT: Well, again, it's. Any of these behaviors [00:43:50] function on a spectrum. Right. [00:43:51] Dr. Taz: Right. [00:43:52] Melissa Mose, LMFT: Anxiety too. We have that optimal anxiety. Right, [00:43:55] right. So a little anxiety before a test is a good thing. Is a good [00:43:58] Dr. Taz: thing. Yeah. [00:43:59] Melissa Mose, LMFT: If it gets [00:44:00] too intense, then it starts, you know, taking, you know, taking me away from [00:44:05] what you know, what I'm meant to do. [00:44:07] Melissa Mose, LMFT: So, you know, if you have a touch of perfectionism, [00:44:10] that's not a bad thing. Um, but if your perfectionism is keeping you from sending an email [00:44:15] until you reread it about 70 times. [00:44:17] Dr. Taz: Yeah. [00:44:18] Melissa Mose, LMFT: You know, so [00:44:19] Dr. Taz: it's on a [00:44:20] spectrum. [00:44:20] Melissa Mose, LMFT: Yeah. It's on a spectrum. And I do think that people who really have [00:44:25] the disorder who are locked in their homes or can't leave [00:44:30] until, I mean, they're just an agony. [00:44:32] Melissa Mose, LMFT: Yeah. I think that that kind of, I'm so [00:44:35] OCD or, or OCD works for me, kind of attitude. It feels, [00:44:40] feels, um. Dismissive and Yeah. Of the [00:44:43] Dr. Taz: actual condition [00:44:43] Melissa Mose, LMFT: of the actual [00:44:45] gravity of it, you know? [00:44:46] Dr. Taz: Interesting. [00:44:47] Melissa Mose, LMFT: Yeah. [00:44:47] Dr. Taz: So going back to internal family [00:44:50] systems. Mm-hmm. Right? So someone you love, has OCD child or [00:44:55] a partner can, can we be participants in a [00:45:00] internal family system for somebody, or is that something that really needs to be done with like a [00:45:05] professional who's trained in that work and knows how to do that work? [00:45:08] Melissa Mose, LMFT: Well, I think the most [00:45:10] fundamental thing we can do as parents is our own work. [00:45:13] Dr. Taz: Mm-hmm. [00:45:14] Melissa Mose, LMFT: Right? [00:45:15] So if I show up. When my daughter is struggling, I [00:45:20] show up with a really anxious part in the lead or a controlling one that, [00:45:25] that wants to tell her what to do, or one that's exasperated because [00:45:30] you know, like if I show up with a part in the lead, it's, it's gonna [00:45:35] negatively impact her. [00:45:36] Dr. Taz: Mm. [00:45:36] Melissa Mose, LMFT: Because my parts are gonna draw her parts right. My [00:45:40] overly gonna fix it part. Mm-hmm. Might draw her anger and or whatever. It [00:45:45] just in general, we wanna be as self-led as we can be. So I wanna notice, okay. I have a part [00:45:50] that's like wanting to just. Tell her what to do. [00:45:53] Dr. Taz: Right, [00:45:54] Melissa Mose, LMFT: right. [00:45:54] Dr. Taz: We all [00:45:55] do. [00:45:55] Melissa Mose, LMFT: Yeah. And, um, then I have another part that just wants to do it for her.[00:46:00] [00:46:00] Dr. Taz: We have that part too. [00:46:01] Melissa Mose, LMFT: It's hurting. [00:46:01] Dr. Taz: Yeah. [00:46:01] Melissa Mose, LMFT: Right. [00:46:02] Dr. Taz: Mm-hmm. [00:46:02] Melissa Mose, LMFT: And I can really [00:46:05] speak for those parts in my own mind, like naming them really helps. [00:46:09] Dr. Taz: [00:46:10] Yeah. [00:46:10] Melissa Mose, LMFT: Just like anytime you, you know, are in a struggle to really name what the other person [00:46:15] is feeling, helps them relax. So. Naming that, or I'm [00:46:20] angry. Like sometimes the level of anger we have, we don't wanna be that parent. [00:46:23] Melissa Mose, LMFT: Right, right. [00:46:24] Dr. Taz: Yeah. [00:46:24] Melissa Mose, LMFT: [00:46:25] So I, that's one for me, I just like, I'm not angry, but sometimes I'm angry. So if [00:46:30] I can just notice, and now that she's older, I can say, A part of me is really angry right now. I know you're [00:46:35] doing the best you can. So just that kind of communication and that kind of [00:46:40] self-awareness allows us to be self-led in a situation where we can have [00:46:45] compassion for what they're going through. [00:46:46] Dr. Taz: Mm-hmm. [00:46:47] Melissa Mose, LMFT: We don't have to say, there's nothing wrong. Go ahead [00:46:50] and touch it. [00:46:50] Dr. Taz: Yeah. [00:46:50] Melissa Mose, LMFT: Or, or, [00:46:51] Dr. Taz: or, you're being crazy. [00:46:52] Melissa Mose, LMFT: You're being crazy. So we don't have to be sort of overly [00:46:55] demanding of functioning. And we don't have to be overly reassuring and, oh, it's okay. [00:47:00] I'll, I'll help you. 