Obsessive-Compulsive Disorder (OCD) and related disorders can take an emotional toll on those who cope with and manage the symptoms daily. Although scientists cannot determine a cause for OCD, they have found that trauma and OCD commonly occur together. Many psychiatrists are beginning to find most OCD treatments remain unsuccessful if a patient’s past trauma has not been addressed. EMDR therapist Dr. Kendhal Hart discusses how she uses EMDR therapy with clients who have OCD.
- Did I Lock the Door? Treating OCD with EMDR Therapy, Exposure, and Response Prevention and Ego State Therapy by Sandra Paulson, Ph.D.
- An OCD podcast episode of an interview with therapist Robert Fox, who has OCD and is an EMDR and IFS-trained clinician. He talks about his journey.
- EMDRIA Practice Resources
- EMDRIA Online EMDR Therapy Resources
- EMDRIA’s Find an EMDR Therapist Directory provides listings for more than 13,000 EMDR therapists.
- Read or subscribe to our award-winning blog, Focal Point, an open resource on EMDR therapy.
- Follow @EMDRIA on Twitter. Connect with EMDRIA on Facebook or subscribe to our YouTube Channel.
Musical soundtrack, Acoustic Motivation 11290, supplied royalty-free by Pixabay.
Produced by Kim Howard, CAE.
Kim Howard 00:04
Welcome to the Let’s Talk EMDR podcast brought to you by the EMDR International Association or EMDRIA. I am your host Kim Howard. In this episode we’re discussing EMDR therapy and OCD or obsessive compulsive disorder. Today’s guest is EMDR therapist, Dr. Kendall Hart. Dr. Hart is based in Texas and has extensive experience working with clients who struggle with OCD. Let’s get started. Today we are speaking with an EMDR, therapist, trainer and consultant Kendall Hart about treating OCD with EMDR therapy. Thank you, Kendall, for being here today. We are so happy that you said yes.
Kendhal Hart 00:41
Thank you so much for having me.
Kim Howard 00:42
So tell us a little bit about your journey to becoming an EMDR therapist.
Kendhal Hart 00:46
So I sort of stumbled into EMDR, maybe 12 or so years ago, just kind of heard about it from other therapists and thought this sounds interesting. So I signed up and did the training, I was in a group of about 100 people. So it was very overwhelming. I was still an intern at the time. And so it was all just quite overwhelming to me. I really did not practice EMDR for about a year after I got trained, I was so anxious about it and nervous and just really wanted to do it right. And so I eventually saw it consultation and found some great clients that I had great rapport with and was able to start using it and immediately began to see the benefit. And I have not turned back since then. So that’s kind of how I got started.
Kim Howard 01:35
That’s great. That’s a good story. Thanks. So what is your favorite part of working with EMDR therapy?
Kendhal Hart 01:40
It is really the nuances of information that you can learn from a person, I used to try to predict how someone would process in EMDR. And even you know what their negative cognition would be or where we would end up as we worked through Phase four. And it is really just astonishing the work that clients do and the progress that they make, just allowing their own brain and nervous system to do the work. And it’s it’s been a journey for me to learn to get out of the way have a lot of desire to join them in the process and have realized through consultation, my consultant was amazing at compassionately telling me to get out of the way. And just really watching you know, people go through their journey and find their successes without me having to lead them or you know, push them through it. Like it’s really just amazing to watch the healing the things that people have healed from it. It’s just It’s overwhelming sometimes.
Kim Howard 02:41
That’s a great segue to the next question, which is what successes have you seen using EMDR therapy for OCD?
