queer-affirming

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I have experience and training in providing care across the gender and sexuality spectrum, and continue to develop professionally in this area. I identify as queer  (my preferred term) myself, and have gay and trans people in my immediate family and my chosen family. The space I provide is a safe space for you to be your authentic self, to explore your identity, and to share any concerns or anxieties you may be facing.  If you identify as LGBTQ+ know you are loved, and you are welcome here. 

In working with people with Sexual Orientation-OCD or Gender Identify-OCD, I have encountered two fears from these clients about working with a therapist (especially a queer-affirming therapist). 

1. "The therapist will try to make me accept that doubting means I am X gender/sexuality."
2. "The therapist will judge me for having these doubts and fears, thinking that I am unaccepting of LGBTQ people."

I wanted to address these common fears in case they resonate with you. 

1. My job is not to tell you what your identity is. Instead I see my job as helping you embrace the uncertainty and changing nature of identity. 
2. I understand that you did not choose your OCD. I do not judge people for having doubts or fears. This is a safe space for expressing and sharing for everyone.  

OCPD is characterized by a preoccupation with orderliness, perfection, and internal control. People with OCPD often exhibit the following:

• excessive list-making
• difficulty completing or starting tasks due to excessively high standards
• prioritizing productive activtities over leisure and socialization activities
• often highly rigid in following rules, morals, ethics

People with OCPD often find that these characteristics often interfere with their relationships with friends and loved ones, and as a result experience more conflict and loneliness. ACT and interpersonal connection are useful in addressing OCPD characteristics.  

ARFID often develops in childhood or adolescence, but can affect adults as well.   ARFID is characterized by extreme avoidance of a number of foods, or restricting intake of food, and frequently resulting in malnutrition. Working closely with medical professionals is important for severe ARFID, and there are two protocols I use to treat ARFID: 

• CBT-AR - This is the CBT protocol for  building tolerance of foods or of eating larger amounts of food.  ACT and ERP can also useful in addressing any fears or sensory sensitivities that affect avoidance. 
• SPACE - Supportive Parenting for Anxious Childhood Emotions is helpful in coaching parents to learn how to support their child without contributing to anxiety or unhelpful patterns

PDA is a unofficial term that describes a specific sub-profile of Autism Spectrum Disorder. PDA is characterized by:

• resisting and avoiding everyday demands, sometimes even with preferred activities, due to anxiety 
• Significant anxiety meltdowns or shutdowns
• Wanting friends, but having difficulty with closely connecting with others (friendships remain superficial)
• Significant inner fantasy world (creating characters, interacting with them in imagination) for hours a day
• Often enjoys (sometimes prefers) role play and pretending to "real life"
• Excessive mood swings

PDA requires a delicate balance of providing and encouraging facing challenges, while also building competency and confidence, connecting to what the individual values and wants to achieve, rather than meeting external (society / parental / systemic) goals. 

PANS and PANDAS are autoimmune diseases triggered by infection (usually strep throat) and often result in sudden changes in a child's personality, and sudden onset of OCD, tics, restrictive eating habits, and other behavioral changes. A medical professional is needed to treat the underlying autoimmune issue, but ERP and CBT/ACT are helpful in addressing the new behavioral symptoms. 

Tics and TS are usually diagnosed by a medical professional. There are medications that can be helpful in reducing tic frequency. In addition, Comprehensive Behavioral Intervention for Tics (CBIT) and Habit Reversal Training (HRT) are highly effective in reducing tic frequency. Some have found that with CBIT and HRT they are able to discontinue or not take medications at all. I find it important to use CBIT and HRT in the context of a compassionate and values-oriented approach. 

Misophonia is an extreme discomfort of specific sounds, usually accompanied by feelings of anxiety and/or anger. Individuals with misophonia may feel that their reactions are irrational and out of proportion to the trigger, but the extreme discomfort leads them to avoid situations where they may encounter the triggering sounds. People with misophonia can also feel like they are out of control or losing their mind.  Exposures are useful treatment for misophonia, but need to be approached even more slowly, compassionately, and values-focused than with traditional ERP. 

Of course people and our minds are complicated. People with OCD or anxiety disorders frequently feel depressed, at times even fall into severe depression. They may need to process grief, may experience a trauma, or have a previous trauma triggered. When these happen I usually address it as it shows up with the client, but if I ever feel that the severity or symptoms are outside of my scope, I will work with my client to connect with other services to address them. 

These are not specialities of mine, but again, they often co-occur with OCD and anxiety. I do provide support for insomnia (CBT-I) and improving sleep habits. Similarly I use ACT to support clients who also experience chronic pain and/or chronic health conditions. Using an ACT approach I am usually able to address the needs of my clients, however, when symptoms are severe or have been present for many years, I've found it best to refer out to specialists in these areas.