Episode 76: OCD (Part 2): Exposure Therapy—You Don’t Have to Lick Toilets [featuring Aiden Reis]
Oct 17, 2024
Show Notes
OCD is often misunderstood and can manifest in many forms from a variety of experiences that create associations with a compulsion and an outcome.
In this episode, Patrick Casale and Dr. Megan Anna Neff, two AuDHD mental health professionals, are joined by Aiden Reis, a trans, Autistic therapist who specializes in OCD, anxiety, phobias, and panic. They discuss practical strategies for effectively managing OCD through Exposure and Response Prevention (ERP) therapy using a value-driven and neurodivergent-affirming approach.
Top 3 reasons to listen to the entire episode:
- Learn practical strategies for rebuilding self-trust after anxiety-inducing experiences, drawing from Aiden Reis’s invaluable insights into Exposure and Response Prevention (ERP) therapy adapted for neurodivergent individuals.
- Discover the importance of accommodating sensory needs in therapy without reinforcing anxiety, and understand how to effectively differentiate between sensory sensitivities and anxiety responses.
- Gain a richer appreciation of how addressing "what if" scenarios and unhooking from distressing thoughts can lead to profound empowerment and emotional resilience, helping you live a good life despite potential challenges.
OCD can be challenging, but there are ways to manage it, and ERP done using a neurodivergent-affirming approach, can be an effective tool in managing OCD for neurodivergent individuals.
More about Aiden:
Aiden is a trans and autistic, private practice therapist based in Massachusetts. Working with Autistic and ADHDer clients, he is passionate about providing neurodivergent-affirming and LGBT-positive therapy. He specializes in OCD, anxiety, phobias, and panic. Aiden is a member of the International OCD Foundation.
- Website: www.divergecounseling.com
🎙️Listen to more episodes of the Divergent Conversations Podcast here
🎙️Spotify
🎙️Apple
🎙️YouTube Music
▶️ YouTube
A Thanks to Our Sponsors: Resilient Mind Counseling & Learning Nook
Resilient Mind Counseling is a neurodivergent-affirming therapy and medication management practice operated in North Carolina. We specialize in supporting neurodivergent individuals, especially Autistic ADHDers, the LGBTQ community, and the BIPOC community. For mental health therapy, we accept Blue Cross Blue Shield, UnitedHealthcare, MedCost, Aetna, and self-pay. For medication management, we accept Blue Cross Blue Shield and self-pay. We can see clients all throughout North Carolina. If you are looking for medication management services, you need to be within a 60-mile driving distance to the office in case you need to come in. All of our clinicians identify as either Autistic, ADHD, or Autistic-ADHD, or have some form of neurodivergence or are neurodivergent-affirming. We strive to create a neuro-inclusive healthcare community. You can text or call our main line to get started at 828-515-1246 or visit our website at resilientmindcounseling.com. We look forward to helping you along your healing journey.
Explore the power of the neurodivergent community with the Neurodivergent Insights Learning Nook—a neurodiverse space that welcomes all neurotypes. Our community fosters personal growth with access to workbooks, eBooks, workshops, and more. We also host body double sessions, parent gatherings, and monthly live events. Clinicians can join our special tier for exclusive resources and networking. Limited to 20 new members monthly. Enroll at neurodivergentinsights.com/membership. Scholarships available.
✨✨ Hurricane Relief for WNC communities:
This money will go to nonprofits who are boots on the ground. It will go to struggling individuals who do not have enough money for gas to get out, or who do not have enough money to provide their basic needs right now. Donate to Patrick's GoFundMe to help provide urgent aid for WNC communities affected by Hurricane Helene. Visit: atppod.com/wnc
Transcript
PATRICK CASALE: Hey, everyone. You are listening to the Divergent Conversations podcast. We are two neurodivergent mental health professionals in a neurotypical world. I'm Patrick Casale.
MEGAN NEFF: And I'm Dr. Neff.
PATRICK CASALE: And during these episodes, we do talk about sensitive subjects, mental health, and there are some conversations that can certainly feel a bit overwhelming. So, we do just want to use that disclosure and disclaimer before jumping in. And thanks for listening.
Hey, everyone. Welcome back to Divergent Conversations. We're continuing our OCD series today. And we have a really cool guest, Aiden. I never asked you how I say your last name. So, I'm going to Reis [CROSSTALK 00:02:25]-
AIDEN REIS: [CROSSTALK 00:02:25].
PATRICK CASALE: Aiden Reis. I am so jet lagged you all, so reading the bio is not my strong suit right now.
Aiden Reis is a trans and autistic private practice therapist based in Massachusetts, working with the autistic and ADHD clients. He is passionate about providing neurodiversion affirming and LGBTQ positive therapy. He specializes in OCD, anxiety, phobias, and panic. Aiden is a member of the International OCD Foundation. And we are really excited to have you on here today.
AIDEN REIS: Thanks so much for having me. It's really exciting to talk.
PATRICK CASALE: Megan, do you want to introduce what we're talking about? Because…
MEGAN NEFF: Yeah, I mean, well, I was going to see if we wanted more context for Aiden? But that's also a hard question. I'm going to hot potato it to you, Aiden, and you can either pick it up or not. Is there any other context for our listeners that you'd like to share about kind of who you are as a therapist or how you come into this conversation?
AIDEN REIS: Yeah, definitely. So, as Patrick was saying, I'm autistic myself, but I don't have OCD. But, like, early on as a therapist in community mental health I was working with a lot of autistic clients, just kind of naturally drawn to that population, of course, even I didn't know it at the time, why? And then, it kind of seemed like OCD kept coming up over and over again. And I go to my supervisor and say, "Okay, what should I do here?"
And she wasn't trained on what to do with OCD, so she couldn't help me. And I was really new. and she would just say, like, "Refer out." But that was, like, the most motivating thing she could have said to me to get trained because I didn't want to refer out these clients who had so much, like, attachment disruption already, and I was really connecting with them in so many other ways. Yeah.
MEGAN NEFF: I love that. That's such, like, a beautiful responsiveness. And I absolutely have seen that a lot too, of like, yeah, most of us, maybe that's an exaggeration, but many of us also have OCD, but especially, because, do you work with the neuro queer population?
AIDEN REIS: Mm-hmm (affirmative), yeah.
MEGAN NEFF: So, especially when it's like, I feel like so often neuro queer clients, particularly, are like, having to choose between, like, someone who gets my identity, someone who specializes in the thing I'm struggling with. So, for you to go out and be like, "No, I'm going to figure out how to do this." Like, do you ever get the, like, tingly feelings of like goodness?
AIDEN REIS: Mm-hmm (affirmative).
MEGAN NEFF: I have that right now. I just think that's really beautiful.
AIDEN REIS: Yeah.
MEGAN NEFF: Yeah, and I've seen a few therapists do that. And I just think it's really lovely to respond to the need you're seeing by kind of leveling up training.
