– Hello. Welcome to Behavioral
Health Behind the Scenes. I’m Kimberley Quinlan, a licensed mental health
professional in California with specialized training in OCD and Eating Disorders. On this show, you’ll learn first hand how leading health care executives, navigate the ever changing
behavioral health industry. We aim to help you build a strategy that empowers your organization
to do good clinically and well financially. Enjoy. Welcome, I am so excited
to have here with us, Patrick McGrath, thank you
so much for being here. – No problem, good to be here. Happy to be here with you too Kim. – So, Doctor Patrick McGrath, how would you like me to address you? – Patrick’s fine, that works for me. – Okay. Patrick tell us about
you, tell about yourself and the work that you do. – Sure so, I’ve been treating
OCD for 20 years now, started off in a post doctoral fellowship with Alec Pollard down at the St. Louis
Behavioral Medicine Institute and over the course of my career, I’ve opened up two intensive
out patient programs and a partial hospitalization program for OCD and anxiety, as well as recently a
residential treatment center for anxiety and co-occurring
substance use as well. – Mm, so good. So good. Thank you for all the
work that you put in. That’s amazing. – Sure, it’s been fun and then, peppered in
there are a book called the OCD Answer Book and another book called Don’t
Try Harder, Try Different and I speak at the anxiety and depression
association of America conference, the association for behavioral
and cognitive therapies and the International
OCD foundation conference almost every year as well too. So try to make the rounds and do that and usually, here in the Chicago area, probably about 30 talks a year or so and training’s for people
in the local community on anxiety disorders,
schooling’s, I do school refusal. Which is another area where we opened up an
IOP as well recently too. – Very cool, very cool. Well I’m so glad to have you here cause you’re so obviously, just filled with expertise and knowledge. Tell us a little bit
about your understanding of the behavioral health industry that’s a lot of why we’re here. What do you think are some
of the biggest problems that we’re facing in the
behavior health industry? – There are so many things I
think that we could talk about, but the biggest piece that
I’ve really noticed recently would be, insurance probably, insurance reviews. We recently had a case that
met amazingly great criteria, we felt for residential. Someone who had failed two
partial hospitalization programs already and who was actively abusing substances and they were denied at admission when they came to residential and when we called to do the peer review, that was denied and a second
peer review was denied too. All of them saying “well
he should go back to PHP” and our statement was
“he’s tried that twice, “and he’s failed twice “and there are no anxiety
PHP’s in his area”. And that leads me to another area that I think we really have to talk about and one that is one of my biggest, just gets my goat kind of thing, which is, there’s a lot
of therapists out there who say that they treat anxiety disorders and who say they they treat OCD, because they’re just
ticking off boxes on things. And a lot of companies who are looking at this from
a managed care point of view, will see “well, this place
says that they treat OCD, “so therefore, we’ll
just send them there”. And they may not have any
specialties at all in OCD, they just clicked the
box that said they do. So I don’t think that
there’s a lot of vetting that goes on that really ought to go on with a lot of the managed care companies that we’re dealing with
to really make sure that the patients are
being seen by somebody who really knows how to treat them. Instead of throwing them
in the general program with a room full of people
who have mood disorders, psychosis, drug addictions and all trying to do the
same therapy with everyone and hoping that it’s gonna touch everybody and cure all of them. – Right. Absolutely, absolutely. So, to use the example that
you gave of that patient, how can we solve this problem that this patient and I know
many many more are facing, what is some of your
thoughts in terms of us coming up with a solution
to these kinds of problems? On those different levels too. – Yeah, I think it takes
really grassroots effort on therapists part to
really talk to the payers and say in the, maybe negotiations
of contracts for payment and things like that to really talk about, “here are the things that
we really do specialize in”, and also getting the
payers to recognize that they may have more of a
problem in certain areas than they suspect. For example, we get a
lot of people with OCD who say have fears of harm, right? It’s probably recently the
most common way that OCD’s coming about, and yet we still here stories
about people who go to a psychologist or psychiatrist or maybe even go to an inpatient unit and they call department of
