Robert Fox, a therapist in Woburn, Massachusetts, also wishes more people knew about IFS. Diagnosed with obsessive- compulsive disorder at age 21 after a lifetime of unusual compulsions, Robert spent 23 years receiving the standard care: cognitive behavioral therapy (CBT) and exposure response  prevention (ERP).

Neither had much effect, especially ERP, which involved repeatedly exposing himself to things he was anxious about in the hopes of gradually habituating to them. “When you think about it, it’s a very painful method of therapy,” he says.

Robert discovered IFS in 2008.Before, he had always been encouraged to think of his compulsions as meaningless pathologies. Now, for the first time, they began making sense to him as the behavior of protectors who were trying to manage the underlying shame and fear of exiles.

( in “Inside the Revolutionary Treatment That Could Change Psychotherapy Forever” July 21,2020. Elemental)

For more info about Robert Fox please visit Rob's website

 

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Today on IFS Talks we're speaking with Robert Fox. Robert Fox is a therapist in Woburn, Massachusetts, who wishes more people knew about IFS. Robert was diagnosed with Obsessive Compulsive Disorder at age 21 after a lifetime of unusual compulsions. Robert spent 23 years receiving the standard care – cognitive-behavioral therapy and exposure response prevention. In 2008, Robert Fox discovered Internal Family Systems therapy. Before, he'd always been encouraged to think of his compulsions as meaningless pathologies. Now, for the first time, they began making sense to him as the behavior of protectors who are trying to manage the underlying shame and fear of exiles. Now, Robert is an IFS level 3 trained and certified and EMDR certified therapist. He's also trained in AEDP. Robert, welcome to IFS Talks and thank you so much for being here with us today.

Robert Fox: Thank you. It's great to be here and I appreciate the warm welcome.

Aníbal Henriques: Thanks much, Robert, for sitting with us and willing to have such an open conversation. Robert, this bio of yours that Tisha just read, was published in July 2020 on this article called Inside the Revolutionary Treatment That Could Change Psychotherapy Forever. And it also says “After two particularly powerful unburdenings, his symptoms abided by 95% and stayed that way.” And then this article quoting you goes: “OCD used to be almost like kryptonite around my neck when I would have serious flare ups. I feel a lot of freedom and peace and I really owe it to Dick Schwartz and the model. So, Robert, was this symptom reduction of yours really like this article reports?

Robert: Well, you know, the humorous thing about OCD is there's a lot of doubts sometimes when OCD is pretty extreme, it's kind of a doubters disease in a way or doubters condition. And when you say that question, it's interesting because I can quickly flashback to “Oh, is that really true? 95% reduction, maybe, maybe it's overstated.” But I do feel really good. I mean, compared to where I was back in, say 2010, it's been an amazing journey and I have to say, yeah, it's pretty good that I'm at this place.

Aníbal: Amazing.

Robert: And I'm so grateful for it.

Aníbal: Beautiful.

Tisha: I was wondering if you would share with us what it was like to be diagnosed with OCD and what some of your symptoms were like?

Robert: Yeah, so, I was diagnosed as the introduction said at age 21. I had a psychiatrist who actually told me over the telephone when he seemed to have been a little bit frustrated with me, which is understandable because OCD can be so challenging even for very very, you know, experienced therapists. And he was a bit, I think if I'm not mistaken, a little bit frustrated at the time with some of my symptoms. So, at 21 is when I was diagnosed, but I had the symptoms pretty much since I was, as far back as I can remember. A lot of symptoms of needing to confess things to my parents or others due to extreme guilt. The word shame was not part of my vocabulary back then, but I certainly felt it as I now look back on it, for sure. That is a hallmark that I have found in my work with clients with OCD is that it seems to be shame is a very big part of what drives some of the symptoms of OCD.

Aníbal: And not so easily seen by those that carry this kind of struggle, right?

Robert: Right. I didn't see it myself until one day I was out for a walk with my dog Gizmo around my block, walking around the block with him and I had been to all these lectures about shame and I was walking one day and all of a sudden it was like, it just came to me “Holy, Holy, Holy shit. I carry that shame.” And it was like a dark cloud that was overhead and just kind of followed me wherever I went. And it was actually not an awful thing to realize. That's what had been basically walking around on my back for so long. It was this deep shame.

Aníbal: Besides this need to confess things to those around you, what type of obsessions or compulsions have you struggled with?

Robert: Well, I had the usual, like a need to hand-wash, need to touch things a certain number of times to feel just right. I remember very much being a little kid, my parents would call me for dinner, and I'd be downstairs needing to touch something so many times to land on an even or odd number or a number of times that I touched something in order to feel enough freedom to move to go upstairs. And until I did that I was left with this sort of aches in my body. So those are pretty typical that are out there in terms of what others suffer from. Yeah.

