Examining The OCD Project With Dr. Tolin – Episode 6



All this season, board-certified clinical psychologistDr. David Tolin will be checking in with this blog for episode-specific interviews on The OCD Project, which places six people living with obsessive-compulsive disorder in a house in an attempt to treat and control their disorder. Our chat on the sixth episode is below. In it, Dr. Tolin talks about Kevin’s dismissal, Kristen’s improvement, Arine’s driving exposure and the fake funeral for Traci’s son…

Was it difficult to tell Kevin you couldn’t treat him in this format? He seemed to take it very hard.

Kevin wasn’t happy to hear that news and I wasn’t happy to have to give it to him. But when it comes down to it, I have an ethical and moral obligation to Kevin and part of that ethical and moral obligation is to do no harm, to not subject him to things that could be painful, or uncomfortable, or anxiety provoking unless there was a really good reason to do them. It was becoming clear that the things we were doing with Kevin were not paying off and therefore for me to continue along those lines with him would have been, in my view, unethical.

You mentioned to him that you could find him a doctor with the “flexibility” he needs. What does that mean exactly?

People with Asperger’s very often have trouble with emotional processing and emotional learning, which really is what we’re doing in this program. We’re teaching people a new emotional reaction to things besides fear. It’s not that Kevin is not capable of learning this new reaction, but it was becoming clear to me that he was not going to do it in this format. In this format, we had only 21 days to do our treatment and as a result we had to keep moving with these exposures and get them going fairly rapidly. I thought that if Kevin could have one-on-one attention from a doctor that could do the same kind of program, but take it at a much slower and more gradual pace and explain it to him in ways that would make sense to him, he could benefit.

During the Kristen face-touching, she was resistant the whole time, telling you to get off of her. You assuaged her anxiety by saying, “This is your fear.” At what point would you have actually yielded to her request for you to get off of her? Is there a line that you draw?

Absolutely, the patient needs to have control over the process. Exposure therapy should never be something that I’m doing to them. I don’t know if you heard it, but when Kristen said, “Get your hands off me,” I paused and asked her, “Do you want me to?” The response was, “No.” I made sure I had her ongoing consent and permission to do the exposure exercise. The moment a patient says, “I’m not doing it,” we’re done. It’s over. I can’t force people to do these exercises, even if I think they’re going to be helpful.

Do you remember how long you did have your hands on her face?

I would guess that my hands were on her face for anywhere between 10 and 15 minutes. It was a long time. It takes time for these fears to come down, to habituate.

I’m impressed that she was able to withstand that.

I came away from that exposure feeling a bit more hopeful about Kristen. I was glad to see that her fear level did in fact come down and I was glad to see that she didn’t immediately retreat to her shell or start fighting and arguing, which had been some of the patterns in the past.

It does seem that at this point she’s been making a turnaround, especially after the hospital last week.

We might have not been pushing her as much in the hospital. I think around this point in the program, Kristen seems like she’s starting to engage a little bit more. She seems like she’s exerting less energy fighting me and fighting the program and exerting more energy in working on beating her OCD and facing her fears. I think the concern I have at this point is that it’s getting pretty late in the program. I kind of wish she would’ve got into gear earlier. I’m glad to see that she’s getting there, I just hope there’s enough time remaining in the program for her to really get a lot of benefit.

Right after that exposure, she interviewed that it’s hard to feel satisfaction after an exposure. I wondered if that was typical or kind of telling of how far she hasn’t yet come.

One of the things that I noticed about Kristen right away is she has the tendency to focus in on all the things that were bad and all the things she thought she couldn’t do. She had the tendency to ignore the things that were good and to downplay the things that she could do. It was like she couldn’t accept her own ability to start to improve her life and I think we continue to see that. I think when you look at where Kristen is and what her mindset is, you see it’s rather different from what we’re seeing in some of the other patients. What you really want to be seeing and what we are seeing in some of patients is them taking the bull by the horns and saying, “I can do this. I can face these fears and I can beat OCD.” I’m not sure I’m hearing Kristen saying that. Instead what I can hear Kristen say is, “God this sucks,” and, “All these people are being so mean to me,” and I worry that that mindset is going to get in the way of her ability to really engage in the program and to really benefit the way she needs to.

