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You're listening to the OCD Stories podcast hosted by me, Stuart Ralph. The OCD Stories is a podcast dedicated to raising awareness and understanding around obsessive compulsive symptoms. I do this for interviewing inspired therapists, psychologists and people who have experienced OCD. Welcome to the OCD stories and welcome to episode 543 of the podcast. And on this one I got back on Johnny C. Jonny has been a guest many times on the podcast. Jonny is a UK based therapist and co director at the Intricacive Centre for OCD Therapy which I am also a co director of. We discuss Self Compassion, integrating self compassion into exposure and response prevention therapy, Some benefits of self Compassion, the inner critical voice Shame real event themed ocd. Jonny guides us through an exercise in self compassion to the past and much more. So if you're a therapist listening and you're interested in self compassion, the center is running a training with Johnny and Alex who's another therapist at the center towards the end of June. And I'll put a link in the show notes where you can find out more about that. But for everyone else, I hope you enjoy this episode. It was great having Jonny on to talk about self compassion and I'm glad I've now covered it with Alex and Jonny in the past sort of four weeks. And I'll look to cover self Compassion much more in the future because it's something that I think many of us struggle with and it is definitely a skill worth learning. And thanks to our podcast partners. Nocd. If OCD is interfering with your life, NOCD can help. They're licensed therapists, specialise in exposure and response prevention therapy. The most proven therapy for OCD with NOCD, effective treatment that is 100% virtual, is available for children and adults with OCD and most members can get started within seven days on average. No hassle, just real science backed help and support between sessions. Begin your journey@nocd.com where I'll put the link in the episode description. So thank you to Jonny and of course thank you to you guys as always, it means a lot. And without further ado, here is Jonny. Welcome back to the podcast, Jonny.
B
Thanks Stu. Great to be here as always.
C
Yeah, it's good to have you on. And we're back from the OCD camp which we did this past weekend, which
A
was good, fun, went well, meaningful, lots
C
of exposures that people pushed through which was really great to see.
D
Yeah, yeah.
B
Again I was overwhelmed by the courage, you know, seeing people visibly pushing through high levels of anxiety, disgust, working with Very intense shame. So inspiring again to see that. So, yeah, I felt honored to have that couple of days with an amazing group of people and yourself. And for us to have that time at the camp in nature is brilliant.
D
Fantastic.
A
Yeah, it's awesome.
C
Always nice to get that reset of a few days in nature and being around good people. So, yeah, I mean, we already had this episode booked in to talk about compassion because we wanted to build on the episode I did with Alex recently from our team and obviously his training that's coming up in CFT for ocd. But I think the camp also highlighted. Yeah. The importance of compassion and sometimes how challenging that can be for many of us. So, yeah, I guess it's very timely as well.
B
Yeah, yeah. I think within the group of people, we saw, you know, a lovely, compassionate group of people that were able to extend that compassion out, but all had different levels of being able to bring it inwards towards themselves. And I think some of the people who were struggling with very intense ocd, it probably correlated with intense shame. Right.
D
There was that strong correlation.
B
And hopefully the camp, the connection of community, the work we were all doing together, has helped with that and will continue to help with that. But I was. Yeah, again, really saw that link between intense OCD symptoms and shame and how often that really is the case.
A
Yeah, yeah, absolutely.
C
So where should we start today?
B
Well, I was thinking Alex did such a brilliant job of sort of defining compassion and talking about some of the ways compassion focused therapy can be brought into OCD training. I wondered if we sort of build off that and maybe talk a little bit about integrating compassion into exposure and response prevention, you know, ways to practice it and really, the barriers. I'm really passionate about working with the barriers to self compassion because I think that's where the work really is. You know, no one hears about self compassion or no one with. Or very few people with OCD hear about self compassion and immediately can implement it. And it just flows abundantly. You know, it's very difficult. So how you work against the barriers would be a good one. And then maybe going a bit deeper on shame and OCD a little bit and thinking about that.
A
Perfect, perfect.
C
So integrating into erp, where do we start?