Aníbal: And what has been your lowest moment in your struggle with OCD?

Robert: Ah, you know, it's hard to say the lowest because there's so many, but, you know, fortunately that feels in the distant past, but I think when I was riding on a shuttle bus or van to the mall, when I was a patient at a hospital here in Boston -McLean hospital, and I had been in that unit for about five weeks and on the weekends it's a very, it's like a skeleton crew there. And they would take us on these like field trips. And I was sitting on the bus and I just felt very hopeless, like “Wow, how did I get here?” That was probably one of my lowest moments.

Aníbal: How old were you back then?

Robert: That was a 2010. So, I'm 56 now. So, 40, 46, well 45 years old. Well, one way I was grateful that I was getting treatment. There's so many people who don't have access to treatment, but what made it lower than low was I was actually getting worse even after four or five weeks in the hospital there. And so therefore my hope was fading. I still had some hope, but it felt pretty dismal that I wasn't improving.

Aníbal: What kind of treatment where were you having at that time?

Robert: I was receiving what was considered sort of the gold standard still in, you know, in terms of evidence-base, which is a type of CBT or cognitive-behavioral therapy or exposure response prevention, where a person is repeatedly asked to expose themselves to a very unpleasant material. Material that's very triggering for the anxiety. And it's understood that that will happen, that you will habituate to that anxiety after it gets to a certain peak and then it'll start to come down and that can be in the form of behavioral or thoughts. And it's hard. It's hard to watch. There was a young lady in the unit who had a difficulty with feeling contaminated by like things in bathrooms. So, she was asked to rub her hands all over the toilet, the sink all around and then put her hands in her hair and then be with that feeling for a certain amount of time and just sort of habituate to that anxiety. But it's meant to be, it's meant well, the intentions are good, but unfortunately, it's painful work, no doubt.

Tisha: It sounds incredibly painful.

Robert: Yeah.

Tisha: Yeah. Did it ever feel for you like it was supportive?

Robert: In the five weeks that I was there, it's strange, but I never did the type of, well, I’m not here to blame people in the unit that had good intentions...

Aníbal: Of course.

Robert: But my type of issue was called sort of relationship OCD. I obsessed about whether the person I was married to was the right person. And I never really got into that work in that unit. I was just sort of living there. It's strange that I never got to that work, but even when I did an outpatient, I didn't benefit from it, you know, the typical ERP or exposure response.

Tisha: So, it sounds like, we're piecing together more of your story and your life experience, it sounds as though it's been something that you've been living with for a really long time. It sounds like it was there when you are young around relationship with parents and then morphed into relationship with your wife or your partner.

Robert: Absolutely.

Tisha: What was it about growing up that brought these symptoms on? What were some of the circumstances that set the environment for you?

Robert: Yeah. I like what Gabor Maté says, you know, he's a person who works with addictions and trauma. There's no benefits of blaming parents, their intentions are always, are usually very good as was my parents. My parents, I know, love me very much. They're still both alive, not knock on wood. I was very attached to them emotionally when I was a kid, a psychiatrist that I saw said we were almost attached at the hip, that we were so close. And being sensitive and being very close to my parents I had tremendous anxiety whenever I would leave their presence like to go to camp for overnight. So, you know, I was so anxious when I was not in their presence that these obsessions and compulsions was probably my way of being able to almost regulate, in some way, the anxiety that was way too much for me when I wasn't in their presence, that was a harsh way for me to regulate, but it was a way for me not to probably be overwhelmed with something going on around me, whether it be the social scene at camp or school and college where freshman year, I was like, remember sitting in the dining hall, my freshman year, feeling overwhelmed with extreme feeling of loneliness frightened out of my mind.

Tisha: You're answering it so beautifully and I also appreciate like the parts language in there of understanding the purposefulness of what the OCD was doing, you know, and how helpful might have been early on to have that functionality of the parts that were checking as part of your language and part of the understanding.

Robert: I never knew that's what the OCD was doing. I never realized how much of my feelings were dissociated in a way from...you know, I was definitely anxious. I knew that, but I didn't know that the OCD was a way that my body was trying to help me get through

Aníbal: Ok, makes sense. Tell us, Robert, how did IFS help your OCD?