Kendhal Hart 02:48
Yeah, this has been a really interesting journey. I again, I find myself stumbling into things I stumbled into working with OCD. It’s not something that I sought out to work with. I just happen to have a grouping of clients that showed up in my office that had OCD. And I really didn’t know how to diagnose it early on. And I didn’t recognize it early on. And then eventually I just kind of found myself having this realization that oh, this person has OCD. And this person reminds me of these other clients that I have. And so I actually think maybe they have OCD. And so I started doing some more learning about it. And I’ve seen great success pairing EMDR with OCD, the clients that I tend to work with have a big trauma history, and it’s typically relational trauma. And so I always say that I approach working with OCD from a trauma perspective. And I know that that’s not everyone’s perspective, but that’s how I approach it. And that’s what works for my particular clients. And so really looking at, like what happened in their life around the time that they started noticing these symptoms, and then helping them identify some negative beliefs that are tied to that. And reprocessing those negative beliefs and the memories that they have really gives them symptom relief. And it’s it’s been such an amazing experience to watch people not compulsive in the same way. I mean, because it really it’s sort of like an addiction like it takes over your entire life when when you have OCD. And so to watch the transformation and then not compulsive in the same way is just it’s changing people’s lives. So it’s, again, like such an amazing thing to be a part of, like somebody’s journey.
Kim Howard 04:31
Yeah, that’s great. That’s great. I have a friend who has a daughter who has OCD. And one of her complaints generally is that people tend to throw that term around a lot even though they they think that because they’re a neat freak or because they do things that they have, you know they use it casually even though they don’t have a true diagnosis of OCD. And that leads us to the next question. What What are Are there any myths that you would like to bust about? EMDR therapy and OCD?
Kendhal Hart 05:01
Yeah, I mean, one of the biggest things I see with OCD specifically is that that kind of idea that it’s, it’s compulsive hand washing, it’s flipping the light switch on and off. And it’s just so much more than that. It’s so much more complex than that. And I so I do I work with clients that have OCD. And then I do a lot of consultation with therapists that are using EMDR to help treat OCD. And so I’m hearing this from various people. And I’m also experiencing it with my clients, I have clients will show up to therapy, and they don’t know that they have OCD. Most of the time. It’s me saying, you know that that sounds a little bit like, you know, OCD or it sounds, you know, like compulsive or, you know, just whatever kind of wording I’m using, depending on the client, sometimes I’ll have people come in, and they’ll say, I’ve been diagnosed with OCD, and it’s more overt like that. But most of the time, it’s me sort of bringing it up, or it’s the therapist bringing it to somebody’s attention. I just don’t think that that there’s a clear picture of what OCD truly is, because you see it in the movies and TV. And again, it’s flipping the light switch, it’s washing the hands compulsively. But there, there’s such a mental process, like an obsessive mental process that goes into it, that isn’t visible to the naked eye. And most people that struggle with this, I think, from my observation tend to hide it, like there’s a shame component to it. And so it’s not overt. I mean, you can have it and I wouldn’t know, because it’s something that’s going on internally for you. Yeah. And unless you show up and share it with someone, you know, and again, if there’s a lot of shame there, you’re not, you’re not going to share it openly.
Kim Howard 06:42
Yeah, I think there’s I think there’s a lot of shame and a lot of people with any kind of mental health condition. So I don’t think that’s something you would put on your Facebook page or, or your dating profile or on your resume or say, hey, oh, I have OCD, you know, come Come look at me do whatever it is fill in the blank, right? So I, I do understand why people would would, would want to hide that. And if they’re coming to you, and they’re having issues, and for professionals to say them, I think you have this, I think you have it, I think there’s probably some kind of sense of relief, that they’re feeling as a patient and of client that somebody finally understands what they’re going through. And they haven’t been able to diagnose it or pinpoint it, or if they have in the back of their mind, but somebody’s validated them. And now they’re like, Okay, at least I know what this is. And now I can press forward with learning how to heal from this, right, and how to manage this.
Kendhal Hart 07:33
And so that’s yeah, and I see that a lot too, with arfid, which I my sort of definition of arfid is it’s the OCD of eating disorders, and I see it show up, and I treat adults primarily. And so they’ll show up and they’ll say, you know, I have this thing called orphan and I’m like, yeah, yeah, I know what that is. And they’re, they’re always surprised, like, oh, you know what it is because most people in most places have not heard of it. And, and I mean, I don’t know that it’s relatively new, but it’s more like, unheard of. And so again, like, that’s what comes up for me as I listened to you talk about, like, feeling seen, and that somebody gets it, but I already speak the language, I already know what it means. I know, you know, I can ask you questions about how does it show up for you and these various facets of of your life, and it makes sense and it feels really validating and, you know, again, like they’re being seen and that they’re not alone. I mean, there’s a lot of loneliness with any kind of mental illness that you know that they’re different quote different than the norm.