I thought the scene with your friend Wade was really moving. In it, Arine was confronted how her OCD might affect other people and hurt other people’s feelings.

Wade was really wonderful and he was very patient and very understanding. I think that both Wade and Arine did a great job at acknowledging some very tough issues. Arine and to a lesser extent Kristen have been so worried about things like HIV at a microscopic level and for Arine to recognize that HIV has a face is a little bit jarring. For her to start to put this into human term is a bit of a wake-up call. Initially, I asked Arine, “Why do you need to get over OCD? What is so important about beating this?” She told me she had this unfulfilled dream of working with people who are impoverished, who are sick, who are in need, and her fear of these microbes was preventing her from doing that. That to me is a very compelling reason to help Arine get past this and I think Wade was able to play a big role in helping her do that.

Any thoughts on Jerry and Cody’s pseudo-arrest? It seemed to go really well.

By this point, I think Jerry is really starting to do well. You can see that he doesn’t get nervous nearly as easily as he used to. I think he’s becoming increasingly aware of the fact that he’s not going to somehow snap and become a serial killer. Cody’s anxiety was a bit higher during that exercise and I think it paid off with him. I think that he was able to engage with it. He was able to face that fear. He really did come out of that jail looking very different. He was tired, yes. He was pretty exhausted from a long day of exposure, but I also got a sense that something had clicked in his head, the same way I saw in Jerry in the hospital. It had really started to sink in that I am who I am. I’m not going to turn into some despicable person and there’s no magic to it.

You sent Arine off to drive at night to confront that fear. But obviously car accidents are accidents for reasons and you can’t always predict them. What if she had gotten into an accident, even if it weren’t her fault? Could that have damaged her process and recovery?

Certainly, it would’ve been a setback if an accident had happened, but I think you can make that same argument about anything. What if we really had gotten sick from touching a toilet? What if Jerry really had slashed my arm? Clearly there are bad things that can happen and the consequences of those bad things can be pretty dire. For the most part however, these things are low risk. They are not impossible, but they are unlikely. Therefore when you hold the probability of damage up against the probability and the impact of the pay off, I think it’s a no-brainer. These are the things that we should do. If occasionally there’s an unfortunate incident, most of the time we can recover from that setback.

I wondered if you ever considered taking Traci’s funeral scenario one step further to put her actual son in the coffin during his staged funeral?

I think that would be a bad idea on a couple of fronts. I’m sure Traci could handle it although it would be awfully tough for her. My bigger concern would be traumatizing her son. You’ll notice that even though we did lots of exposures related to Shawn, Shawn had very little involvement in any of them and no awareness of the things we were doing. Even earlier on when I was encouraging Traci to try using her thoughts to see if she could stop Shawn’s heart, you’ll recall that Shawn was in another room [and she was] watching him by a video feed. There’s a reason for that. I didn’t want Shawn to be exposed to that.

Any thoughts about her eulogy which seems to continue to play into her OCD-fueled beliefs? She mentions regret over not turning on the sink or tapping enough.

That was exactly the eulogy that I had instructed her to write. At the very beginning we were doing those fear movies when I asked people to write down and then listen to and watch scenes around their worst-case scenario. The idea is: let’s take this obsession to its logical conclusion. If everything you worry about is absolutely true and you don’t do any compulsions or rituals what’s the outcome going to be? That’s the exposure we’re trying to get for Traci here. So in a way, she didn’t do her fear movie the very first time we did it. This is her opportunity to come back around and face that nightmare scenario. It is only in facing it that she starts to really understand how illogical it is.

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Dr. Tolin’s official site

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  1. Tabitha says:

    I am a huge fan of the show! I love to watch shows about people overcoming things. It gives me hope. Do you think the therapy you do with the people for the OCD Project is beneficial for other types of disorders such as other anxiety disorders or phobias?

