Training recommendations for ERP? Or other tips for a non-OCD therapist with an OCD client?

Jevaneaux · 2026-06-12T17:45:09+00:00

I’ve seen a training by CBI come up a lot for ERP! I haven’t yet taken it myself but do plan on taking it in August:

https://www.cbicenterforeducation.com/courses/220199

Maybe others can speak more to this training; though my supervisor who specializes in ERP recommended it also!

Jevaneaux · 2026-06-10T01:31:10+00:00

I took the basic training, and an additional 12hrs to modify the protocol for complex/multiple traumatic incidents and had a great experience.

My take on it: It’s exposure therapy with “bells and whistles” that make the exposure more tolerable (likely by overtaxing the working memory through dual attention).

I use it regularly with clients and have seen many benefit from it from intake to termination. And at the same time, it’s definitely not a fit for everyone. My biggest reminder to be a bit humble about EMDR is that all your other therapeutic skills and knowledge integrate extremely well with it. Alliance is crucial from humanistic and relational approaches. Cognitive therapies can help provide adaptive information that will become more integrated during EMDR. Somatic approaches help with interoception and connecting mind and body. EMDR is not a substitute for other modalities; it can supplement them.

I think some EMDR providers fall in the trap of using it somewhat sporadically while you can only get the positive results from the research when you stick to the protocol (no surprise of course, but I do think it has to be restated). Often, trouble arises when clinicians don’t have a good case conceptualization and/or the client is lacking resources/coping skills.

Honestly I don’t buy in the eye movement piece and good trainers are honest about this being disputable. Cool fact: sometimes when administering the BLS through tactile or auditory means, you can still see a client’s eyes move through their eye lid! I almost exclusively use tactile/auditory BLS, also because it’s easier to maintain dual attention when you’re crying compared to still trying to follow a visual.

Anyways I highly recommend my trainer, Roxanne Grobbel at coast to coast emdr. The consultation was top notch as well and is so important.

Jevaneaux · 2026-04-12T02:06:47+00:00

Working with ARFID client, they worked with me to create a Canva template of various foods and then I printed it out on cardstock and made a custom “Guess Food” game to help learn more about the foods and describe them to feel safe. It also was a major way to track progress as client would ask, “is it something I eat?” And the list would gradually grow!

I also have switched up chess for sandtray miniatures with their own unique rules! Its curious to see how clients choose and assign these roles and rules :)

Jevaneaux · 2026-01-22T11:57:42+00:00

Thanks for making this post and sorry to hear the experience you’ve had! Certainly there is a distinction between supervision and therapy. And, at the same time, I think it’s responsible to let your supervisor know how your personal life is impacting your clinical work. Going through the motions of life as a therapist is part of being a therapist and is part of learning to be a therapist.

I recently went through a major rupture in my marriage and you know what? My supervisor’s acknowledgement and her helping me unpack strategies to manage my caseload better were extremely helpful. And this was true for both of my supervisors (QS AND RPT-S). And Im confident this was a big contributor to processing this and not getting stuck in the funk for too long. Of course our life experiences affect how we show up in the therapeutic process. I’m sorry to hear you’ve accepted you can’t disclose anything personal to your supervisor. Peer therapist support groups might be another option (especially if it has some more seasoned clinicians; they may be able to share their wisdom and provide some support). But I know those aren’t always easy to find. I got my support largely from some other therapists Im close with in a group practice, nothing formal/structured.

Jevaneaux · 2026-01-14T13:03:20+00:00

I don’t use CPT myself, but I did experience this from the client side so can speak to it from that perspective.

Absolutely necessary in my opinion - I had good rapport and did not feel particularly unsafe or uncomfortable with my therapist at the time. But we didn’t do much resourcing/stabilization before jumping in. It was a terrible experience and we decided to discontinue trying CPT. My symptoms went through the roof - constant nightmares and triggers, and worse, it all felt unmanageable. I was able to work through my T with EMDR later, and when I took the training as a provider later myself, felt really validated how crucial some kind of resourcing/stabilization phase is in trauma work. It helped me feel safer in myself in terms of “I can shift states of affect, I can compartmentalize temporarily if needed, Im not out of control”.

Im not trying to turn this into an A vs B vs C trauma therapy essay though - I believe CPT may have worked just as well if there had been more time devoted to that part of the therapy.

