180. Why OCD Treatment Doesn’t Always Feel Right: Understanding the Overlap with Autism

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I have Jenna stone and we're gonna be talking about autism and OCD

But not just that, but I think one of the common things I heard from you guys is you know

What would the evaluation process even look like for that?

How would you how would you do therapy for that?

So Jenna is gonna talk about that with us. Welcome to the show Jenna

Hi, thank you so much for having me

Absolutely if you don't mind just to give our audience a little background and a little bit about kind of what you do who you are that would be great

So I am a licensed clinical social worker in Maryland

I'm also licensed in Virginia and Florida and I have a private practice called side-class psychotherapy here and

And I

Primarily specialized in OCD and eating disorders with neurodiverment hopes

So I also will offer

ADHD and autism assessments

Amazing in my work with OCD

Hi, I'm Christina Arlova host of the OCD Whisperer podcast as someone who lives with OCD

I understand the struggles firsthand if you're here. You're not alone

Before we start grab your free OCD survival kit at

www.coreresults.com to help you take control

That's K-O-R results dot com now. Let's dive into today's episode

Okay, well, let's dive right in I mean

I guess one of the things I always like to know from my guess is kind of what got you into this work

What got you interested like do you there a little piece of a story about you that you want to share?

Yeah, sure

So I actually became a therapist because I recovered from an eating disorder

I was struggling with OCD in graduate school and thought I would never get into OCD as a provider because it hit too close to home

and then I met other lived experience

clinicians learned iCBT got involved in that community and the rest is kind of history

Okay, God I love it. So you have like a personal connection to this. Yeah

I get that

Yeah, I mean, yeah, like I have OCD partially why this podcast even exists at this point is really because of clients and

Kind of you know realizing like God it took so long for me to even find treatment

That you know, like okay, let's let's let's keep talking about this and not make it so taboo and weird

Um, well, okay, so let's talk about autism in OCD. So what does that evaluation even look like?

Yeah, so sometimes so I um

People will reach out to me either just coming to me specifically for evaluation

Or they will be in like eating disorder OCD treatment with me like as a therapist and I recommend it to go through that process

Because it actually gives us a lot of insight about what's happening for them. So um as a social worker

I provide what we call like neuro-affirming

evaluation

So they're a little bit different than what a you would get from a neuropsych

So we don't touch like IQ testing or anything like that

We're not looking at that

We're actually looking at the social differences in autism the sensory domains how emotions um

Are experienced and expressed and things like that through this assessment to call it the MIG does too

um and that's um

Dr. Montero's model which is based on this triangle of how autism

um is basically

Uh, when these the amount of demands kind of on your nervous system are going to kind of bring out some of these um

Uh, autism symptoms and what I see with OCD is OCD if you have OCD

It's going to place a lot of demands on your nervous system like oh you have to wash your hands

You have to what you know do things over and over again and that can really just regulate someone even more

They are um autistic

Yeah, so let's let's talk about this because I've heard on you know on the internet

Let's say you know more conversations about the nervous system and

Of course like everything on the internet, you know, there's these intense polarities and

You know, what are we talking about nervous system like no that's not even that's not even a thing to discuss

We're dealing with you know OCD stuff or and I'll be honest

I'm a little it's a little Adam a wheelhouse way for talking about autism because I I'm not as

While verse or trained in that I know some basics, but like what do you mean when you say that when you're talking about the nervous system?

So um, I'm not sure if you are following but like poly bagel theory was just a bump um

However, when I'm talking about the nervous system

I'm really talking about what a lot of us who are trained in CBT models are talking about staying within your window of tolerance

And so for me as a therapist I'd like to explore

What are the things that really toss someone out of that window of tolerance for some people?