  2. Tanya says:

    The show is captivating and even if I do not have OCD I am so immersed in it, I feel all anxiety they feel.

    I think you should have another show with Kevin and alike. At least an update on Kevin.

  3. Laura says:

    I’m so glad you are doing this series. I work with teens in a high school and the prevalence of OCD has skyrocketed (or at least the proper identification has). I’m hoping that the more people know about the disorder, the more they won’t feel alone with dealing with their own personal struggles.

  4. Grant Godwin says:

    Dear Dr. Tolin & Producers,

    Well done! This show is excellent and so is your work. I hope you plan on continuing this show with a second season and so on … I have OCD and I find it very helpful in doing my exposures. I belong to a support group based on the 12-steps called Obessive Compulsive Anonymous (OCA)a program designed to help people recover from OCD.

    I also see a skilled professional, Dr. Alec Pollard, who is a behavioral therapist for OCD. Dr. Pollard helps me design the exposures and therapy to recover from OCD and OCA (support group) gives me the emotional strength to do the hard work of exposures and stay in recovery by focusing on others and accepting life on life’s terms.

    I would like to encourage OCD suffers to seek out trained professionals in OCD recovery, as well as a support group that will endorse the physician’s treatments and advocate a life of living in recovery.

    I believe recovery is possible for OCD and we can get our lives back. One of my goals this summer is to be symptom free by the end of summer. I have been doing daily exposures for 1 hour each day and encourage others to face their fears and realize they are not alone. There are trained professionals and others with OCD who support your good efforts. Also, become a member of the International Obsessive Compulsive Disorder Foundation (IOCDF), this is an outstanding organization of trained professionals dedicated toward OCD recovery

    Thank you VH1 for bringing Dr. Tolin’s show to the public. If anyone needs support, information, or an ally in the trenchs of OCD recovery, please feel free to call our OCA phone number in St. Louis (636)394-0564. The St. Louis OCA 12-step website is: stlocdsupport.com May God bless you in your efforts for recovery.

  5. Heidi says:

    Part of my OCD revolves around me thinking I smell bad. I would HATE to see what torture he would make me endure.

  6. MamaKas says:

    I really liked Kevin, and felt a connection with him. Finding out he may have Asperger’s made me realize why. I have known many people with Asperger’s or Autism in my life time (family, good friends of family)and have learned a lot about communicating with them. One of my husband’s cousins can carry on an almost normal conversation, but he has to be literally walking circles around you to do it.

    Long story short, I would really like to hear more about Kevin’s situation. I hope we will get an update on him at some point.

  7. LS says:

    I thought what you did to Kevin was awful! I understand having him leave the program if it wasn’t working for him, but to do it on national TV is down right humiliating. Why did you broadcast that scene? Also, I, a psych student, noticed that it looked like he had some form of Autism or Aspbergers from the first episode? Why wasn’t that detected earlier? Like at a pre-screening? Also, I find it hard to believe that he was just then “diagnosed.” I really hope he agreed to be filmed and have the footage shown and that he was able to get the help he needed in a way that would work.

    Also to answer Tabitha’s question, cognitive-behavioral therapy, which exposure is a part of, is used to treat a variety of common disorders such as all anxiety disorders, insomnia and depression. Exposure and response prevention is often used when there are specific fears/anxieties present, such as with phobias, panic disorder and social anxiety disorder. When done properly, it’s a great technique for several conditions. If you are struggling with anxiety disorder or phobia, I encourage you to find a therapist trained in that technique. There are also self-help books that teach you how to do it, which some people find helpful.

  8. TimHBaham says:

    I was a big fan of the show!! No Kevin’s gone, it’s like, I don’t reaaly want to watch. I hope we can see him again WITHOUT humilating him. I read other comments and there still is no answer about “If seomething was obviously “wrong” since the beginning, why have in on the show, to show over and ove and over that he is not quite making the grade, then throwing him off. That other girl was like “You have to leave now”. No, don’t give him a breather or time to decompress, get him out of the house so that you can start putting fear in the other members? WHo will leave next? My guess is that another person will be asked to go by the end of these, what…10 weeks. I understand there are tests and things for Asberger’s. Not jsut a knee jerk, oh this is something he might have, let’s use this. Psy was my major. And yes, the show should be intereesting and attnetion grabbing but not like this. I wonder how hes doing now. Does anyone know if show in in “real time”?