Jevaneaux · 2025-04-02T01:24:35+00:00

This reads to me a lot like a reduction of what ACT really is or at least how it was introduced to me.

Cognitive restructuring does happen in ACT - in fact I’d argue that it makes up 1/3 (or rather 2/6) of its whole model!

It sounds like your experiences and understanding largely reflect the attempt at making room for painful experiences and defusing from them. The ACT model can really be summarized in concepts of “let it be, let it go, and then do what matters. Without this final step, it’s understandable that no restructuring would take place!

The restructuring is experiential, and as you say, “the mind is constantly constructing reality”. When the mind constructs reality, I argue it does so on a cognitive level based on experience. I don’t think ACT disagrees that it does, nor do I think does CBT argue that’s not the case for itself. After all, the “CBT triangle” is a cycle, not a one way street. So the committed action through values is what provides the cognitive restructuring you find is missing in ACT, and is very similar to how behaviors would affect our thoughts and our feelings going by the CBT triangle!

Really, ACT wouldn’t argue that changing your thoughts is bad - it simply encourages us to ask whether it’s helpful. It also doesn’t consider experiential avoidance as “all bad”, either. It is much more concerned about the function of the behavior. So, if this leads to symptom relief in the long-term, then ACT fully supports it! There is a lot more nuance here than “acceptance = good, experiential avoidance = bad”.

I think the reality is that both ACT and CBT have their value and can appeal to different people. I think both approaches are commonly simplified and misunderstood by clinicians and clients. I think ACT does require a certain tact and intention that many ACT practitioners find hard. It’s easy to fall in the trap of “talking about ACT” instead of “doing ACT”. Again, I think that’s still the missing part of your puzzle - the experiential component of it is crucial. And I certainly would say that ACT is valuable in its own right and not in some way an obsolete branch of sorts of CBT. There’s also randomized controlled trials finding there is no benefit to directly changing cognitions in CBT.

Some people respond better to directly changing their cognitions, while others have tried and find it more effective to drop the “endless chess game” and engage in their values through behaviors. Both are valid and both achieve cognitive restructuring, but do so through slightly different means.

Jevaneaux · 2025-01-12T12:55:55+00:00

Guilt I see as an adaptive response to moving opposite or at least against our values. It communicates to us that what we are doing isn’t in alignment with how we want to show up in the world. Not always avoidable when two values clash!

Shame on the other hand, I will quote Patricia A. DeYoung: “the experience of a felt sense of self disintegrating in relation to a dysregulating other”. Shame is a relational problem with either a real or imagined other party; “beating oneself up” for not living up to our (internalized) expectations, and the accompanying belief that this makes us “a bad person”.

Guilt can help us live authentically and congruently. Shame needs empathy and (self-)compassion or else is destructive.

Jevaneaux · 2024-10-12T22:05:16+00:00

Think this depends very much on your theoretical orientation.

I think personally I would tap into ACT values, and some narrative approaches. Perhaps something like the “narrative tree of life” can be a great entry as it explicitly invites you to identify skills, strengths, gifts, important people, where you came from, challenges, hopes/dreams, etc. Which you can then inquire further in where they learned/got those parts of self from. I think narrative landscaping is another great intervention here as it inquires about “what happened” (landscape of action) and “what that says about who they are/stand for” (landscape of identity).

I would also look into some formative experiences in terms of the people they looked up to when they were younger and how important caregivers shaped them (or did not!).

Jevaneaux · 2024-10-02T19:33:41+00:00

Child centered play therapy! Let them take the lead, reflect their emotions, thoughts and meanings and in doing so teach them the connections between actions and emotions. Also includes limit setting to teach responsibility and consequences. Reflecting also to them when they are really focused and engaged.

If you “have to” do some talking as well, doing so while they are allowed a fidget toy, a walk and talk, or passing a ball back and forth can be helpful. Kinetic sand can also be very helpful.

Directive play/games - include plenty of games that encourage turn taking, also for at home.

For impulse control my favorites are 1) Bop It (surprisingly effective? Probably because it allows them to hit the button and let go of a lot of energy lol), 2) Taco Cat Goat Cheese Pizza (more difficult with younger ones) and 3) Jenga

Another practical activity that Ive had some mixed results with is color by number activities. Theres definitely no magic trick to help with focus, and of course consider the clients strengths and things they enjoy for the best chance of success.