Kim Howard 08:36
For the audience members who may not know what that is, can you explain one to them what that is.
Kendhal Hart 08:40
Yes. ARFID is avoidant restrictive food intake disorder, oftentimes it will start in childhood and and you know, it is a childhood disorder will it will show up with restricting kinds of food intake and different things like that, and it very well could be a medical condition, but what I see in my adults that show up with it, which you know, it’s gonna look a little bit different in adults than it will in a child is there’s this fixation over food from a variety of different angles, it could be contamination, which you can hear the overlap with OCD already with this sort of contamination, fear of, you know, I have to the avocado has to look a certain way the potato has to look a certain way, or, well, I can’t eat this with this, or I have a list of safe foods and unsafe foods, and it is an eating disorder. And it can literally lead to like complete weight loss, like total devastation as eating disorders can do. And then over time, like as you learn to deal with it and identify like the safety components that are related to it, your safe food list becomes a lot longer and your unsafe food list becomes a lot shorter. And so there’s just a lot of obsessions and fixations and fear and anxiety around foods specifically when it comes to arfid. And again, I mean, I always do describe it as the OCD of eating disorders. And so far, I’m not saying that this is a blanket statement. Totally true. But in my experience I’ve not met. So I’ve not worked with a client who has arfid, who does not also have OCD, there just tends to be a lot of overlap there and symptomology. So, yeah, so that’s kind of the gist of it. Yeah.
Kim Howard 10:20
Okay. That’s good to know. Thanks for the explanation. Are there any specific complexities or difficulties with using EMDR? therapy with OCD?
Kendhal Hart 10:28
Yeah, there’s a lot. This tends to be what I consult on most often is like, number one, it’s, it’s identifying that you even have a client that has OCD. And then what, you know, there’s a lot of blocking that happens in Phase four. So this yeah, there’s, it’s hard to even condense, like all the things that would happen, I would say the most common things that happen are, you’re going to have these protective blocks that show up that are that will impede face for processing. And that can look like a lot of different things of you know, various different protective negative beliefs. So I want to take a step back and just kind of say, there are really important reasons why this obsessive process exists in the individual system. And I’m always looking at that in EMDR, phase one, where I’m history taking, getting to know them and trying to make sense of their system and what’s going on and what their triggers are, what the compulsions are and and you know, what they’re avoiding, and different things like that. And so I’m very much focused on a perspective shift with them, which is oftentimes they show up and they hate their OCD, because it has taken over my life, and I can’t do the things that I want to do, I can’t eat the way I want to, I can’t engage with friends, I can’t have a healthy relationship, you know, so on and so forth. And it’s a perspective shift. There’s something important about this behavior, and about the way that your system is operating and responding to things your system, your internal system is trying to take care of you. And if we can shift that perspective, we can get a lot of buy in from the client of like, these parts of me mean well, in the way that they’re showing up and trying to take care of me. But the fallout is problematic. And yeah, you know, we want to address the Fallout, but we want to do it in a really compassionate way. And so I’m spending much longer in phase one with a client that has OCD, then I would somebody who doesn’t have OCD, who doesn’t have complex trauma. And so then moving into phase three, and four, a few of the things that I see are perfectionist stuff showing up. So we’ll start a phase four, we’ve got the perfect negative cognition and the perfect memory, we worked really hard to figure out what it is, and we start processing. And after the first round of bilateral, I’ll say what are you noticing, and they’ll say, I just don’t know if this is going to work. And historically, there’s been a part of me that’s like, I need to like prove to you that this is going to work I need to cognitive interweave our way through this. And again, through consultation. My consultant was amazing compassionately helped me step back. Now it’s about just notice that just notice that we do more bilateral. What are you noticing, now I really need this to work. Just notice that 25 more passes, what are you noticing now, and we work through that in Phase four. And so a lot of times when I do consultation, or if I’m doing basic training and trying to help people kind of get prepared for this, I think there’s a natural desire in us for it to like work well, you know, we want MDR to work well for the client. And when we feel that resistance, especially speaking from I will speak for myself as someone that has anxiety, I react, you know, and I want to I want to help them get through this. But the best way to help them get through it is just have them notice it and do bilateral stimulation, whatever it is that shows up, whether it’s perfectionism, whether it’s you know, any sort of other block that just it will show up really, really, really fast. Because OCD is all encompassing, it’s intense. And it’s going to show up the second you start phase four processing, just have them notice it and add bilateral stimulation.