AIDEN REIS: Yeah, absolutely.
MEGAN NEFF: Yeah. And then, autism, is that a newer in life discovery for you? Like, since-
AIDEN REIS: Yeah.
MEGAN NEFF: …being a therapist? Okay.
AIDEN REIS: Yeah, I'd say a couple years ago. I was actually diagnosed with a learning disability as a child and kind of put under the like NVLD category.
MEGAN NEFF: Yep, yep, it's common.
AIDEN REIS: And then, I was, yeah. And then, I was, like, looking later at that paperwork like, "Okay, what did that even say?" And it's like, this is just a description of autism.
MEGAN NEFF: Yeah, you know, yeah, I've heard that about NVLD before. Now, it's obviously in the news a lot because of Tom Walt's son. And people have been asking me to make a diagram for that for years. And I should probably go do that, because, yeah, there's so much molarities.
Okay, and I'm excited to talk about exposure because I think exposure gets kind of a bad rap. And I actually feel bad. I feel like I contributed to that in my early work. But actually, exposure is really helpful for anxiety. So, you do exposure response prevention or OCD, but you adapt it for neurodivergent clients. Do I have that right exactly?
AIDEN REIS: Exactly, yeah. I'd say I'm really ACT informed. And I think that was really helpful and starting to adapt because I think the values piece, so many people connect so well with that, and a lot of other pieces, too. So, I'd say really ACT informed, ERP, and then adapting even further past by just adding in the compassion and values from ACT, but going further to making it friendly, specifically.
MEGAN NEFF: I love that. I draw on ACT a lot. I really like ACT. I think it feels very gentle. And I do love how values aligned it is. I am blanking, Terra Vance has an article I really like in the title of something like Autistic People Don't Have Values. We all have values.
AIDEN REIS: Yeah.
MEGAN NEFF: Just that how it's so key to our identity. So, I think an approach that helps us be value-aligned while holding hard emotions, like it holds that paradox, personally, I found the most healing in my anxiety and in a lot of my mental health through that framework, as well as psychodynamic stuff, but…
AIDEN REIS: Yeah, absolutely.
MEGAN NEFF: Yeah.
AIDEN REIS: Yeah.
MEGAN NEFF: Did you have a thought or…?
AIDEN REIS: I had a thought, but it escaped me.
PATRICK CASALE: [CROSSTALK 00:07:38]-
MEGAN NEFF: But what happens when, oh-
PATRICK CASALE: [CROSSTALK 00:07:39] I like that we're having you on to talk about ERP, or exposure response engine, for those of you listening, from a neurodiversion affirming lens. Because, again, like Megan said, getting a bad rap in a lot of circles. But we also had someone on recently who did the same thing for our listeners with EMDR, which also gets a bad rap. And she did a really fantastic job of saying, like, individualizing, taking into account people's backgrounds, cultures, their identities, really ensuring that this is not a black and white protocol. And I think that's really important.
AIDEN REIS: Yeah, absolutely. And I really, like you all talked about, like, finding the access point. What's going to help someone access this tool that we already know works for lots of other people, but it's not always so accessible right off the gate. Yeah.
MEGAN NEFF: Yeah, yeah.
AIDEN REIS: Yeah, and-
MEGAN NEFF: Oh, go ahead. [CROSSTALK 00:08:30]-
AIDEN REIS: No, it's okay. You were saying, Megan Anna, that like has been really helpful to you, and I wanted to share that it's been helpful to me as well doing exposure on my own anxiety, even though I'd say it's from an OCD context, but it was, like, helpful to kind of learn myself, or really, like, helping clients tease some things out a little bit.
And so, I used to experience a lot of anxiety about food. Like, what if I have a negative sensory experience eating a food? And I think I would not recommend someone try to do exposure for sensory sensitivities, like try to eat food that really bugs you to get better. Maybe there are some people who feel okay about that, but that's not my personal style. But I was able to tease out the sensory versus the what if anxiety about having an experience and do exposure to that.
MEGAN NEFF: I love that.
AIDEN REIS: And I feel like that made me even, like, more autistic. Like, meet my autistic needs even better because I was practicing facing that what if and the uncomfortable feelings of the anxiety that came up when I was doing it. And then, I was able to find more same foods and more foods I learned. And what my actual autistic preferences are around food, like, and actually meet my needs better because I was exploring them.
MEGAN NEFF: Oh, that's so interesting. So, in working through the anxiety you were actually able to better meet your sensory needs.
AIDEN REIS: Yes.
MEGAN NEFF: Oh, I love that.
AIDEN REIS: Yeah.
MEGAN NEFF: Yeah, okay. So, how did you… because I get this question a lot because I talk about this too, the importance of teasing out anxiety versus sensory. Because, yeah, we don't want to do an exposure to sensory stuff. How did you walk yourself through teasing out? I think this is a what if anxiety thing versus I think this is a sensory thing.
AIDEN REIS: Yeah, I think paying attention a little bit. You know, sometimes people are saying ERP "the content doesn't matter." Like, the thoughts don't matter. And we can talk more about that because I think that's a really cruel thing to say to someone, especially, autistic people [CROSSTALK 00:10:32]-
MEGAN NEFF: Like your thoughts don't matter.
AIDEN REIS: Yeah, I wouldn't say to someone-
MEGAN NEFF: [CROSSTALK 00:10:34] thoughts, yeah.
AIDEN REIS: Yeah. It's like a lot of who we are, our values, our thoughts. And so, I really don't like that kind of frame. That's another way we can adapt, "Don't say that to people." Just because the ERP is a behavioral model doesn't mean we can't look at the thoughts.
And the thoughts are going to tell us what's anxiety. So, like, what if or any kind of future-oriented thought kind of points to that's our sensory sensitivity, that's our anxiety. But also, just like, you know how in ACT is like turning towards the feeling, whatever that feeling is to be with it. So, in turning towards the feelings that come up when I was eating, I could say, "Okay, this feels like something I don't like in my mouth." Not something I don't like because my heart is racing, because my muscles are [INDISCERNIBLE 00:11:46] and it's like, tuning in. It's really hard to deal with alexithymia.
MEGAN NEFF: I was going to ask you Aiden because I'm like, that's really precise self-awareness. Yeah, yeah. So, how did you-
AIDEN REIS: [CROSSTALK 00:11:39]-
MEGAN NEFF: How did you do that with alexithymia? Well, like, yeah, I know, for me, I track a lot of my behaviors and my thoughts because the feelings are harder. So, that's my access point to, like, figuring out how I'm feeling or dealing with it. Is that similar to what you did or…?
AIDEN REIS: Yeah, I would say so. Like, having a sense of, I kind of like do this with clients, too, with a SUD scale. Sometimes people use the SUD scale with ERP to see like [CROSSTALK 00:12:09]-
MEGAN NEFF: And we'll just break that SUD scale is, do you want to unpack that real quick?