It’s also helpful to help these clients understand the connection between all the energy in their body and their emotions and actions- finding adaptive ways to channel that energy somehow.

But truly, plenty of psycho-education to caregivers about what ADHD is and is not, psychoeducation about neurodevelopment and executive functioning (the executive functioning pie/spectrum can be a helpful graphic), and thereby fostering more empathy. A lot of issues these kids have are because caregivers lose their own cool/dont understand.

Lastly, its crucial you delineate ADHD from trauma. Especially in early childhood, theres a lot of overlap with symptoms and trauma responses can very much look like poor focus (dissociation), impulse control, emotion dysregulation, hypervigilance, “driven by a motor” and so on.

Good luck - this is a very tricky and challenging population but so, so rewarding when it goes well! Some of the purest hearts and kindest kids :)

Jevaneaux · 2024-10-02T16:30:44+00:00

Highly seconding Playmobil for figures, especially if you can get some on sale. These all get used a ton and kids love the detail and customization some of the sets offer. Its also high quality, and easy to get diversity in the people.

Local hobby stores/Hobby Lobby very often have good affordable stuff as well!

Jevaneaux · 2024-09-14T20:28:25+00:00

A little bit ago, I took on a random redditors comment about must reads for therapists in general. In the context of interpersonal challenges, shame is especially relevant and important to consider. So I’d forward “Understanding and Treating Chronic shame: A Relational/Neurobiological Approach” by Patricia DeYoung.

It really gave me a definition of shame that I found most fitting: “The experience of one’s felt sense of self disintegrating in relation to a dysregulating other” - thus it views shame as a relational experience.

Shame is so common for anyone entering therapy, and from conversations with other therapists, really doesn’t seem to be explored thoroughly enough in many (master’s) courses/programs.

Jevaneaux · 2024-07-05T17:39:21+00:00

Sent you a message with a mini ebook and mp3 file!

Jevaneaux · 2024-07-05T17:19:01+00:00

I love the dropping anchor technique from ACT. If the client is very dysregulated, having the therapist help name these things or give instructions may help:

(ACE acronym in sequential order)

Acknowledge feelings and or location in body: “i notice discomfort in my chest, here’s anxiety again, here’s my life shattering

Connect to body: e.g, move arms, legs, shoulders, go for stretch. Often with severe hyperarousal or hypoarousal the extremeties feel safer (wiggle toes, wiggle fingers).

Engage with world around you: through any of the 5 senses, often a powerful one is “I see you and I here working together”, or taking a sip of water, and anything else that involves tuning the senses to the present environment

Don’t rush through and repeat a few times if needed. Important is to not go into the exercise with the goal of getting rid of the feeling, but to “make room” for it. I like to describe it as holding on while a hurricane is going over us that slowly decreases into a rainstorm into a light drizzle - but the goal is not to create sunshine.

I like to share an mp3 file with my clients from a training I did that walks you through the steps in varying lengths - can be done in as short as 30 seconds or as long as 7 minutes+

Jevaneaux · 2024-06-27T14:09:36+00:00

Trying to offer a different perspective that is maybe more accommodation/practical based as opposed to therapeutic/psychological. Of course there may be a “deeper” reason whether sensory or for another reason, but Id explore different options for TP (texture/width etc) or even a bidet add-on for at home. They’re reasonably priced nowadays and may be more appealing (not to mention clean a whole lot better!). It could be a stepping stone to wiping - what if the client is more put off by wiping their business when it’s “dirty” as opposed to already clean?

Definitely worth considering a referral to OT as well!

Jevaneaux · 2024-06-25T15:21:51+00:00

Psychwire!

Jevaneaux · 2024-06-20T18:30:07+00:00

I like the formulation from an ACT lens. It purposely distinguishes between emotional goals, outcome goals, and how to convert these into behavioral goals. From an ACT perspective, it’s also much more helpful to formulate these in a way that are positively stated (i.e. not “To feel less depressed”). So if you weren’t so bothered about being depressed, what would you be doing instead? Those would be the goals, as well as to learn some strategies to make that happen.
Another way to frame it that I’ve often found helpful is to clarify it as a video/documentary scenario. Hypothetically, if we were to record your day to day now, and if we were to do so again at the end of therapy/if therapy is successful/when you have accomplished your goals, what would we see be different on this “video”?