B
Yeah, I was thinking that, you know, obviously exposure response prevention is the gold standard treatment for ocd. So why would you bring compassion in? Why would you integrate it? Lots of CBT therapists and ERP therapists are highly compassionate people that are, you know, delivering ERP in that way. And I think there's still benefit in Targeting it as a process on its own, you know, really going for it. You know, lots of people are doing this. I was thinking in the uk, I mean, I know from interactions with therapists that, you know, some of the major treatment centers in the UK have compassion focused therapy groups alongside erp. Many of the colleagues I work within the nhs, when I worked into NHS Trust, they were all using compassion alongside erp. Over in the States, we've got John Hirschfeld and Charlotte Nicely's work, the Mindfulness, the little mindfulness workbook for ocd. That one has a great bit on self compassion. You've got Kimberly's book, which Kimberly Quinlan's book, Jonathan Abramovich in his Living well with ocd, there's a whole chunk of self compassion. So lots of people, big in the ERP world are very much targeting self compassion and seeing the value of it. And I think it dates back in cbt. Right. Even the ideas of Albert Ellis and the unconditional self acceptance and some of the early cognitive strategies, they have compassionate ways of doing it. So I think really it's part of CBT in many ways, but I think it's so difficult to be self compassionate that it almost needs a sort of training module and a focus on it. I don't know about you, what you make of that, but I think there's value to really addressing it directly rather than just assuming it's part of ERP and that there's compassion there already. What do you reckon?
C
Yeah, I absolutely think so. And I think it's the same with, like the therapeutic relationship. That's no different. We kind of think it's a given. Oh, naturally you build a relationship with your client and naturally you're compassionate with your client, but actually these are also skills that need to be developed. So, yeah, I'm all for that.
A
Absolutely.
B
Yeah. And I think compassion focused therapy, mindful self compassion, they provide ways of increasing compassion in the therapeutic alliance as well, and tangible, direct ways to sort of train it. So we're agreed. We think it's very much a benefit. I mean, obviously you and I think that because it's big part of our center and our practice, but I think there's a lot of agreement in the field. I don't think it's a particularly controversial thing and I think a lot of people are using CFT across other disorders, other difficulties and integrating it with cbt. And Paul Gilbert always hoped that it was compassion focused therapy. So it was like a philosophy you could apply to any therapy, really. It wasn't a New therapy. It was just a way of really highlighting that. And I think, I don't know about you, but a lot of people I work with who may have done a fair bit of ERP and may have really benefited, may be doing a lot more in their life and have greatly reduced their OCD symptoms, may carry a lot of shame still. They may not have even impacted the shame much at all. And so I think you can sometimes have expansion in behavior, but not much change in internal relationship.
D
And
B
this is really why compassion focused therapy was developed. Paul Gilbert saw that and he was working a lot with CBT when he developed it in depression, more in treatment resistant depression and in hospitals and things like that. And he found that people would do these strategies, behavioral activation, cognitive strategies, but do it with a lot of harsh, critical voice. And I think people do ERP like that, right? They sort of, kind of say they're not. I mean, the amount of times a client will say to me something that I hear as a massive win, and then they'll completely undermine it and say,
D
well, you know, I did a load
B
of compulsions in it or it wasn't that big a deal, or, you know, other people, it's not that deep. Or other people can go out, you know, and see their friends or do this or that, you know, so, you know, people undermine the ERP by criticizing the erp. So I think it's so useful to bring it to erp to make sure that people are, you know, they're celebrating their wins, however small they may feel. You know, I think it builds a different relationship with your mind. I think the more self compassionate you are, the easier it is to observe these thoughts as events and not as things that define us. They come and go. And if I have this core of self compassion, self acceptance is easier for that to wash over me. And that's what regular people without OCD are like. That's why they can have the same intrusive thoughts and go, that's a weird thought, right? Whatever, I get on with my day. You know, they don't have that vulnerable core of shame that goes, gosh, that fits with how I see myself. I must be this terrible person. So I think it's so helpful for that. I think it's helpful for motivation. Getting us to do erp, getting us to recommit, dealing with very intense emotions. It gives us an additional sort of tool for that. What about you? What do you think are other benefits with erp?
C
Well, just on the points you've said, I think, yeah, it's like changing the dialogue in your head. Right. That we have. Many of us have a voice that's not helpful. It's berating, it's downplaying. And we're going to be less motivated with that voice versus the voice that's encouraging, nurturing. Keep going. You got this. Doing your best. You know, you tried your hardest today. Maybe it wasn't where you wanted to be, but keep going. You know, tomorrow's a new day. Is that kind of voice. You're more likely to go further in life, so to speak, than the voice that's like, you're an idiot. Why did you mess up?