child and family services because this person has
intrusive thoughts of “what if I were to harm my child”? So now, that person is
being treated maybe for psychosis or various other things when we’ve missed the diagnosis and we’ve missed the
best way to treat them is that this person has
obsessive compulsive disorder and intrusive thoughts and it’s very treatable
if we would allow for that to be treated, but we’re missing out on it. I think then that the
bottom line comes down too, and maybe we could convince
some manage care companies of this, if they were to
get the correct diagnosis and have people who really specialize in some of the disorders
that they’re hoping to cover, that in the end it would
save them a lot of money from these people continuously going back to inpatient units, going back to partial programs that don’t really work or specialize, or seeing therapists that
don’t specialize in it, or being put on medications that they may have to pay for, for the rest of this members life. When maybe if we got the right therapy, we could significantly decrease
the amount of medications or maybe even get them
off of it over time. – Right, right. And what’s your experience, cause as a clinician myself, what’s your experience with trying to get the payers to take clinicians
who are very well trained. What advice would you give there? – That is probably where we’re at, is trying to figure that out right now. And what can we do to
get in front of payers, again, not just to discuss
contracts in terms of numbers and what would be covered at what rates, but really to also to say “we’d like to be your preferred provider “for this disorder” and I think it’s going to
take something like that. And maybe some kind of grassroots effort, one thing that I’ve been
very interested in doing, and I take a cue from our friends in the substance abuse community, who have these criteria, that they call ASAM criteria and it’s a list of all
the different levels of treatment that are available
along six different dimensions and you take a look on
those six dimensions where a patient falls and then you see on the column where that says the level of treatment should be provided at. And I’m wondering if we
could kind of use a model similar to that for anxiety disorders. So it’s an area that, through
my company, Amita Health that I’ve been kind of
charged with taking a look at if we can do, my goal over the next
year or two is to really propose this idea and maybe some talks and group discussions at conferences to see,
“our there other people who “would also be interested in doing this” and maybe we could really
work on setting a standard for anxiety disorder, PTSD, OCD treatment. Like our friends in the
substance abuse world have already done and done a very good job at. – Oh fantastic. That’s so interesting, and it’s true for the eating
disorder community too. They do have some levels in their as well but we don’t have it for anxiety so that’s really really interesting. We’ve already been talking about OCD, could you dive in a little bit deeper into how this particular
population misunderstood in these industries? – Sure. First of all, there’s just a lot of
people who want to do talk therapy with people with OCD, and I can’t think of a
larger waste of time, (laughing) doing something along those lines, if any of you out there watching this have ever talked to someone with OCD and tried to convince
them to not have OCD, you’ve realized what an
amazingly futile attempt that is. It’s analogous to telling someone not to think of a pink elephant, – Mm hm. – And seeing if they don’t. Which they are going to think of it. So, first of all, it’s
getting people to recognize that there really is a
specialized treatment out there for OCD, and there’s not a ton of people who do it, so steering people with
OCD to those folks, is going to be in your best
interest in the long term, in terms of saving you
money as a payer over time. – Hm. – I think also it’s getting
people to recognize the myriad ways that OCD presents itself. We’re not just talking about hand washing, or checking the stove to see if it’s on. We’re talking about, scrupulosity, about “did I do something morally “or ethically or religiously wrong? “and will I be damned
to hell for all eternity “or hated by all the human race “for a thought or an action
or an urge that I had? It’s a fear that I’ve harmed someone and maybe I had just a thought about it but maybe I even, well I was
standing at the train station thought about pushing somebody
into an oncoming train. Well, do I really want to
go and talk to somebody who isn’t familiar with that, about that thing, because I’m really afraid of the way they’re going to react to it. Right? Versus somebody who specializes like we do in OCD who’s going to go, “oh yeah, I’ve seen like 27
of those already this month, I can treat that very easily”. So it really does also
put the patients at ease when they talk to