AIDEN REIS: Oh, yeah, the subjective units of distress. So, how distressed are you from, you know, zero to 10 scale. But it can be really hard for clients with alexithymia to rank something with a number or word.
MEGAN NEFF: Totally and it's often like I'm one or two or I'm 10 because we don't feel that slow creep, which is why this is actually one of the reasons people with alexithymia can often look like they have borderline personality disorder because like, it looks like an extreme emotional reaction because it's like, well, I'm fine, and then I'm not fine. Versus, like, that middle ground. Yeah, absolutely.
AIDEN REIS: Right. We can really, like, break that down for people, like, what does this look like on the outside at a 10, a five, a zero?
MEGAN NEFF: Yes. What are you doing? What are you thinking? Absolutely, yeah.
AIDEN REIS: All external.
MEGAN NEFF: I really like doing that.
AIDEN REIS: And then mapping that with some internal things until people get more comfortable, and you can kind of grow your awareness, if you want to. That's the other piece, is like, the SUD scale's helpful. We can use it in ERP. But we don't have to. And that's another piece of adapting. So, if something's not working, just like, chuck it did. We don't need it.
I think people get really hung up on SUDS because of the idea of, like, habituation in exposure. Like, the idea that we're supposed to, like, keep exposing ourselves to anxiety until we feel less and less and less of it. And that's like, what success looks like, ERP.
But that's an older model. And the newer model is more about inhibitory learning. And we don't need to, like, measure SUDs and watch them go down if we're measuring our goals more in an inhibitory learning way of, like, how are we living with this feeling instead of, is it going away?
MEGAN NEFF: Oh, yeah. I hear the ACT in that because it's like, I really like, there's exercise from ACT called the Matrix. And it talks about the inside-out trap of, like, oh gosh, okay, I cannot unpack this with words. But the idea is we often get stuck with I can't move toward what's important to me. I can't move toward my values while I have these negative feelings inside. And that's often the measure of success, which is kind of what you're saying with the SUDS, the SUDS.
AIDEN REIS: Yeah.
MEGAN NEFF: Is it pronounced SUDS not… Okay, with the SUDS is that it's measuring like the distress versus how much are you moving toward what's important to you?
AIDEN REIS: Yeah, exactly.
MEGAN NEFF: Yeah. And so, with the inside-out trap where it's like, well, you know, I can't move toward friendship until I feel better about this part of my life. It would be like, I can feel anxiety and move toward friendship and move towards socialization. And so, it's taken that I can feel this thing and move toward this thing.
AIDEN REIS: That's really how I would describe ERP in general. Like, sometimes people are talking about ACT or ERP, and it's kind of like, are these all things all synonymous? Because that was exactly how I would describe it, like moving towards something you value with the feeling, and turning towards that feeling, and towards your values at the same time. And paradoxically, it does tend to lead to habituation, but [CROSSTALK 00:15:28]-
MEGAN NEFF: Yeah, yeah. And I think this is really hard for a lot of neurodivergent people. There's been some research out there that many of us, especially, with alexithymia, we tend to cope through emotional avoidance, and this requires… And you're saying how doing the exposure work on yourself is really hard. I've also done a lot of exposure on my anxiety. It is really hard because you're looking at the emotion, you're sitting with it. It is the opposite of emotional avoidance.
And many of us, for understandable reasons have coped with our overwhelm through emotional avoidance. So, it can also feel really vulnerable to start one of these approaches where all of a sudden we're relating to our emotions very differently.
PATRICK CASALE: I believe we kind of talked about that Megan in our first, like, intro episode for OCD when we talked about exposure. A lot of people can view exposure therapy as like a last resort. Like, I am so desperate for this to be different, or for this to no longer impact me in this way. And how there's such as a level of vulnerability to saying that and placing yourself in a position where a lot is going to come up, you know, comparatively to just talk therapy or…
And I like what you're saying, Aiden, about kind of individualizing this and moving towards values makes so much more sense as opposed to saying, like, there's going to be this almost rigidity, like, process of extremism, in a way.
AIDEN REIS: Yeah, I really do see that. I think that critique is really valid when people are talking about some exposure therapists being pretty rigid and extreme. I've definitely been in trainings, conferences where people are advocating for that, like, kind of have this bravado, almost like, "We're ERP therapists, we're going to lick the toilet."
Like, it's not an episode of fear factor. We don't need to be extreme and we don't need to, like, go up a hierarchy in a rigid way. That's another piece of this change in model from habituation to inhibitory learning is showing good outcomes can come without going up in a rigid way of hierarchy.
MEGAN NEFF: Can you unpack inhibitory learning real quick? That's a mouthful.
AIDEN REIS: Yes, definitely. So, inhibitory learning is about making new connections and new associations. It's not necessarily about getting rid of the old ones like unlearning, not necessarily unlearning fear, but learning safety on top of fear.
So, basically, like, if you were to touch a hot stove as a kid, your brain would generalize automatically, "Don't touch hot stoves." That's a really protective thing we need. And in order to feel safe again touching hot stoves, you would have to, like, approach that and have a new association, new learning come, and then not be burned over and over again, and probably in different situations and at different times, so that you can form a new understanding. And like a new neural connections around safety. And it doesn't necessarily have to replace the old ones, but create new ones.
So, that's like kind of the process of inhibitory learning. But it's also just like a shift in how we're talking about OCD away from this kind of older model into this newer model.
MEGAN NEFF: That feels way more empowering to think about, okay, I can create new neural pathways here versus I have to unlearn something that I've got, like, years of like ridges, like neural ridges around. And again, it holds the both and, yeah.
AIDEN REIS: Absolutely, yeah.
MEGAN NEFF: Yeah. Okay, I kind of want to backtrack. I kind of want to go back to exposure because I feel like this is a pretty, like, foundational idea. Can we just talk about why exposure works for anxiety? Because I think, exposure does not work for sensory sensitivities. And I think that's where this idea that, like, exposure doesn't work for autistic people, we're talking about a very, like, specific part of the autistic experience. So, can we just talk about exposure a little bit like what it is, why it works for our society?
AIDEN REIS: Yeah, it's a really good place to be. So, in ERP we conceptualize the OCD cycle has, like there's a trigger, and then, experience intrusive or obsession with thinking that's distressing, causes anxiety or distress. And then, we have a compulsion come right in after that, in order to relieve the distress, which kind of gives some temporary relief, or just like, a little bit, which kind of reinforces the whole cycle. Because, okay, that worked a little bit. Of course, you're going to try again and again and again. That's kind of the OCD cycle.
