Subscribe
Share
Share
Embed
OCD is often misunderstood as being about cleanliness, checking, or perfectionism. In this episode, Dr. Taz sits down with therapist and author Melissa Mose, LMFT, to unpack why OCD is frequently misdiagnosed for over a decade and what’s really happening beneath the surface of obsessions and compulsions. Melissa’s book Internal Family Systems Therapy for OCD bridges compassionate parts-based work with proven science to offer a richer path to lasting change.
Using clear science and compassionate explanations, this conversation explores how OCD hijacks the brain through a cycle of alarm and relief, why reassurance and family accommodation can quietly reinforce symptoms, and what actually works in treatment. Melissa breaks down why talk therapy alone often fails OCD, how Exposure and Response Prevention (ERP) retrains the nervous system, and how Internal Family Systems (IFS) adds depth, self-compassion, and relational healing to recovery.
Using clear science and compassionate explanations, this conversation explores how OCD hijacks the brain through a cycle of alarm and relief, why reassurance and family accommodation can quietly reinforce symptoms, and what actually works in treatment. Melissa breaks down why talk therapy alone often fails OCD, how Exposure and Response Prevention (ERP) retrains the nervous system, and how Internal Family Systems (IFS) adds depth, self-compassion, and relational healing to recovery.
In this hol+ conversation, Dr. Taz sits down with therapist, educator, and author Melissa Mose, LMFT, to unpack what OCD really is and why it often goes undiagnosed for over a decade. Melissa shares why OCD disguises itself as “just anxiety,” how well-meaning reassurance can quietly reinforce the disorder, and why many people spend years in talk therapy without real relief.
Using clear science and compassionate language, this episode explores how OCD operates through a cycle of alarm and relief, why the brain learns to depend on compulsions, and how Exposure and Response Prevention (ERP) helps retrain the nervous system. Melissa also explains how Internal Family Systems (IFS) adds a relational, self-compassionate layer to treatment, helping people work with their inner world instead of battling it.
This conversation also looks at the bigger picture. OCD does not exist in isolation. Dr. Taz and Melissa explore how neuroinflammation, PANS and PANDAS, hormonal shifts, trauma, ADHD, eating disorders, and chronic stress can overlap with or intensify OCD symptoms. They discuss why intrusive thoughts can be disturbing and taboo, why intolerance of uncertainty sits at the core of OCD, and how relationships and intimacy are often quietly impacted.
From shame and self-blame to clarity and support, this episode offers a grounded reframe of OCD as a treatable condition rooted in brain-body patterns, not personal failure. Whether you are seeking help for yourself, supporting someone you love, or trying to understand OCD beyond the stereotypes, this conversation replaces fear with understanding and helplessness with practical pathways forward.
Dr. Taz and Melissa Mose, LMFT discuss:
- Why OCD often goes undiagnosed for 11 to 17 years
- How reassurance and family accommodation make OCD worse
- The obsession-compulsion cycle and why it gets reinforced
- Why talk therapy alone often fails OCD
- What ERP actually does to retrain the brain
- How Internal Family Systems supports compassion and healing
- The role of uncertainty intolerance in OCD
- How OCD affects families, partners, and intimacy
- Neuroinflammation, PANS, PANDAS, hormones, and symptom flares
- Why intrusive thoughts do not define who you are
About Melissa Mose, LMFT
Melissa Mose is a licensed marriage and family therapist, educator, and specialist in the treatment of obsessive-compulsive disorder. With over 30 years of clinical experience, she works with individuals and families navigating OCD and anxiety, and trains clinicians in evidence-based treatment approaches. Melissa integrates Exposure and Response Prevention with Internal Family Systems to support deep, sustainable change that goes beyond symptom management. Melissa is the author of Internal Family Systems Therapy for OCD: A Clinician’s Guide, a resource designed to help therapists bring compassion, parts-based awareness, and relational healing into gold-standard OCD treatment.
Stay Connected:
Melissa Mose is a licensed marriage and family therapist, educator, and specialist in the treatment of obsessive-compulsive disorder. With over 30 years of clinical experience, she works with individuals and families navigating OCD and anxiety, and trains clinicians in evidence-based treatment approaches. Melissa integrates Exposure and Response Prevention with Internal Family Systems to support deep, sustainable change that goes beyond symptom management. Melissa is the author of Internal Family Systems Therapy for OCD: A Clinician’s Guide, a resource designed to help therapists bring compassion, parts-based awareness, and relational healing into gold-standard OCD treatment.
Stay Connected:
Connect further to Hol+ at https://holplus.co/- Don’t forget to like, subscribe, and hit the notification bell to stay updated on future episodes of hol+.
Follow Melissa Mose, LMFT
Learn more about Melissa’s work: https://melissamosemft.com
Instagram: https://www.instagram.com/melissamosemft
Learn more about Melissa’s work: https://melissamosemft.com
Instagram: https://www.instagram.com/melissamosemft
Follow Dr. Taz on Instagram:
Subscribe to the audio podcast: https://holplus.transistor.fm/subscribe
Subscribe to the video podcast: https://www.youtube.com/@DrTazMD/podcasts
Get your copy of The Hormone Shift: Balance Your Body and Thrive Through Midlife and Menopause
Host & Production Team
Host & Production Team
Host: Dr. Taz; Produced by ClipGrowth.com (Producer: Pat Gostek)
Creators and Guests
Host
What is hol+ with Dr. Taz MD | The Future of Medicine is Holistic?
hol+ with Dr. Taz MD is redefining holistic medicine as the future of healthcare—integrating modern science, functional medicine, and time-tested healing systems to treat the whole human, not just symptoms. As a 2025 Webby honoree and pioneering show, hol+ dares to enter the next dimension of health-where both science and spirit converge to drive our health, happiness, relationships and family ecosystems.
Recent guests include mental health advocate and author, Sophie Gregorie Trudeau, best-selling author, Katherine Schwarzenegger, Emmy-winning host, actor, and health enthusiast, Cameron Mathison, supermodel Carol Alt, veteran actress and sometimes medicine woman, Jane Seymour, author and journalist, Tamsen Fadal, wellness advocate and cancer thriver, Kris Carr.
From cutting-edge and innovative experts to celebrities and thought leaders, veteran TV personality, author, and trople board-certified physician, Dr. Taz MD, the host of hol+, leads these game-changing conversations - redefining the future of medicine.
On the heels of her successful 8-year-long podcast, Super Woman Wellness, which boasted over 1 million downloads, hol+ continues to be recognized as a show to watch, recognized in the same category as the Mel Robbins Podcast in the 29th Annual Webby Awards.
[00:00:00] Dr. Taz: Okay. Real talk. I get the best dms from you guys after each [00:00:05] episode. So before we start, if you've been listening and you're thinking, that's [00:00:10] me, go ahead and send me a quick message on Instagram at Dr. Taaz md. [00:00:15] I love hearing what resonates, what you're struggling with and what you want more of. [00:00:20] That's how whole plus stays real in the conversation.
[00:00:22] Dr. Taz: And it's not just a lecture. Let's [00:00:25] jump in.
[00:00:25] Melissa Mose, LMFT: Does OCD go undiagnosed for long periods of time in both kids and adults? [00:00:30] That's the sad part. The, the statistic for a while was 11 to 17 years was the [00:00:35] average.
[00:00:35] Dr. Taz: Oh my
[00:00:35] Melissa Mose, LMFT: gosh. And in about the last 10 years, that's improved. But it's [00:00:40] still like on the 11 year end of things because it masquerades.
[00:00:43] Melissa Mose, LMFT: Yeah. And anybody who [00:00:45] works with OCD has clients who have come. To us after [00:00:50] decades of being in therapy that didn't work.
[00:00:52] Dr. Taz: Wow. When one person in a [00:00:55] family struggles with OCD, everyone feels the ripple effects, the [00:01:00] anxiety, the routines, the endless reassurance loops that quietly take over their [00:01:05] daily life.
[00:01:05] Dr. Taz: My guest today, Melissa mos, LMFT, is a therapist, educator and [00:01:10] author of the book, internal Family Systems Therapy for OCDA. [00:01:15] Clinician's Guide. In it, she integrates the compassionate parts based lens of Internal Family [00:01:20] Systems with the proven science of exposure and response prevention to [00:01:25] create a more rational relational healing approach to OCD treatment.
[00:01:29] Melissa Mose, LMFT: So [00:01:30] talk therapy, you can sit and just do reassurance with your client for years
[00:01:34] Dr. Taz: and it goes [00:01:35] nowhere.
[00:01:35] Melissa Mose, LMFT: Yeah. And they really like you and you really do make you know
[00:01:38] Dr. Taz: good connection.
[00:01:39] Melissa Mose, LMFT: Yeah. Right, right. It feels [00:01:40] better when they feel better when they leave. But it's a compulsion and it's repetitive and nothing moves,
[00:01:44] Dr. Taz: [00:01:45] right?
[00:01:45] Dr. Taz: So we are subconsciously doing things to accommodate to the people within [00:01:50] our family that may have OCD. Is that a good thing or a bad thing?
[00:01:53] Melissa Mose, LMFT: With OCD? It's a [00:01:55] negative feedback loop, meaning, yeah, the compulsion works, [00:02:00] right, calms everything down in the short term. But what it does is it [00:02:05] makes it more likely for there to be the similar obsession and need in the future.
[00:02:09] Melissa Mose, LMFT: So the brain [00:02:10] says, Hey, that worked. Let's do that again. And the, the ritual happens again, or [00:02:15] the question happens again. And so every time we do a compulsion for our [00:02:20] family member, we're making their OCD worse, right? So in that sense, [00:02:25] it's not good.
[00:02:26] Dr. Taz: Melissa's work shows that recovery isn't just about symptom [00:02:30] reduction.
[00:02:30] Dr. Taz: It's about building new relationships, both with our loved ones and with the parts of [00:02:35] ourselves that try to protect us from fear and uncertainty. Please join me in [00:02:40] welcoming Melissa to the show. Melissa, I'm so glad that you're here today. I have spent [00:02:45] a lot of time in practice. We have a pretty big team at Whole Plus as well.
[00:02:48] Dr. Taz: We see all kinds of [00:02:50] patients with all kinds of different diagnoses, but I think the key is that we do see the whole [00:02:55] family and one of the things that I am. Personally very passionate about, and I would say my [00:03:00] team is as well, is that we have understood that healing happens within families and [00:03:05] family systems.
[00:03:05] Dr. Taz: And we could do these beautiful treatment plans for, you know, the [00:03:10] mom or a child or even the dad. But if it's not integrated within the [00:03:15] family, the results and the success are only so much. So I know you spent a lot of time looking at [00:03:20] internal family systems, so I, I would love to hear how you, you know, have [00:03:25] stumbled upon that, how you feel about that, you know, and kind of how that fits [00:03:30] into really what's your area of expertise, which is OCD or Obsessive compulsive [00:03:35] disorder.
[00:03:35] Dr. Taz: And we definitely wanna spend some time talking about that as well. 'cause we see that, I almost feel like that's on the [00:03:40] rise, but we can get into that in just a second. But talk about the family, the family dynamic. What does it [00:03:45] mean to have an internal family system of healing and your work in that space?[00:03:50]
[00:03:50] Melissa Mose, LMFT: Okay, great. Well, thank you so much for having me because it's a near and dear to my heart [00:03:55] topic as well. Um, my 30 years of being a therapist has, has [00:04:00] taken wildly different courses at various different times. I started out sort of [00:04:05] more psychodynamic, but my training was all in family systems. So my very first [00:04:10] internship, my very first 15 years really of being a clinician [00:04:15] was working with teens and families.
[00:04:17] Melissa Mose, LMFT: So we'd commonly have that [00:04:20] feeling of, of doing great deep work in session. Kid goes home, [00:04:25] the normal dynamics happen at home, and things, things just fall apart.
[00:04:29] Dr. Taz: Right.
[00:04:29] Melissa Mose, LMFT: [00:04:30] So, uh, Richard Schwartz, who was the developer of Internal Family [00:04:35] Systems, uh, was a regular family systems therapist.
[00:04:39] Dr. Taz: Okay.