A
You.
C
You're not making any progress. What's the point? Like, that's where depression kicks in and other things. And. Yeah, and I said it to a client today, actually, because they downplayed a really big achievement, I think, and they were like, you know, it's not that deep. It's, you know, and I'm like, it is that deep. You know, if it, you know, you made progress, it is that deep. And I said, if you're gonna like, berate yourself for your perceived failures, then you better praise yourself for your wins.
D
Yeah.
C
You know, so it's. I wasn't even trying to stop the sort of critical voice, but it's like, if you're gonna do that, you've gotta praise yourself too.
D
Yeah.
B
You've gotta see the facts. You gotta be balanced. Yeah. Yeah. And I think, you know, outside of ocd, people motivate themselves with criticism and it sort of develops as a language from a young age. We get used to, like, if I don't perform, I get told off or, you know, I get negative feedback and I desperately don't want that. So I'll do anything to avoid that. And then I'll internalize that voice, which kind of motivates me because I really don't want to beat myself up and be hard on myself. So I better achieve. You know, there's fear motivating us and sort of tension and, you know, sometimes it doesn't even work. You know, it's more correlation, not causation. So we're being hard on ourselves and really we're achieving stuff because we have goals and, you know, we have internal abilities and resources. And the, the critical voice is not even helping at all. But even the times it is helping. I mean, I've. I've worked with a fair number of kind of high performing people across sports and business and other places like that, and the people that are just achieving these incredible things but are so hard on themselves, they don't enjoy it at all. You know, as soon as they have a massive win, their mind is instantly undermining it, instantly saying, you got to do the next thing, you got to do the next thing. And actually there's no joy even in achieving all these great things. And one client I had, actually, I talked about this with him and he said he used the example of two very well known elite sports people and he said Usain Bolt. And it was a rugby captain that he knew both of these people and he said, usain Bolt uses joy, pleasure, energy. He's just kind, he's having fun all the time, time, enjoying everything. Never heard him be critical of himself once. And then this other, you know, this other rugby captain stood there at the, you know, the, the, I can't remember which cup they, they won some cup. And he literally said in his head his mind was going, this isn't enough, what are we going to do next? And he couldn't even enjoy that moment. He was like, there are these two strategies you can choose. And you know, some people are lucky like Usain Bolt. You know, he's obviously got that internally and there's probably reason that, but certainly people with OCD are typically the other motivation pattern. And so they're undermining all their wins and achievements in ERP and as you said, all their insights. So the more we can start to cultivate a new language, actually it's going to be more effective because we take out that stress from that critical voice which actually exacerbates OCD symptoms. We make it more likely people will pick themselves up after failure and go again and go again. Less procrastination and avoidance with. When you get, when you reduce the internal critic, you know, so many reasons why it's helpful, but it's very hard to do, you know. It is, it is. That's the challenge, right, is how do you get someone that may have a long life path of shame inducing incidents to start to learn this new language? And I think we have to start with psychoeducation and some Socratic dialogue to understand someone's beliefs about compassion, their barriers, their reservations, what they make of it, what they understand, misunderstandings of it. You gotta sell someone on why it's helpful and draw it out of them, of why they're, what their fears and blocks and resistances are. And then like any language, it's. Then we practice the language, right? We start practicing Italian and you get your lingo up and you start practicing every day. And then you stop practicing and then think, God, I better start practicing again. And you get into it, you practice and practice and practice. And then hopefully you also go and speak the language in Italy. And in this example you hopefully with a therapist that's highly compassionate and is reinforcing in that language. And I'm sure you've had the experience where my clients will say, like, I could hear your voice in my head almost being supportive and kind and willing me on. And it's like that internalizes it. Hopefully they start to build good compassionate connections. So friends who really got their back, friends who are non judgmental and aren't, you know, so, so critical and competitive and you know, they build this compassionate group of maybe through the OCD community, maybe other places. And then that speaking the language makes
D
it more and more natural.
A
Yeah, yeah, absolutely.