somebody who knows exactly what they’re talking about and not somebody who says, “you know, I’ve never
heard of that before, “and I’m a little concerned about it”. So there’s a lot of things
probably in those lines, that we can do to really
improve the whole experience for patients who have OCD and, that way I think
that the payers would see that they have a lot more people with OCD in their community and on their list. They’re probably being
misdiagnosed very much and there’s some certain
things that we’re working out now with NOCD and AMITA to take a look at, “are there ways to kind of go back “and look at some of the records “that people have submitted over time”. And maybe we can see, “here’s where we didn’t
miss those diagnosis” and “this would have been a
better option for treatment “then what was done, “and maybe this is why the
person’s come back multiple times “because they never got the treatment that they really needed”. – Right, right. And what I’ve experienced
on my end has been a significant degree of
secondary depression, because they’re in talk therapy. I mean, once you clue on to the fact that you’re not getting better, you will get depressed and that’s an additional problem to solve at that point too. Which costs money. – Absolutely. And what I’ve been
really interested lately is the secondary substance use, that also occurs in anxiety disorders and taking a look at how much of the substance abusing
community has an underline anxiety issue, that has never really been treated and maybe why some of
the reasons there’s so many relapses that we might see in the substance abuse community is because we continue to just
treat the substance use and we don’t treat some
of the underlining issues that are there, and we might see a decrease in relapses if we were to start
finally taking a look at “what is that underlining
anxiety that’s going on for these individuals?” – Right, right. Why do you think this, particularly OCD and anxiety disorders as well, why do you think they
are so misunderstood? Why are we still hear in your opinion, in regards to other disorders having these hierarchies and these levels, why do you think OCD is so misunderstood? – Well, it’s been the butt of
jokes for a very long time. We’ve had whole TV series’
that are surrounded with OCD themes, we’ve
had movies about it. So I don’t know if enough
people have thought about how serious it actually is. We also have a unique thing with OCD, where people will say to me
“Oh, I have a little OCD”. No one has ever said to me, “you know, “I have a little schizophrenia”. I’ve never heard that
at all from anybody that I’ve interacted with, but once you tell someone
you run an OCD clinic, most people will say “I’ve got a little OCD” about something. So, I don’t know that
most people see OCD as a really significant
problem, except for people who actually have the diagnosis of OCD. And now with the increasing, lets say, attendance at the International
OCD Foundation conference and the quality of speakers
and keynote addresses, I think that we’re finally
kind of seeing a rise of it. Plus our work with NOCD
that’s happening as well too, and it being one of the
largest app’s out there in health care community, specifically for this one disorder, I’m hoping that we’re gonna
see a bit of a groundswell here and finally people starting to recognize, not only what OCD is, but also what OCD isn’t. It’s not just worrying about something and thinking about it over time. It’s that plus, having to do
something to neutralize that because if I don’t neutralize it and something bad happens,
it’s totally my fault and my responsibility and everyone in the world will hate me, or I’ll hate myself for
having not done that one little thing that I could have done just to prevent it from happening, so. It’s a two part disorder,
not just a one part disorder. And maybe that’s what it is because most of our individuals
who come in I think for other disorders have this thing, “I have this phobia”. “Okay well, then we’re gonna treat that”. And with OCD it’s, “I have these really bad awful, horrible, “intrusive thoughts that I describe, “or images or impulses, “and, I also do all these
other things as well too.” And everybody sees all the
other things that are done but no one sees the images or impulses. Maybe there’s a lot of people who are just afraid of talking about them because of how embarrassing
they might potentially be. And believe me, people
have opened up about what would be an amazingly
embarrassing array of things, if you were to say it
in the general public. – Right. Absolutely. Even this morning on
social media I posted, something to do with “what
was the most annoying things “people have said to you about OCD?” And a lot of people responded
saying there clinician was saying things like “turn it into good” or you know, “use it for your benefit”, “it’ll make you more clean” and all these kinds of things. It’s so misunderstood. – Yeah, or you know, stupid