[00:04:39] Melissa Mose, LMFT: And so [00:04:40] his training was all in systems dynamics and so he, [00:04:45] he.
[00:04:45] Melissa Mose, LMFT: When he began to listen to his clients in a different way and understand about [00:04:50] multiplicity, which is normal. And, and he really created a [00:04:55] beautiful system for kind of understanding the internal landscape, internal [00:05:00] conflict, uh, in very common language that people can understand. [00:05:05] So, um, what he brought, and I'll get to that in a minute, but what he brought to it was [00:05:10] his family systems experience.
[00:05:11] Melissa Mose, LMFT: Mm-hmm. Where if somebody's dominating the conversation in the [00:05:15] room
[00:05:15] Dr. Taz: right,
[00:05:16] Melissa Mose, LMFT: and the child isn't getting to speak, you might ask that [00:05:20] person to go wait in the waiting room. So when he began working with [00:05:25] parts on the inside of a person, he tried it and he said. Do you see? [00:05:30] Do you think that really loud, critical part of, you could maybe just go wait on the side for a [00:05:35] minute and to his surprise it worked.
[00:05:38] Melissa Mose, LMFT: So, [00:05:40] um, the two pieces that are really important is that we see the inner [00:05:45] landscape as a multiplicity, and it's really intuitive because we [00:05:50] all know the experience of part of me wants to go work out and part of me [00:05:55] wants to sit on the couch. Right?
[00:05:56] Dr. Taz: Right.
[00:05:56] Melissa Mose, LMFT: Or I'm so mean to myself. People [00:06:00] say that all the time.
[00:06:00] Dr. Taz: Yeah.
[00:06:01] Melissa Mose, LMFT: So who's the I and who's the myself. Right. [00:06:05] Already we're at a multiplicity. Uh, it works really well with OCD where [00:06:10] people are constantly saying, my brain's telling me to do this, but I know I don't have to. Or, [00:06:15] you know, we call it the bully in your brain. So, um. [00:06:20] After I switched my career and began working in OCD entirely.
[00:06:24] Melissa Mose, LMFT: So [00:06:25] the last 15 years I've specialized in that. Um, the training [00:06:30] was fabulous. I learned amazing treatment modalities, [00:06:35] um, and, and the OCD community very well aware of the role of family accommodation, which I'm sure we'll get to, [00:06:40] but
[00:06:40] Dr. Taz: Right.
[00:06:40] Melissa Mose, LMFT: Um, IFS wasn't, is not a part of that [00:06:45] landscape. Right. They're, they know what works and they have gold standard treatments and [00:06:50] that's what you do.
[00:06:51] Melissa Mose, LMFT: But because I've spent so much time as a clinician before [00:06:55] specializing, you know, you go in the room, you bring your whole self. And all [00:07:00] your tools and I found myself using not just my family systems [00:07:05] experience, but the internal family systems training that I had.
[00:07:09] Dr. Taz: So is in, so [00:07:10] for somebody like me who's not familiar mm-hmm.
[00:07:11] Dr. Taz: With any of this, so is Internal Family Systems, is it more about you, the [00:07:15] individual and everything inside your landscape? Mm-hmm. Meaning your thoughts, [00:07:20] your feelings, you know, your different emotions and learning to separate that [00:07:25] out? Or does it also apply to the external family, like who you're living with and things [00:07:30] like that?
[00:07:30] Melissa Mose, LMFT: Yeah. There, there's an awareness of internal and external, right? The [00:07:35] external constraints, um, are important, but primarily what [00:07:40] Internal Family Systems is focused on is the parts of you and how they interact, [00:07:45] how they blend, meaning take you over, uh, how [00:07:50] they step back constantly throughout a day.
[00:07:52] Dr. Taz: Mm-hmm.
[00:07:53] Melissa Mose, LMFT: Uh. And that's [00:07:55] how we interact with the world. It's not that parts aren't bad and they're, you don't wanna get rid of even [00:08:00] bad parts.
[00:08:00] Dr. Taz: Right.
[00:08:01] Melissa Mose, LMFT: Dick Schwartz is known for saying there are no bad parts. It has a good [00:08:05] intention. It's going about it in a way that's rather extreme. So it's about shifting your [00:08:10] awareness inside and becoming aware of various different parts of you that are [00:08:15] like states of mind that are familiar.
[00:08:18] Melissa Mose, LMFT: Right. Like a [00:08:20] people pleasing pattern.
[00:08:21] Dr. Taz: Mm-hmm.
[00:08:21] Melissa Mose, LMFT: Um, thoughts and feelings show up as parts too. [00:08:25] Um, not always, you know, images or urges. Anything you can [00:08:30] experience on the inside that kind of drives what you do.
[00:08:33] Dr. Taz: Mm-hmm.
[00:08:34] Melissa Mose, LMFT: Um, [00:08:35] is, is sort of one form of consciousness that we call parts. [00:08:40]
[00:08:40] Dr. Taz: Gotcha.
[00:08:41] Melissa Mose, LMFT: There's also a self, and self [00:08:45] is really what's there when parts aren't taking over.
[00:08:48] Melissa Mose, LMFT: Right. It's just your awareness. [00:08:50] It's the you who can be aware that you have parts. And that's [00:08:55] an important state of mind or or place to be able to access because [00:09:00] that's where healing happens. That's where we can be open and curious and not [00:09:05] judge and push away and struggle with our parts.
[00:09:07] Dr. Taz: Gotcha.
[00:09:08] Melissa Mose, LMFT: So there are [00:09:10] parts that have categories.
[00:09:12] Melissa Mose, LMFT: They typically function in certain ways that [00:09:15] are. You know, useful, not useful. They get into [00:09:20] struggles, they polarize, they, um, have alliances, team up [00:09:25] together, you know, certain parts. Pinch hit for one another, you know, a lot
[00:09:29] Dr. Taz: [00:09:30] going on.
[00:09:30] Melissa Mose, LMFT: Yeah. In the human
[00:09:30] Dr. Taz: body.
[00:09:31] Melissa Mose, LMFT: Exactly. So it's like a whole family. It really, they do operate really just like a [00:09:35] family system inside.
[00:09:35] Melissa Mose, LMFT: So,
[00:09:36] Dr. Taz: so you were talking about the, your internal landscape and how, [00:09:40] how you have different things probably at different times that act as the parent or the [00:09:45] child mm-hmm. Or the friend or the bully or Yeah. You know, the motivator [00:09:50] or the cheerleader, but they're all within us. Yeah. Essentially at the end of, at the end of the day, [00:09:55] when we think about OCD, okay.
[00:09:56] Dr. Taz: Mm-hmm. Obsessive compulsive disorder, which we know affects [00:10:00] children and we know affects adolescents. Mm-hmm. And definitely affects adults too. [00:10:05] What do we not understand about it? When we see maybe something on TV or in a [00:10:10] movie or things like that. Like what, what is OCD? How do you truly define it [00:10:15] and what's maybe the biggest misconception around it?
[00:10:18] Melissa Mose, LMFT: Right. So the biggest [00:10:20] misconception, I think, is that it, it stops at wash and check the familiar [00:10:25] kinds of O-C-D-O-C-D is actually very complex and it can [00:10:30] attach to pretty much anything. Um, and it can be very subtle. So, [00:10:35] um, hoping to raise some awareness about that so people recognize it sooner,
[00:10:38] Dr. Taz: right?
[00:10:39] Melissa Mose, LMFT: Um, but, [00:10:40] but what it really is, is it's a combination of obsessions and [00:10:45] compulsions.
[00:10:45] Melissa Mose, LMFT: No big surprise there,
[00:10:46] Dr. Taz: right?
[00:10:47] Melissa Mose, LMFT: They operate in a loop where [00:10:50] obsessions stir up things, right? They sound the alarm, they alert the [00:10:55] system. Um, they, their function is to make sure [00:11:00] nothing bad happens, but the, their method is sound, the alarm scan for [00:11:05] data. Compare things, make sure you're on guard. So there's the, the one side that's a really [00:11:10] alerting energy and then compulsions come in and fix it.
[00:11:14] Melissa Mose, LMFT: And [00:11:15] so compulsions can be the normal rituals that we see. Uh, this is
[00:11:19] Dr. Taz: where [00:11:20] the hand washing,
[00:11:21] Melissa Mose, LMFT: hand
[00:11:21] Dr. Taz: stereotype, the door checking, that's
[00:11:24] Melissa Mose, LMFT: the stereotype. Flipping [00:11:25] switches going in and out rooms, right?
[00:11:26] Dr. Taz: Yeah.
[00:11:26] Melissa Mose, LMFT: Anything physical we're a little more familiar [00:11:30] with because we can see it. But they're also mental rituals where people will [00:11:35] review conversations over in their head or if they say something that's [00:11:40] feels bad or off, they'll unsay it or they'll repeat things over and [00:11:45] over.
[00:11:45] Melissa Mose, LMFT: They'll try and have a good thought and get rid of a bad thought. There's all mental [00:11:50] rituals are happening all the time for people and it's, uh, that can be a real struggle. [00:11:55] Um. Reassurance Seeking is the one that really involves the family [00:12:00] because it's, it involves the family members in doing compulsions with and [00:12:05] for the person with OCD.
[00:12:07] Melissa Mose, LMFT: So it might be asking a question [00:12:10] over and over and over again for hours on the extreme end.
[00:12:13] Dr. Taz: Mm-hmm.
[00:12:14] Melissa Mose, LMFT: Um, [00:12:15] sometimes it's, um, more subtle, like it's a statement or a confession. Oh, I [00:12:20] was really mad at so and so today. I, I had this thought, I wish, you know, [00:12:25] whatever and to see if mom reacts in the car. Right. And if mom doesn't [00:12:30] get all upset, then I feel better.
[00:12:32] Melissa Mose, LMFT: So there's subtle ways to get reassurance. [00:12:35] Um, and
[00:12:36] Dr. Taz: so when they're making, so when somebody in your family's making these statements or has these [00:12:40] habits that they're doing over and over again
[00:12:42] Melissa Mose, LMFT: mm-hmm.
[00:12:43] Dr. Taz: Correction is not the first. [00:12:45] Thing to do. Right. Right. It's more reassurance is the first thing to do, is what I'm [00:12:50] hearing you say.
[00:12:50] Melissa Mose, LMFT: Well, naturally we reassure.
[00:12:52] Dr. Taz: Mm-hmm.
[00:12:53] Melissa Mose, LMFT: Right. Naturally. [00:12:55] Um, whether it's, um, avoidance, which is another kind of compulsion, actually just [00:13:00] stay out of it mm-hmm. Out of anything that's gonna stir stuff up. But as, as family members. [00:13:05] We know if we're at all attuned, we know when somebody's agitated or [00:13:10] upset,
[00:13:10] Dr. Taz: right?
[00:13:11] Melissa Mose, LMFT: And as parents, of course, we want to help our children,
[00:13:14] Dr. Taz: right?
[00:13:14] Melissa Mose, LMFT: [00:13:15] We want to make sure they, you know, feel good and can function. [00:13:20] And so we tend to be reassuring, and that's not a bad thing. I want it [00:13:25] being re being a reassuring presence is not a bad thing. Answering a question for the [00:13:30] sake of giving information is not a bad thing.
[00:13:32] Melissa Mose, LMFT: But when somebody already has the [00:13:35] information and they're asking you just to reassure them,
[00:13:38] Dr. Taz: mm,
[00:13:39] Melissa Mose, LMFT: this is okay, [00:13:40] right? Yes. Okay. You know, these kinds of questions or questions that don't have any [00:13:45] answers, like, you know. Safety questions or is there gonna be an earthquake?
[00:13:49] Dr. Taz: [00:13:50] Right.
[00:13:50] Melissa Mose, LMFT: Right,
[00:13:50] Dr. Taz: right.
[00:13:50] Melissa Mose, LMFT: And, and as parents, you know, it's bedtime, of course you're gonna say like, [00:13:55] no, there's not gonna be an earthquake.
[00:13:56] Melissa Mose, LMFT: Right. Well, we don't really know that. So it's, it's questions that [00:14:00] are repetitive and they're not about getting the information.