And then, exposure kind of interrupts that cycle. As behavioral therapy, we picked interrupted at the place of compulsion. That's kind of one of the things that makes it different from ICBT as is it's more behavioral, less cognitive. So, instead of doing the compulsion, we practice staying with the emotion and whatever that is, distress, anxiety. And in doing so, we have that new learning that happens where we can't blame our safety on the compulsion. We can actually learn safety elsewhere.
So, let's say, and I'm going to give an example of something related to harm OCD just because I think a lot of times people talk about OCD with like contamination or hand washing. That's so not what it is so much of the time that I like to use more common example like harm.
So, let's say someone's really [INDISCERNIBLE 00:21:27] like a really autistic affirming example, too. So, let's say someone's special interest or intense interest is cooking, and they really love being experimental in the kitchen, and all of that. But then, OCD kind of comes to that area of their life, and they become really afraid of harming someone or themselves with a knife in the kitchen. So-
MEGAN NEFF: I've literally had this before, yeah.
AIDEN REIS: Common, really common.
MEGAN NEFF: Yep.
AIDEN REIS: And so, then the compulsions can be to avoid being in the kitchen, or to avoid knives, or clench your fists really tight, and don't pick up the knife or something like that. And then, if you were to cook that way and go through the OCD cycle, you get to attribute safety to the fact that you did those compulsions. Like, I was safe. I didn't murder anyone because my fists were clenched.
MEGAN NEFF: Right. So, it's very reinforcing because it's like, it worked, I was safe. Yeah, yeah.
AIDEN REIS: Yeah, exactly. There's a little bit of a confirmation bias there, but it's there, and it makes perfect sense.
MEGAN NEFF: Yeah. And then, in ERP, when we're doing the exposure, and we're kind of in a slice through the cycle, that would mean, in that example, like maybe at first just standing in the doorway of the kitchen. We don't need to get too intense, like we were saying before. It's just about practicing turning towards the emotion without the compulsion.
So, impact of standing in the doorway and feeling the feelings that come up when doing that and not engaging in the compulsions. And then, because of that, you got to learn, like, no, I'm safe. I didn't murder anyone. And we kind of learn by doing.
MEGAN NEFF: Yeah, yeah. And there's so much strength and, like, I think, a reclaiming of agency that I've seen with that. Like, both, like, I can survive hard emotions.
AIDEN REIS: Yes.
MEGAN NEFF: But also, like this thing, I fear didn't actually happen. Yeah. So, it's, you know, something I talk about a lot is, I think that the autistic experience, I think we lose a lot of trust with ourself for a lot of reasons. One, because a lot of our, like, sensory experiences throughout our whole life have been invalidated, and a lot of our ways of socializing have been invalidated. So, we experience a lot of loss in our self-trust. And when we can do that sort of exposure, what you're describing it, doing it well, not the kind where we're just flooding ourselves and shutting down, then it rebuilds self-trust, which I think is so powerful for anybody, but especially, for those of us who have kind of had self-trust eroded through our lives.
AIDEN REIS: Absolutely. And I appreciate how you're saying it's not just about showing that the bad thing won't happen. It's also showing that you can handle the hard feelings that come up because we don't have 100% certainty that nothing bad will ever happen.
MEGAN NEFF: Yes. Have you read… My favorite book on anxiety, right? And I read it… So, I had pretty significant postpartum anxiety. And my OCD started flared during that time. And it lasted the whole time I was nursing. And I nursed for two years because I read a thing about, like, I was doing the autistic thing of like, these are the rules, you're supposed to nurse this long.
Anyways, the whole time I was, like, hormonally in that period I had postpartum anxiety, which was years for me because, yeah. And my favorite book I read, I always mess up the title, maybe you know it, Everything Might Go Terribly Horribly Wrong But it's Okay. It's by one of the, like, big ACT people. But I love it because it's about like, yeah, things might go really, really wrong. And how do we live? How do we live a good life in the face of that?
AIDEN REIS: Absolutely, yeah. Exposure is so about that? Ideally, it's like helping us move towards what we really value, what really matters to us, and not about licking toilet seats for no reason. No one ever is going to need to lick a toilet seat. It's just not practical.
PATRICK CASALE: [CROSSTALK 00:25:34]-
MEGAN NEFF: Okay, so that's, oh, go ahead, Patrick.
PATRICK CASALE: I was just going to make a very stupid joke, that I was just in Italy. And, yeah, the toilet seats are disgusting. So, just that image in itself is just horrifying to me.
With your example, Aiden, like stepping into the kitchen, right? The next step might be like opening the fridge door and like you're tracking the SUDS, the subjective units of distress the entire time, and just paying attention to what's coming up.
AIDEN REIS: You can, you don't have… whatever way makes it accessible to someone to tune in and to then engage in the compulsion we're going to go with that. You can track SUDS, if that helps you tune in. Personally, I think that can kind of take away from them being present in the moment, which is what we're trying to do, is be present with whatever comes.
PATRICK CASALE: Yeah, tracking the units for me never really worked. We used to incorporate a lot of that with addiction work as well, and with when you're having any sort of impulse, or urge, or craving, and then, tracking that unit. I'm like, for me, that's not really how this is working. I'd much rather pay attention to what's coming up for me, what am I experiencing, and how am I supporting myself throughout that process? And I think that always worked a little bit better for myself.
AIDEN REIS: Yeah, that makes so much sense.
MEGAN NEFF: Sorry, Megan, I don't know if you lost your thought, but I cut you off.
MEGAN NEFF: Oh, I think I wanted to, so, okay, not licking toilet seats. That's one way you adapt ERP for autistic people. But I'd love to hear a little bit more about how…. Also, I hear the infusion of ACT versus like ERP is kind of often a more… I've always thought of it as a more classic CBT approach. So, I hear the kind of you're bringing in ACT to bring in values. But, yeah, I'm curious are there ways that you're adapting it to be more neurodivergent affirming?
AIDEN REIS: Yeah, absolutely. I think about accommodating sensory needs in exposure as being really crucial in that way.
MEGAN NEFF: Absolutely, yes.
AIDEN REIS: Someone wants to do an exposure that's outside of the house, but that's really noisy, bring your headphones along, bring your fidgets along. Like, I don't think that a lot of, like, exposure isn't taught alongside accommodation because accommodation for anxiety doesn't tend to work, right? Like, if we could just reassure. And I think a lot of people will identify with this if you say, like, "Don't worry about it. It's fine. You'll be fine." Like, that's [INDISCERNIBLE 00:28:01] go anywhere. And that kind of falls in the accommodation bucket. So, I think not every ERP therapist is thinking, okay, how do we accommodate in these areas without accommodating in other areas? So…
MEGAN NEFF: And can I interrupt you and break that down a little bit? Because I think accommodation is so known and autistic ADHD space is like a good thing. So, I just want to unpack, like, accommodation for anxiety, when that's talked about. When we have anxiety there's a lot of things we do to accommodate the anxiety. I kind of think of it as, like, you're giving more power to the anxiety. So, like, and then family systems will often do it.