Kim Howard 14:12
And I think that’s perfectly normal response from somebody who is a therapist and somebody who does that kind of work. I mean, you Yeah, yeah. People who went into that work, they went into that work because they wanted to help other people, right? It is, I would imagine very hard to distance yourself as a professional and say, Okay, I can’t, I can’t do the journey for them. I just have to help them through the journey. So I think that’s compassionate. And I think that’s extremely normal to do that. And it’s good that somebody who’s further down the line in our career has said, Hey, it’s okay. Just here’s how you can do this without, you know, doing it for them. So that’s right. Yeah.
Kendhal Hart 14:50
Thank you. Yeah, yeah, I had to it was a long journey to learn that but here I am. Good. That’s good.
Kim Howard 14:57
How do you practice cultural competency as an EMDR therapist?
Kendhal Hart 15:02
I think it’s really, really important to ask these questions on the front end about what, again, like what purpose it serves, because there are cultural components. Sometimes that to URI may look like disordered thinking, or disordered behavior, but really asking about it and being proactive instead of reactive later on. And so a lot of it is like seeking out our own training in that area, and being curious with the client about, like, help me understand where this comes from, or where you learned this, or who taught this to you, or what purpose it serves it just really coming from a place of curiosity and not making assumptions, I think is is just the baseline of trying to be culturally competent in the way that we approach things.
Kim Howard 15:55
It’s good advice, do you happen to have a favorite free EMDR related resource you would like to suggest for the public or other EMDR therapists like an article or video or podcast, something like that?
Kendhal Hart 16:06
This is where I’ll say I do have a great podcast that I listened to have somebody talking about their own journey. It’s a therapist talking about his own journey, dealing with OCD and his struggle, really getting through it, even getting a diagnosis and making sense of it, that I will happily provide you the link to there’s not a ton of OCD resources out there that I have found specifically for EMDR. Therapists. A lot of it has just been kind of haphazardly collecting OCD content. And there are some some other trainings, I forget the name of the person that does it. So I have to add this later on. But it’s it’s Did I lock the door? I cannot recall the name of the person that did it. But I’ll definitely link you to it that that one is specific to OCD and EMDR. There’s just not a ton of resources out there specific to this population.
Kim Howard 16:58
That’s great. Thank you. What would you like people outside of the EMDR community to know about OCD?
Kendhal Hart 17:04
Oh, there’s so much I mean, all right.
Kim Howard 17:07
Give me your top three things that you’d like to know. Or five?