[00:14:04] Dr. Taz: How does a [00:14:05] parent or a partner become a part of this sort of OCD cycle in maybe [00:14:10] a non-productive way Right. Without realizing it? Like, what, what's happening there?
[00:14:14] Melissa Mose, LMFT: Well, [00:14:15] it's, it's so natural and I wanna say that, you know, even as a mental health [00:14:20] professional
[00:14:20] Dr. Taz: mm-hmm.
[00:14:20] Melissa Mose, LMFT: Right? I did everything quote unquote wrong at first when I really [00:14:25] didn't know what was going on with my daughter because. You know, sometimes there's more than [00:14:30] one kid or everybody has to get out the door,
[00:14:32] Dr. Taz: right?
[00:14:32] Melissa Mose, LMFT: And, and so you wanna smooth things over. [00:14:35] And so sometimes a, a question will come up, or, [00:14:40] um, it's just easier if I open the door for her, right?
[00:14:44] Melissa Mose, LMFT: Or it's [00:14:45] just easier if I answer the question or, um, she, I know how [00:14:50] agitated she gets, right? So it might be simple things like I, I learn through [00:14:55] experience that everything's smoother. If I don't bring up this topic, I learn through [00:15:00] experience. It's better if I leave the house late last, so nobody feels like [00:15:05] responsible for leaving the stove on or right.
[00:15:07] Melissa Mose, LMFT: Nobody wants to go back in and check. Um, we just [00:15:10] naturally learn how to make things go smoothly. And when that happens [00:15:15] and you start to notice, you're doing it over and over, you start to notice there are things that you're [00:15:20] doing for your child. That you wouldn't do for your other child, for instance.
[00:15:24] Melissa Mose, LMFT: Right. Or your [00:15:25] partner, um, that you wouldn't wanna do. Right. You might be, [00:15:30] but you're just doing it to prevent or to reduce anxiety. That's an, [00:15:35] that's an accommodation.
[00:15:36] Dr. Taz: Gotcha.[00:15:40] [00:15:45] [00:15:50]
[00:15:50] Melissa Mose, LMFT: Well, it's a complicated question. I mean, it's bad for OCD, right? Right. [00:15:55] Because with OCD it's a negative feedback loop.
[00:15:58] Dr. Taz: Ah, meaning, yeah.
[00:15:59] Melissa Mose, LMFT: The [00:16:00] compulsion works, right. Calms everything down. In the short [00:16:05] term, but what it does is it makes it more likely for there to be the similar [00:16:10] obsession and need in the future.
[00:16:11] Melissa Mose, LMFT: So the brain says, Hey, that worked. Let's do that again. [00:16:15] And the, the ritual happens again, or the question happens again. And so every [00:16:20] time we do a compulsion for our family member, we're making their OCD worse. [00:16:25] Right? So in that sense, it's not good. Right? It, there are really high [00:16:30] correlations between high accommodation and low treatment.
[00:16:33] Melissa Mose, LMFT: You know, we're poor [00:16:35] treatment gains. So it does make OCD worse. Now, I wanna say to parents, [00:16:40] it doesn't mean it's your fault, right? Right. We're doing the best that we can, but what we do [00:16:45] matters. There are programs that actually treat just the parents and [00:16:50] the kid with OCD gets better. I've done it any number of times.
[00:16:53] Dr. Taz: Mm.
[00:16:54] Melissa Mose, LMFT: Because we [00:16:55] can just by changing our own behavior. Not reinforce [00:17:00] patterns that make a, make a big difference. So,
[00:17:01] Dr. Taz: so what are you noticing? Like what, what are three [00:17:05] things for parents listening or even partners listening mm-hmm. That three [00:17:10] accommodations we may be doing within our home
[00:17:13] Melissa Mose, LMFT: mm-hmm.
[00:17:13] Dr. Taz: That we don't even realize we're [00:17:15] doing.
[00:17:15] Dr. Taz: I don't know if there's like tactical examples you can give and I would, I would do both for a [00:17:20] parent and for a partner too. Yeah. Because I know there are partners with OCD, [00:17:25] you know, and that can be a dynamic as well, you know?
[00:17:29] Melissa Mose, LMFT: [00:17:30] Right. But, right. Yeah. So with, with kids, uh, it, it is [00:17:35] oftentimes question answering over and over.
[00:17:37] Melissa Mose, LMFT: Um. Serving [00:17:40] this particular food on that particular dish to avoid the temper tantrum, uh, laying [00:17:45] clothes out in a certain way.
[00:17:46] Dr. Taz: Mm.
[00:17:47] Melissa Mose, LMFT: Uh, washing extra loads of laundry, [00:17:50] uh, sneaks up on you. Right, right. You don't realize, like, why are all these like things in the, [00:17:55] in the laundry basket? Well,
[00:17:56] Dr. Taz: right.
[00:17:57] Melissa Mose, LMFT: Um, they've been removed and put on the floor and then they can't [00:18:00] be worn until it just, that sense of urgency is kind of a tip off.
[00:18:04] Melissa Mose, LMFT: But for [00:18:05] kids, it might be particular foods, it might be clothing items, [00:18:10] might be that they, um, I have to wash my hands [00:18:15] before I touch your stuff. You know, those kinds of things. Uh, [00:18:20] so I'm trying to give examples of both the. The sort of the reassurance ones and the ones [00:18:25] where it's outright, outright rituals,
[00:18:27] Dr. Taz: right.
[00:18:27] Melissa Mose, LMFT: Participating, buying more soap
[00:18:29] Dr. Taz: Mm.
[00:18:29] Melissa Mose, LMFT: [00:18:30] You know, keeps running out. You, you don't even even know it at first. Right. It's like, why, why are they using so much [00:18:35] soap?
[00:18:35] Dr. Taz: Right.
[00:18:35] Melissa Mose, LMFT: Yeah. And then you realize, okay, I'm, I'm funding their OCD.
[00:18:39] Dr. Taz: Gotcha.
[00:18:39] Melissa Mose, LMFT: [00:18:40] Right. Okay. Um, opening cabinets for people. So with, with partners, I've seen it [00:18:45] end up being, well, there are certain people I just, we don't have over, we can't [00:18:50] entertain or, or we don't entertain at all.
[00:18:51] Dr. Taz: It's making
[00:18:52] Melissa Mose, LMFT: accommodations
[00:18:52] Dr. Taz: for them.
[00:18:53] Melissa Mose, LMFT: Yeah. Because it's such [00:18:55] a disruption to the, the world and the way everything has to be. Or, well, when [00:19:00] I turn off the TV, I know that to put the remote in the right place, or I get up and put the [00:19:05] pillows back. Um, or sometimes, um, you know, [00:19:10] spouses might. Work less, and so people accommodate by working more.[00:19:15]
[00:19:15] Melissa Mose, LMFT: Or one partner, uh, has to be the one responsible for giving [00:19:20] medication to the children because it's too triggering for the other one. Wow.
[00:19:23] Dr. Taz: Yeah.
[00:19:23] Melissa Mose, LMFT: Yeah.
[00:19:23] Dr. Taz: Are, are [00:19:25] there ways, well, first of all, let me ask one question. Does OCD go undiagnosed for long periods of [00:19:30] time? Yes. In both kids and adults.
[00:19:31] Melissa Mose, LMFT: That's the sad part.
[00:19:32] Melissa Mose, LMFT: Yeah. I, I, yeah. It, the, the [00:19:35] statistic for a while was 11 to 17 years was the average.
[00:19:38] Dr. Taz: Oh my
[00:19:38] Melissa Mose, LMFT: gosh. [00:19:40] Yeah. And in about the last 10 years, that's improved, but it's still like on the 11 year end [00:19:45] of things because it, it masquerades. Yeah. Anybody who works with OCD has [00:19:50] clients who have come to us after decades of being [00:19:55] in therapy.
[00:19:55] Melissa Mose, LMFT: That didn't work.
[00:19:56] Dr. Taz: Wow.
[00:19:57] Melissa Mose, LMFT: So, talk therapy, you can [00:20:00] sit and just do reassurance with your client for years and
[00:20:02] Dr. Taz: it goes nowhere.
[00:20:03] Melissa Mose, LMFT: Yeah. And they really like you and [00:20:05] you really do make, you know,
[00:20:06] Dr. Taz: a good connection.
[00:20:07] Melissa Mose, LMFT: Yeah. It feels better when they feel better when they leave, [00:20:10] but it's a compulsion and it's repetitive and nothing moves.
[00:20:13] Dr. Taz: Right. What [00:20:15] then, you know, I'm thinking again about the family and about relationships. You [00:20:20] know, how can somebody, you know. Like, have a quick [00:20:25] checklist of like, oh my gosh, you have OCD, or I think you have OCD. [00:20:30] Mm-hmm. And let's go try to get some help, you know, rather than being like, okay, [00:20:35] let's, let's make this this way.
[00:20:36] Dr. Taz: Mm-hmm. So and so doesn't get upset or mm-hmm. Let me change, you know, [00:20:40] my behavior or what I wanna do so that this person's happy. You know? What's, is [00:20:45] there a, like a quick, like warning signs, triggers, checklist that a, a parent or [00:20:50] a partner could have in their mind to be like, ah,
[00:20:53] Melissa Mose, LMFT: mm-hmm.
[00:20:53] Dr. Taz: I see what's [00:20:55] really going on here.
[00:20:55] Melissa Mose, LMFT: Right, right. Well, noticing when things start to take longer than they [00:21:00] used to, or they should, you know, showers are longer, homework takes forever. Getting [00:21:05] dressed is something, so you, you might find yourself, uh, noticing that we're late more of the [00:21:10] time.
[00:21:10] Dr. Taz: Mm-hmm.
[00:21:10] Melissa Mose, LMFT: Um. It's also, um, rigidity. [00:21:15]
[00:21:15] Dr. Taz: Hmm.
[00:21:15] Melissa Mose, LMFT: Uh, and, you know, not that this masque, this can masquerade, this can be multiple different [00:21:20] things, but you know, it has to be this way, can't be that way.
[00:21:23] Melissa Mose, LMFT: And so lots of [00:21:25] agitation or keeping things separate, not wanting school things, [00:21:30] uh, in the bedroom, you know, those, those kinds of things that they look a little odd or they don't seem [00:21:35] connected with anything logical. Um, but you also see repetitive [00:21:40] things. You'll, you'll notice, um, behaviors are going in and out of doors, little signs [00:21:45] like that.
[00:21:45] Melissa Mose, LMFT: And if it's in, you know, starting to get bigger, that's when, [00:21:50] when to pay attention. But mainly, I would say to, to really try and find the [00:21:55] curiosity so that it's, you know, it can be very frustrating,
[00:21:58] Dr. Taz: right?
[00:21:59] Melissa Mose, LMFT: To be [00:22:00] waiting for somebody who is taking their socks off and putting them back on again, or getting [00:22:05] totally undressed so that they could put the clothes on the right way.
[00:22:07] Dr. Taz: Right.
[00:22:07] Melissa Mose, LMFT: And, you know, those kinds of [00:22:10] things. They don't wanna be doing either. And I hear it sadly, [00:22:15] called manipulation. You know, they, they, they just, they're just manipulating you because [00:22:20] they want, they don't wanna go to school or, and, and it's really not, [00:22:25] OCD is agonizing for the person who's experiencing it.
[00:22:28] Melissa Mose, LMFT: So when we [00:22:30] can, as, as the family member, just try and lead with some [00:22:35] curiosity, like, what's going on for you and, and how, you know, like, [00:22:40] can we just like explore it? Like, tell me more.
[00:22:42] Dr. Taz: Right.
[00:22:42] Melissa Mose, LMFT: You know, I think is really important because a [00:22:45] lot of OCD has to do with thoughts that are taboo, they're [00:22:50] intrusive and they're horrifying.
[00:22:51] Dr. Taz: Mm.
[00:22:52] Melissa Mose, LMFT: And this is the type of OCD we don't see. [00:22:55] So you might, this is another one. It might appear that your [00:23:00] family member is just sort of spacing out and, and like tuning out.