things like thought stop, “well just stop thinking that” or “Picture a stop sign in your head” or “snap a rubber band on your wrist “every time you think it”. You’re just going to get a sore wrist and maybe, you know a
latex burn from that. It’s not going to be anything
beneficial to you whatsoever. – Right, right. How do you think we get the payers and the providers to understand this? – Well, a lot of us are
going to have to think more in terms of data collection and providing clinical data. I think we’ve had a bit of divide where we’ve got great researchers who are doing wonderful
work on it and studies, but with anecdotal populations, like college samples and
things of that nature and one thing that we’re looking at doing at AMITA now is we’re
converting over to an electronic data collection system so that we’ll have instantaneous feedback and be better than just the paper system that we were doing where inevitably, a page gets lost or something happens. So I’m really excited that
the data collection is going to really help
bolster what we’re doing and I think then be
able to prove to payers that what we’re doing actually does work. We’ve relied way too long on, “I know what works
because I’ve seen it work” and we have to follow it up with data. So my hope also is that we can
kind of light a bit of a fire under individual clinicians as well too, that maybe together at
conferences or something, everybody could get a pile
of data clumped together and we could, kind of
mass all that into one if we have an agreed upon
set of questionnaires that everybody does and then we could analyze
all of that data together and show, “listen, here’s
from 40 different providers “across the country who are doing OCD work “and the changes that
they’ve seen in their patients with OCD”. I think that would be worth it. – Yeah. I agree. I totally agree. This is so great and it sounds like you guys
are making some massive movement here. – We’re trying. Cause, we need to make some changes and we can’t just let
people suffer anymore, and I go back to that one
denial that I had of that guy, and I just think how
frustrating it was for me. And when you’ve got a
patient in your office cause he had come to the residential, and he’s crying because
now he has to go home because he can’t afford the payment and he knows he’s just gonna go home and he’s gonna go back to drinking again. And he knows that the
partial they’re gonna pay for is the partial he’s went too twice and has already failed, and you can see why people get depressed, secondarily as well too because of this, because they just feel like
“Nobody’s listening to me, “and nobody cares. “And here’s this insurance that I’ve paid “all this money for, “and they don’t care either. “Because they just want to see me do “what they think is best for me”. Which we all already know
isn’t best for that person. – Right. And how frustrating for him cause the answer is right there, like, he was in the door. – He was in the door. Yeah, I mean he’d already
done his programming, and already seen what we
were gonna do and everything, he was so excited about it and it was heartbreaking
to have to say to him, “your insurance denied you”. – Yeah, that is heartbreaking. I feel it right now. That’s really hard. Okay, all right. I love the work you’re doing and thank you again, you know, even hearing that story
empowers me even more and fires me up, right. Which is a good thing. – Absolutely. – Let’s talk about the future, right. Cause that’s what we’ve got to work on. So, if we were to fast forward, 20 years let’s say, into the future. What would you like to see in the behavioral health industry? What would you like to, you
know, what’s your dream here? – Well a few things, I’d like to see that we have stopped the split
between behavioral health and chemical dependency. And that we all embrace that we can treat both of
these things at the same time. My work with Margaret
Sisson and her foundation Riley’s Wish is so important to me because her son, who was studying
to be an OCD therapist and who had OCD and who had early in his
life been turned on to drugs and alcohol as a way
to manage things before he started getting treatment. And who eventually, though
he was sober for a bit and was back to school,
was at a party one night and offered something and decided to take it, and it was Fentanyl and it killed him. I don’t want to see people dying anymore because of this. And his story was that
he went to a residential treatment center for OCD and they kicked him out because he was trying to
get into the nurses room in order to get some medications. And then he went to a treatment center for drugs and alcohol and he got kicked out of there because he couldn’t get to groups on time, and the reason was because he was doing rituals in his room. And no one was treating the whole person. And he’s dead because of that. And it’s very blatant to say but it’s very true. And Margaret would say it as well too if she was here with me. And so my talks with Margaret