So, like, I'll give an example that I've got permission to share. One of my children who had OCD related to her veganism, the whole family started accommodating that. Like, you know, I've got some, like, leather shoes. Sorry, I bought them before I was vegan. Please don't hate me, but I do. I have some leather items. And that was becoming like an OCD trigger. So, over time, like, the whole family started eating vegan even though, like, we we're all vegetarian. We all started eating vegan because, like, the presence of cheese was so distressing. Or if anyone had touched milk and then touched something. So, our whole family system was accommodating the anxiety.
That's not good for anxiety, because then, like, you go from a home that's like sterile, there's nothing to school, and there's triggers all over the place. So, when we're talking about accommodating anxiety, like, I kind of think of it as, like, the ways we're adjusting our behavior that gives the anxiety more space to take over. Feel free to correct my definition.
But so, with anxiety it's like accommodation of anxiety tends to be seen as counterproductive, unhelpful accommodation of like sensory stuff, executive functioning. This is good. So, then when you're working with an ADHDer or an autistic person with anxiety, it's like, okay, we want to identify what's the executive functioning struggle that's causing stress, and we want to accommodate that. What's the sensory thing causing stress? We want to accommodate that. What's the anxiety? We want to actually lower accommodations. Or, yeah. But, yeah. And I think that's confusing for probably non-clinicians, it's like, "What?"
AIDEN REIS: Yeah, that makes so much sense. And we would accommodate and be fine to accommodate because it worked, or where it's helpful, or reduced anxiety. Like, if it was ever helpful to accommodate by saying, "Don't worry about it. Like, it'd be fine." If that was ever helpful, fine. If it's one and done, great. But it tends to be that, like, your experience with the veganism. First, it's like, everyone has to be vegan, and things can't touch. Like, it just grows and grows. The anxiety is so big that it really takes over and can bring people away from their values and away from the life they want to live.
MEGAN NEFF: Yeah, exactly. I think I saw this in, like, a children's book I've always loved. It's like feeding the anxiety monster. Like, every time you do that, and then that gets bigger, and it takes over more of your house, more of your emotional space. And I've certainly experienced that personally as well, of like, where I've fed the anxiety through avoidance or through accommodation. And then, it's taken up a lot of space in my life.
AIDEN REIS: Yeah, absolutely. And think similarly in terms of accommodations, like really letting clients know what to expect in the process. Again, with that kind of stereotype of ERP clinicians it's like, "Ready to go." And it might look like an accommodation for anxiety to let people know what to expect, if you're kind of not understanding that as a processing need. I really like to let clients know, like, this is what the building looks like that you're going to be coming into. This is what my office looks like. These are some of the things we're going to talk about in the first session. Like, really giving a sense of what to expect because it is really hard work to do exposures and to feel feelings no matter how small we make it and friendly we make it it's hard. So, letting people know what to expect is really helpful.
And I don't see that as an anxiety accommodation. I see that's a processing need because someone sends me a picture of the therapy office ahead of time, that means it's less visual processing for me to do in the moment, and I can be more present.
MEGAN NEFF: Yeah, you're also making the ERP more effective because it's like, we're going to use your resources for the exposure that is important, not for like you, yeah, navigating a new space, or figuring out how am I supposed to approach this space? Or what's coming? Like, what to expect? I love that. Yeah, you're accommodating our communication style and our processing. That's a great one.
AIDEN REIS: And it helps us stay in the window of tolerance enough to learn from the exposure. Like you're saying before about flooding, it's not helpful for exposure. You know, things do happen. And it's not our goal to flood someone because you're not really creating a lot of new connections when you're flooded. There's less learning happening during a panic attack than when you're more regulated and feeling things in a more manageable way.
MEGAN NEFF: I'm so glad you said that because it's not like all exposure is good. Like, if it's the kind of exposure where you're not doing that good neural, like, learning, then that's actually counterproductive, yeah.
AIDEN REIS: Absolutely.
MEGAN NEFF: Yeah.
AIDEN REIS: And then, people have a really bad experience, they don't want to try again.
MEGAN NEFF: Part of what I'm hearing, so this is my psychodynamic brain coming out, but part of what I'm hearing is you create a really, really sturdy frame for autistic clients to go through ERP. And the frame is so important because what they're doing is incredibly hard.
AIDEN REIS: Absolutely.
PATRICK CASALE: Yeah, good summation, Megan, wow.
MEGAN NEFF: Okay, so you adapt for, like, communication and processing. Are there other things that you do that's different than kind of classic ERP?
AIDEN REIS: Yeah, I know you were saying earlier about this idea of not saying things that are really invalidating. And this is like basic stuff that we should be doing for everyone, not just autistic clients. But like, I have heard and been in some trainings where people will say, "Oh, like thoughts are garbage. Don't pay attention to thoughts." And that can be incredibly disempowering to hear someone say.
And I think the reason that people say that is because it's behavioral. We're more about standing in the doorway than we are about thinking about what kind of thoughts you're having while you're standing in the doorway.
MEGAN NEFF: So, like, just do the thing, don't worry about the thoughts, okay.
AIDEN REIS: Yeah, so I think they're trying to encourage that maybe, or trying to prevent people from doing a compulsion in the therapy session by ruminating on the thoughts out loud to the therapist. But it can [CROSSTALK 00:34:55].
MEGAN NEFF: Yeah because the thoughts are causing pain. Yeah, yeah. I'll be curious to your thoughts on this because I do this a lot with my mind, and I certainly taught people this, like, kind of the ACT idea of, you know, the brain, the mind is like a thought-making machine, and thoughts are thoughts. Like, it's a produce of your mind. So, I will do a lot of, like, unhooking from my thoughts of like, "Oh, wow, Megan. That's a beautiful thought you just had." I'm not dismissing it, but like, I'm not also being, like, because I'm thinking that thing, therefore, it's true. And I'm actively working to unhook myself from the thought. Is that still something you do while also validating that thoughts are hard and…?
AIDEN REIS: Yeah, exactly. We can validate them. We can have compassion for them and how hard they are. And if a client has a story about where that came from, like a trauma, where they developed that thinking pattern, we can have so much compassion for that. And then, unhooking is response prevention. So, when you get hooked on a thought, and you start ruminating, and thinking about it over and over again, or trying to solve it or figure it out, or kind of be in the thought, that's a compulsion, a mental compulsion.
And when we unhook from thoughts or kind of like diffuse from thoughts, that's response prevention. We're not letting the cycle complete. We're staying with the distress. We're staying with the experience without trying to fix it or solve it, which is what you're doing when you get hooked in your thoughts.
MEGAN NEFF: So, I like what you're bringing in there too, like, unhooking from the thoughts, but not in a way of, like, emotionally avoiding. Oh, that is tricky because, yeah, it could be tempting to be like, "Okay, I'm having this thought. I'm going to practice some…" And for those listening diffusion, I feel ACT, like, made a bunch of complex language to it, to probably to create a culture, but sometimes I don't know how helpful it is.