[00:23:04] Dr. Taz: Yeah. [00:23:05]
[00:23:05] Melissa Mose, LMFT: And. Because they may be trying to undo a thought that popped into their head that was really [00:23:10] atrocious. Right?
[00:23:10] Dr. Taz: Like
[00:23:10] Melissa Mose, LMFT: a lot of people will get really violent images or really inappropriate [00:23:15] sexual images, and they, they're terrifying because they don't know it's OCD.[00:23:20]
[00:23:20] Melissa Mose, LMFT: So real gentleness and, and just noticing [00:23:25] lots of time in the head, um,
[00:23:27] Dr. Taz: is a sign,
[00:23:28] Melissa Mose, LMFT: is a sign.
[00:23:28] Dr. Taz: Interesting. [00:23:30] What is the current standard of treatment for OCD, whether again, kid or [00:23:35] adult, like what, what's sort of established as like, you know, how do you, okay, let's say you're [00:23:40] suspicious of it. You think you might have it or somebody that you love has it, what's the, [00:23:45] what's standard treatment?
[00:23:46] Melissa Mose, LMFT: Yeah. It, it, and this is important because for, for [00:23:50] decades ever, well, until about 40 years ago, I think OCD was considered untreatable.
[00:23:54] Dr. Taz: [00:23:55] Really?
[00:23:55] Melissa Mose, LMFT: Yeah.
[00:23:56] Dr. Taz: Wow. It was
[00:23:57] Melissa Mose, LMFT: the, it was people were, that's just your
[00:23:58] Dr. Taz: personality. [00:24:00]
[00:24:00] Melissa Mose, LMFT: Yeah. It's psychotic. Even people were put in institutions and just sort of left because [00:24:05] nobody could, could help.
[00:24:06] Melissa Mose, LMFT: So it's really important that the thing that helped, the [00:24:10] very first treatment that helped was exposure and response prevention therapy.
[00:24:14] Dr. Taz: Mm-hmm.
[00:24:14] Melissa Mose, LMFT: So [00:24:15] exposure, um, was being done in the way of like, [00:24:20] habituation, you know, like Pavlov dogs. Right. And, you know, like we all, we all sort of [00:24:25] settle down. Our nervous system settles down for a while.
[00:24:27] Melissa Mose, LMFT: But the, the important critical [00:24:30] element was the response prevention or the ritual prevention. So if you expose [00:24:35] the client or the person to the scary thing, touch the doorknob to be [00:24:40] like, you know,
[00:24:40] Dr. Taz: right.
[00:24:41] Melissa Mose, LMFT: Easy example. And then you don't allow them, [00:24:45] or they choose. 'cause it's always gotta be willing, uh, they choose not to wash.
[00:24:49] Dr. Taz: Mm-hmm. [00:24:50]
[00:24:50] Melissa Mose, LMFT: What will happen is just like if you walk in a dark room. Your eyes adjust. [00:24:55] Right? Or you walk in a house that smells funny, you know, you get used to it [00:25:00] in the very same way. Anxiety will go down on its own eventually. [00:25:05] And by having that experience of anxiety going down, the brain learns [00:25:10] something new.
[00:25:10] Melissa Mose, LMFT: Like, I can tolerate this, I can be with it, and it [00:25:15] won't be, it won't last forever and ruin my day.
[00:25:18] Dr. Taz: Gotcha.
[00:25:19] Melissa Mose, LMFT: So unless they [00:25:20] have that experience, the, the reinforcement of the compulsion is just too powerful. [00:25:25] So exposure and response prevention is really important and really works. And, [00:25:30] um, I'm a big fan. I used ERP.
[00:25:33] Melissa Mose, LMFT: There are other [00:25:35] methods out there now that are more cognitive therapy.
[00:25:38] Dr. Taz: Mm-hmm. Like CBT, like [00:25:40] cognitive behavioral therapy.
[00:25:40] Melissa Mose, LMFT: Yeah. Like infra. And there's inference based. CBT is sort of another way of looking [00:25:45] at it, but, but really nothing has the research. That ERP [00:25:50] has and the true gold standard is ERP plus medication.
[00:25:54] Dr. Taz: So exposure [00:25:55] response therapy. Yeah. Plus medication.
[00:25:56] Melissa Mose, LMFT: That's right.
[00:25:57] Dr. Taz: And what medications?
[00:25:59] Melissa Mose, LMFT: Typically [00:26:00] it's an SSRI, it's a, it's a Zoloft, or, you know, one of those types of [00:26:05] medi medications that help and, um, and, and they really do, they really work. [00:26:10] And it's different for every person. Right. Right. I think a lot of people don't wanna go that route until it gets [00:26:15] more extreme.
[00:26:15] Melissa Mose, LMFT: But, you know, OCD, and this is another thing, people don't always know [00:26:20] OCD can be disabling.
[00:26:21] Dr. Taz: Mm-hmm.
[00:26:21] Melissa Mose, LMFT: You know, people don't leave the house, people don't shower, [00:26:25] people, you know, don't eat food, um, or wipe until they bleed.
[00:26:29] Dr. Taz: [00:26:30] Right.
[00:26:30] Melissa Mose, LMFT: It's really excruciating. And it, it can really ruin a life.
[00:26:34] Dr. Taz: So the [00:26:35] combination, so I'm curious, what does the research say about medication alone with an ssri
[00:26:39] Melissa Mose, LMFT: [00:26:40] mm-hmm.
[00:26:40] Dr. Taz: Versus the exposure response therapy alone? Mm-hmm. Versus both together. Is there. [00:26:45]
[00:26:45] Melissa Mose, LMFT: Yeah, there's
[00:26:45] Dr. Taz: some data on all of
[00:26:46] Melissa Mose, LMFT: that there. There's data. I don't think I have the numbers in my head. Yeah. But you know, [00:26:50] yes. There's data that, and it, and it depends on the person. If you have somebody who's responding well to [00:26:55] SSRIs, that may be all they need.
[00:26:58] Melissa Mose, LMFT: They have a pretty mild form of [00:27:00] OCD and it seems to get better enough that they're functioning and that's all they wanna do. [00:27:05] Um, vice versa, some people don't wanna do medication 'cause that [00:27:10] just has a certain resonance for them. Right. Or, um, and so they just do [00:27:15] ERP and it may be harder for them. Right.
[00:27:17] Melissa Mose, LMFT: Because part of what the medication combination [00:27:20] does is make it a little easier to lean into the tough work.
[00:27:23] Dr. Taz: Mm.
[00:27:23] Melissa Mose, LMFT: To lean into having the [00:27:25] difficult experience. Gotcha.
[00:27:26] Dr. Taz: Yeah.
[00:27:26] Melissa Mose, LMFT: And then ideally, I, I think ideally you can [00:27:30] then stop the medication, but some people are like, I wanna do this without that. And they [00:27:35] try and it's effective.
[00:27:37] Melissa Mose, LMFT: And then, you know, for those, it, it [00:27:40] combine, it, it, it definitely works better
[00:27:42] Dr. Taz: if it's combined.
[00:27:43] Melissa Mose, LMFT: If it's combined.
[00:27:43] Dr. Taz: And what's the [00:27:45] treatment course like? Is this something they have to do for a year, for 90 days? Like, [00:27:50] or is it variable?
[00:27:51] Melissa Mose, LMFT: Yeah, it, it is variable, but, but people who, who really work in [00:27:55] the OCD clinics really feel like there shouldn't be anything that can't, you can't make a big [00:28:00] difference in a few months.
[00:28:01] Dr. Taz: A few months.
[00:28:01] Melissa Mose, LMFT: Yeah.
[00:28:02] Dr. Taz: Gotcha.
[00:28:02] Melissa Mose, LMFT: And it, it does work quickly. It's [00:28:05] a really compassionate treatment. I think it gets kind of a, a bad wrap out [00:28:10] there because it's, it's portrayed in the media is looking toilet seats and
[00:28:13] Dr. Taz: Right.
[00:28:14] Melissa Mose, LMFT: Really horrible. So, [00:28:15] you know, fear factor kinds of things. And it's, it's really not with a good clinician, you know, you're, [00:28:20] you're being, you're being encouraged and are you willing to try something new?
[00:28:24] Melissa Mose, LMFT: And how would [00:28:25] it be? So, you know, those, um, yeah, I think it, it works [00:28:30] quickly and it's very compassionate. And
[00:28:32] Dr. Taz: do you see OCD coexisting with [00:28:35] other. Conditions or diagnoses or diseases. For example, in clinic we see a lot of [00:28:40] pans or pandas, the pia, pediatric autoimmune neuro encephalitis. [00:28:45] We see a lot of that often triggered by a virus or a big [00:28:50] stressor or a bacteria or something like that.
[00:28:51] Dr. Taz: And then turning into this autoimmune type [00:28:55] scenario that then becomes, or presents itself, I should say, as [00:29:00] OCD in some of the patients. Um. We have patients with eating disorders [00:29:05] and, you know, I'm curious like of that connection mm-hmm. And does that change [00:29:10] treatment? What's the chemistry happening there?
[00:29:12] Dr. Taz: Is there something that we, as clinicians are missing? Are [00:29:15] there other como, you know, comorbidities that we don't know about or we're not thinking about? [00:29:20] So, you know, comment for a second on, on some of that.
[00:29:22] Melissa Mose, LMFT: Yes.
[00:29:23] Dr. Taz: That's heavy. That's a [00:29:25] heavy, that's a heavy category.
[00:29:26] Melissa Mose, LMFT: Let's do a conference. Yeah.
[00:29:27] Dr. Taz: Yes. Pretty much, right?
[00:29:28] Dr. Taz: I
[00:29:29] Melissa Mose, LMFT: mean it really is. Yeah. [00:29:30] Because yes, it overlaps with all kinds of different things and the, the pans and pandas [00:29:35] piece is really key. Uh, especially to bring the family, you know, families need to be [00:29:40] involved in those situations. Um, and that was, that was really what sparked my turn [00:29:45] into, into OCD treatment.
[00:29:47] Dr. Taz: Yeah.
[00:29:47] Melissa Mose, LMFT: Was my daughter's experience after a strep [00:29:50] infection. Yeah. So sudden onset. Really severe and really terrifying, right? [00:29:55] Because it comes outta nowhere. So it's great that there's more awareness to neuroinflammation [00:30:00] as something that can cause these symptoms. Um, and eating disorders actually [00:30:05] for some reason co-occur with pans and pandas kids quite a bit.
[00:30:09] Melissa Mose, LMFT: The food tends to [00:30:10] be the object of, um, the obsessions and the fear. Um, [00:30:15] so eating disorders [00:30:20] can, can look like O-C-D-O-C-D can look like eating disorders. They can [00:30:25] actually be function one another and, and really intricate, intricately related. And [00:30:30] you would do different treatment if it were OCD than if it were [00:30:35] pure eating disorder.
[00:30:35] Melissa Mose, LMFT: So a lot of times, you know, the a i avoidant, [00:30:40] restrictive food intake. Disorder. Yeah. Mm-hmm. Um, that's one that [00:30:45] happens a lot because it's not a, and for people who have OCD that looks kind of eating [00:30:50] disorder ish,
[00:30:50] Dr. Taz: right?
[00:30:51] Melissa Mose, LMFT: They're obsessions aren't really about their body, how they look, they're, it [00:30:55] really is more about, I don't like things that are that [00:31:00] texture.
Yeah.
[00:31:00] Melissa Mose, LMFT: That, you know, I don't like eating in these places. It has, it has a [00:31:05] obsessive compulsive quality to it and,
[00:31:07] Dr. Taz: well, it's a big wellness. And movement [00:31:10] risk, right. Where people are now, like, I'm not gonna go anywhere that serves seed oils. Mm-hmm. [00:31:15] Or I'm not going to eat anything with sugar. I'm not gonna eat anything with, you know, [00:31:20] I mean I've actually had patients that we've tried to like reverse.
[00:31:23] Dr. Taz: This was early in the practice, but we've tried to [00:31:25] reverse neuroinflammation in different ways. And honestly looking back may have made things [00:31:30] worse because it triggered like orthorexia in them, right. Where they became obsessive compulsive. Mm-hmm. About like the [00:31:35] ingredient in every single thing to the point that they're food restricting and food restricting and food [00:31:40] restricting and next thing you know is turned into an eating disorder.