  9. mike says:

    How mysterious the brain is!! Dr.Tolin is a psychologist which means that he didn’t have to go to med school which means that hes not really a doctor haaa

  10. Imazay says:

    VH1–Are the full episodes for Episode 2 & 3 uploaded? I cannot find them. Thank you!

  11. shawn says:

    I am 52 and have suffered from scrupulosity since the age of 19. Thankfully,after years of near constant hell, I am doing TERRIFIC! My fear has revolved around thinking something negative about the Holy Spirit or someone of a charismatic religious persuasion. (I used to think that such a thought would send me to hell for eternity.) To calm myself I would write out scriptures and write out refutations to my thoughts. I could spend hours a day just writing, writing, writing. What type of exposure would you recommend for a patient with this type of obsession?

  12. Ben H says:

    The Dr. is not really a doctor.

  13. Terry Crumley says:

    My son is 31. He has had OCD since childhood. In 2000 he developed Magical OCD. His OCD kept him from finishing school, being able to drive and having a job. He had to get on disability and Medicare. Imagine your worst nightmare and multiply it 1000 times, that is what life for my son is 24/7. His compulsions and rituals are very intense physically and vocally. For example he runs back and forth or gets stuck in one place crying out for help and for the thoughts to stop. He hits the walls hard enough to put holes in them all because his OCD tells him something bad will happen if he doesn’t. He cries saying he can’t take it anymore. This is his life everyday and night. No one knows how to treat OCD in our area. He has seen every psychiatrist in our area and been on all kinds of meds. He has been hospitalized several times. Words cannot describe the heartbreak of how OCD has kept him from having a life. I have been trying for years to get him help. I’ve spoken to every OCD center and some of the most prominent OCD doctors including a few years ago Dr, Tolin. I’ve tried to get money to get him help but haven’t been successful. For those watching the program who thinks OCD is funny it is not. OCD is devastating and heartbreaking. It takes away your life and makes you think you are crazy and it breaks a mother’s heart into a thousand painful pieces.

  14. Terry Crumley says:

    PS: My son’s Magical OCD tells him that the people he loves will die a violent death like being decapitated or mutilated.

  15. Liz says:

    I just want to say that I think the show is very well done. I welcome it as a contrast to Celebrity Rehab. I have very much appreciated watching Dr. Tolin doling out ethical care and being careful to match appropriate level of care and appropriate programs. One thing is to do it in real life, another is to do it on television. For me, watching him tell Kevin that the program was not an appropriate fit was in no way meant to humiliate the patient but instead his duty as a clinician in doing the best he could for his client. The program was not a good fit for the client; for Kevin to continue he may have grown more and more frustrated at his lack of progress in the face of others rapid ascent and he would not have been able to receive the specialized care he need. Kevin, was however, entertaining and kicking him off in many ways might not have been “best” for tv which is why I really appreciate this show; patients’ needs seem to trump those of ratings. Thank god. Dr. Drew are you taking note?

    Because of this loyalty to patient or client care, Dr. Tolin, the producers, and the participants have been able to really humanize OCD and its struggle. They also have been able to show that recovery is a possibility and a battle. It seems there have been a plethora of these types of shows of late. Unfortunately, they are rarely well done. This is the exception. Now if only we could have a show of similar caliber about addiction…..

  16. KF says:

    I am so tired of reading wienery Psych majors question Dr. Tolin and his techniques on the blog comments. Going to college and taking a bunch of classes on Freud doesn’t establish your ethos or make you an expert. Once you have a doctorate and have years of experience treating OCD, maybe then you can challenge Dr. Tolin’s methodology. Until then, shut up, PLEASE–because you look so dumb right now.

  17. Jill says:

    Whatever happened to Kevin? Please give us an update..