So, diffusion is when you unhook. The metaphor I often use, when you're hooked on a thought, like if you've ever worn sunglasses with like blue tinted or red tinted sunglasses, and you see the whole world, the whole world is blue or red. When we're hooked on a thought, that's kind of how I see the thought. It's like it's influencing how we're seeing everything. It feels very real.
And then, I think about hooking is kind of like you're taking off the sunglasses and holding them. It's like, okay, you're still there. I see you. I also am not seeing the world through you. Maybe that just adds more confusion, but it's a way of getting some distance from the thought and observing it. Like, we're bringing an observing mind to be like, "Hi there thought." Versus being, yeah, in the thought.
And I lost my stream of thought, but I think… So, yeah, to be able to do that I could see how that could also become an emotional avoiding tactic. I think I've probably used it that way at times of like I'm unhooking from you, but to be able to stay present to and this is a hard moment. And this is the emotion coming up for me.
AIDEN REIS: Yeah, and we can unhook without running a mile away from the thought. Just kind of like a spectrum between being in the thought and thinking it actively, and kind of contending with it and giving it power versus, kind of like letting it stay, letting it hang out while you attend to what matters to you.
So, let's see, like, [INDISCERNIBLE 00:38:19] like to kind of explain as like burners on a stove, like the thought comes up, it's on the front burner. You're kind of cooking with it. You're mixing the water or whatever. And diffusing is kind of like putting that hand on the back burner so it's still there. You're not avoiding it. You're not shoving it out of the room and running a mile away. There it's boiling. It's doing whatever it's doing. But whatever's on the front burner, the next dish of cooking, or whatever is where you're focused on, and that's whatever is a value to you.
MEGAN NEFF: I like that metaphor. I haven't heard that one. So, it's like-
AIDEN REIS: [CROSSTALK 00:38:55]-
MEGAN NEFF: I want to put you in the background and like, this is what's important to me. And that's, again, doing that, like, instead of getting pulled into the inside-out trap of like, "I can't do this thing until this is off the stove completely." Which, again, like a lot of us do have all-or-nothing thinking.
So, I know I fall into that a lot of, I just wrote a newsletter about this of how, like, I'm in middle of revisions on my next book, and that's a cumbersome process, but it's also, like this sense of I can't do anything until that's off my plate. I can't, like, do the things, like, go on a walk, things that I know would be healthy for me or… So, I do that with tasks, but I also just do it with life in general of like, I can't do this thing until this thing is done. Or with emotions, I can't do this thing until this emotion is taken care of. And I think because our brains, I think do tend to have more all-or-nothing thinking, I think we can fall into those traps quite often.
AIDEN REIS: Yeah, and it's just a way to practice doing things a little differently and seeing how that works or doesn't work, or…
MEGAN NEFF: Mm-hmm (affirmative). Yeah, I got this from Dr. Jonathan Dalton. And I know you know his work, too. He does a lot with anxiety, and kids, and school avoidance. And something he teaches kids is like, I can be anxious and, and then fill in the blank. And I love that exercise. Like, I could be anxious and, and then whatever the activity is.
AIDEN REIS: I'm also thinking about another place of adapting in terms of like another one, where it's just good ERP, in general, but also, happens to work really well for autistic folks is not being coercive. And unfortunately, I have heard people say that they've had coercive experiences in ERP where therapists push them in ways that they didn't want to be pushed, or used rewards, or something like that in order to enforce behaviors. And I think autistic clients are even more sensitive for very good reason, to the use of rewards, and rewards just doesn't have a place in ERP. Personally, I wasn't taught that way, but I do see people suggesting it because it's kind of in that behavioralism category.
MEGAN NEFF: Yeah, yeah, yeah. Sorry, I laughed, but I laughed because I was like that just feels so obvious. But you're right, it's absolutely not. Yeah, absolutely. And so, I just finished up… I did a course in my community on the interest-based nervous system. And so, we did like a six-week experiment while we went through the motivators PINCH. So, passion, interests, novelty. Okay, I'm doing the thing where I'm sharing too much context.
Okay, top-down thinking, I can do this. So, anyways, one of the things that came up that I thought was so interesting and I loved was we realized if we, like, infuse a task with play or with competition, if we do it in a way where we know we're, like, trying to manipulate ourselves it tends to backfire. Like, I think we're so sensitive to manipulation even if it comes from ourself, versus if so, kind of what we settled on is it's like, well, I'm going to do this task. I might as well infuse some playfulness in it versus I'm going to make this playful to get myself to do the thing.
So, I think we're so sensitive to manipulation, including self-manipulation. So, I would see why that kind of classic approach would really backfire, if it feels at all manipulative. Again, even if we're doing self-manipulation. Like, that still pulls a big response for a lot of us.
AIDEN REIS: Absolutely. And I think that the other, like, reason to do natural exposures versus planned or kind of fabricated exposures, sure it's good to practice in therapy sessions doing exposures so people feel more confident doing them at home themselves. So, a little bit of, like, trying to do something on purpose can be helpful, but I really like having more of a natural exposure. Like, doing response prevention in your everyday life, that's exposure. We don't need to go hunting or creating elaborate scenes, or imagining certain things happening. Like, life is full of the opportunity for exposure. We experience these all the time. We don't need to, like, manipulate or set up this kind of, like, scheme to practice this kind of stuff. We can weave it in pretty naturally.
PATRICK CASALE: That's a really good point. I have a question. I'm just thinking out loud because of the amount of time that I spend traveling, exposure for travel, especially, intro, I know a lot of people who have intense fear, whether it be for anxiety, whether it be phobic, in general, but in order to make that experience more neurodivergent affirming, I mean, I'm just thinking loud, I assume, like fidget toys, noise-canceling headphones. Like, all the sensory things that we can think of because those experiences are just sensory overload in magnified times a million. And then, bring into [INDISCERNIBLE 00:44:07] like the intense panic, or phobic fear, or anxiety of that experience. I'm just curious about your thoughts on that.
AIDEN REIS: Yeah, absolutely. I think commenting in all those ways, and even, like, some things around processing ahead of time, like, maybe you want to look at a map of the airport ahead of the time, or planning kind of contingency plans. Like, okay, if this doesn't go well what am I going to do next? So, some of that processing demand is lower when you're actually there, but you are doing the hard thing, facing fears. And also, the hard thing of being in an airport.
PATRICK CASALE: Yes.
AIDEN REIS: So, all of that, and then, yeah, whatever kind of entry point is accessible to the person. So, someone might experience flight anxiety just going on my website to book a flight. Okay, so let's practice that a couple times. Let's practice feeling that feeling and whatever comes up doing that without going away really quick and closing the tab really quickly or whatever that is. Like, we can have a really quick or minor experience of that just to get confidence in practice, to get started.