[00:31:42] Dr. Taz: You know?
[00:31:43] Melissa Mose, LMFT: And then that gets into the whole lifestyle [00:31:45] piece, right. Of wanting to have the right mindset.
[00:31:47] Dr. Taz: Right.
[00:31:47] Melissa Mose, LMFT: Right. And I can't get out of bed until I get in the right [00:31:50] mindset.
[00:31:50] Dr. Taz: Right.
[00:31:50] Melissa Mose, LMFT: And they're watching,
[00:31:51] Dr. Taz: yeah.
[00:31:51] Melissa Mose, LMFT: You know, influencers, you're gonna protect
[00:31:52] Dr. Taz: my piece.
[00:31:54] Melissa Mose, LMFT: Yeah, exactly. Like, [00:31:55] exactly. Got got it. And so then that's really it.
[00:31:57] Melissa Mose, LMFT: Quite a head trip, right? Am I in the right mindset? Can I move [00:32:00] forward? What is it? How's it gonna, so, um, because you can hyper focus on pretty much [00:32:05] anything,
[00:32:05] Dr. Taz: right?
[00:32:05] Melissa Mose, LMFT: Yeah. So it's the balancing act of, you know, teasing apart [00:32:10] what's sweat because, um, you know, it also co-occur with trauma. [00:32:15] Um, autism,
[00:32:17] Dr. Taz: yes.
[00:32:17] Melissa Mose, LMFT: Right?
[00:32:18] Melissa Mose, LMFT: That's another one where [00:32:20] it can, there can, they can both be there, right? Or one can look like the other, uh, a [00:32:25] DH adhd. So
[00:32:25] Dr. Taz: just sorry to interrupt. Yeah.
[00:32:26] Melissa Mose, LMFT: Does trauma trigger OCD? Well, trauma doesn't [00:32:30] cause OCD we're pretty, you know, solid and wanna be very clear about that, right? It can trigger an [00:32:35] onset in somebody who is maybe genetically predisposed, maybe also [00:32:40] has some other co-occurring thing, like a, like the inflammation.
[00:32:43] Melissa Mose, LMFT: Um, but [00:32:45] OCD can get. Kind of wrapped up in a traumatic [00:32:50] experience and serve as a protective mechanism and get [00:32:55] reinforced. So when both are there, it's really complicated. Um, but [00:33:00] we do, yeah, we, we do sort of, I. It's not just trauma causing [00:33:05] OCD
[00:33:05] Dr. Taz: in, how is OCD related to A DHD or, uh, attention [00:33:10] deficit syndrome?
[00:33:10] Melissa Mose, LMFT: Yeah. It tends, it's, there's this triad, uh, you know, especially in kids, right? Yeah. [00:33:15] OCD
[00:33:15] Dr. Taz: well, I talk about the triangle all the time for everything. I'm like, it's always three. There's always, there's always three, [00:33:20] there's always a triangle. That's So your goal is to figure out your triangle.
[00:33:22] Melissa Mose, LMFT: Exactly. Exactly.
[00:33:24] Melissa Mose, LMFT: Yeah. So [00:33:25] O-C-D-A-D-H-D and Tourette syndrome.
[00:33:28] Dr. Taz: Right?
[00:33:28] Melissa Mose, LMFT: Right. So with the tics in, [00:33:30] in young kids, and yeah, that does complicate things also a little bit because [00:33:35] sometimes A DHD medications can increase trigger anxiety and cause [00:33:40] those kinds of things. So, um, also they get misdiagnosed. Um, [00:33:45] I've, the, a number of kids that I've worked with were diagnosed with A DHD [00:33:50] because they're staring out the window.
[00:33:51] Melissa Mose, LMFT: They're inattentive.
[00:33:52] Dr. Taz: Right.
[00:33:53] Melissa Mose, LMFT: And teachers don't realize they're [00:33:55] inattentive because they're trying to replace the bad thought they just had with the good thought. And things have to be [00:34:00] just right before they can take the math book out. And so, uh, [00:34:05] yeah, the, the co-occurring, they do find that people with [00:34:10] OCD have a much higher incident of other co-occurring disorders, and so [00:34:15] we do have to be careful about how we
[00:34:16] Dr. Taz: is OCD born in a, in.[00:34:20]
[00:34:20] Dr. Taz: Can, let me phrase this correctly, is OCD born in [00:34:25] conditions where there is chronic inflammation?
[00:34:27] Melissa Mose, LMFT: I am beginning to believe we're, [00:34:30] we're gonna find out more and more that, that's true. Um, I think that [00:34:35] that's what the pans and pandas
[00:34:36] Dr. Taz: right.
[00:34:37] Melissa Mose, LMFT: You know, like cases that were more extreme kind [00:34:40] of led us to discover.
[00:34:41] Melissa Mose, LMFT: Uh, and also when people get sick, [00:34:45] their OCD spikes.
[00:34:46] Dr. Taz: Mm.
[00:34:47] Melissa Mose, LMFT: Um, it spikes with hormones. That's why you [00:34:50] see all the perinatal OCD. So, you know, there's all kinds of What
[00:34:54] Dr. Taz: about like [00:34:55] perimenopause and menopause?
[00:34:56] Melissa Mose, LMFT: Yeah. I think that can,
[00:34:57] Dr. Taz: that will trigger it as well.
[00:34:58] Melissa Mose, LMFT: You, you don't see that as [00:35:00] much because it's a decline in hormones.
[00:35:02] Melissa Mose, LMFT: Right. Rather than the, a spike, the surge that happens hormones, you know, [00:35:05] but, but I, working with teenage girls, I, you know, it's like, or you know. [00:35:10] Young women, you always see, well, it's, you know, week before my period and my [00:35:15] OCD is going crazy. So it's very standard to recognize that it's biochemically [00:35:20] based and And induced.
[00:35:21] Melissa Mose, LMFT: And triggered. Yeah.
[00:35:22] Dr. Taz: So is the solution for somebody like that, [00:35:25] if anyone's listening to us and they notice these symptoms worsen like maybe the week before your cycle, [00:35:30] or they're worsening when you ovulate, like at a spike, right? Mm-hmm. When you have that surge, [00:35:35] or you might be pregnant and having a surge of progesterone or doing IVF and getting a surge of [00:35:40] hormones.
[00:35:40] Dr. Taz: Mm-hmm. Mm-hmm. So for any of of those folks, if they're noticing that, that's when they're [00:35:45] OCD flares and it's not constant necessarily, what is their treatment [00:35:50] strategy to manage that?
[00:35:51] Melissa Mose, LMFT: You know, that's a tough one because there, there are probably a lot [00:35:55] of things out there Yeah. In the way of, you know, supplements or [00:36:00] anti-inflammatories, the anti-inflammatory diet.
[00:36:01] Dr. Taz: Mm-hmm.
[00:36:02] Melissa Mose, LMFT: There, there are probably things out there that would [00:36:05] be helpful, and I'm not an expert on those things, but. I also know that it [00:36:10] really depends on the person, you know, what kind of energy, effort, and ability they have to [00:36:15] utilize those kinds of auxiliary treatment methods to [00:36:20] optimize their functioning.
[00:36:21] Melissa Mose, LMFT: I think a lot of, for me, the way I work because of the [00:36:25] internal family systems approach
[00:36:26] Dr. Taz: mm-hmm.
[00:36:27] Melissa Mose, LMFT: Is to notice again that [00:36:30] parts are, you know, your parts are really active right now.
[00:36:33] Dr. Taz: Right.
[00:36:33] Melissa Mose, LMFT: And, and [00:36:35] helping people learn the, the skill of unblending so they can say [00:36:40] a part of me's freaking out right now and I just need to focus on getting my kids to school [00:36:45] rather than, I'm so anxious I can't function, rather than identifying with the [00:36:50] feelings.
[00:36:50] Melissa Mose, LMFT: So
[00:36:51] Dr. Taz: are you concerned that when you look at Gen Z. For example.
[00:36:54] Melissa Mose, LMFT: Mm-hmm. [00:36:55]
[00:36:55] Dr. Taz: Um, that there's a little bit of parking or [00:37:00] hyper fixating on the fact that there is a mental health issue. Mm-hmm. [00:37:05] In fact, I think I saw a survey recently that said 75% of Gen Z [00:37:10] women girls report that they have some mental health something.
[00:37:13] Dr. Taz: Right. And. [00:37:15] There's a TikTok trend going around recently of like all [00:37:20] these young women, girls and younger women, like, yeah. You know, well, here's [00:37:25] my mental health cocktail, and like, downing like a bunch of whatever. Right. You know? Are, [00:37:30] are you concerned that there's this hyper fixation just around that and [00:37:35] not an understanding that we gotta keep moving?
[00:37:36] Dr. Taz: Like, right. You know, this is not a reason to stop what you're doing, to [00:37:40] quit what you're doing. You gotta keep moving through it, you know? Right. Um, especially for somebody who's practiced [00:37:45] for 15, 16 years.
[00:37:46] Melissa Mose, LMFT: Right, right. So yes. I, and, and I have to say, [00:37:50] I, I love Gen Gen ZI have a
[00:37:52] Dr. Taz: Gen ZI have, they're in my home, trust [00:37:55] me.
[00:37:55] Dr. Taz: Yeah,
[00:37:55] Melissa Mose, LMFT: yeah, yeah. Their sense of humor and the view of the world, it cracks me up. They're great and [00:38:00] yes, they're like, love me. A good diagnosis. I've heard that one. Right? Yeah.
[00:38:03] Dr. Taz: Uhhuh.
[00:38:03] Melissa Mose, LMFT: And so that's great. [00:38:05] Um. Can't, you know, like anything else, right? It's like it's functional until it [00:38:10] stops being helpful anymore, I think in a certain way.
[00:38:13] Melissa Mose, LMFT: Um, open [00:38:15] awareness, inclusion, it's easier to talk about these things,
[00:38:18] Dr. Taz: right.
[00:38:19] Melissa Mose, LMFT: Is great.
[00:38:19] Dr. Taz: [00:38:20] Right.
[00:38:20] Melissa Mose, LMFT: I am well aware that when I was a teenager, I probably had [00:38:25] some clinical anxiety around things. Right. Or social anxiety. Right. But I didn't, I didn't [00:38:30] think I even knew the word anxiety. I, I literally thought that I got excited [00:38:35] about taking the SAT.
[00:38:36] Dr. Taz: Right. And
[00:38:37] Melissa Mose, LMFT: I was just nervous probably, you know? Right. [00:38:40] So it was good for me to not know. That is my point. Yeah. You know? Yeah. And I think with, um, [00:38:45] with these kids, I, yeah, yeah. It can, it can be a rabbit hole, it can [00:38:50] be an excuse to opt out.
[00:38:51] Dr. Taz: Yeah.
[00:38:52] Melissa Mose, LMFT: And that is not healthy. Um, [00:38:55] and then identifying with the diagnosis and, um, so it's [00:39:00] unfortunate.
[00:39:01] Melissa Mose, LMFT: It also, it's a
[00:39:02] Dr. Taz: reality.
[00:39:02] Melissa Mose, LMFT: Hopefully like, like other things, [00:39:05] you know, it gets extreme and then it comes kind of back into the fold when people start to [00:39:10] realize the other side of it
[00:39:11] Dr. Taz: would a better message be. One that we could all spread [00:39:15] that, look, this is a disorder of inflammation. Mm-hmm.[00:39:20]
[00:39:20] Dr. Taz: Neuroinflammation in particular, which actually has solutions. Mm-hmm. You know, and it's [00:39:25] not necessarily a part of your personality. 'cause I think that's the myth out there. Yeah. Like, oh, I [00:39:30] just have OCD, like Yeah.
[00:39:31] Melissa Mose, LMFT: You
[00:39:31] Dr. Taz: know what I mean? It's almost like a type, you know? Yeah. So instead of [00:39:35] like. Perpetuating that myth that OCD is, is integrated into your personality.