'cause that sends the wrong message too. [00:47:02] Melissa Mose, LMFT: Right. You can't handle it. [00:47:05] Anxiety's bad. We don't have anxiety in this house. We fix it. [00:47:08] Dr. Taz: Mm. [00:47:09] Melissa Mose, LMFT: Right. So [00:47:10] both of those send the wrong message. But if I can be in a little bit of clarity [00:47:15] en enough to have. The compassion, but also the confidence. Like [00:47:20] I know it's really uncomfortable right now. I know you're struggling and you're really anxious, [00:47:25] but I have confidence in you. [00:47:26] Melissa Mose, LMFT: I know you will get through this. Not, I know [00:47:30] everything's gonna be okay. 'cause that's a reassurance, but, but I'm here with you. Well, you'll, [00:47:35] [00:47:35] Dr. Taz: okay. So help us with that. Yeah. Because, okay. I'll put my, fix it. [00:47:40] Angry controlling pieces off to the side. [00:47:44] Melissa Mose, LMFT: Mm-hmm. [00:47:44] Dr. Taz: And I [00:47:45] wanna be present. Right? Give us like three phrases that we could use if it's a child [00:47:50] or if it's an adult. [00:47:50] Melissa Mose, LMFT: Right? Yeah. I know this is really hard for you. [00:47:54] Dr. Taz: Yeah. [00:47:55] [00:47:55] Melissa Mose, LMFT: And I know you'll get through it. I mean, just like I just said, I, I'll. [00:48:00] I'm here with you, I'll hang out and you know, I really trust that you can [00:48:05] be with this and do the thing that you know, your therapist has been telling you to do. [00:48:10] Or, you know, I think you, I think you, you know, I'll help you resist that [00:48:15] compulsion, like by just being a presence, right? [00:48:18] Melissa Mose, LMFT: Because what we know is we wanna, [00:48:20] we wanna partner with the part of our child or our partner. [00:48:25] I'm gonna partner with the aspect of them that wants to get better because they [00:48:30] know they don't really wanna do the compulsion. [00:48:32] Dr. Taz: Mm. [00:48:33] Melissa Mose, LMFT: Right? And [00:48:35] so you, you trying to really find the self in somebody. Like, I [00:48:40] get that you wanna go take your clothes off again. [00:48:43] Melissa Mose, LMFT: I also know, you know [00:48:45] what that means, right? So I'm here. [00:48:50] I know you. I believe in you. I think I believe in you, is really important, and I know you're [00:48:55] struggling. So that's compassion and it's confidence. [00:48:58] Dr. Taz: Mm. [00:48:58] Melissa Mose, LMFT: And I'm here. [00:48:59] Dr. Taz: So are those the [00:49:00] two words we should remember? Compassion and confidence? Yeah. In our statements. [00:49:03] Melissa Mose, LMFT: I really think so. Yeah. Yeah. [00:49:05] It, it's because our confidence that when anxiety isn't gonna kill you, so it's an [00:49:10] uncomfortable [00:49:10] Dr. Taz: feeling that's really real. So I think that's really important. I think for everyone needs to hear that. Yeah. Anxiety's [00:49:15] not gonna kill anyone. Yeah. [00:49:15] Melissa Mose, LMFT: We don't need to like, yeah. If it bec, if the other option is [00:49:20] doing things that are ruining your life, taking you away, making you quit soccer, stay in the [00:49:25] room, you know, not take that job it, you know, be, feel [00:49:30] anxious. [00:49:30] Melissa Mose, LMFT: It's just a feeling, right? Mm-hmm. If we can have that kind of message, [00:49:35] um, it's a really uncomfortable feeling. You know, I think we can share anything [00:49:40] that, you know, we can relate. Um, I've developed this fear of [00:49:45] heights, right? So I get near a banister or something, all of a sudden my nervous system flares, but.