It's sensory

struggles um

And that could just be like motherhood and all the noises of children things like that can really make someone

Struggle more with their mental health overall and of course OCD can kind of sneak in and create stories for people

That they then kind of get sucked into

So we just want to kind of get people more at their baseline

We know like learning happens when we are in the window of tolerance

So when we're doing therapy with autistic clients specifically we want to make sure like if we're doing the exposure therapy

The exposure in that moment right like it could change moment to moment depending on what's going on for that client

If they're able to access the learning that they're going to get through the exposure

Okay, so since we're naturally talking about that

Let's let's let's dive a little deeper so

When you're working with somebody who has autism and OCD like is there a certain degree of autism or you would say

It might not be helpful to do exposure and response prevention

Is there some some because people talk about high functioning lower functioning where things like that so

I think we need to do away with the functioning labels honestly

Um because a lot of and in this back to the assessment that I use which is the MIG does

um the MIG does is looking at how people experience um like they're we take in a lot of consideration for masking presentations

And how much um that can lead to like what we call autistic burnout and

Just really people are walking around they appear functional on the outside

But internally they're really struggling they might um do a social

Like a podcast for instance right and then after that podcast to ruminate or something like that

Just because like oh was I appropriate there's kind of things because they're also living usually with a lot of complex trauma

About maybe you know being not picking up on social cues saying things that are inappropriate

Whatever that is and that can kind of trigger anxiety um post

Speaking spirals whatever they want to call it um it kind of looks like OCD, but it's it's not um

Unless it turns into more of like a story where there's like a consequence and they're like

Mental compulsions because autistic brains like to ruminate and I think that's one of the things are therapies that we're trained in

Don't really acknowledge that much is that the autistic brain really wants to make sense of things to feel safe

To even have that experience of felt safety people need to understand

You know what if I'm going to um, I don't know some networking event

What are we wearing what are we supposed to wear how are we supposed to talk to each other in all these little social rules

Those details are so so important for autistic people

So if they're ruminating about that that makes sense um from that kind of

Understanding and I think sometimes what looks like OCD or anxiety like generalizing anxiety is actually what we call distinct

Autistic anxiety is a very distinct form of anxiety experienced by autistic folks

Okay, so let me be sure I'm I'm tracking this correctly. So you're saying like okay, so if somebody

Let's say with OCD we know people well people in general can ruminate and and do but we're talking about that people with

Autism tend to ruminate really in a specific way part of it is understanding

Um, whatever the situation is understanding also social cues. There's also a history of of course socially if

That isn't something that's known and then there can be some

You know consequences for a negative feedback that they've gotten and they can

You know trying to understand what that is or why or they can maybe figure it out and so

Basically, they will tend to ruminate a lot because they're really kind of the purpose of that

It's just to try to understand what's going on or what's the right thing to do or how to be

From a small detail to you like okay. What's how should I address then for this

Or best way to come and connect

Etc. And like that's going to be different than you know cd for example when you start to feel this urge like I have to keep

Figuring something out because otherwise something horrible is going to happen and catastrophic or whatever

Yeah, this is more kind of like the way I would explain this um is if you're a vegetarian and you're going out to dinner with a bunch of friends

Who are restaurant that you've never been to before it's going to make sense that you're going to check that menu to see if you can actually order all of that

That's kind of how it is for autistic people

Is to just kind of like need to know what to expect so

You know, they can get their most basic needs met whatever that is

um could also be something more around

Like the sensory a lot of like the sensory sensitivities. Is it going to be too loud? Do I need to bring my loops or something like that

These are all very reasonable things for an autistic person navigating a nerd

That was not designed for them and so a lot of the rumination that I think we see in clients actually does make sense

And we want to get curious about what they're worrying about and is this worry um I did that of the metacognitive therapy training

So I really use that language a lot too is you know, what is the metacognitive belief?

um

You know that you a lot of the times people think well I have to worry to feel safe and

Sometimes yes and sometimes most of time know like where it turns into more of like this and like this

Presentation that we would want to treat and I think sometimes as a therapist

I'm just helping people make more sense of their experience so they can actually be more prepared and

Um confident that like yeah, it's okay. I'm autistic. I'm sitting here with my

My fidget toy and this is totally valid

I'm not avoiding uncomfortable emotions. I'm using it to stay engaged

Um here tonight, right? So it's kind of like that where we don't have to um, you know

um, I don't know apologize fidgets or whatever because we're not leaning into the discomfort that kind of language

