Counseling Tags

Counseling Tags

There’s no Shame in Having OCD – Addressing Shame in OCD Treatment

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Shame is all too common among people with obsessive-compulsive disorder (OCD). Almost every person who I have worked with has expressed feeling ashamed and embarrassed about the content of their intrusive thoughts or the nature of the compulsions they engage in to combat them. This has been true for my clients whether they have been struggling with obsessions about contamination, self-harm, relationships, or something else. A common question I hear is “Why can’t I do X, Y, or Z like a ‘normal person’?” Along with such questions usually comes a barrage of self-critical thoughts like, “I’m such a weirdo” or “I’m so weak for repeatedly giving in to my intrusive thoughts.” In addition, it certainly doesn’t help to hear friends, family, and strangers – even if unintentionally – belittle your struggle when they talk about “being so OCD” as if this were a punchline.

Hopefully you are already well aware that highly effective, evidence-based treatments for OCD exist (e.g., Exposure and Response Prevention, Cognitive Behavioral Therapy, Acceptance and Commitment Therapy)and are provided by our expert clinicians in the Portland Psychotherapy Anxiety Clinic. A lesser known component of these treatments is that they often involve an explicit focus on developing skills to more effectively respond to shame and self-criticism. Below are two examples of how evidence-based OCD treatments might address shame and self-criticism related to OCD, including links to helpful resources.

ADDRESSING SHAME VIA ENHANCING SELF-COMPASSION

People, including individuals with OCD, are often naturally skillful at acting compassionately towards others. However, it can be much harder to turn that compassion inwards. Therapeutic approaches to enhancing self-compassion include learning about self-compassion, understanding how it operates in your own life, and developing a consistent self-compassion routine via practicing self-compassion-focused exercises. To learn more about self-compassion and to see example exercises, use the following links:

ADDRESSING SHAME VIA COMBATING OCD STIGMA & MISINFORMATION

The reality is that most people’s understanding of OCD is limited to media caricatures they have seen of people who are highly perfectionistic and/or extremely focused on cleanliness. One of the most common initial tasks of OCD treatment is to dispel common myths about OCD and provide more factual information. Whenever possible, I like to incorporate individuals’ main support systems in this “de-mystifying OCD” process. It becomes easier to feel less ashamed about OCD when you and the people around you understand OCD and feel like you’re on the same team in treating it. For folks who encounter OCD-related stigma especially frequently, treatment may also involve learning and rehearsing ways to practice self-advocacy. Lastly, people often find it helpful to develop a sense of community in order to feel less isolated and alone in their struggles with OCD. To learn more about OCD and to see example exercises and resources, use the following links:

https://iocdf.org/about-ocd/

https://iocdf.org/realocd/

https://iocdf.org/programs/conferences/

New Insights into Psychologists’ Views on Psychedelic Therapy 

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As interest grows among both clinicians and the public, psychedelic knowledge and reduced stigma within the psychology field will be critical to ensuring these treatments are implemented ethically, safely, and accessibly. Outreach, education, and interdisciplinary collaboration remain key priorities moving forward. 

A recent survey-study involving researchers at Portland Psychotherapy provides intriguing insights into psychologists’ attitudes toward the emerging use of psychedelics like psilocybin and MDMA in psychotherapy. The study, published in the Journal of Psychoactive Drugs, found psychologists hold cautiously optimistic views about the promise of psychedelic-assisted therapy but also harbor concerns about safety risks. 

Led by Jason Luoma, PhD and Brian Pilecki, PhD of Portland Psychotherapy, the survey queried 366 licensed psychologists in the U.S. Using vignettes of client scenarios, the researchers examined psychologists’ openness to exploring psychedelic experiences therapeutically compared to alternative interventions like meditation retreats. 

Overall, most psychologists indicated receptiveness to discussing psychedelic experiences compassionately in therapy to foster learning. However, around 75% said they would likely warn clients about potential risks of psychedelic use, whereas only 25% would issue cautions around spiritual retreats. Many also expressed the need to consult colleagues due to limited knowledge of psychedelics. 

In ratings of treatment acceptability, psychologists viewed psychedelic-assisted therapy much less favorably than conventional medication-assisted treatment for opioid use disorder. They also saw greater risks and lower confidence in effectiveness with psychedelics compared to established interventions. 

Additionally, participants rated psychedelics as equivalently safe to alcohol and far riskier than cannabis. In truth, research shows psychedelics like psilocybin have very low rates of harm, in contrast to the extensive public health burden of alcohol. This highlights an urgent need to educate psychologists on the actual safety profiles and therapeutic mechanisms of psychedelics. 

On a positive note, most participants believed controlled psychedelic use in research is safe and merits continued scientific investigation. Over 80% felt research on psychedelics should continue to be researched. Still, less than half agreed psychedelics show promise for mental illness, signaling cautious optimism. 