[00:49:50] [00:49:50] Melissa Mose, LMFT: I think of it as, wow, my body's doing that thing again. I don't feel like [00:49:55] I'm scared, but I know how uncomfortable it is. [00:49:57] Dr. Taz: Mm. So you're almost like reassure, not [00:50:00] reassuring. You're almost calming yourself down a little bit. [00:50:03] Melissa Mose, LMFT: Yeah. Yeah, yeah. Yeah. [00:50:05] I'm, I'm, I'm just, I'm, and I disidentifying from the, from the [00:50:10] feeling I don't have to see the thing my body is doing as [00:50:15] me. [00:50:15] Dr. Taz: Gotcha. [00:50:15] Melissa Mose, LMFT: Because there's so many other parts of me. [00:50:18] Dr. Taz: Mm. [00:50:18] Melissa Mose, LMFT: You know, there's, there's the part [00:50:20] of me that wants to like go stand at the edge or go skydiving, I don't know. [00:50:25] But, um, so, so there's, you can always find another part of you that sees it differently. [00:50:30] And when you do that, you know, um, you're more aware of the, you [00:50:35] who's aware, and that's the selfly, that's where we wanna be. [00:50:38] Dr. Taz: How does OCD affect [00:50:40] intimacy? Between partners? Yeah. It be, and community even like connection. How does it impact that [00:50:45] [00:50:45] Melissa Mose, LMFT: a lot. It, uh, can, it can really get in the way, especially there's a type of OCD [00:50:50] called relationship OCD. [00:50:51] Dr. Taz: Mm-hmm. [00:50:52] Melissa Mose, LMFT: And the obsessions, I begin [00:50:55] to, um, swirl around the partner or your own feelings about the partner.[00:51:00] [00:51:00] Melissa Mose, LMFT: So, you know, do I have, is this the wine? He's, is this person the [00:51:05] right person for me? Um, or does he love me in the right way? Um, [00:51:10] or, you know, all of the, [00:51:11] Dr. Taz: so the person with OCD is constantly processing. Yeah. That, [00:51:14] Melissa Mose, LMFT: yeah. [00:51:15] So it's kind of along the lines of an intolerance of uncertainty and we haven't [00:51:20] talked about that yet. [00:51:21] Dr. Taz: No, we haven't. We need to talk about that, [00:51:23] Melissa Mose, LMFT: so, yeah. Yeah, yeah. Yeah. Because that's at the [00:51:25] root of almost all OCD Okay. Is I need to know for sure. Like [00:51:30] OCD is like it guilty until proven innocent. I need to know for sure that he loves me. I need to know for [00:51:35] sure that I'm a good person and I'm not going to hell. [00:51:37] Melissa Mose, LMFT: I need to know for sure that that thing is [00:51:40] clean and hasn't touched anything. And even if I can't see anything on it, does it have the [00:51:45] essence of that dirty substance on it? Right. It it's like OCD wants [00:51:50] absolutes and answers. Yeah, yeah. Answers for questions that have no answers. Right. [00:51:55] Um, no concrete answers. [00:51:57] Melissa Mose, LMFT: And so, uh, living in uncertainty is really [00:52:00] one of the main solutions to the problem, right? It's the treatment method of choice. It's the [00:52:05] exposure lifestyle. It's like, what if we don't get to know? So to, [00:52:10] to bring it back to your question about relationships, it's, it's a [00:52:15] risk, right? It's kind of the ultimate risk. [00:52:16] Melissa Mose, LMFT: You, you sort of. Invest in this other person and, and you don't [00:52:20] get to know what they're thinking all the time. Um, so, [00:52:24] Dr. Taz: and how do we get [00:52:25] comfortable in that for people with OCD? How do they get comfortable in, in living in [00:52:30] uncertainty Or how do any of us get comfortable? And I mean, I know some people have faith and some people [00:52:35] have other tools, but how do, how does one get comfortable with that idea that we just [00:52:40] don't know? [00:52:40] Melissa Mose, LMFT: Yeah. [00:52:40] Dr. Taz: And that's okay. [00:52:42] Melissa Mose, LMFT: You know, the first word that came to mind, and [00:52:45] I haven't thought of this in a long time, was, awe, [00:52:47] Dr. Taz: awe. [00:52:48] Melissa Mose, LMFT: If we can, [00:52:48] Dr. Taz: I haven't heard that word in forever. [00:52:49] Melissa