C
There's a few things in my head. One is like when a client, like maybe they've got a history of being hard on themselves and then I say something, they say something to me in a session, then I say something about, oh, you know, maybe about compassion not being hardened. And then they go, oh no, I wasn't actually, I was okay with that. I kind of forgave myself for it. When I see that shift, that's like one of the best feelings because,
A
you
C
know, now they're going to go through life not berating themselves as much and that's, that's such a win. Um, and, and for some people, you know, especially like taboo intrusive thoughts or maybe because of compulsions people have done, they can build up this shame about themselves and it can affect their sense of self and their identity. So I think for some people practicing self compassion becomes an exposure in and of itself because it's triggering those fears and that ocd.
B
Yeah, yeah, exactly. And I think you can get high levels of shame across all the different OCD themes. And actually we see high levels of shame in things like POCD and Real Event and the taboo OCD themes. But actually you can see equally high levels of shame in all OCD themes, depending on the kind of culture that someone's grown up in, what they've been taught about mental health, as you say, the impact of the compulsions on their life, maybe even how much OCD has set them back. I mean, we've both worked with clients and myself, to be honest, it really set me back in any shape or career because it really dictated all my choices in terms of what I studied, in terms of the jobs I was managed to take and stay in. I mean, before as a therapist, this is, it really can set you back and then other people are unable to work and it might really have put your whole life on hold and all your goals. So there can be huge amounts of shame around symptoms around impact on life, social comparison with others, the messages that are sort of passed down through family systems about mental health and culture. And I think. But you write some themes, it's like the self compassion is the exposure. And I see that a lot in real event because real event is something where people are judging themselves so harshly they're unable to see the wider context of whatever happened, the common humanity, the fact that other personally myself I get inquiries multiple times a week often about these sorts of things. It's just such a huge area of common humanity to have real event. I think OCD just latches onto either catastrophes about the future, hyper awareness in the present, or real event, false memory, uncertainty in the past. And to try to build a compassionate view of that history is the exposure, as you say, and very, very hard to do because it's like the shame is so locked in, you know, because they believe it protects people. It's like that's the way to protect other people. And you know, I've done this awful thing, what if I could do something again? I don't deserve to live, put my life on hold. And I think that kind of starting to open that up and look at that real event, whatever OCD theme it is from a compassionate lens to see that you do deserve a life. You know, I think that's a big part of OCD recovery because people will talk about like taking the risk risks in ERP and a lot of really lovely, kind empathic OCD sufferers will be like, I'm not gonna take the risk, I'm gonna put my life on hold because I don't deserve it because of my thoughts and what's happened. And I don't wanna put people at risk. And there's something about seeing that they're a person suffering who deserves a life and no one's asking them to put their life on hold. And if an educated person who understands OCD and mental health knew their situation, someone's going to say put your life on hold. That's a, you know, you deserve a life. So I think there's a compassionate exposure to sort of break the self punishment compulsion and start to go now I'm worthy of a life here. And that's a hard thing to do when you're just so afraid of hurting others.
A
Yeah, yeah.
C
A hundred percent.
A
Yeah.
C
I think shame is such a block
A
or barrier to recovery.
C
And yeah, you see so many people stuck and then that shame pulls them back into the compulsions and resistance of ERP or maybe any therapy, including ICBT and stuff. I'm sure it happens there too. Because I don't deserve to get better. That's the feeling of thought. Obviously it's nonsense. You do deserve to get better. But that, that's the. Yeah. And trying to, trying to break through that is really hard. But I've seen like sometimes maybe even with Real event where they are somewhat willing to try self compassion, you do it with them. There's often just floods of tears because you can see that self compassion is just like, maybe even for that split second, they're just completely eased up on themselves. It's a huge relief. Or unburdening.
B
Unburdening.
D
And there's potentially grief as well.
B
And yeah. Compassion Focused Therapy talks about we often have to grieve for the life we could have led that would have led to a more compassionate version of ourselves.
D
Whether that's attachment or other experiences. Sometimes we have to grieve that.
B
Yeah, I've seen it in people. And again, I've seen because I work with people with other difficulties, I've talked to clients who don't have ocd, have other difficulties, who've just happened to have told me about real event type childhood sexual exploration or things they've done that have hurt people in the past, that
D
they regret, things like that.