[00:39:39] Dr. Taz: [00:39:40] It may actually be a symptom
[00:39:41] Melissa Mose, LMFT: mm-hmm.
[00:39:42] Dr. Taz: Of neuroinflammation. Right. And for that, there is a plan, [00:39:45] you know?
[00:39:45] Melissa Mose, LMFT: Yeah. And, well, I think anything that reduces shame Yeah. Is important. And that [00:39:50] increases hope. I hear a lot OCD is untreatable, right? Mm-hmm. And it's not, not the case. And then [00:39:55] the other end of I'm so OCD, you know?
[00:39:57] Melissa Mose, LMFT: Yeah.
[00:39:57] Dr. Taz: Ooc
[00:39:57] Melissa Mose, LMFT: D is not an adjective. If you actually have the [00:40:00] D part, it's wrecking your life. Right? So that's not anything. Right. Right. Right. [00:40:05] So I do, I really agree with you to, to focus on, we are a brain body system [00:40:10] and we come wired in a certain way and we have capacities and [00:40:15] we have, we have, you know, things that we're not as good at and our, you know, [00:40:20] like to see it as the body can be attended to in a way that's gonna minimize that.
[00:40:24] Melissa Mose, LMFT: [00:40:25] And no, it's not a personality thing.
[00:40:27] Dr. Taz: Yeah. I think that in itself is such an important [00:40:30] message. Does it look different in men?
[00:40:32] Melissa Mose, LMFT: Oh, interesting. You know, in some very [00:40:35] major ways. No. Okay. You know, it's like, it's, I [00:40:40] mean, it may be, it, it appears at different times, you know, I, I get a lot of 11-year-old girls.[00:40:45]
[00:40:45] Dr. Taz: Yeah.
[00:40:45] Melissa Mose, LMFT: And, you know, the boys tend to be a little older or adolescent. Um, [00:40:50] but in terms of the fears and the, uh, you know, the [00:40:55] thoughts, the intrusive thoughts, I mean, intrusive thoughts seem to be very different or very much [00:41:00] the same. People don't wanna be, what if I'm a bad person?
[00:41:03] Dr. Taz: Mm.
[00:41:03] Melissa Mose, LMFT: Right. What if I'm [00:41:05] careless or I'm, or what if I'm a monster?
[00:41:06] Melissa Mose, LMFT: What if I really want to hurt people? I wanna really call [00:41:10] attention that. That's a really common kind of OCD that we don't really talk about. [00:41:15] Like, and people are wandering around thinking, what if I really intended to bump her elbow when I [00:41:20] passed her on the street? What if I'm, you know, like, and it's, it's really debilitating, but [00:41:25] I see that in.
[00:41:26] Melissa Mose, LMFT: Boys see that in girls. Um, I think the [00:41:30] subtypes, you know, OCD is the process underneath it. All right. It's the alert and then [00:41:35] the fix and the alert, and then the fix. And that's how we tell it from other things. [00:41:40] But the content of it, um, might occur more in [00:41:45] certain contexts than in others. Um, in religious [00:41:50] households.
[00:41:50] Melissa Mose, LMFT: Mm-hmm. The scrupulosity piece, like, did I pray enough? Am I devout enough? [00:41:55] Whereas other places that might look more like morality and, you know, did I [00:42:00] cheat or did I represent myself accurately? So, so the, [00:42:05] the flavoring of the content might change. Um, but no, [00:42:10] it's pretty equal opportunity. It's pretty
[00:42:11] Dr. Taz: consistent, yeah.
[00:42:12] Dr. Taz: Across the board. Mm-hmm. Are there medications that worsen [00:42:15] OCD?
[00:42:16] Melissa Mose, LMFT: It depend. It can depend. You know, again, medications are so. [00:42:20]
[00:42:20] Dr. Taz: Tricky
[00:42:21] Melissa Mose, LMFT: people specific. Yeah. Uh, but, you know, Ritalin can [00:42:25] definitely, you know, that, like we said, the A DHD medicines can, can worsen it. Um, I'm sure that [00:42:30] there are some that I'm not aware of.
[00:42:31] Melissa Mose, LMFT: Mm-hmm.
[00:42:31] Dr. Taz: But
[00:42:32] Melissa Mose, LMFT: I think anything, you know, whenever you [00:42:35] notice I'm in a spike or you notice your family members in a spike, they may [00:42:40] not even realize it, but you've just seen them walk in and outta a room five, five times or whatever.
[00:42:44] Dr. Taz: Right. [00:42:45]
[00:42:45] Melissa Mose, LMFT: You know, you're not necessarily without being judgmental. Right. You want, you [00:42:50] wanna maybe call attention to it, but.
[00:42:52] Melissa Mose, LMFT: But track what happened.
[00:42:54] Dr. Taz: Mm-hmm.
[00:42:54] Melissa Mose, LMFT: Like what are [00:42:55] the antecedents to this? Um, and so, and maybe, maybe if it is a [00:43:00] medication or if it is some sort of a substance or, or it's a [00:43:05] interaction, it's certain people right, that they hang out with or stress, you know, stress [00:43:10] can definitely make it worse.
[00:43:11] Dr. Taz: Now, sometimes OCD is also worn as a badge of honor, right?
[00:43:14] Dr. Taz: [00:43:15] Mm-hmm. I'm Type A, I'm OCD.
[00:43:17] Melissa Mose, LMFT: Mm-hmm.
[00:43:18] Dr. Taz: I am blah, blah, blah, blah, blah. Right. [00:43:20] Or because they're OCD, they were successful and able to do [00:43:25] X, Y, and Z. Yeah. Or we hear about, I think Steve Jobs or like some of these, you [00:43:30] know, figures in our culture and history that like you hear about like how they [00:43:35] worked or, you know, some of their habits and their rituals, and people [00:43:40] attribute that to being part of why they're successful, like,
[00:43:43] Melissa Mose, LMFT: mm-hmm.
[00:43:43] Dr. Taz: What's your thought there? [00:43:45]
[00:43:45] Melissa Mose, LMFT: Well, again, it's. Any of these behaviors [00:43:50] function on a spectrum. Right.
[00:43:51] Dr. Taz: Right.
[00:43:52] Melissa Mose, LMFT: Anxiety too. We have that optimal anxiety. Right, [00:43:55] right. So a little anxiety before a test is a good thing. Is a good
[00:43:58] Dr. Taz: thing. Yeah.
[00:43:59] Melissa Mose, LMFT: If it gets [00:44:00] too intense, then it starts, you know, taking, you know, taking me away from [00:44:05] what you know, what I'm meant to do.
[00:44:07] Melissa Mose, LMFT: So, you know, if you have a touch of perfectionism, [00:44:10] that's not a bad thing. Um, but if your perfectionism is keeping you from sending an email [00:44:15] until you reread it about 70 times.
[00:44:17] Dr. Taz: Yeah.
[00:44:18] Melissa Mose, LMFT: You know, so
[00:44:19] Dr. Taz: it's on a [00:44:20] spectrum.
[00:44:20] Melissa Mose, LMFT: Yeah. It's on a spectrum. And I do think that people who really have [00:44:25] the disorder who are locked in their homes or can't leave [00:44:30] until, I mean, they're just an agony.
[00:44:32] Melissa Mose, LMFT: Yeah. I think that that kind of, I'm so [00:44:35] OCD or, or OCD works for me, kind of attitude. It feels, [00:44:40] feels, um. Dismissive and Yeah. Of the
[00:44:43] Dr. Taz: actual condition
[00:44:43] Melissa Mose, LMFT: of the actual [00:44:45] gravity of it, you know?
[00:44:46] Dr. Taz: Interesting.
[00:44:47] Melissa Mose, LMFT: Yeah.
[00:44:47] Dr. Taz: So going back to internal family [00:44:50] systems. Mm-hmm. Right? So someone you love, has OCD child or [00:44:55] a partner can, can we be participants in a [00:45:00] internal family system for somebody, or is that something that really needs to be done with like a [00:45:05] professional who's trained in that work and knows how to do that work?
[00:45:08] Melissa Mose, LMFT: Well, I think the most [00:45:10] fundamental thing we can do as parents is our own work.
[00:45:13] Dr. Taz: Mm-hmm.
[00:45:14] Melissa Mose, LMFT: Right? [00:45:15] So if I show up. When my daughter is struggling, I [00:45:20] show up with a really anxious part in the lead or a controlling one that, [00:45:25] that wants to tell her what to do, or one that's exasperated because [00:45:30] you know, like if I show up with a part in the lead, it's, it's gonna [00:45:35] negatively impact her.
[00:45:36] Dr. Taz: Mm.
[00:45:36] Melissa Mose, LMFT: Because my parts are gonna draw her parts right. My [00:45:40] overly gonna fix it part. Mm-hmm. Might draw her anger and or whatever. It [00:45:45] just in general, we wanna be as self-led as we can be. So I wanna notice, okay. I have a part [00:45:50] that's like wanting to just. Tell her what to do.
[00:45:53] Dr. Taz: Right,
[00:45:54] Melissa Mose, LMFT: right.
[00:45:54] Dr. Taz: We all [00:45:55] do.
[00:45:55] Melissa Mose, LMFT: Yeah. And, um, then I have another part that just wants to do it for her.[00:46:00]
[00:46:00] Dr. Taz: We have that part too.
[00:46:01] Melissa Mose, LMFT: It's hurting.
[00:46:01] Dr. Taz: Yeah.
[00:46:01] Melissa Mose, LMFT: Right.
[00:46:02] Dr. Taz: Mm-hmm.
[00:46:02] Melissa Mose, LMFT: And I can really [00:46:05] speak for those parts in my own mind, like naming them really helps.
[00:46:09] Dr. Taz: [00:46:10] Yeah.
[00:46:10] Melissa Mose, LMFT: Just like anytime you, you know, are in a struggle to really name what the other person [00:46:15] is feeling, helps them relax. So. Naming that, or I'm [00:46:20] angry. Like sometimes the level of anger we have, we don't wanna be that parent.
[00:46:23] Melissa Mose, LMFT: Right, right.
[00:46:24] Dr. Taz: Yeah.
[00:46:24] Melissa Mose, LMFT: [00:46:25] So I, that's one for me, I just like, I'm not angry, but sometimes I'm angry. So if [00:46:30] I can just notice, and now that she's older, I can say, A part of me is really angry right now. I know you're [00:46:35] doing the best you can. So just that kind of communication and that kind of [00:46:40] self-awareness allows us to be self-led in a situation where we can have [00:46:45] compassion for what they're going through.
[00:46:46] Dr. Taz: Mm-hmm.
[00:46:47] Melissa Mose, LMFT: We don't have to say, there's nothing wrong. Go ahead [00:46:50] and touch it.
[00:46:50] Dr. Taz: Yeah.
[00:46:50] Melissa Mose, LMFT: Or, or,
[00:46:51] Dr. Taz: or, you're being crazy.
[00:46:52] Melissa Mose, LMFT: You're being crazy. So we don't have to be sort of overly [00:46:55] demanding of functioning. And we don't have to be overly reassuring and, oh, it's okay. [00:47:00] I'll, I'll help you. 'cause that sends the wrong message too.
[00:47:02] Melissa Mose, LMFT: Right. You can't handle it. [00:47:05] Anxiety's bad. We don't have anxiety in this house. We fix it.
[00:47:08] Dr. Taz: Mm.
[00:47:09] Melissa Mose, LMFT: Right. So [00:47:10] both of those send the wrong message. But if I can be in a little bit of clarity [00:47:15] en enough to have. The compassion, but also the confidence. Like [00:47:20] I know it's really uncomfortable right now. I know you're struggling and you're really anxious, [00:47:25] but I have confidence in you.
[00:47:26] Melissa Mose, LMFT: I know you will get through this. Not, I know [00:47:30] everything's gonna be okay. 'cause that's a reassurance, but, but I'm here with you. Well, you'll, [00:47:35]
[00:47:35] Dr. Taz: okay. So help us with that. Yeah. Because, okay. I'll put my, fix it. [00:47:40] Angry controlling pieces off to the side.
[00:47:44] Melissa Mose, LMFT: Mm-hmm.