Mose, LMFT: [00:52:50] Yeah. Just like, like it's a kind of amazing how much we don't know if we [00:52:55] really think about it, you know, and that can be very triggering for people. [00:52:57] Melissa Mose, LMFT: Mm-hmm. But, um, you [00:53:00] know, making space for that, um, giving it a different spin, like [00:53:05] beginner's mind. Right. Traveling's fun because it's like, it's like [00:53:10] everything's new. [00:53:11] Dr. Taz: Yeah. [00:53:11] Melissa Mose, LMFT: Right. Yeah. So, so that uncertainty, like kind of learning [00:53:15] how to em embrace it and lean into it and realize when you lean into a [00:53:20] one uncertain situation, for instance, the more you're with it, the [00:53:25] more familiar it becomes. [00:53:26] Melissa Mose, LMFT: And so just knowing it's not [00:53:30] what you know or don't know, it's what you do when you don't know, when it's [00:53:35] what you do when you're uncertain and can you just breathe into it and [00:53:40] make space for it and let it sort of be there and focus on what you do [00:53:45] know. [00:53:45] Dr. Taz: Hmm. [00:53:45] Melissa Mose, LMFT: Um, and, and the trick is kind of turning the flashlight of your [00:53:50] attention out into the world and, and to look around and say, I'm [00:53:55] safe right now. [00:53:57] Melissa Mose, LMFT: I, I'm doing this thing that's really fun [00:54:00] and I'll just focus here and be in the present moment. So I think that that's really the [00:54:05] mindfulness tools that we see everywhere can be really useful. Getting [00:54:10] into your body, finding all of your toes, [00:54:14] Dr. Taz: it's [00:54:15] almost like grounding, grounding and kind of bringing you back into your [00:54:20] physical. [00:54:20] Dr. Taz: Right. Do you have favorites, favorite tools that kids can use to get there? Favorite tools that [00:54:25] adults can use to get there? [00:54:27] Melissa Mose, LMFT: Well, kids do really well with [00:54:30] IFS. Yeah. Like they, they do really well with internal [00:54:32] Dr. Taz: family systems. [00:54:33] Melissa Mose, LMFT: Yeah. With internal family systems. Okay. Like, like [00:54:35] seeing the obsessional part and the compulsive part as different parts of them. [00:54:38] Dr. Taz: Yeah. [00:54:38] Melissa Mose, LMFT: You know, this is my what if [00:54:40] monster. Um, this is negative Nancy. [00:54:42] Dr. Taz: Mm-hmm. Yeah. Mm-hmm. Yeah. [00:54:44] Melissa Mose, LMFT: Um, this is, [00:54:45] um, and so I think externalizing is really helpful. [00:54:48] Dr. Taz: Okay. [00:54:48] Melissa Mose, LMFT: So if you're a [00:54:50] child and you want to, like, this toy represents that thought and this toy represents that [00:54:55] thought, and I can look at them and go, I know they're just, that, they're just [00:55:00] thoughts. [00:55:00] Melissa Mose, LMFT: Yeah. You know, so it helps, you know, it, it helps to put things outside of your [00:55:05] body, draw it. [00:55:05] Dr. Taz: Right. [00:55:06] Melissa Mose, LMFT: Um, I think adults kind of, well, I, I love. [00:55:10] I mean, of course having a kid, I still have lots of little toys around the house. Mm-hmm. And my office has [00:55:15] lots of things, but I think it's great to just go, you know, the part of me as I was writing [00:55:20] this book, the part of me that's taking this perspective is here. [00:55:23] Melissa Mose, LMFT: And the part that's taking [00:55:25] this perspective is there, because I'm balancing two very different worlds. Right. And, and it's a [00:55:30] reminder in the external world, um, adults, I think like, [00:55:35] to maybe put things out in writing. So [00:55:39] Dr. Taz: writing [00:55:40] about it. [00:55:41] Melissa Mose, LMFT: Yeah. Not getting entangled in content. This is where I'm a little bit [00:55:45] cautious. [00:55:45] Melissa Mose, LMFT: It's like, uh, worry. You know, it, that's a worry. [00:55:48] Dr. Taz: Yeah. [00:55:48] Melissa Mose, LMFT: Right now I'm gonna [00:55:50] set it aside and keep functioning. So it's that kind of unblending tools I think are great. [00:55:55] Um, but also