B
And they'll tell it in such a different way. And it's exactly the same as another client I'm working with Real Event, they've done the same behavior, but the person with, you know, higher sense of self esteem and worthiness and deserving can see it as like, oh, that was a mistake.
D
I've learned from it.
B
I'm a different person now. I'm moving on. But the person with high degrees of shame and vulnerability within themselves, it latches on. And I think understanding that wider pattern of shame, like why is someone prone to that? And it's normally other factors as well. Right. When people carry a lot of shame with their OCD theme, there are normally shame, interpersonal shame through relationships, there might be social anxiety, which a lot of people call a shame disorder. Really, there might be pervasive patterns of shame in work relationship, all kinds of goals, different things. So I found doing the broader exploration of shame as a timeline, I think you do the same. The kind of looking through someone's life and understanding what are these Critical incidences that caused shame or caused someone to be so vulnerable to shame. Firstly, to validate it. I mean, again, with any work on the past with ocd, we have to be careful that it doesn't become a compulsive ruminative process. If I figure all this out about my past, I'll cure my ocd. We've got to watch out for that. But when someone's ready to do it, to normalize and validate why it might be difficult to be self compassionate because of your history and then to work on some of the those incidents like trauma therapy, but working on the kind of shame wounds at these different developmental stages. I use self compassion to the past, which is a sort of act practice where we, you know, and it's in CFT and lots of other therapies as well, where you sort of connect with a compassionate version of yourself or perspective and then you go back to those earlier memories and you expose them really with emotional acceptance. So you do some exposure and feel the painful emotions and accept that and then extend self compassion. So it's almost like I think of it a little bit like, you know, in one respect you're doing a bit of prolonged exposure and then a bit of cognitive processing, but you're doing them both with an ACT and a compassion type lens. And I think it really can soften up those, you know, beliefs and that relationship with yourself that then leads to a more compassionate perspective in the present and.
A
Yeah, absolutely.
C
So should we try it now?
B
Yeah, yeah, let's do it.
A
If you want, you can lead me
C
through it and then anyone wants to follow along, please do so at your own risk. That's the disclaimer.
B
Yeah. And what I would say is like, this is not something to do on your own with intense trauma. You know, that's obviously something to do with a therapist. More experienced people can do this with trauma. I mean, I do this with traumatic memories and you can certainly work with trauma when you're in a place in your recovery where you know it's not going to pull you into PTSD symptoms or intensive compulsion and more ocd. So either listen, if you're unsure, just listen along and just take it in and understand the practice. But if you're more experienced and you're feeling a bit more familiar with kind of recovery skills in erp, then certainly
D
feel free to follow us.
B
So yeah, just sit in there comfortably and you can drop anchor to begin.
D
So acknowledge your thoughts and feelings gently notice what your mind is doing. Gently notice what you're feeling in your body. And then get into your body a little bit with some movements, stretching, shifting position, feel your feet on the ground, Showing that no matter what your thoughts and feelings are doing, you can take action with your body and then engaging in what you're doing in the present moment, focusing on this practice. And if your mind is very distracted, just gently noticing and coming back. And if you take the experience of shame, guilt, embarrassment, that perhaps goes along with your OCD and you just think and connect with that feeling for a
C
moment
B
and then you track that feeling
D
back into the past and you see where it takes you. It's almost like you've got a photo deck of photos of significant memories and you're flicking through them to see where it takes you.
B
So it might be the earliest experience you had when you felt this feeling.
D
It might be particularly intense period,
B
might
D
be relationship experiences or other difficulties. And you can just choose any memory. If you're not sure, just land on any memory or any time period and
B
go back to that memory.
D
And as you think about that memory, drop anchor again. Notice the thoughts and feelings. Accept any emotions in your body by gently observing them where you feel them. You can always open your eyes, you
B
can always come out of the practice
D
if you are not ready to do this. But staying with the emotion.
B
And then moving into a compassionate perspective. So it's almost like you step outside
D
of the memory as a compassionate observer, looking on at that younger self, seeing the context. So where were they, who were they with, what was happening, what led up to it?