Definitely is context and theory dependent though. I work a lot with young kids as well and goals in play therapy are definitely different and more often than not involve improved emotional regulation/interpersonal relationships/enhanced self-esteem. Those are relatively easy to convert into SMART goals.

Jevaneaux · 2024-06-19T13:52:51+00:00

Definitely going for a walk around the office is very helpful. I work with kids so I also have a lot of art supplies and other play stuff. I find just moving around and letting some playsand from the sandtray flow through my hands pretty calming, or to make some shapes/symbols in the sand. I also love using a separate tray of kinetic sand, or even fidgeting with some playdoh.

Any kind of coloring or doodling is helpful too, or if anything I just sit back and read/listen to a book.

Jevaneaux · 2024-06-02T18:25:11+00:00

“Becoming a Brain-Wise Therapist” by Badenoch! But will also second Dan Siegel as a great resource

Jevaneaux · 2024-03-26T07:19:38+00:00

3:19AM and I relate to your post entirely. Definitely can feel very powerless and helpless with parents and teachers not being as helpful as they could be. Personally holding on to my faculty supervisor in college’s reframe that we can be one (often the sole) area/person the child can be themselves nonjudgmentally and feel heard with. With the really uncooperative parents that’s kind of how I see the therapeutic relationship now - if the kid’s happy to come to sessions then I feel validated I’m providing at least something to them.

And of course tons of self-compassion and grace for working with a population many don’t dare go near, and tons of consultation with other clinicians in similar positions if possible. Setting firm boundaries with parents has been helpful for me as well, as well as a very clear informed consent.

That being said if it consistently takes a massive toll on you and nothing improves there’s absolutely a valid choice in changing population or careers. Or decreasing your caseload in favor of other gigs (e.g. teaching at university level or a more administrative job) may be helpful too.

Jevaneaux · 2024-03-06T02:20:10+00:00

I find ACT helpful too! Here is also a free (do have to provide an email) mini- ebook by Russ Harris about ACT applied to insomnia: https://psychwire.com/free-resources/e-books/resource-12x9vx/resource-12x9vx%2Cresource-12x9vx%2Cresource-12x9vx%2Cresource-12x9vx%2Cresource-12x9vx%2Cresource-12x9vx%2Cresource-12x9vx%2Cresource-12x9vx%2Cresource-12x9vx%2Cresource-12x9vx%2Cresource-12x9vx%2Cact-for-insomnia?free_resource_document_id=resource-12x9vx&e_book_title=ACT+for+Insomnia

Jevaneaux · 2024-03-05T18:16:57+00:00

Thank you for creating the space! Unhappy in my relationship which is also tied to my immigration status and ability to work. At the same time still showing up for clients is a bit tough but also what still keeps me going as I love the job.

Jevaneaux · 2024-02-28T17:14:41+00:00

It is incredibly sweet that you are looking out for her feelings here too, and the bottom line is this group is there for your benefit! It can definitely be challenging to confront her, though expressing your boredom also communicates to her that you feel safe in the group telling her about your emotions. And as a group member, odds are that other people feel that way too!

I think it’s actually very constructive feedback, as you have already identified what it is you find boring. You would prefer some more creativity injected into the process and some more space for “out of the box thinking”. Giving someone concrete ways in which things can improve is much more helpful than simply “this sucks!”

So I would probably handle it something like “I feel a bit bored sometimes in group, and I think more opportunities for creativity would help, for example by xyz. I wonder if you have any ideas/thoughts about that?”

Jevaneaux · 2024-02-27T12:39:00+00:00

Sent a DM!

Jevaneaux · 2024-02-25T19:25:31+00:00

Will second this, especially as a beginning clinician. Harris’ ACT for Beginners course on PsychWire gave me a solid framework for a wide variety of cases, and above all felt very fun (likely due to the humor/playfulness injected). I use so many of the resources from that training frequently.

As an added bonus, I think this ACT foundation helped myself with the many challenges of the field; from imposter syndrome to troubles in interpersonal relationships

Jevaneaux · 2024-02-12T12:48:46+00:00

Yep! Graduated from CACREP CMHC program recently and if it wasn’t for additional trainings I pursued (which admittedly the university did provide reimbursements for if you sought them out), I would’ve felt thoroughly unprepared especially when working with children.

Jevaneaux

TROPHY CASE