just welcoming. [00:55:58] Dr. Taz: Mm-hmm. [00:55:58] Melissa Mose, LMFT: Whatever is [00:56:00] coming up that's uncomfortable [00:56:02] Dr. Taz: and uncertain. [00:56:03] Melissa Mose, LMFT: And uncertain. [00:56:05] Right. So I like to say, you know. [00:56:08] Melissa Mose, LMFT: Welcome. [00:56:10] Whatever's arising, just don't follow it. [00:56:12] Dr. Taz: Right, right, [00:56:13] Melissa Mose, LMFT: right. [00:56:15] Let it go through and out. Take a deep breath and then keep moving. Don't [00:56:19] Dr. Taz: park and [00:56:20] attach to it necessarily. [00:56:20] Melissa Mose, LMFT: Yeah, exactly. Exactly. [00:56:22] Dr. Taz: So tell us about the book. We haven't talked even about the book, and I know [00:56:25] you're training, you told me, uh, in the beginning of our conversation, you were training a lot of clinicians. [00:56:28] Dr. Taz: Mm-hmm. I'm curious, [00:56:30] like from your vantage point, what do we clinicians miss frequently in practice? [00:56:35] What's your hope for the book? [00:56:36] Melissa Mose, LMFT: Yeah. Well, my, my hope for the book is [00:56:40] that, um, it just enlivens enriches and deepens what we're already [00:56:45] doing when we're treating OCD and, and the, the gold standard treatments are, are great.[00:56:50] [00:56:50] Melissa Mose, LMFT: IFS is just a deeper way of getting there, and it's a really helpful tool for when [00:56:55] people aren't ready to or willing to do exposures. Mm. Because we can [00:57:00] work with the parts of them that get in the way. So. I've, [00:57:05] I've, um, it, it was a dicey thing because I, because the [00:57:10] people in my OCD community right, and I'm very deeply in that community of [00:57:15] clinicians, were really protective of new methods [00:57:17] Dr. Taz: Ah, [00:57:17] Melissa Mose, LMFT: that don't have evidence. [00:57:18] Melissa Mose, LMFT: Right? Yeah. It's like [00:57:19] Dr. Taz: same, [00:57:19] Melissa Mose, LMFT: don't [00:57:20] try that. Right? [00:57:20] Dr. Taz: Yeah. Yeah. [00:57:21] Melissa Mose, LMFT: But IFS is just such a natural, it's like if you [00:57:25] infuse your practice with an awareness of who am I talking to right [00:57:30] now? [00:57:30] Dr. Taz: Mm-hmm. [00:57:30] Melissa Mose, LMFT: Right. I'm talking to the compliant part of my client [00:57:35] who's just doing whatever I say to get to do treatment. Right, [00:57:39] Dr. Taz: [00:57:40] right. [00:57:40] Melissa Mose, LMFT: Or am I talking to a part that, you know, [00:57:45] I don't know, is just engaging in white knuckling through this thing you mm-hmm. Just being [00:57:50] aware of what part of your client you're talking to, resistant part. Um, [00:57:55] sometimes the, the part that's like, nah, that one's too scary. I can't do that. You know? Yeah. It's just like [00:58:00] parts with agendas. [00:58:01] Melissa Mose, LMFT: Um. I think that's incredibly helpful. I've had clients [00:58:05] say, well, when you have access to yourself while you're doing an exposure, it [00:58:10] makes all the difference. Hmm. Right. The other thing that IFS is really good for when you're [00:58:15] really aware of that internal family systems dynamic is, um, [00:58:20] self-compassion. And we have discovered that, that, that [00:58:25] there's a lot of shame and blame and guilt, uh, in everywhere. [00:58:28] Melissa Mose, LMFT: But in OCD in [00:58:30] particular, uh, people. Get really hard on themselves when they don't do, [00:58:35] uh, their exposure homework or, or if they go ahead and do a compulsion [00:58:40] because they just couldn't stand not doing it. Right. [00:58:41] Dr. Taz: Yeah. [00:58:42] Melissa Mose, LMFT: So self-compassion is a very healing [00:58:45] state, but it's really hard to tell somebody to have [00:58:50] some compassion for yourself. [00:58:51] Dr. Taz: Right. [00:58:51] Melissa Mose, LMFT: You know, I don't deserve it. Or there's all these things that come up. [00:58:54] Dr. Taz: Right. [00:58:55] [00:58:55] Melissa Mose, LMFT: Internal family systems is a really natural way to [00:59:00] notice the part and ask