B
And then speaking to that younger self
D
from a compassionate perspective. So what would you say to you? Validate and empathize with what they're going through. First of all, I see the pain you're going through. That was a really difficult interaction that was very painful experience of thoughts, feelings, the situation. So use your own language to empathize and then validate that the emotions made sense given the person you were at that time.
B
And then think about what they need to hear.
D
What did that younger self need to hear? Do they need someone to express unconditional self acceptance that they're worthy, that they're lovable, that they belong? It's not their fault. They didn't cause the experience, they didn't choose it.
B
If your mind resists that and says
D
no, you did, or starts judging you, notice that judgmental mind and then come back gently to the compassionate perspective and
B
offer kind, supportive words.
D
You might connect with a common humanity that they're not the only one going through this experience, that many people who struggle with their mental health have had the same experiences. They're not alone. And see if you can get a
B
phrase that captures compassion for you that
D
you can repeat a few times, something that acknowledges the pain and responds with kindness. And then moving into motivation and support as well. What would you say that reflects the journey they're on and where you're going to now in your recovery as you work on erp, act, icbt, other modalities, whatever you're working with, what compassionate words would reflect that? Keep going. Face your fears, observe your thoughts and feelings, pursue your values, trust your senses, whatever words work for you. And it's likely you will have some resistance. And notice the thoughts and feelings if your mind is judging or doubting. If there are painful emotions, notice them.
B
If you're ever overwhelmed in a practice
D
like this, you can always open your eyes, move, engage with the world around you a bit. Get active. Can build up over time. These practices are more difficult. And then saying any final words to that younger self can even give them a hug, if that feels like a authentic way to express compassion. And then letting go of the memory. And then back to your body now noticing your thoughts and feelings, accepting any painful emotion in your body, gently observe it, let it be there. And then you can offer any compassionate words in this moment for what you're going through. Keep going, never give up, keep working on your recovery, keep doing your erp, you've got this.
B
And also think about a compassionate action. So I always like to plan at least one compassionate action.
D
So this week, what do you need? What would support you? Is it something soothing? Is it social connection? Is it something proactive? Is it something fun or exciting? Is it restarting something? Is it taking action on something you're procrastinating? Just choose diffuse and choose one action that will be supportive for you this week and make the commitment you're going to do that. And then coming back to your body and engaging with the world around you, where you are, what you're doing.
B
Yeah, so, yeah, that's a practice I do with a lot of clients, especially people who have more shame or childhood invalidation, adverse childhood experiences, trauma, things like that. How was that?
A
That was. Yeah, that was good.
C
It was tough because when, when I, you know, I didn't consciously think of it, the memory that popped into my mind was one that, from my childhood where I think I probably one of the earlier memories where I felt inadequate or shame. And I definitely talked about it in therapy before and I got lots of great compassion from my therapist and that was very healing at the time, but I don't think I'd ever really given the memory self compassion. So it was hard being in that exercise. I definitely felt the pressure in my chest and the sadness. But it was nice to be able to be there for that younger me. Hug him, tell him exactly what he should have heard and. And basically offered to play with him in that moment, you know.
D
Awesome.
B
Yeah, that's exactly it.
C
Yeah, yeah. It was the play that was shut down.
A
So. Yeah, no, it was good though. It was hard.
B
Yeah, yeah. And I think sometimes we have to repeat with memories just like exposure.
D
Right. We just have to go over something
B
until you feel this deep, compassionate perspective. And sometimes we cry, but crying's not the only emotion.
D
Sometimes we feel numb, sometimes we feel,
B
sometimes we feel anxious, you know, all
D
kinds of different emotions.
B
Again, you know, if you're feeling like this is overwhelming, this is certainly something
D
to be doing with a therapist.
B
But for me, and I do a lot of these practices, I still, you know, I've done things like this for years and I still work on certain memories. And it's like you go deeper, it's like an onion, you know, you peel back another layer of shame, another layer of shame. And, you know, I think it's really powerful.
A
Yeah, yeah, absolutely.
C
It is, it is. And there's a ton of exercises. Right? That was just one.
B
Yes, yes. Yeah, yeah. I mean, I've got a lot on my Johnny say YouTube channel again, there's a compassion playlist which has lots and lots of practices. I like Paul Gilbert's work, I like
D
Chris Germer's work on compassion and Kristin
B
Neff and I also like the act compassion work.