So they think a lot of us were trained in when we got into this work

Well, I think too the if I may even be on language is just really understanding the different ways that things show up

Right because like you said to your point like look like right now like if if we're doing with autism like me fidgeting

Has nothing to do with me avoiding a feeling. It's actually serving more as a as a thing to kind of make sure

I'm really here right versus somebody with OCD like they're doing everything they're doing is to try to avoid and get rid of

Any and all discomfort. So like when you're having both

I mean, it seems pretty important to be able to slow down and kind of discern and figure out what's going on. So

Yeah, and like the really have language right like language for what's happening and I think really slowing things down and doing that

Functional analysis like what is

What is the purpose of this behavior in this moment and that can look very different

So when we do have clients that have both autism and OCD

They can start to tell um

You know, this is my OCD or no. This is this is an autistic need. I actually need

um, you know, I'm not going to go to this event because

Uh, it has bright lights and I'm prone to headaches and I really um, I'm beyond my window of tolerance for the day or whatever kind of language

They want to use. I'm out of spoons things like that a lot of us with autism

We also have a lot of chronic illnesses. So there's that big overlap with some major chronic illnesses

And it's just taking care of yourself and knowing what are my limits and being okay with that

So would you say like what happened? Yeah, so my question is okay

I know you said we want to do a way with a like high level of functioning low level of functioning

I don't know better words or language

So, you know, let me know what that is, but but I am curious about because I like I have some people who've come and reached out of people

I know where um being able to really communicate and and have this kind of conversation to understand or figure it out

Sometimes it's challenged and so

How do you how do you what do you do there? How would you work with that?

Yeah, so that is actually I would say um one of the hardest parts of my um as as someone who is late diagnosed with autism and ADHD

I didn't believe it when it was first presented to me that I could have these things because I've went my entire life masking

And so I think you want to have that trust that good like for core in the therapeutic relationship to start to breach that like hey

Have you ever thought that maybe these things um

Are coming from sensory issues or whatever it is or hmm. I'm curious why um

In relation late especially with relationship about CB. I see this all the time and autism because there's the social differences

A lot of the times our clients are just trying to understand social situations

And that can spend an OCD story right like that can absolutely trigger OCD

um and

Sometimes it's just a matter of like

Hmm, I wonder if the way that you're expecting relationships to work just isn't how

Relationships are and just getting curious about those kind of things and kind of sneaking in some autism

Language because sometimes people just aren't open to it and um and I think it's it's more about really check

In and being attuned with our clients and they're like are they ready to explore this and if you know

If you're trained to kind of explore it with them and that neuroperman way. Yeah

Well, let me pivot for a second because we're talking about if you're a therapist and you're working with clients

Right like I mean and I think that's a that's that's fear and that's its own category

But I'm also thinking about like I actually have some friends as parents and and they have kids who are autistic and you know

Like I'm thinking of somebody where you know one of the kids struggles a little more than the other and

You know trying to be as patient as possible and this is a kid that has autism and OCD and it's it's a little bit again harder to communicate and

Get that clarity and I mean a lot of work has gone into you know

Understanding and doing some of the behavioral things and also, you know trying different ways to

Communicate and also listen and kind of translate a little bit of what's being said and what what is being meant

So like you know when you're thinking about families and parents and dynamics like that like what's something that

You know parents can do with with how to kind of navigate when you're seeing your kiddo and it's pretty clear like okay

We're now doing OCD behaviors like I don't know lining certain cups and feeling like it has to have excellent of water because

In their mind with autism to maybe like oh water equals something, you know or I have to use X amount of

clean access or tissues or papers or whatever it is

Yeah, so that's a great um

You know example is that you know really my my whole question is is this lining up of object springing that person joy or distressed

Like is there that fear attached to it and when usually what parents see when you have that overlap is that it's a bit of both

And to start to like ask um the child, you know

Um questions about like is this enjoyable for you and and see if they're actually like maybe they don't have the language a lot of autistic people are