it to step back, you know? How do you feel towards [00:59:05] that obsessional part? I hate it. Oh. So let's focus on the part that hates it for a minute. [00:59:10] How does that show up in your body? [00:59:13] Melissa Mose, LMFT: Oh, it's just like a clenched [00:59:15] feeling or whatever, so let's just focus on that one and, and. Listen to its message, let it know [00:59:20] that you hear it right. It's got a point. This has been really hard on you. I kind of don't [00:59:25] blame that part of you for hating OCD. [00:59:27] Dr. Taz: Mm-hmm. [00:59:28] Melissa Mose, LMFT: Yeah. But if we're gonna help [00:59:30] OCD, we might need to spend some time looking at it. [00:59:33] Melissa Mose, LMFT: So would that [00:59:35] hatred for it be willing to soften for a second? Could it sort of sit to the side of you? [00:59:40] Um, and people really have great experiences with that. [00:59:45] When they, when they turn their attention inside and they start to notice all the [00:59:50] different parts of them that are going and they unblend from those, [00:59:55] um, what happens naturally is compassion and self-compassion. [00:59:59] Melissa Mose, LMFT: [01:00:00] So after you unblend from the part that hates it. Now, what do you [01:00:05] feel towards that scared, anxious part of you that's running the show? [01:00:10] Well, now I kind of feel for her, you know, [01:00:13] Dr. Taz: it's [01:00:13] Melissa Mose, LMFT: empathy. [01:00:13] Dr. Taz: Yeah, [01:00:14] Melissa Mose, LMFT: yeah. [01:00:15] Now, yeah. Or I'm kind of curious what that's all about. Or [01:00:20] some, you know, eight. The eight Cs. [01:00:22] Dr. Taz: Yeah. [01:00:22] Melissa Mose, LMFT: Curiosity. Yeah. Compassion, [01:00:25] clarity, courage, confidence. One of those will show up and people tend to have [01:00:30] proclivities and towards one or another, but some aspect of it, even just neutral, like, [01:00:35] I don't know, maybe I'm a little open, open's a good word. [01:00:40] Um, and that's what we're looking for, is just finding that open space so that we [01:00:45] can be with whatever's going on in a, in a deep and present way and [01:00:50] have a new experience because that's. [01:00:52] Melissa Mose, LMFT: Really the key. It's like when I [01:00:55] hear, wow, that wasn't as hard as I thought it was gonna be. Right. I know. You know, [01:00:59] Dr. Taz: that's a [01:01:00] win. [01:01:00] Melissa Mose, LMFT: That's a win. That's great. We've had a new experience and you know, let's face it, it's all about [01:01:05] learning. [01:01:05] Dr. Taz: Mm-hmm. [01:01:06] Melissa Mose, LMFT: Do it again. And you know what you practice, you get better at. [01:01:10] If you can practice noticing the parts that are with all the [01:01:15] chatter and allowing your attention to shift them into the background rather than the [01:01:20] foreground. [01:01:21] Melissa Mose, LMFT: Um, every time you do it, you get a little better at it. You're a [01:01:25] little more present. There's a little more space inside of you to be strong through the next [01:01:30] challenge. [01:01:31] Dr. Taz: Those are lessons that. We can all use. I know. Not just an [01:01:35] OCT. Right? [01:01:35] Melissa Mose, LMFT: I know. That was, that was my thought when, when my daughter was little, it was like, well, silver [01:01:40] lining is, she's learning stuff now that a lot of adults never get [01:01:43] Dr. Taz: to. [01:01:43] Dr. Taz: We never learn or never get [01:01:45] to, but I love that the lessons of self-compassion. Blending. Mm-hmm. You talked about multi [01:01:50] blending. Mm-hmm. Separating out right. These different pieces of ourselves. Hopefully this will be [01:01:55] helpful for any family dealing with somebody that has OCD or if somebody individually is dealing with [01:02:00] OCD and maybe hasn't gotten diagnosed, like you said, for almost, you know, 11 to 17 [01:02:05] years. [01:02:05] Dr. Taz: That's a long time. You know, so I hope, you know, I hope this message gets out there. [01:02:10] Mm-hmm. And if someone wanted to reach out to you and