have really influenced me and I don’t want to see that
happen to anyone ever again. We have to treat the
whole person going forward and our schools have to be more open to treating the whole person and teaching about the
whole person as well and not just saying “hey, all those of us “in the psychology and
the counseling community “and the LMFT community, “we can treat all these disorders”. And then there’s those
chemical dependency things, they treat those things themselves. We can’t do that anymore. People are going to continue
dying because of that. Especially with the opioid crisis and the things that we
see going on right now, we can’t let that happen anymore. I hope 20 years from now, that we’ve opened up, that all substance abuse centers are focusing also on some
mental health concerns. And all mental health centers, have a person on staff who really knows about substance abuse, and can help coordinate care for both of the problems that
are going on with this individual who’s walked into the doors. – Right, right. It’s true, a lot of treatment
centers won’t except someone if they’re currently using. Which eliminates a lot of people. – Absolutely. – Right. What roll do you see teletherapy
playing in the future? – Well there aren’t enough
of us who treat OCD really, out there. And most of us are centered
around major cities. So there’s a paucity of
people available to folks in rural communities, or in states that have lower populations, where you don’t see a large amount of psychologists or therapists
really moving toward. And if you do see people moving toward, they’re probably very
general practitioners. And so they might be the only
therapist for a hundred miles and they have a very general degree. So I think that the telehealth
community is going to be a boom for people who have OCD, who find themselves in
places where they don’t have access to really
well trained clinicians. – Hm. And do you feel like
teletherapy is as effective, in your opinion? As face to face? – From what I’ve seen
so far, I believe so. But I’d say, we’re still
working on the data from that. That would be another
really interesting study to really show that “look, we
can get very similar results”. And the other piece would be, even if the results are
slightly less effective, I still think you’re better off, if you’re in an area
where you have the choice between teletherapy with
someone who does OCD specialty, or a general therapist. I still say, in the
end, your better result, is gonna be that teletherapy piece, than that one therapist who, if you go to their website says they treat depression, psychosis, schizophrenia, children adolescence,
adults, older adults, marriage therapy, divorce mediation and every other disorder under the sun. Which you know that they don’t because nobody in the world can specialize in that many things. And again, that always
annoys the heck out of me, when I see that, because people assume that
this person is being truthful when they’re saying that they
specialize in these things, and they’re not. I think it’s a falsehood,
if you’re going to say that. I mean, you go to my website, it’s going to say “I
specialize in exposure “to response prevention
therapy for anxiety disorders”. And that’s what I do. And I’m not gonna put
anything else on there. Cause I don’t specialize in anything else. – Right, right. Yeah, I agree, I agree. It’s so frustrating. The thing I found really
beneficial about teletherapy is, you can do it in somebody’s home. So if they’re struggling to be
near an area they’ve avoided, we can do that. On the phone, or on the computer. So I think teletherapy actually opens up some opportunity that we don’t get, face to face with our
clients in our offices and our patients in our offices. – Yeah, I agree. And that’s a beautiful piece of it because in the past we just
had to rely on a person telling us that they had done it. Or that they were on a speaker phone and they might not have actually been in the place that they
were telling us they were. Now we can actually say “do you wanna just “turn that phone around, so that I can “actually see that you’re
touching the stove”, or something like that. “That would be great”. – Yeah, I agree. I found that teletherapy
has been really beneficial for particularly the exposure
and response prevention piece. – Yeah. – Very cool, very cool. – It opened a lot of windows for us which is wonderful. – Yeah, yeah, absolutely. Okay, so you’re obviously so
knowledgeable in this area. If you could give one piece of advice for the behavior health executives, what would that be? – Maybe the vetting piece
is going to be some of the most important things that
we can get people to do. And don’t just look at your lists and trust that somebody
says that they specialize in something. But really, have a way to see
if that’s actually the case. Specialization on my part, was a two year, post doctoral fellowship in