Alexa thimic and they just may not know that they're in as much distressed as they are which is really heartbreaking actually

As a parent to neurodivergent kids that is just it's really hard to see your kids suffer like that when you know there's a problem maybe

Um and they're just not really able to see that yet

Because they have no words

So that's so what do you do how do you how do you help them in that moment the parent or the child

Well, how is it helped the parent to support them to help the child right like so is it am I hearing you like help to

Give language even even

Was it this or this or is it that or that? I'm just getting curious um with kids about you know what what their

Experiencing because to just like as a therapist we can see a behavior and get it wrong and that we really want to trust our clients

Just as his parents we run a trust our kids

Um to kind of give us feedback about what's actually going on and not falsely accused like oh it's is the OCD monster

And it might actually not be or it is and we just want to kind of figure out what's going on

So so we can get them connect them to the right kind of supports the the therapist that are actually trained to you know

Treat OCD if this is OCD

Um, and if there's also autism someone who's neuroaffirming and will pace their treatment based on their neuro type

And so if you well, so I'm getting I'm thinking of of course if you if you can because I'll be honest

I think I've seen a very small

Um amount of folks who really

Understand and I think are skilled

To treat both of the same time where you don't need to go to because for a long time

It was like you have to go to an OCD specialist or a separate autism specialist

And now we actually are seeing more where you know a person can actually hold both which is amazing

Um, but if

Let's say you know you're

Not there yet. What can the parent and the child do on their own? How can they

Start

With you know, okay, we've identified that this isn't necessarily just pleasure

This is I'm having some sort of a fear or something around it like

I kind of think I've drawn my I put on my space cap um for this one where I really go into you know

We don't want to as parents. We don't want to accommodate the the anxious driven behaviors, right?

And so usually what I see in these these family systems not all of them

But the parents are also very anxious too and working toward lowering those

Accommodations um when they see their kid in distress

The ones that are more even if your kiddo is autistic and has OCD

I mean, yeah, and then you kind of see and identify that okay

This is the most CD stuff

Then you want to kind of work with the parent or you'd want to see the parents try to learn how to step back a little bit and

Not going

Yeah, yeah, I mean for sure

Yeah, hard. It's it's really hard

Um, and I think uh space does a wonderful job

Um of really explaining like why accommodations over accommodation is actually going to make it worse

Um, and so the parents actually have a lot of power and helping their kids

um by lowering those um

Accommodations for the anxious behaviors and then maybe encouraging like you know if

Someone's kid likes to line up their cars or their Legos or put them in rainbow order just for for fun

Then like you know

Noticing that they're doing that and like and they know that it brings their child joy like oh

I really like what you're doing there with your Legos. That's really cool. You're so creative and giving those positive, you know

um feedback

Statements for the the autistic behaviors that will probably um

You know, I I have a very strengths-based approach with like looking at autism

I don't use the deficits like yes living with autism's very hard at the same time

There are things that our brains can do that are

Unique and different and and I think feeling like really affirmed and embraced in those ways those beautiful ways that autism can show up

Is a really great way to parent a child and then when they are struggling with OCD like hey

I love you and I know you don't have to go check

And I'm and I'm gonna you know stop driving you to school um every morning and whatever the accommodation is right and like I know you've got this

Because you know you're strong

I love that. Yeah, so still bringing back bringing that back in and and really like you said focusing on

Um the ways that the person is able to you know

Yeah, use some of those other things that they're actually interested in and just because it brings some joy or helps them

Go better what not and like yeah, that's awesome

That you you know what that is and you're doing it right now because that's actually a good thing to do

Um, yeah, is there anything else from your experience?

um you could think of that'll be valuable from folks to hear in terms of you know how else

Because I'm thinking also, you know, I've had several um kind of DMs and messages from parents about like gosh

I don't know what to expect like do it like is it europee is it i c b t is like

What are we doing what kind of therapy like is it better to

Maybe not sit and have to kind of do all those processing kind of thing not to be processing

But a lot of this kind of back and forth kind of high level cognitive stuff

If maybe sometimes it seems like we can't access sometimes maybe we don't access it as well

Like there's a more europee kind of based approach better

How do you augment it like what would you say?

