What is OCD?
Obsessive Compulsive Disorder, otherwise known as OCD, is an anxiety disorder in which a person experiences unwanted thoughts that are so bothersome or frightening that they will engage in some specific behavior to remove the uncomfortable or threatening thought. For example, a person may be getting ready for bed and suddenly be struck with the thought that maybe they forgot to lock the door. The thought is extremely threatening as they imagine an intruder will likely come in that night, burglarize their home, and it will all be their fault as they were negligent in locking the door. As result, the person would redress, go downstairs, and checks if the door is locked. In many cases the ordeal is far from over. They may lock and unlock the door several times till they get a feeling that it is really locked. In the end they will retire to bed, often without the sense of satisfaction that the door is actually locked. There are various forms of OCD. This one is called “checking.”
People may check repeatedly that the oven is off, that they have not accidentally hit someone while driving, and that the children are breathing in their beds. Let me explain a bit about how the anxious mind works. “As long as I don’t know for sure that my feared consequence won’t happen, it probably will.” This is in contrast to the non anxious mind whose thinking goes “There is probably nothing to worry about unless I’m provided with sufficient evidence that there is.” Individuals with OCD are not nervous about everything, rather each person has specific areas that feel threatening to them.
What is Generalized Anxiety, Panic Attacks and Phobias?
Generalized Anxiety Disorder is when a person worries excessively on a regular basis about day to day stuff. There is a general feeling of dread and that the worst is sure to happen. Besides being an uncomfortable way to live, this robs an individual of the ability to live in the present. One’s brain is always somewhere else and never in the current experience. Panic Attacks can be described as a sudden wave of intense anxiety and fear. They are often experienced with rapid heart-beat, shortness of breath, lightheadedness and / or a feeling like one is losing their mind and going crazy. While there is nothing dangerous about these symptoms, they feel so awful and frightening that an individual may begin to avoid any activities associated with it. Furthermore, a person may begin living in dread of when the next panic attack will strike. Almost every panic attack sufferer has a story of being in the supermarket with a cart full of groceries when a panic attack struck. Many will leave the cart and the groceries and race to safety. A phobia is an overwhelming fear of something that in reality poses little or no danger. The individual usually realizes that the fear is irrational, however the distress is so great that a person will avoid it at all costs. Common phobias that I have seen are driving, flying, elevators, bugs and insects.
What is Your Formal Education?
I received my Masters Degree in Social Work from Wurzweiler School of Social Work and became certified as a social worker. My second year field placement was at Monsey’s Bikur Cholim Mental Health Clinic which had recently opened. It is now quite large, but I was its first student. I stayed on after graduation and expressed an interest in working with anxiety disorders. They were supportive of my interest and helped me attend The Obsessive Compulsive Foundation’s annual nationwide conference. There, I met the top therapists who were treating OCD and learned all about effective treatment.
Several months later, I was contacted and invited to attend a training with two top professionals, Dr. Jonathan Grayson and Dr. Charles Mansueto. They encouraged me greatly as they felt a tremendous need for frum professionals that specialize in OCD treatment, especially a frum woman. This training included supervision. I then began training under Dr. Grayson who is the director of the OCD and Agoraphobia clinic in Philadelphia. I have had extensive supervision from him and I began using his techniques in conjunction with Rabanim with my clients and was amazed at the results. I have worked with individuals with OCD, Generalized Anxiety, Panic Attacks and Phobias. The work was exhilarating. An anxiety disorder will limit a person in many areas as they begin to avoid more and more situations that may trigger the feared response. I worked with individuals to slowly get back everything they had given up in their lives and more. People began doing things they hadn’t done for 5, 10, 20 years! The thank you cards I received from clients and parents of clients were overwhelmingly heartwarming. They frequently expressed how they were given their lives back and felt a new lease on life.