D
So.
B
So Russ Harris's act, his sort of interpretation of compassion. John Forsyth, who's actually my ACT supervisor, he was one of the first people to bring practices from Pima Chodron and Sharon Salzberg and people like that into compassion based practices from these sort of compassionate teachers, really. So, yeah, I've been.
D
Been inspired and influenced by his work a lot as well.
B
But yeah, finding someone who talks about compassion in a way that resonates some practices, you need to often find the right voice and someone guiding you that you feel a connection with and that will vary greatly from person to person. But then doing those practices, things like loving kindness practice or there's lots of ACT compassion practices. If you Google Russ Harris compassion practices
D
and other things and lots on my channel.
B
So, yes, seeing it as a practice, I think in erp, using it as you start ERP using it throughout erp. And then as you finish ERP and deal with the backlash, you can have a compassionate inner coach the whole way through.
D
And I think Kimberly Quindler's book does
B
a really good job of articulating that as well. I'm going to have a. I'm actually in the process of finishing a book, an OCD book on existential ocd, and I'm going to have a big chapter
D
on compassion within that. So some of my ideas will be in that.
B
So yeah, lots of places.
A
Excellent.
C
And on that book, just when roughly will it be out, do you think?
B
Well, I think I'm finishing it all. Final delivery September. And then hopefully it'll be, I think, out kind of in the new year, but you know how these things go.
D
We'll have to see.
B
But yeah, I've pretty much finished it.
D
It's just. Yeah, the final sort of editing.
A
Nice. Oh, awesome. Awesome. Well, obviously we'll discuss it when it comes out. So.
C
Yeah, thank you for adding to this conversation and self compassion. I'm sure we'll do more in the future because it's definitely a topic that probably needs more screen time.
B
Yeah, yeah, yeah. I think there's so much we could say about it and I think, you know, it's repetition and it's practice and I'll certainly come back and talk away about it anytime you like.
A
Yeah, yeah, cool. Well, thank you so much, Jonny.
D
Brilliant.
B
Cheers, Stu.
A
Thank you for listening to this week's podcast and thank you to our patrons who helped make this episode possible. And if you would like to find out more about Patreon and the rewards and benefits, then there will be a link in the episode description. If you enjoy the OCD Stories podcast and would like to support us, please subscribe and rate the show wherever you listen to the podcast. And thank you to NOCD for supporting our work. If you want to find out more about nocd, you can click the link in the episode description and quick disclaimer. Guys, this podcast is not therapy. It is not a replacement for therapy. Please seek treatment from a trained professional
C
and until we speak. Take care,
D
Sam.
Date: June 21, 2026
Host: Stuart Ralph
Guest: Jonny Say, UK-based therapist, co-director at the Intricacive Centre for OCD Therapy
This episode centers on integrating self-compassion into OCD recovery, particularly within Exposure and Response Prevention (ERP) therapy. Host Stuart Ralph and returning guest Jonny Say explore why self-compassion is crucial, how it addresses barriers like shame and the inner critical voice, and practical methods for cultivating compassion, both in and out of therapy. The conversation includes personal reflections, real-world examples, and a live guided self-compassion exercise, making the episode invaluable for people with OCD, therapists, and anyone struggling with self-critical thinking.
Integration with ERP:
Jonny and Stuart discuss why compassion isn’t just a “nice extra” but a fundamental component of effective OCD treatment. Although ERP is the gold standard, shame often goes unaddressed, and without self-compassion, recovery can stall (04:20–09:20).
“You can sometimes have expansion in behavior, but not much change in internal relationship.”
– Jonny Say (08:55)
Widespread Adoption in the Field:
Both cite prominent ERP and CBT therapists and authors (e.g., John Hirschfeld, Charlotte Nicely, Kimberly Quinlan) who incorporate compassion strategies, showing it’s becoming mainstream (06:10–08:15).
Direct Targeting is Necessary:
Self-compassion is not automatic for most people with OCD; it’s a skill requiring explicit focus and practice, much like other therapy components (05:29–07:38).
“No one with OCD hears about self-compassion and immediately can implement it… It’s very difficult. So how you work against the barriers would be a good one.”