In interpreting their findings, the Portland Psychotherapy researchers emphasized the influential role psychologists have in healthcare settings and policy. As interest grows among both clinicians and the public, psychedelic knowledge and reduced stigma within the psychology field will be critical to ensuring these treatments are implemented ethically, safely, and accessibly. Outreach, education, and interdisciplinary collaboration remain key priorities moving forward. 

Though this initial survey faced limitations like possible sampling bias, it provides a springboard to track evolving psychedelic perceptions among mental health professionals. Replication with psychologists and other providers will paint a clearer picture of where additional training and open dialogue are needed to overcome enduring misconceptions. As Luoma summarizes, “We must continue the complex process of safely integrating psychedelics into science and society.” 

Mitigating Risks in Psychedelic Integration Therapy: Practical Considerations 

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Psychedelic HRIT is an emerging clinical area that requires careful consideration of risks associated with this type of therapy. Although it can be a powerful tool for mental health treatment, clinicians must be aware of the potential for licensing board sanctions, criminal prosecution, malpractice litigation, and professional reputation damage.

Psychedelic therapy has gained increasing attention as a potential treatment for a range of mental health conditions, from depression to PTSD. Along with this comes the need for harm reduction and integration therapy (HRIT) to help individuals navigate their psychedelic experiences safely and effectively. However, there are risks associated with conducting this type of therapy, particularly in regions where it is still illegal. In this blog post, we will outline some of the most common types of risk associated with psychedelic HRIT and suggest steps clinicians can take to mitigate these risks. 

One of the most significant areas of risk for clinicians offering psychedelic HRIT are licensing boards. Although clinicians may not be engaging in any illegal behavior, licensing boards have a broader mandate to assess professional conduct and determine if a clinician is acting outside the boundaries of acceptable practice. Licensing boards may receive complaints from clients, other clinicians, or members of the public, particularly in areas where psychedelic therapy is stigmatized. A client’s family or another provider may discover that a therapist is offering HRIT and perceive that the therapist has encouraged the client to use illegal substances, which could trigger a complaint. In addition, licensing boards may consider it a violation to engage in intention setting or other strategies aimed at maximizing benefit as they may be perceived as encouraging clients to engage in illegal activities. 

Another area of risk is criminal prosecution. If a therapist wants to do the maximum to avoid risk, they should avoid facilitating access to prohibited substances in any way and refrain from providing a space in which psychedelics could be used. Referring clients to underground guides or assisting them in the attainment of prohibited drugs is a clear violation of the law and could implicate a clinician in racketeering, conspiracy to commit a crime, or aiding and abetting unlawful acts.  

Malpractice litigation is another potential risk associated with psychedelic HRIT. If a client is harmed during a psychedelic experience, a therapist may be sued for failing to protect the client from harm, especially if psychedelic HRIT is considered a new treatment that lacks scientific evidence. Violation of standards of care could also be argued if a therapist does not take a more conventional approach to treatment. Practicing in any new or less proven area of practice will necessarily increase your liability and HRIT is no exception. 

Professional reputation is also an area of risk for clinicians offering psychedelic HRIT, particularly in more conservative regions or traditional therapeutic contexts. If clinicians perceive that publicizing their HRIT services might jeopardize their income or employment, it may limit the accessibility of this type of therapy for the public. Agencies may not support or permit this type of practice, and clinicians must be aware of these risks. It’s best to consider how your agency, your locale, and your colleagues might react before you offer this type of therapy. 

Mitigating these risks includes many possible steps, such as avoiding facilitating access to prohibited substances in any way, whether it be by referring clients to websites to obtain illegal substances or by providing a space in which psychedelics could be used. It is also important to carefully consider language used in advertising and documentation to ensure clarity and reduce the probability of misperceiving HRIT therapy as involving the administration of psychedelic substances. Clinicians should expand their competency by obtaining adequate training and access to consultation resources, and they should become familiar with empirical support for psychedelic-assisted therapy, including both strengths and limitations. Understanding the science and being able to speak from an informed, balanced, and evidence-based perspective demonstrates sound ethical practice. 

Psychedelic HRIT is an emerging clinical area that requires careful consideration of risks associated with this type of therapy. Although it can be a powerful tool for mental health treatment, clinicians must be aware of the potential for licensing board sanctions, criminal prosecution, malpractice litigation, and professional reputation damage. By avoiding facilitating access to prohibited substances, carefully considering language used in advertising and documentation, expanding competency through training and consultation resources, and becoming familiar with empirical support for psychedelic-assisted therapy, clinicians can mitigate risks and provide a valuable service to their clients. If you want to learn more about the ethical and legal aspects of working with psychedelics as a therapist before widespread legalization, you can read more at this paper that researchers at Portland Psychotherapy wrote that is a result of months of work and consultation. 

New Research Sheds Light on How Self-Criticism Damages Social Relationships 

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The findings suggest some behaviors that may partially explain why highly self-critical people often experience poorer quality relationships and social isolation. Out of a desire to avoid rejection, self-critical individuals may mute their emotional expressions and conceal thoughts and feelings. Unfortunately, this emotional guardedness can distance others and undermine relationship intimacy and closeness. 