PATRICK CASALE: Yeah, I like that. I like the quick, easy entry points that don't feel so sick, like don't dive off the deep end situations. Like, don't just go jump on a flight with someone and just, you know, try to force yourself through that experience, yeah.
AIDEN REIS: Yeah. It's not going to help. And it's also practical because one of the actual steps of going on a flight is looking at the website. It's not just, I think sometimes we really need, like, the why to do something. It's not a role for role's sake. We're not just going to do something as we should, or the therapist says, or whatever. It has to be practical and realistic. So, it's like a second natural process.
PATRICK CASALE: Absolutely.
MEGAN NEFF: That also makes sense with natural exposures, like because the exposure has to make sense, it has to be connected to a why, yeah, yeah.
AIDEN REIS: Exactly.
MEGAN NEFF: So, I think I actually shared this on the first episode, and maybe you can correct me because this is probably classic, ERP. The idea being that with the exposure, you have to kind of overshoot the natural triggers that would show up in day-to-day life. And I think I understand the thinking because you're kind of like, if you've done that, then these are going to be less stressful as maybe the logic. But I get the sense that's actually not how you work.
AIDEN REIS: It isn't how I work unless someone wants to. And that's great. Like, some people do want to. They really want to, like, grab OCD up by the roots and pull it completely out. And that's fine. That's [CROSSTALK 00:46:45]-
MEGAN NEFF: I mean, that sounds nice. I wouldn't mind that if someone wanted to do that to my brain.
AIDEN REIS: Yeah, and so, like, going that far past is totally a thing we can do. And I don't think we need to be afraid of doing it. It's kind of calling preference personally. And I have heard lived experience stories of people really benefiting from that because later down the road something bigger did show up, and they were glad that they did that. And okay, something bigger comes down the road later, that will be the exposure then, it's okay.
MEGAN NEFF: Maybe like as autistic ADHD humans, we just create enough, like, big exposures ourselves that we don't need to overshoot because, like, our lives are just filled with, yeah.
AIDEN REIS: I think it depends on what's practical and what's going to actually help you achieve your actual goals. Like, sometimes over-correcting, okay, but it's actually going to make any difference in your life, maybe, maybe not, that we can kind of be flexible there about whether we do that or not.
PATRICK CASALE: So, like, a lot of self-determination in this process, too, of like, really, what do you want out of this experience? Opposed to, like, this is what we are going to do and I'm going to drive that ship as the therapist. And I think that makes a lot more sense for people to just say, this is kind of what I'm targeting, this is what I want to have happen, instead of, you know, again, going back to the all or nothing like thinking.
AIDEN REIS: Yeah [CROSSTALK 00:48:15]-
MEGAN NEFF: [CROSSTALK 00:48:15].
AIDEN REIS: [INDISCERNIBLE 00:48:15] can still be it. We can still be like client-led and centered, even though it's a behavioral affair. And I think we forget that sometimes.
PATRICK CASALE: Sure.
MEGAN NEFF: Yeah, it sounds like you do a lot to really connect to the clients why? Like, of like, what is your outcome. Like, that you desire? Like, why is this important to you?
And again, I think doing something that, it is, exposure is hard, like, and then, especially, for those of us who need things. Like, knowing why I need to wear a certain piece of clothing is, like, I need to know the why. Like, so to do something like exposure, we really need to feel pretty connected to the why. And that is something that's, like, striking me, as I hear you talk is about how much you really do to connect to the why for your clients.
AIDEN REIS: The other risk is, if we don't connect to the why or have something like that, it can really be forced behavioral norms kind of arbitrarily, and be a lot of harm there. Like, sometimes I'll see people in ERP Facebook groups posting about like, "Well, what do you do? When you're opening a soda can, do you clean off the top, or what's normal?"
And I don't really personally care what's normal. I care what the client wants. Like, I'm not trying to make everyone clean or not clean a soda can. I personally don't care. But if that's bobbing the client that they have to clean it and just stuck in their day, they don't want to. They want to be able to face that anxiety or it's taking too much time or mental energy, great, let's work on that. But I'm not in the business of enforcing behavioral norms oppressively.
MEGAN NEFF: That's a great tagline for this episode. I'm not in the business of enforcing behavioral norms.
PATRICK CASALE: Something in the title can be something about you don't have to lick the toilet.
MEGAN NEFF: Yes, yeah.
AIDEN REIS: [INDISCERNIBLE 00:50:10]to be a toilet thing, [INDISCERNIBLE 00:50:14].
MEGAN NEFF: Great here. Let's do it. The first time I heard that I was a clinical mentor because ERP is not something I've done. And I had a clinical trainee in my clinical group, who was at a ERP site. And the first time she told me, like, this was an intervention that she'd done. I was like, "Wait, what? Like, this is actually safe."
PATRICK CASALE: I told you in our first episode, like, my grad school professor was huge into CBT and all things CBT, and talked about exposure all the time. And this is stuff he would do with clients constantly, licking toilet seats in the mall or taking them on short 30-minute airplane flights, like back and forth. And I just got thinking like this makes me horrified. Like this is not comfortable for me.
AIDEN REIS: No.
MEGAN NEFF: And this is where, like, I really love that we've had you on Aiden because I think those stories get out there about exposure. Like, all of the really negative things about exposure. But then, I think what if that narrative is dominant in autistic space, then we might actually be encouraging emotional avoidance because exposure is really important to anxiety.
And there's been some studies. There's one study, I think it was teens, it was like 90%, I'd want to look it up, but it was around like… I think it was as much as 90% of autistic teens had at least one anxiety disorder. I've yet to meet an autistic person who has not had anxiety.
PATRICK CASALE: Yeah, if you're out there listening and you're autistic…
MEGAN NEFF: Autistic and never have had anxiety-
PATRICK CASALE: [CROSSTALK 00:52:01].
MEGAN NEFF: …not help, like there's like helpful anxiety, and then there's, like, pathological or disordered anxiety where it's like, this is no longer helpful.
PATRICK CASALE: Yeah, if that's you, please send us a message.
MEGAN NEFF: Tell us.
PATRICK CASALE: We'd love to hear from you.
AIDEN REIS: Yeah. I think it's great to be able to, like, share some positives that can come from this because I really have seen so many clients really get closer to their special interests, closer to their sensory preferences, closer to who they are, who they want to be, and how they want to interact in the world through ERP. It really can be such a positive thing for people, so to be hearing more of those stories and negativity, not that I don't like to discount that at all. I think we really need to reckon with that in the field, but to have some positive as well.