Tell us about Your Private Practice in Monsey
After a very positive experience working at Bikur Cholim I went on to open a private practice in Monsey treating children, adolescents, and adults with anxiety Disorders. I had the privilege of working with all types of Jews from secular to modern to Yeshivish to Chasidic backgrounds. One young Chasidic boy actually came with an interpreter to translate my English into Yiddish! Most sessions took place in my office but if a person had a particular fear that I felt could be better treated in its actual environment I took that into consideration. For example, if an individual was afraid of elevators or high places we would find such a place to practice in. If a child was afraid to go upstairs at home by themselves we might practice in the child’s own home. Did you find many instances of OCD interfaced with Judaism? I work a lot with religious OCD. Men and women alike would obsess whether they had davened each word correctly, touched fleishig with their hands that may have had milk on them, heard every word in the Megilah, checked food well enough for bugs, and so forth. I worked a lot with local Rabbanim to establish guidelines for my work. The Rabbanim were very supportive of my work understanding that this really was an anxiety disorder and not a religious issue. The individuals only wanted to serve Hashem in the best way possible. Religious OCD can also manifest itself in unwanted negative thoughts about Hashem, or doubts regarding the existence of Hashem. I’ve had many clients telling me that they have read every Sefer possible regarding Emunah and Bitachon and they nevertheless can’t rid themselves of their doubts. When I asked one seminary student if she had discussed this with any of her Rebbeim, she looked at me incredulously. She said, “Last week I discussed with my Rebbe whether or not I should marry a Kollel boy. Today I’m going to tell him that I’m having doubts about the existence of Hashem? What’s he going to think?” Sometimes it went further and the individual coming for help was a Rebbe whom others turned to for guidance with Emunah. They would feel hypocritical giving advice in Emunah when they themselves had these uncomfortable thoughts. Working with OCD I’ve learned that the intrusive thoughts an individual gets are usually quite the opposite of what they believe and what they value. It is because they value a certain idea so much that they get nervous when thoughts creep up that may suggest the opposite. This is just one of the many forms of OCD that I treat.
I Have heard that People with Anxiety are often quite talented…
With no exception, the clients I treat are bright, imaginative and creative. You need to be bright and creative to be able to wonder “What if?” Most are quite successful, holding it all together while experiencing extreme pain and suffering. Jonathan Grayson, in his book Freedom from OCD describes this as Competence. This is an ability that one could be feeling so stressed on the inside yet function so well on the outside. It’s only when the suffering gets too much that people come in for treatment. For the most part my typical client is a respected member of the community. Kind, warm hearted, someone who’d you want to be your friend. The kids who come for treatment are unbelievable as well. They are extremely talented and have many great ideas. They often have perfectionistic standards that are not attainable. Sometimes they are carrying guilt. Kids take very well to treatment. They even start giving advice to friends and siblings on how to face their fears. Sometimes I’ll meet a child I treated, years later and they tell me that they still practice what we spoke about. Kids are really great learners.
What is Your Therapeutic Approach or Methodology?
The cornerstone of treatment is Exposure and Response Prevention. This falls under the umbrella of Cognitive Behavioral Therapy. If an individual is avoiding certain situations we want to gradually expose them to those exact situations without them performing the unhelpful comfort behaviors. The individual then gets to learn that although our bodies may sometimes become anxious, our bodies are also programmed to calm themselves down. Before treatment a person will feel that they cannot tolerate the anxiety and they look for a shortcut out. The problem is that their bodies never learn to tolerate the uncomfortable feeling and they stay perpetually stuck in this cycle. There are a couple of themes that run through anxiety. The anxious person always wants to feel just right and exhibits extreme discomfort in the face of uncomfortable thoughts and feelings. The way anxiety works is the harder you try to push it away the longer it lingers. I work with my clients on accepting the anxious feelings and they are amazed at how they pass. Often a client will tell me that if they let their anxiety be there they won’t be able to get through their busy day. I ask them to look at their anxiety in the same way they would look at a bad cold or a headache. You can prefer not to have it, but let it be there. I tell them that their job is to do the best they can with how they are feeling on that given day. I compare it to playing a game of cards. You do the best you can with the hand you’ve been given. The more we stop fighting anxiety and let it be, the more it is free to pass. Also, the truth is that people do accomplish an incredible amount, even with their anxiety.
Another common theme is the inability to live with uncertainty. With OCD, a person wants to know that their worst fear won’t materialize or their bad thoughts don’t mean that they are a bad person. A person experiencing a panic attack wants to know for sure that nothing will happen to them and that they won’t embarrass them self publicly. A person with a phobia wants to know that if they face their fear, everything will be ok. Yes, we think so. However, unfortunately there are no guarantees in life for any of us. I share with my clients that there are risks in everything we do. Our job is to take good guesses, make decisions and live with the results. I like to focus on the fact that Hashem created us strong and if life doesn’t go the way we plan, we will find a way to cope. It may take some time and we might need some extra help. However, we can learn to cope with what comes our way. Limiting ourselves because of our fears, now that’s something that would be tragic.
How Can You Be Reached?
I can be reached in Israel at 052-713-4130. My American line is 845-510-4169. I am currently practicing in Ramat Beit Shemesh. I work with clients in person, on the phone with clients from the USA, England, South Africa and other locations worldwide by telephone or on Skype at Rachel-Factor.