A team of researchers from Portland Psychotherapy recently published an intriguing study that sheds light on how self-criticism can damage social relationships. Self-criticism, defined as the tendency to negatively and harshly evaluate oneself, has been linked to poorer interpersonal functioning and social isolation. However, the specific mechanisms underlying this association have been unclear. In this new study, published in Current Psychology, the research team identified some likely interpersonal behaviors through which self-criticism exacerbates social disconnection. 

The researchers, Jason B. Luoma, PhD and Christina Chwyl surveyed over 300 participants from the community. They measured self-criticism along with three interpersonal variables – expressive suppression, expression of positive emotions, and self-concealment. Expressive suppression involves inhibiting the outward display of emotions. Self-concealment refers to the tendency to hide personal information perceived as negative or distressing. 

The results showed that higher self-criticism was associated with greater expressive suppression, less expression of positive emotions, and more self-concealment. These relationships held even after accounting for the roles of depressive symptoms and emotional intensity. Among these variables, reduced positive emotional expression had the strongest link to lower feelings of social belonging among self-critical participants. 

The findings suggest some behaviors that may partially explain why highly self-critical people often experience poorer quality relationships and social isolation. Out of a desire to avoid rejection, self-critical individuals may mute their emotional expressions and conceal thoughts and feelings. Unfortunately, this emotional guardedness can distance others and undermine relationship intimacy and closeness. 

Suppressing positive emotions, in particular, may deprive self-critical people of opportunities for social connection. Expressing positive emotions promotes relationship development and maintenance. Failing to outwardly share happiness, excitement, and affection could impair self-critical individuals’ ability to form close bonds. This intriguing study thus highlights the importance of fostering positive emotional expression for self-critical people’s social wellbeing. 

As the researchers note, their cross-sectional design precludes firm causal conclusions. Experimental and longitudinal research is needed to further test the study’s model. However, these results move our understanding forward by pinpointing specific interpersonal pathways that may fuel the isolating effects of self-criticism. 

The findings suggest that psychotherapies which help clients express emotions openly, authentically share about themselves, and connect with positive emotions could aid self-critical individuals in building fulfilling social relationships. By targeting key interpersonal behaviors, clinicians may be able to alleviate self-critical people’s loneliness and foster a greater sense of belonging. Remediating deficits in positive emotional expression seems particularly promising based on this study. Overall, these insights enhance our grasp of how self-criticism operates interpersonally and point toward avenues for reducing its detrimental social impacts. 

Reducing Stigma Associated with Substance Use and Criminal Involvement

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Stigma creates significant barriers to accessing addiction treatment within the criminal legal system. New research led by Dr. Kelly Moore, and including Portland Psychotherapy’s Jason Luoma, PhD, aims to address this issue by testing a multi-level intervention called CSTARR (Combatting Stigma to Aid Reentry and Recovery). CSTARR involves training for criminal legal system staff to reduce stigmatizing attitudes and group therapy using Acceptance and Commitment Therapy (ACT) for clients to cope with self-stigma.  

The CSTARR staff training focuses on substance use and criminal involvement stigma. It teaches skills for interacting with clients in a more validating way and facilitates contact with a person in recovery who shares their experiences. This is meant to improve staff attitudes and behaviors that can undermine treatment. The ACT groups help clients accept difficult thoughts and feelings stemming from stigma and build skills for staying engaged in meaningful activities despite stigma stressors. 

CSTARR is being tested in Tennessee across court, probation, and treatment staff working with shared clients in a drug recovery court program. Around 70 staff will complete the training and 70 of their mutual clients will engage in the ACT groups. The study will look at how feasible it is to implement CSTARR in real-world legal settings. It will also gather initial data on whether CSTARR impacts important outcomes.   

For staff, the research will analyze if the training changes stigmatizing attitudes, beliefs about treatment, and social distancing from people with criminal records. For clients, it will evaluate whether ACT reduces self-stigma, shame, and isolation while improving efficacy and coping skills. At the systems level, the study will look at impacts on client retention in mandated treatment and legal infractions during the program. 

The results will inform revisions to the CSTARR manual and survey measures. They will also provide key insights into implementing multi-level stigma reduction in criminal legal settings. This research addresses an important gap, as most existing interventions have not focused on substance use and criminal involvement stigma simultaneously or been designed for legal contexts.  

The criminal legal system presents unique challenges for stigma reduction that require creative solutions. People involved in the criminal legal system often face compounded stigma, yet legal settings have historically perpetuated stigmatizing attitudes. Initiatives like CSTARR that recognize the harm of stigma and include contact with people who have lived experience have promise for making these systems more just.  

We are eager to see the results of this groundbreaking work by Dr. Moore and our colleague Dr. Luoma. Findings will elucidate strategies for reducing stigma among staff and clients in incarceration diversion programs. They will also demonstrate whether multi-level approaches that target stigma at public and self-levels can improve legal and recovery outcomes. We hope this spurs broader interest in dismantling unjust societal stigma and increasing access to unbiased, compassionate addiction care. 

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