I think uh first we want to find out like where is the child um when kids are in burnout

I don't recommend ERP it places way too many demands on their nervous system

Um, though it can be done. I'm not going to say it can't um

I have to make sure like at least the way I work like my clients are totally on board like they have full

The our hierarchy doesn't look like a hierarchy. It kind of changes every week whatever we're working on

Because we're really just like kind of like where are you at today? What what do you want to work on?

Progress just isn't linear with this population and that's okay and we have to be okay with that

And I think that's actually like a big thing to tell parents is that this expectation that your kids going to start ERP

And just kind of work up this hierarchy and it's it's you know, it's not like that. It's a longer process

Um for kids with these kind of brains and I think just being okay with that um and then

um sitting in the grief of that right like it's so hard

Especially when you are a parent and your kid has all these issues and then maybe your friend your friend group their kids are like

Doing normal stuff or whatever and it's and you're you're like taking your kid to their occupational therapist and they're mental health therapist

They're psychiatrist and just running around to all these different appointments

That can be really hard and so like you know sitting in the parents grateful with them

We're not there to just fix it and make the feelings go away. That's not how

You know being human works. We have life can be really uncomfortable. Um, I think like I love at

Um, that's another like good approach. Um, just like for the parents sometimes who are struggling

Uh along this journey with their kid

Um, but like I have seen now I work as young as 10 and up. Um, I don't do I CBT with kids that young

Um, but I have seen other therapists that have done it successfully

Um, but I do overall I do like I CBT a lot

It's just really depends on the kid I think and

cognitively where they're at like if this makes sense um

Sometimes I will just do just neuro affirming treatment um

Just kind of like a lot of

Plain Lego

Whatever it is my naturals, you know, just kind of like really connecting with them and establishing that

I spend more time on the rapport building before we can start to even talk about exposures

That's what I mean when I say like

It takes longer. I'll sometimes that you're just

Building that rapport that so they feel safe and attuned in um

With you and you're not just this scary person like you have to you know, do these exposures to get better

You're never going to get better. That's not going to work and we really just collaborate like wow like I wonder

You know, do you think you know

You know, you want to go out and try this exposure or something like that and then get their buy-in that way

Just by building that connection

While we play Lego or something like that. Yeah, so a lot of that's playing that's really cool to hear

Yeah, that like you you really like what this population you take your time to build and create that sense of safety

And like that there's a mutual understanding

There's no rush. There's no

Kind of goal like in the same way you might work with somebody else and that and then when you kind of built more of that and that

Kind of bond and connection then like you said to your point

Kind of the hierarchy or whatnot. Well, it'll change because it's whatever is in that moment

Okay, so the way I explain it to a lot of my clients is so I grew up doing figure skating and when you know

We would go out there and try um like double axles or whatever

They would put us on a harness right the coach would like hold me on a harness on the ice and I as a therapist

I feel like a coach when I'm doing this kind of

Oh, yeah, and like I'm not going to let you fall on that we're never going to do an exposure that I know you can't handle in this moment

And that you know, we're really

Creating like the safety so that they can access this learning that happens from wow the bad thing didn't happen

I can do. Yeah, even if you do like little increments. That's like that's the the name of the game is to

Build some of those wins and successes so they can feel like okay. I'm getting some confidence around this

Yeah, yeah

Love it. I love that

Thank you so much for sharing all this and I super appreciate you being open about

Yourself you've included yourself in this sharing process and

I love it. I mean, I think it's great to hear directly, you know from somebody who's actually living the experience

You know and kind of what that's like um

Yeah, so for anybody who would like to find you how can they find you

Um, yeah, so I am like I said, I'm based in Maryland on Instagram. I'm

My practice name is side quest psychotherapy and then my actual count is side quest with Jenna

I don't know what my tip-knock user name is to be honest. I think it's one of the same but

But I'm out there you can find me. I'm also on sub stack under genostone um

So yeah, awesome. Well, thank you so much for coming on the show

Yeah, absolutely

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