Kendhal Hart 17:11
Yeah, I want to start with OCD is more normal? I think then a lot of people realize, I think it’s probably under diagnosed. It’s it’s very normal. And another thing I was thinking earlier, there was a question that you asked that that got me thinking about this is there’s there’s some confusion about like, Where does OCD even come from? Is it inherited? Is it genetic? Is it trauma based? And, you know, ultimately, it’s a little bit of everything. Like there’s there’s definitely genetic components to it. And there’s also trauma components to it, that there’s research to support that, you know, with the increase, children that have experienced, you know, abuse and neglect in their childhood are more likely to develop OCD, in my personal work with clients. I’ve definitely seen, there’s some sort of brain thing there that somebody’s like predisposed to it because there are other individuals that can go through really similar life experiences and not develop OCD. And so it just really seems like there’s a genetic component. And research obviously supports that. So another myth, like kind of circling back, and I’ll just use this as one of my points here is that, that OCD can’t be cured, for lack of a better word. And I don’t mean that in an all or nothing sort of terminology. But there’s sort of this idea that once you have OCD, like that’s it, you have it for the rest of your life. And a lot of times clients will present it, it really feels like there’s this lack of hope, like there’s this hopelessness there about, well, this is I just have to learn to live with it. And I think that when we approach it from a trauma perspective, and we shift some of these negative beliefs, and we shift the vantage point on some of the memories that are tied to these negative beliefs, we can see a lot of symptom relief. And for some people, they can experience full symptom remission, while others won’t. And that’s fine. I mean, everybody’s different. But any sort of turning the volume down on OCD makes such a huge impact. And there’s such a huge ripple in the person and the way they show up in relationships, the way they show up at work. They’re everything I mean, because it really just impacts everything. So I think that that’s important is that there is hope, there is hope. And you don’t always have to live with your OCD at the extreme level that it operates right now, and that it serves a really important purpose because a lot of times it’s developed what I’ve seen as a result of parental education, and taking on a lot of responsibility in childhood, and that that’s a trauma response. And so if we can, if we can use EMDR to address the traumatic components of your OCD, we can see symptom relief, and then the genetic component of it, you know, is maybe something that remains So we can help address some of the the traumatic, the trauma responses that you’re experiencing with OCD.
Kim Howard 20:07
That’s good. That’s good to know. That’s good to know. So if you weren’t an EMDR therapist, what would you be?
Kendhal Hart 20:12
Who knows? I don’t know. My dream would be to be a singer, except that I can’t sing. Actually, I would probably be a teacher that was my original major in college was I was going to be a kindergarten teacher, which my mom thought was laughable. So eventually, I changed that I changed my major. So something with teaching, I don’t know, project managing. I don’t know.
Kim Howard 20:36
Does she think it was laughable because she didn’t think you had the patience to be a teacher?
Kendhal Hart 20:41
Or there was some of that? Yeah.
Kim Howard 20:45
Yeah, it takes, you know, takes a really special person to be able to work with children. Oh, absolutely.
Kendhal Hart 20:51
Yeah. And I don’t regret I don’t regret that major change.
Kim Howard 20:56
It’s good. You were guided to the right path.
Kendhal Hart 20:59
Yes. Yeah. Teachers are stronger than me for sure. Yeah. I’m not cut out for it.
Kim Howard 21:05
Is there anything else you would like to add?
Kendhal Hart 21:07
Yeah, the main thing I’d like to add on is, personally, I have found that integrating some ifs parts language, which if you have any education on parts language, you’ve probably heard me speak like that. The length of this podcast really using this parts language and helping clients with OCD, reconceptualize their obsessions, and their compulsions as various parts of themselves, I have found to be incredibly helpful. There’s this externalization of their OCD process, which I think helps them conceptualize it differently, and also removes a layer of shame because it’s not who they are. It’s some of what they’re doing in order to survive or function. It’s a byproduct of something else. And so I have just really found that integrating internal family systems into my EMDR work and my case conceptualization, especially with these clients and with clients that have complex relational trauma has been incredibly helpful. Very, very helpful. So I think that’d be the main thing that I just want to throw in there.
Kim Howard 22:18
This has been the Let’s Talk EMDR podcast with our guest, Dr. Kendall Hart, visit www.emdria.org for more information about EMDR therapy, or to use our Find an EMDR Therapist Directory with more than 13,000 therapists available. Our award winning blog, Focal Point, offers information on EMDR and is an open resource. Thank you for listening.
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Howard, K. (Host). (2022, September 29). EMDR Therapy and Obsessive-Compulsive Disorder with Dr. Kendhal Hart (Season 1, No. 9) [Audio podcast episode]. In Let’s Talk EMDR podcast. EMDR International Association. https://www.emdria.org/letstalkemdrpodcast/
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