[00:47:44] Dr. Taz: And I [00:47:45] wanna be present. Right? Give us like three phrases that we could use if it's a child [00:47:50] or if it's an adult.
[00:47:50] Melissa Mose, LMFT: Right? Yeah. I know this is really hard for you.
[00:47:54] Dr. Taz: Yeah. [00:47:55]
[00:47:55] Melissa Mose, LMFT: And I know you'll get through it. I mean, just like I just said, I, I'll. [00:48:00] I'm here with you, I'll hang out and you know, I really trust that you can [00:48:05] be with this and do the thing that you know, your therapist has been telling you to do. [00:48:10] Or, you know, I think you, I think you, you know, I'll help you resist that [00:48:15] compulsion, like by just being a presence, right?
[00:48:18] Melissa Mose, LMFT: Because what we know is we wanna, [00:48:20] we wanna partner with the part of our child or our partner. [00:48:25] I'm gonna partner with the aspect of them that wants to get better because they [00:48:30] know they don't really wanna do the compulsion.
[00:48:32] Dr. Taz: Mm.
[00:48:33] Melissa Mose, LMFT: Right? And [00:48:35] so you, you trying to really find the self in somebody. Like, I [00:48:40] get that you wanna go take your clothes off again.
[00:48:43] Melissa Mose, LMFT: I also know, you know [00:48:45] what that means, right? So I'm here. [00:48:50] I know you. I believe in you. I think I believe in you, is really important, and I know you're [00:48:55] struggling. So that's compassion and it's confidence.
[00:48:58] Dr. Taz: Mm.
[00:48:58] Melissa Mose, LMFT: And I'm here.
[00:48:59] Dr. Taz: So are those the [00:49:00] two words we should remember? Compassion and confidence? Yeah. In our statements.
[00:49:03] Melissa Mose, LMFT: I really think so. Yeah. Yeah. [00:49:05] It, it's because our confidence that when anxiety isn't gonna kill you, so it's an [00:49:10] uncomfortable
[00:49:10] Dr. Taz: feeling that's really real. So I think that's really important. I think for everyone needs to hear that. Yeah. Anxiety's [00:49:15] not gonna kill anyone. Yeah.
[00:49:15] Melissa Mose, LMFT: We don't need to like, yeah. If it bec, if the other option is [00:49:20] doing things that are ruining your life, taking you away, making you quit soccer, stay in the [00:49:25] room, you know, not take that job it, you know, be, feel [00:49:30] anxious.
[00:49:30] Melissa Mose, LMFT: It's just a feeling, right? Mm-hmm. If we can have that kind of message, [00:49:35] um, it's a really uncomfortable feeling. You know, I think we can share anything [00:49:40] that, you know, we can relate. Um, I've developed this fear of [00:49:45] heights, right? So I get near a banister or something, all of a sudden my nervous system flares, but.[00:49:50]
[00:49:50] Melissa Mose, LMFT: I think of it as, wow, my body's doing that thing again. I don't feel like [00:49:55] I'm scared, but I know how uncomfortable it is.
[00:49:57] Dr. Taz: Mm. So you're almost like reassure, not [00:50:00] reassuring. You're almost calming yourself down a little bit.
[00:50:03] Melissa Mose, LMFT: Yeah. Yeah, yeah. Yeah. [00:50:05] I'm, I'm, I'm just, I'm, and I disidentifying from the, from the [00:50:10] feeling I don't have to see the thing my body is doing as [00:50:15] me.
[00:50:15] Dr. Taz: Gotcha.
[00:50:15] Melissa Mose, LMFT: Because there's so many other parts of me.
[00:50:18] Dr. Taz: Mm.
[00:50:18] Melissa Mose, LMFT: You know, there's, there's the part [00:50:20] of me that wants to like go stand at the edge or go skydiving, I don't know. [00:50:25] But, um, so, so there's, you can always find another part of you that sees it differently. [00:50:30] And when you do that, you know, um, you're more aware of the, you [00:50:35] who's aware, and that's the selfly, that's where we wanna be.
[00:50:38] Dr. Taz: How does OCD affect [00:50:40] intimacy? Between partners? Yeah. It be, and community even like connection. How does it impact that [00:50:45]
[00:50:45] Melissa Mose, LMFT: a lot. It, uh, can, it can really get in the way, especially there's a type of OCD [00:50:50] called relationship OCD.
[00:50:51] Dr. Taz: Mm-hmm.
[00:50:52] Melissa Mose, LMFT: And the obsessions, I begin [00:50:55] to, um, swirl around the partner or your own feelings about the partner.[00:51:00]
[00:51:00] Melissa Mose, LMFT: So, you know, do I have, is this the wine? He's, is this person the [00:51:05] right person for me? Um, or does he love me in the right way? Um, [00:51:10] or, you know, all of the,
[00:51:11] Dr. Taz: so the person with OCD is constantly processing. Yeah. That,
[00:51:14] Melissa Mose, LMFT: yeah. [00:51:15] So it's kind of along the lines of an intolerance of uncertainty and we haven't [00:51:20] talked about that yet.
[00:51:21] Dr. Taz: No, we haven't. We need to talk about that,
[00:51:23] Melissa Mose, LMFT: so, yeah. Yeah, yeah. Yeah. Because that's at the [00:51:25] root of almost all OCD Okay. Is I need to know for sure. Like [00:51:30] OCD is like it guilty until proven innocent. I need to know for sure that he loves me. I need to know for [00:51:35] sure that I'm a good person and I'm not going to hell.
[00:51:37] Melissa Mose, LMFT: I need to know for sure that that thing is [00:51:40] clean and hasn't touched anything. And even if I can't see anything on it, does it have the [00:51:45] essence of that dirty substance on it? Right. It it's like OCD wants [00:51:50] absolutes and answers. Yeah, yeah. Answers for questions that have no answers. Right. [00:51:55] Um, no concrete answers.
[00:51:57] Melissa Mose, LMFT: And so, uh, living in uncertainty is really [00:52:00] one of the main solutions to the problem, right? It's the treatment method of choice. It's the [00:52:05] exposure lifestyle. It's like, what if we don't get to know? So to, [00:52:10] to bring it back to your question about relationships, it's, it's a [00:52:15] risk, right? It's kind of the ultimate risk.
[00:52:16] Melissa Mose, LMFT: You, you sort of. Invest in this other person and, and you don't [00:52:20] get to know what they're thinking all the time. Um, so,
[00:52:24] Dr. Taz: and how do we get [00:52:25] comfortable in that for people with OCD? How do they get comfortable in, in living in [00:52:30] uncertainty Or how do any of us get comfortable? And I mean, I know some people have faith and some people [00:52:35] have other tools, but how do, how does one get comfortable with that idea that we just [00:52:40] don't know?
[00:52:40] Melissa Mose, LMFT: Yeah.
[00:52:40] Dr. Taz: And that's okay.
[00:52:42] Melissa Mose, LMFT: You know, the first word that came to mind, and [00:52:45] I haven't thought of this in a long time, was, awe,
[00:52:47] Dr. Taz: awe.
[00:52:48] Melissa Mose, LMFT: If we can,
[00:52:48] Dr. Taz: I haven't heard that word in forever.
[00:52:49] Melissa Mose, LMFT: [00:52:50] Yeah. Just like, like it's a kind of amazing how much we don't know if we [00:52:55] really think about it, you know, and that can be very triggering for people.
[00:52:57] Melissa Mose, LMFT: Mm-hmm. But, um, you [00:53:00] know, making space for that, um, giving it a different spin, like [00:53:05] beginner's mind. Right. Traveling's fun because it's like, it's like [00:53:10] everything's new.
[00:53:11] Dr. Taz: Yeah.
[00:53:11] Melissa Mose, LMFT: Right. Yeah. So, so that uncertainty, like kind of learning [00:53:15] how to em embrace it and lean into it and realize when you lean into a [00:53:20] one uncertain situation, for instance, the more you're with it, the [00:53:25] more familiar it becomes.
[00:53:26] Melissa Mose, LMFT: And so just knowing it's not [00:53:30] what you know or don't know, it's what you do when you don't know, when it's [00:53:35] what you do when you're uncertain and can you just breathe into it and [00:53:40] make space for it and let it sort of be there and focus on what you do [00:53:45] know.
[00:53:45] Dr. Taz: Hmm.
[00:53:45] Melissa Mose, LMFT: Um, and, and the trick is kind of turning the flashlight of your [00:53:50] attention out into the world and, and to look around and say, I'm [00:53:55] safe right now.
[00:53:57] Melissa Mose, LMFT: I, I'm doing this thing that's really fun [00:54:00] and I'll just focus here and be in the present moment. So I think that that's really the [00:54:05] mindfulness tools that we see everywhere can be really useful. Getting [00:54:10] into your body, finding all of your toes,
[00:54:14] Dr. Taz: it's [00:54:15] almost like grounding, grounding and kind of bringing you back into your [00:54:20] physical.
[00:54:20] Dr. Taz: Right. Do you have favorites, favorite tools that kids can use to get there? Favorite tools that [00:54:25] adults can use to get there?
[00:54:27] Melissa Mose, LMFT: Well, kids do really well with [00:54:30] IFS. Yeah. Like they, they do really well with internal
[00:54:32] Dr. Taz: family systems.
[00:54:33] Melissa Mose, LMFT: Yeah. With internal family systems. Okay. Like, like [00:54:35] seeing the obsessional part and the compulsive part as different parts of them.
[00:54:38] Dr. Taz: Yeah.
[00:54:38] Melissa Mose, LMFT: You know, this is my what if [00:54:40] monster. Um, this is negative Nancy.
[00:54:42] Dr. Taz: Mm-hmm. Yeah. Mm-hmm. Yeah.
[00:54:44] Melissa Mose, LMFT: Um, this is, [00:54:45] um, and so I think externalizing is really helpful.
[00:54:48] Dr. Taz: Okay.
[00:54:48] Melissa Mose, LMFT: So if you're a [00:54:50] child and you want to, like, this toy represents that thought and this toy represents that [00:54:55] thought, and I can look at them and go, I know they're just, that, they're just [00:55:00] thoughts.
[00:55:00] Melissa Mose, LMFT: Yeah. You know, so it helps, you know, it, it helps to put things outside of your [00:55:05] body, draw it.
[00:55:05] Dr. Taz: Right.
[00:55:06] Melissa Mose, LMFT: Um, I think adults kind of, well, I, I love. [00:55:10] I mean, of course having a kid, I still have lots of little toys around the house. Mm-hmm. And my office has [00:55:15] lots of things, but I think it's great to just go, you know, the part of me as I was writing [00:55:20] this book, the part of me that's taking this perspective is here.
[00:55:23] Melissa Mose, LMFT: And the part that's taking [00:55:25] this perspective is there, because I'm balancing two very different worlds. Right. And, and it's a [00:55:30] reminder in the external world, um, adults, I think like, [00:55:35] to maybe put things out in writing. So
[00:55:39] Dr. Taz: writing [00:55:40] about it.
[00:55:41] Melissa Mose, LMFT: Yeah. Not getting entangled in content. This is where I'm a little bit [00:55:45] cautious.
[00:55:45] Melissa Mose, LMFT: It's like, uh, worry. You know, it, that's a worry.
[00:55:48] Dr. Taz: Yeah.
[00:55:48] Melissa Mose, LMFT: Right now I'm gonna [00:55:50] set it aside and keep functioning. So it's that kind of unblending tools I think are great. [00:55:55] Um, but also just welcoming.
[00:55:58] Dr. Taz: Mm-hmm.
[00:55:58] Melissa Mose, LMFT: Whatever is [00:56:00] coming up that's uncomfortable
[00:56:02] Dr. Taz: and uncertain.
[00:56:03] Melissa Mose, LMFT: And uncertain. [00:56:05] Right. So I like to say, you know.
[00:56:08] Melissa Mose, LMFT: Welcome. [00:56:10] Whatever's arising, just don't follow it.
[00:56:12] Dr. Taz: Right, right,
[00:56:13] Melissa Mose, LMFT: right. [00:56:15] Let it go through and out. Take a deep breath and then keep moving. Don't
[00:56:19] Dr. Taz: park and [00:56:20] attach to it necessarily.