get more information, how can, how can folks connect [01:02:15] with you? [01:02:15] Melissa Mose, LMFT: Um, my website is melissa mos mft.com. [01:02:19] Dr. Taz: Okay. [01:02:19] Melissa Mose, LMFT: And I [01:02:20] also have an if FS for ocd.com website where I'm beginning to create. [01:02:24] Melissa Mose, LMFT: A [01:02:25] little more community around if you're curious about that. Um, but yeah, reach out to me. Send me an [01:02:30] email. [01:02:30] Dr. Taz: And the book is targeting clinicians primarily. Right? [01:02:32] Melissa Mose, LMFT: The book is Targeting Clinicians. [01:02:34] Dr. Taz: Okay. [01:02:34] Melissa Mose, LMFT: And [01:02:35] yeah, you know, my hope really is there are a lot of therapists out there who get very little [01:02:40] training on OCD, but they really love internal family systems or curious. [01:02:44] Melissa Mose, LMFT: [01:02:45] And so this book is really meant to spread the word of if you're seeing these things, [01:02:50] these are things you should really know [01:02:52] Dr. Taz: and be thinking [01:02:53] Melissa Mose, LMFT: about. And, and even if you're doing really [01:02:55] beautiful, wonderful, deep IFS treatment, you also need to know that [01:03:00] some, at some point in time, somebody needs to, to face the fears and they can face [01:03:05] it in this really beautiful, compassionate, deep healing way. [01:03:08] Melissa Mose, LMFT: With the addition of of [01:03:10] IFS. [01:03:10] Dr. Taz: I love that. I think this is such important information and even I'm even thinking about our exam room [01:03:15] experience, right? Right. And now being able to identify it a little bit better and really get [01:03:20] folks help and then marrying the work you're doing with a lot of the work that we do day in [01:03:25] and day out around neuroinflammation and understanding the triggers and where it's coming from. [01:03:29] Dr. Taz: I mean, I think [01:03:30] that is a healing journey that I hope anybody with OCD will go on regardless of how old they [01:03:35] are. And for the rest of us supporting those folks, like we're a little bit more educated as well. I'm gonna [01:03:40] ask you one last question. Okay. What makes you whole? [01:03:42] Melissa Mose, LMFT: Oh, wow. [01:03:45] Um, what makes me whole is peace is quiet. [01:03:48] Melissa Mose, LMFT: That just a still moment. [01:03:50] So hard to get those. [01:03:51] Dr. Taz: Oh. [01:03:51] Melissa Mose, LMFT: Just, and, but remembering it doesn't take that long. Yeah. To [01:03:55] just open. Because you know what, yeah, we're whole, nothing [01:04:00] has to make me whole. I just have to notice it. Go find it. Nice. Just have to let it all be there. [01:04:05] And, um. Nature Sure helps. [01:04:07] Dr. Taz: That might be one of my favorite answers. [01:04:09] Dr. Taz: People usually [01:04:10] say family or you know something, but we're already whole. [01:04:13] Melissa Mose, LMFT: Yeah, yeah. [01:04:13] Dr. Taz: We just lose it [01:04:15] sometimes. [01:04:16] Melissa Mose, LMFT: We [01:04:16] Dr. Taz: just forget. Just forget, you know? So, [01:04:18] Melissa Mose, LMFT: so yeah. [01:04:18] Dr. Taz: Well, thank you so much for your time [01:04:20] today. I really appreciate it. I hope this is a good message for everybody. Spread the word. If you know [01:04:25] somebody suffering with OCD or a family that is, you know, knocking around trying to find its [01:04:30] way, or you have a partner, or it's you and you just need some extra help, thank you all for joining me. [01:04:34] Dr. Taz: Don't [01:04:35] forget that we post new episodes every week. I'll see you next time. [01:04:38] Melissa Mose, LMFT: Before you go [01:04:40] take a second to reflect on what stood out for [01:04:42] Dr. Taz: you today. Then if you can [01:04:45] leave a quick review wherever you're listening, it really helps other people discover Whole [01:04:50] Plus and start their own healing journey. And don't forget to follow me on Instagram at [01:04:55] Dr. [01:04:55] Dr. Taz: Taz md. I love hearing how these episodes are supporting you.