treating anxiety disorders. And, even at the end of that two years, I still had lots to learn, but it sure got me on the path
of what I needed to be doing, versus someone who’s just
come out of graduate school and got on a panel and now wants to take all
the patients that they can, so they click off that they
treat all these things, and that they’d be happy to do it. That person isn’t going to
be able to do it to the level that you or I could potentially do it, having done this for so long. So my hope would be that maybe we consider kind of a graduated system of, “hey, if someone has these disorders, “or disorders to this level of severity”, and maybe this is where
those criteria I was talking about earlier come in, that they can be seen by kind of a general type of therapist. But when we get past this certain level, we need to really take a
look at that next level of therapist, that person who really does have some specialty in this, who is really going to, A, be able to give the
patient the therapy they need, and B, be a benefit actually,
to the insurance company who is now going to know that, that patient is seeing a specialist and hopefully is going
to get better results, then in the future, need less therapy than going to see somebody
who doesn’t really know what they’re doing as well, and flounder for quite a while. I have a statement that I
make to all of my patients and I mean it very seriously, and I say to them in the first session, “my goal is to never see you again “for the rest of your life”. (laughing) And I mean that in the
nicest way possible, but I’m always trying to
work myself out of a job and I want to make sure
that all therapists look at it that way. I think there’ some therapists, and maybe there’s some patients too, and they want to just
have that person who’s available to them weekly, and if that’s the case, and everyone’s in agreement, that’s fine. But I think when it comes
down to a very specific diagnosis like OCD, I don’t want to see the person
for the rest of their life. I want them to learn
skills to be able to go and live their life and not need me to help them do that. – Right, right. Yeah, and I say to my clients
that “I don’t want you “to want to come and see me. “If you want to see me,
I’m not doing a good job “because we should
exposing you to your fear” and I think a lot of clinicians who aren’t trained in that way, are actually saying “how can we make you less anxious?” Which is very problematic. – Yeah, another piece too would be, if you go to therapy, if you have an anxiety disorder and this is good info
for payers I believe, that if you’re people go to see someone who has an anxiety disorder and might report back to you somehow, in survey’s of feedback’s
or whatever that, “every week I go to see Doctor so and so, “it’s the best 45 minutes of my week”. That’s an indication that that therapist is doing
awful, horrible things for an anxiety disorder. They’re probably providing tons
of safety seeking behavior, reassurance seeking, and all those types of things. I hope my reviews say, “when I see Dr. McGrath, “it’s the hardest 45 minutes of my week “and I feel like I’ve run
a marathon after I’m done.” Then I know that I’ve done a good job because that person
actually learned something in that session. If we don’t teach people skills and if we don’t require our therapists, who are on our panels from companies, to be really skill based, I don’t think that we’re
serving the patients in the way that they need to be served. If it’s just sitting and talking and hoping to make you feel better, that doesn’t help people in the long term who have an anxiety disorder and OCD diagnosis. They’re already getting
from everybody else and then we’re just
repeating that as well. We have to do something else and something different than what we see everybody else doing, or else, we’re not worth
our salt whatsoever. So, I think that we can
prove that we’re worth while by showing the payers that
we do something different than most therapists do. – Right, so true. And how might they vet? – How might they vet? I think that you really do
have to take a strong look at somebodies CV, and maybe some recommendation letters to say that if someone wants
to click off somewhere on there that I specialize in this, you need to show some proof
of training in that area. And it’s gotta be more than “I went to a two hour seminar on that”. It’s gotta be, “here’s
the specialized training “that I’ve received in this area, “in order to show “that I have proficiency
in treating this”. It takes a lot more work on the front end, but I think it saves
thousands and thousands of dollars on the back end, I really do. – I do to, I do to. Those few questions are so important. Like, if you treat OCD, how
do you plan to treat OCD? – Right. – I mean that question
in of itself can weed out a ton of people. – Absolutely, absolutely. And for anybody who has OCD
who might be watching this, if you catch on to some of this, don’t be afraid to