[00:56:20] Melissa Mose, LMFT: Yeah, exactly. Exactly.
[00:56:22] Dr. Taz: So tell us about the book. We haven't talked even about the book, and I know [00:56:25] you're training, you told me, uh, in the beginning of our conversation, you were training a lot of clinicians.
[00:56:28] Dr. Taz: Mm-hmm. I'm curious, [00:56:30] like from your vantage point, what do we clinicians miss frequently in practice? [00:56:35] What's your hope for the book?
[00:56:36] Melissa Mose, LMFT: Yeah. Well, my, my hope for the book is [00:56:40] that, um, it just enlivens enriches and deepens what we're already [00:56:45] doing when we're treating OCD and, and the, the gold standard treatments are, are great.[00:56:50]
[00:56:50] Melissa Mose, LMFT: IFS is just a deeper way of getting there, and it's a really helpful tool for when [00:56:55] people aren't ready to or willing to do exposures. Mm. Because we can [00:57:00] work with the parts of them that get in the way. So. I've, [00:57:05] I've, um, it, it was a dicey thing because I, because the [00:57:10] people in my OCD community right, and I'm very deeply in that community of [00:57:15] clinicians, were really protective of new methods
[00:57:17] Dr. Taz: Ah,
[00:57:17] Melissa Mose, LMFT: that don't have evidence.
[00:57:18] Melissa Mose, LMFT: Right? Yeah. It's like
[00:57:19] Dr. Taz: same,
[00:57:19] Melissa Mose, LMFT: don't [00:57:20] try that. Right?
[00:57:20] Dr. Taz: Yeah. Yeah.
[00:57:21] Melissa Mose, LMFT: But IFS is just such a natural, it's like if you [00:57:25] infuse your practice with an awareness of who am I talking to right [00:57:30] now?
[00:57:30] Dr. Taz: Mm-hmm.
[00:57:30] Melissa Mose, LMFT: Right. I'm talking to the compliant part of my client [00:57:35] who's just doing whatever I say to get to do treatment. Right,
[00:57:39] Dr. Taz: [00:57:40] right.
[00:57:40] Melissa Mose, LMFT: Or am I talking to a part that, you know, [00:57:45] I don't know, is just engaging in white knuckling through this thing you mm-hmm. Just being [00:57:50] aware of what part of your client you're talking to, resistant part. Um, [00:57:55] sometimes the, the part that's like, nah, that one's too scary. I can't do that. You know? Yeah. It's just like [00:58:00] parts with agendas.
[00:58:01] Melissa Mose, LMFT: Um. I think that's incredibly helpful. I've had clients [00:58:05] say, well, when you have access to yourself while you're doing an exposure, it [00:58:10] makes all the difference. Hmm. Right. The other thing that IFS is really good for when you're [00:58:15] really aware of that internal family systems dynamic is, um, [00:58:20] self-compassion. And we have discovered that, that, that [00:58:25] there's a lot of shame and blame and guilt, uh, in everywhere.
[00:58:28] Melissa Mose, LMFT: But in OCD in [00:58:30] particular, uh, people. Get really hard on themselves when they don't do, [00:58:35] uh, their exposure homework or, or if they go ahead and do a compulsion [00:58:40] because they just couldn't stand not doing it. Right.
[00:58:41] Dr. Taz: Yeah.
[00:58:42] Melissa Mose, LMFT: So self-compassion is a very healing [00:58:45] state, but it's really hard to tell somebody to have [00:58:50] some compassion for yourself.
[00:58:51] Dr. Taz: Right.
[00:58:51] Melissa Mose, LMFT: You know, I don't deserve it. Or there's all these things that come up.
[00:58:54] Dr. Taz: Right. [00:58:55]
[00:58:55] Melissa Mose, LMFT: Internal family systems is a really natural way to [00:59:00] notice the part and ask it to step back, you know? How do you feel towards [00:59:05] that obsessional part? I hate it. Oh. So let's focus on the part that hates it for a minute. [00:59:10] How does that show up in your body?
[00:59:13] Melissa Mose, LMFT: Oh, it's just like a clenched [00:59:15] feeling or whatever, so let's just focus on that one and, and. Listen to its message, let it know [00:59:20] that you hear it right. It's got a point. This has been really hard on you. I kind of don't [00:59:25] blame that part of you for hating OCD.
[00:59:27] Dr. Taz: Mm-hmm.
[00:59:28] Melissa Mose, LMFT: Yeah. But if we're gonna help [00:59:30] OCD, we might need to spend some time looking at it.
[00:59:33] Melissa Mose, LMFT: So would that [00:59:35] hatred for it be willing to soften for a second? Could it sort of sit to the side of you? [00:59:40] Um, and people really have great experiences with that. [00:59:45] When they, when they turn their attention inside and they start to notice all the [00:59:50] different parts of them that are going and they unblend from those, [00:59:55] um, what happens naturally is compassion and self-compassion.
[00:59:59] Melissa Mose, LMFT: [01:00:00] So after you unblend from the part that hates it. Now, what do you [01:00:05] feel towards that scared, anxious part of you that's running the show? [01:00:10] Well, now I kind of feel for her, you know,
[01:00:13] Dr. Taz: it's
[01:00:13] Melissa Mose, LMFT: empathy.
[01:00:13] Dr. Taz: Yeah,
[01:00:14] Melissa Mose, LMFT: yeah. [01:00:15] Now, yeah. Or I'm kind of curious what that's all about. Or [01:00:20] some, you know, eight. The eight Cs.
[01:00:22] Dr. Taz: Yeah.
[01:00:22] Melissa Mose, LMFT: Curiosity. Yeah. Compassion, [01:00:25] clarity, courage, confidence. One of those will show up and people tend to have [01:00:30] proclivities and towards one or another, but some aspect of it, even just neutral, like, [01:00:35] I don't know, maybe I'm a little open, open's a good word. [01:00:40] Um, and that's what we're looking for, is just finding that open space so that we [01:00:45] can be with whatever's going on in a, in a deep and present way and [01:00:50] have a new experience because that's.
[01:00:52] Melissa Mose, LMFT: Really the key. It's like when I [01:00:55] hear, wow, that wasn't as hard as I thought it was gonna be. Right. I know. You know,
[01:00:59] Dr. Taz: that's a [01:01:00] win.
[01:01:00] Melissa Mose, LMFT: That's a win. That's great. We've had a new experience and you know, let's face it, it's all about [01:01:05] learning.
[01:01:05] Dr. Taz: Mm-hmm.
[01:01:06] Melissa Mose, LMFT: Do it again. And you know what you practice, you get better at. [01:01:10] If you can practice noticing the parts that are with all the [01:01:15] chatter and allowing your attention to shift them into the background rather than the [01:01:20] foreground.
[01:01:21] Melissa Mose, LMFT: Um, every time you do it, you get a little better at it. You're a [01:01:25] little more present. There's a little more space inside of you to be strong through the next [01:01:30] challenge.
[01:01:31] Dr. Taz: Those are lessons that. We can all use. I know. Not just an [01:01:35] OCT. Right?
[01:01:35] Melissa Mose, LMFT: I know. That was, that was my thought when, when my daughter was little, it was like, well, silver [01:01:40] lining is, she's learning stuff now that a lot of adults never get
[01:01:43] Dr. Taz: to.
[01:01:43] Dr. Taz: We never learn or never get [01:01:45] to, but I love that the lessons of self-compassion. Blending. Mm-hmm. You talked about multi [01:01:50] blending. Mm-hmm. Separating out right. These different pieces of ourselves. Hopefully this will be [01:01:55] helpful for any family dealing with somebody that has OCD or if somebody individually is dealing with [01:02:00] OCD and maybe hasn't gotten diagnosed, like you said, for almost, you know, 11 to 17 [01:02:05] years.
[01:02:05] Dr. Taz: That's a long time. You know, so I hope, you know, I hope this message gets out there. [01:02:10] Mm-hmm. And if someone wanted to reach out to you and get more information, how can, how can folks connect [01:02:15] with you?
[01:02:15] Melissa Mose, LMFT: Um, my website is melissa mos mft.com.
[01:02:19] Dr. Taz: Okay.
[01:02:19] Melissa Mose, LMFT: And I [01:02:20] also have an if FS for ocd.com website where I'm beginning to create.
[01:02:24] Melissa Mose, LMFT: A [01:02:25] little more community around if you're curious about that. Um, but yeah, reach out to me. Send me an [01:02:30] email.
[01:02:30] Dr. Taz: And the book is targeting clinicians primarily. Right?
[01:02:32] Melissa Mose, LMFT: The book is Targeting Clinicians.
[01:02:34] Dr. Taz: Okay.
[01:02:34] Melissa Mose, LMFT: And [01:02:35] yeah, you know, my hope really is there are a lot of therapists out there who get very little [01:02:40] training on OCD, but they really love internal family systems or curious.
[01:02:44] Melissa Mose, LMFT: [01:02:45] And so this book is really meant to spread the word of if you're seeing these things, [01:02:50] these are things you should really know
[01:02:52] Dr. Taz: and be thinking
[01:02:53] Melissa Mose, LMFT: about. And, and even if you're doing really [01:02:55] beautiful, wonderful, deep IFS treatment, you also need to know that [01:03:00] some, at some point in time, somebody needs to, to face the fears and they can face [01:03:05] it in this really beautiful, compassionate, deep healing way.
[01:03:08] Melissa Mose, LMFT: With the addition of of [01:03:10] IFS.
[01:03:10] Dr. Taz: I love that. I think this is such important information and even I'm even thinking about our exam room [01:03:15] experience, right? Right. And now being able to identify it a little bit better and really get [01:03:20] folks help and then marrying the work you're doing with a lot of the work that we do day in [01:03:25] and day out around neuroinflammation and understanding the triggers and where it's coming from.
[01:03:29] Dr. Taz: I mean, I think [01:03:30] that is a healing journey that I hope anybody with OCD will go on regardless of how old they [01:03:35] are. And for the rest of us supporting those folks, like we're a little bit more educated as well. I'm gonna [01:03:40] ask you one last question. Okay. What makes you whole?
[01:03:42] Melissa Mose, LMFT: Oh, wow. [01:03:45] Um, what makes me whole is peace is quiet.
[01:03:48] Melissa Mose, LMFT: That just a still moment. [01:03:50] So hard to get those.
[01:03:51] Dr. Taz: Oh.
[01:03:51] Melissa Mose, LMFT: Just, and, but remembering it doesn't take that long. Yeah. To [01:03:55] just open. Because you know what, yeah, we're whole, nothing [01:04:00] has to make me whole. I just have to notice it. Go find it. Nice. Just have to let it all be there. [01:04:05] And, um. Nature Sure helps.
[01:04:07] Dr. Taz: That might be one of my favorite answers.
[01:04:09] Dr. Taz: People usually [01:04:10] say family or you know something, but we're already whole.
[01:04:13] Melissa Mose, LMFT: Yeah, yeah.
[01:04:13] Dr. Taz: We just lose it [01:04:15] sometimes.
[01:04:16] Melissa Mose, LMFT: We
[01:04:16] Dr. Taz: just forget. Just forget, you know? So,
[01:04:18] Melissa Mose, LMFT: so yeah.
[01:04:18] Dr. Taz: Well, thank you so much for your time [01:04:20] today. I really appreciate it. I hope this is a good message for everybody. Spread the word. If you know [01:04:25] somebody suffering with OCD or a family that is, you know, knocking around trying to find its [01:04:30] way, or you have a partner, or it's you and you just need some extra help, thank you all for joining me.
[01:04:34] Dr. Taz: Don't [01:04:35] forget that we post new episodes every week. I'll see you next time.
[01:04:38] Melissa Mose, LMFT: Before you go [01:04:40] take a second to reflect on what stood out for
[01:04:42] Dr. Taz: you today. Then if you can [01:04:45] leave a quick review wherever you're listening, it really helps other people discover Whole [01:04:50] Plus and start their own healing journey. And don't forget to follow me on Instagram at [01:04:55] Dr.
[01:04:55] Dr. Taz: Taz md. I love hearing how these episodes are supporting you.