And I think ERP is so like, well-suited practice to people, in some ways, that I think we forget about, like, learning by doing can be so powerful. Like, to be able to see, oh my gosh, like yesterday I couldn't do that and today I can. Like, yesterday, I couldn't drive to the ND group or whatever because I was afraid I might harm someone while driving. And today, I got in the car and I went there, and actually played, and I had a good time. Like, to be able to see that is so cool.
PATRICK CASALE: [CROSSTALK 00:53:23].
MEGAN NEFF: It's so empowering, yeah.
AIDEN REIS: It's so empowering.
PATRICK CASALE: I like that we are dispelling and disputing, like I said before, about EMDR as well in this situation because it's so good to hear the other perspectives opposed to like these blanket statements that just get thrown out there of how extreme things can be when people have bad experiences and when their experiences are not neurodivergent affirming. So, really cool.
MEGAN NEFF: Yes, I am eager for a day where it's a little bit easier to find neurodivergent affirming OCD providers.
AIDEN REIS: Me too.
MEGAN NEFF: Like, that's been a very real struggle. And I feel like we've found the people that exist and like they're coming on the podcast. But like, I really would love to start seeing, well, like, just personally, I think it's so badly needed.
AIDEN REIS: So needed, it really is.
PATRICK CASALE: Are we at that point? I'm reading the room and the energy. So [CROSSTALK 00:54:33]-
MEGAN NEFF: Yeah, is there anything Aiden that we haven't talked about that you're like, "This itch is in the back of my head of like this was a thing I thought I wanted to share."
AIDEN REIS: I mean, I could talk about this for so many hours, but I think that we got all of the major parts. You know, it can really require a lot of teasing out, and not just, you know, the sensory sensitivity versus anxiety, but like echolalia, stimming, scripting. Like, there's so many things that people mistake in either direction and they can require a lot of teasing out. And like, I really encourage people to self-advocate as much as they can. Like, if you think your therapist is trying to do exposure on something that, you know, you think that's an autistic trait, that's not something I want to be doing exposure on, try to speak up if you feel safe to do so, or find someone you can who is more affirming because there's a lot to tease out, even like, respect for routines. Like, we need our routines. This helps our executive function. I really don't want people to mistake that for anxiety or OCD.
PATRICK CASALE: It's a great point.
MEGAN NEFF: And this kind of brings us back to the beginning of the hour around self-awareness. Like, so I think so much of this work because anxiety does often kind of hook on and intertwine with, like, sensory stuff or routine stuff work, or can look like. So, much of this does come back to self-awareness around what is this experience I'm having? Like, is this routine disruption? Like, I get a lot of free-floating anxiety around your team disruption. So, is it that, versus, is it, yeah, that more forward future thinking of like, what might happen, what if?
And so, really figuring out how to, like the inroads to our inner worlds, which might not be feeling based it might be tracking thoughts, tracking behaviors. That just feels really foundational to any work we do with anxiety is developing language to understand our own experience and then to be, I think, it also takes the ability to be a mindful, non-judgmental observer of our own experience. And as so many of us are very judgmental about our experiences. So, that skill feels so foundational here.
AIDEN REIS: Judgment's really big because there can be a lot of internalized ableism or an idealism on behalf of the therapist of like, okay, so you have these needs, but are we going to be non-judgmental towards those needs and set goals that are coming from a place of genuine value and desire, not from judgment or yeah, criticism or anything like that.
MEGAN NEFF: Yeah, yeah. Well, I'm sure lots of people are going to want to work with you as a therapist after this. I'm guessing you're pretty full.
AIDEN REIS: I am. But I really do love consulting with therapists. So, if someone wants to become more like a competent in ERP, or act informed ERP, and wants to get in touch and then spread it wider so you can have more [CROSSTALK 00:57:49]-
MEGAN NEFF: I love that you're doing consultation because, yeah, that's what we need is. And I think a lot of therapists working with neurodivergent clients are starting to realize, like, yeah, I need to figure out OCD. So, that's great.
AIDEN REIS: [INDISCERNIBLE 00:58:04].
PATRICK CASALE: Were you about to say what I'm about to say?
AIDEN REIS: Yes.
PATRICK CASALE: [INDISCERNIBLE 00:58:09]. So, you said you wanted us to hold you accountable to sharing what you're working on. So, here's your time to do that.
AIDEN REIS: Thank you. Yeah, my friend Sharon Aguilar and I, she has lived experience with OCD and is ADHD. And she and I are working on a training right now and recording so that people can have an intro to ERP through an ACT lens, with all this neurodivergent affirming stuff really baked in, so that people can learn more.
All of our case examples are autistic client's case examples, teasing out what's sensory sensitivity? What's this? What's that? Talking about the accommodations needed to do certain kinds of exposures, like really walking you through piece by piece. Yeah, I'm really hopeful that more of us can come into this field because it is so needed and I'm only one person. And I wish I could refer people who are contacting me to, like, 17 [INDISCERNIBLE 00:59:03] trying to get that information out there.
MEGAN NEFF: That sounds like such an incredible training. I'm so excited that you're doing that because, yeah, that's amazing.
PATRICK CASALE: It does sound really cool. But the most important part of that is where can people find that?
AIDEN REIS: Yes, people can find that information and contact me through my website, which is divergecounseling.com.
PATRICK CASALE: Easy, and that will be in the show notes for everyone to have access to Aiden's information and that program. So, really great conversation. And thank you for coming on and being interested in having this conversation. And I hope it wasn't as nerve wracking as it felt prior to starting.
AIDEN REIS: It was a really good exposure for me because it's so connected to my values.
MEGAN NEFF: I actually had that thought midway through. I was like, "Oh yeah, Aiden's doing an expression right now."
AIDEN REIS: Absolutely.
PATRICK CASALE: It's circle homing.
AIDEN REIS: [INDISCERNIBLE 1:00:01].
PATRICK CASALE: And we'll let you know when this is going to air in a couple of weeks in our OCD series, for everyone listening. We still have a couple more great guests who are coming on that we're interviewing in the next couple of weeks as well.
For those of you who listen to Divergent Conversations, you can listen every single Friday on all major podcast platforms and YouTube. You can buy Megan's book, Self-Care for Autistic People, which is right behind her right shoulder and on her shelf anywhere you purchase books. And we will see you next week. I think Megan might jump in and say something before I close this though.
MEGAN NEFF: I just wasn't expecting that. I was like, "Oh, wow, thanks for the…"
PATRICK CASALE: I was just looking at it the whole time. So, I figured people need to continuously know it exists because it's [CROSSTALK 1:00:39].
MEGAN NEFF: I know. My spouse was like, "You never mention your book, like, in your newsletters or, like…" And he was like, "You know you should do that, right?" And I was like, "Oh, right."
PATRICK CASALE: Yeah, that thing that [CROSSTALK 1:00:49]-
MEGAN NEFF: But thanks for doing it for me, Patrick.
PATRICK CASALE: Of course, happy to do it. And we will see you next week. Goodbye.