interview your therapist you’re going to see and challenge them about what they do. Any therapist who’s offended by that, you should walk out the door right away. Don’t talk to them. You can interview the heck out of me and ask me what I do and why I do and the rationale and I will give it to you and tell you exactly
what’s going to happen. – Right, right. I agree, this is good
stuff, this is good stuff. Well, is there anything that you feel we’ve not covered? An important message that you think we really
need to cover here, in this particular topic? – I think that we have to
really take a look at the fact, especially from an OCD point of view that this really is a serious diagnosis. The World Health
Organization has called OCD one of the top ten most
disabling disorders in the world and you’re not going to treat one of the top ten most disabling
disorders in the world with a general talk therapy, right? You really do need a specialized treatment for something that is as
significant and severe as OCD is. And we can’t just lump people with OCD into the rest of all the diagnosis that walk into therapists offices. We really do have to recognize what a life and death sometimes situation this could be for people, who are going to either turn to drugs, or have suicidal ideations,
secondary depression, and all those things. We might be able to wipe
out a ton of substance use, and depression and suicidality by
attacking someone’s OCD, even though, on the front
end, they payers may see “this person’s a substance abuser, “or this person’s depressed” because those secondary things might be what brings someone into therapy and they don’t get to the underlying issue that’s really there, and we have to make sure we
have skilled enough people who can find an underlying issue and treat it, so that that person doesn’t come
back for therapy again – Right, I agree. So much agree. I mean, some of the other
things that are listed in the top ten are like, heart disease. We don’t send people with heart
disease to a general doctor. You know? – Yes, “here’s your primary
care physician, there he is”. – Yeah, and so if OCD’s on that list, they just thought they
deserve a specialization. – Absolutely. – Yeah, amazing point. Is there anything else
you want to share with us? – Probably the last thing and it’s a shameless little
promotion of my book, but, I do want people to recognize that what happens with OCD, is people just keep
trying harder and harder at things that don’t work. And the goal of any therapy’s
gonna get them to do something else instead. And for payers, you may
look at OCD treatment, if you start to kind
of investigate this now and you may see therapists and read some notes and see like “therapist
had patient hold a knife “to his or her neck”. Now, you might look at that and go, “what are we doing?” And “is this ethical?” and it is, because this person
has the intrusive thought of “what if I were to do that”? They don’t have the thought of “I’m going to do that”? Or “I want to do that”? They have the thought of “what
if I’m going to do that”? And remember anxiety
disorders are two words and those two words are “what if?” followed by whatever worst case scenario you can possibly think of. – Mm hm. – So, the payers have to
kind of be open to the idea that, this therapy, exposure
and response prevention that we do, is not like any other therapy likely being done by any of
the members that they have and you’re gonna potentially, if you look at some of these notes, see some really odd and weird things that we do as therapists, but know that we’re
doing it in the service of getting rid of the OCD. And maybe it’s unconventional, maybe it’s outside of the office, where it has to be, maybe it’s at the mall, maybe it’s walking past the hospital, and not going in to be checked out or whatever it might be but we have to go to the
place where people are afraid and really get them to face those fears. It’s not just sitting in an office and talking about it. Cause that ultimately doesn’t leave people to getting better. – No, agreed. Agreed, yeah. And I think once we
can educate the payers, that they wouldn’t question that. – Right. – They would celebrate
it like we celebrate it. – Yeah, I’d invite them to come to the International OCD Foundation conference and just spend a day there and see the patients that
are at the conference and interact with them and go to some of the talks
that the therapists do about how we do therapy and really get educated on this because it really is
it’s own special thing compared to all the other
things that we do for therapies for many other disorders. – True, very true. Well thank you so much Patrick. It’s so fun to have some time with you. – You too Kim. – Yeah , and again, you
bring amazing points, so thank you for what you’re
doing for the OCD community. I think you’re making a big difference. – Thanks. Thanks for the interview,
it was great to talk to you.