– Jonny Say (05:10)
The Link Between Shame and OCD Severity:
High levels of shame can correlate with severe OCD symptoms, and shame is prevalent across all OCD subtypes, not just “taboo” themes (03:34–04:20; 18:40–21:30).
“Some people, practicing self-compassion becomes an exposure in and of itself, because it’s triggering those fears and that OCD.”
– Stuart Ralph (18:34)
Origins of Self-Criticism:
The “inner critic” often arises from learned patterns (parenting, culture, achievement expectations) and becomes internalized as a form of motivation, although it's often counterproductive (11:30–13:43).
Celebrating Wins as an Antidote:
Reframing self-talk to praise achievements, even small ones, can help counteract the critic and foster resilience (12:03–12:34).
“If you’re gonna berate yourself for your perceived failures, then you better praise yourself for your wins.”
– Stuart Ralph (12:32)
The Exposure of Self-Compassion:
For people with shame-based OCD themes (“Real Event,” POCD, taboo thoughts), practicing compassion is itself an exposure, challenging deep-seated beliefs about unworthiness (18:34–22:27).
Self-Compassion vs. Self-Criticism:
Cultivating a compassionate internal voice improves motivation, supports repeated attempts at ERP, and helps move through setbacks without spiraling into avoidance or depression (11:30–14:43).
Changing the Internal Dialogue:
People with OCD often undermine their own progress. Shifting the inner dialogue to one of kindness makes recovery more sustainable (09:22–11:30).
Deeper Healing & Grieving Past Losses:
Self-compassion practices can bring up grief for the life not lived due to shame, and offer healing at the root of longstanding self-critical patterns (23:29–24:15, 23:32).
“We often have to grieve for the life we could have led that would have led to a more compassionate version of ourselves.”
– Jonny Say (23:32)
Timeline Work on Shame:
Mapping a shame “timeline” helps contextually validate why being self-compassionate may be so hard—often linked to early experiences or relational trauma (24:35–27:06).
Psychoeducation & Dialogue:
Therapy starts with understanding and challenging beliefs about compassion, addressing fears, misunderstandings, and resistance (14:43–17:41).
Language Practice:
Self-compassion is like learning a new language; repeated practice with the support of compassionate others (therapist, friends) is key (14:43–17:41).
“You start practicing every day… then you stop practicing and then think, God, I better start practicing again… and then that speaking the language makes it more and more natural.”
– Jonny Say (16:49)
Build Compassionate Communities:
Encouraged forming relationships with nonjudgmental, supportive people (friends, support groups, OCD community) to reinforce the new language of compassion (17:16–17:41).
On Compassion as Exposure:
“For some people, practicing self-compassion becomes an exposure in and of itself because it’s triggering those fears and that OCD.”
– Stuart Ralph (18:34)
On Balanced Self-Talk:
“You gotta see the facts. You gotta be balanced.”
– Jonny Say (12:43)
On Grief and Growth:
“Sometimes we have to grieve for the life we could have led that would have led to a more compassionate version of ourselves.”
– Jonny Say (23:32)
Jonny leads Stuart (and listeners) through a vivid “self-compassion to the past” exercise:
Jonny’s Guidance:
“This is not something to do on your own with intense trauma… If you’re ever overwhelmed, you can always open your eyes, move, engage with the world around you… Build up over time.” (27:19, 34:51)
Reflections (37:34–38:33):
Stuart shares the exercise brought up an early childhood memory. Even after past therapy on that event, directly offering himself compassion in this way was powerful and emotional.
“It was hard being in that exercise. I definitely felt the pressure in my chest and the sadness. But it was nice to be there for that younger me, hug him, tell him exactly what he should have heard…”
– Stuart Ralph (37:35–38:23)
Books Noted:
Both speakers emphasize the need for repeated, ongoing practice, not just intellectual understanding. Building self-compassion is a gradual process that profoundly shift’s one’s relationship with OCD and oneself.
“It’s repetition and it’s practice… I’ll certainly come back and talk about it anytime you like.”
– Jonny Say (42:13, 42:20)
This summary preserves the tone and spirit of the original conversation, condensing rich therapeutic insights and exercises into clear, actionable takeaways. For therapists and OCD sufferers alike, this episode serves as both resource and encouragement to practice the often-challenging—but essential—work of self-compassion.