Robert: Well, after that hospitalization, I was, as you can imagine, in a pretty, pretty dark place. I came out of the hospital due to my insurance running out, but I actually was glad at that point to not be there anymore because I was getting worse and worse. Again, I'm not here to blame the hospital. I just, I was in a rough spot when I left. So, I was actually, I had already done Level 1 of IFS training and it was in Level 2 that I really struggled. And it was during that Level 2 training of IFS that Dick Schwartz did a demo with me, which is not uncommon in trainings. And I was so desperate for some healing and I already knew Dick by then that I could trust the process. So, we did this unburdening where this load of emotion came out. That was transformative, as you all know, because you all been through these. So, you know what it's like, I remember going out that night with my friend who had come to visit me in the hospital and I just felt so lighter in just that one demo and unburdening, I knew I had a lot more to do still, but I already was on my way, like something there clicked. And it was like, you know, like the sun was coming up again, you know,

Tisha: Are you open to sharing what the exile was carrying or what it was that got unburdened there?

Robert: It's interesting, as you say that I can feel in the back of my neck, this tingling, because it's still very powerful just that one time. I was dating someone who I couldn't decide whether to stay with or not at the time. No, it wasn't during the training. It was that the demo I did with Dick Schwartz was about what I carry from dating someone years ago. And you know, that was the theme. I couldn't decide whether to stay with her or not this girlfriend. And I carried a lot of anger, particularly at my dad who in the best way, or his intentions were good and that he said “If you don't stay with this young woman, then you can't come home.” I was, at that time, the time I was dating this young woman living with my parents. And he said, “You cannot come home and live with us anymore. You won't be welcomed.” And that statement from a father would have been so loving, hit me like a ton of bricks. And I remember in the demo yelling out something, all this anger, because I'm a fairly soft-spoken person. I don't usually get angry. And I was able to express that anger, which really was a protector of a terrible fear that my father was dumping me as a son basically. And that anger was protecting that awful feeling. And I had held that in my body for so long, that anger. And when I was able to unburden that exile of I'm shameful or something for having not done what he told me to do, which is stay with her...That's the feeling I had, it was like a ton of bricks had been lifted off my shoulders. And I remember Dick said “Are you open to looking around the room?” This was in the demo and seeing the faces of your peers. And I remember almost like I wanted to look through my fingers so I wouldn't see all their faces because I was worried that they would be looking back at me with shame. And instead I saw, just what I'm seeing right now, your two faces with this big glowing smiles. And it was the most, it was the most powerful sense of love that it gives me tingles right now because that shame was being unburdened. And that's when I knew I was onto something, well, Dick was onto something...

Aníbal: You both.

Robert: Or the group that, the energy of the room again, you know how it is. It's just unbelievable.

Aníbal: I know. Yeah.

Robert, this relates with what you say. You say that “when emotions are suppressed, particularly anger, these emotions find themselves attached to a compulsion.” Can you say more about this that you just illustrated so well?

Robert: Yeah, I didn't quite really realized this until about a year ago. I believe it, or two years ago I was working with some clients with OCD and I came to this realization that when I had the physical compulsion to like put things in a certain place, like sweaters, it brought me back to an argument I was having with my wife where I didn't feel heard or understood by her. I actually felt like I was being dissed and she just walked away. And I had this urge to redo what at the time I was arguing with her, I was putting things in my closet and I had this urge to straighten them out again. Almost like my anger was stuck in these clothes and having straightened it out. And it was like, I had taken that anger that I didn't allow myself to seal and almost transferred it to an obsession or compulsion. It was a protector, because I was afraid of my anger. I was afraid that that made me bad, which is a common theme for a lot of my clients, that they're bad. And would it be like if they were bad or I was bad, which is really a definition of shame, that I'm bad. So, when I talked to some of my clients, now I say, I asked them “Do you feel that you're bad?” It's a very important question. Anyway, I know I'm rambling a bit, but...

Tisha: Oh no, that's, it's very clear. We know that in your work that you work with clients who also struggle with addiction and you have noted that there's similarities to OCD. And, you know, I'm appreciating the, as you're describing, the way of working with the sweaters to transmute the anger that...I'm just appreciating the sophistication of the protectors. And so, I'm curious about your observation of the similarities between addiction and OCD.

Robert: Well, first of all, a lot of clients with addictions, whether it be chemical or behavioral carry shame as well. And there's a feeling of, with OCD of not being able to stop something that you're doing, even though there's a rational part of the brain that says “I know that this is excessive. I know that what I'm doing is out of the ordinary, but I can't stop.” So that's why addiction work felt in some ways, very similar. While drugs and alcohol or gambling and things like that weren't my vice, I still had a compulsion to do something, which I never realized was trying to, in a way, help me. I always thought of it as it's just a problem that I need to get rid of. And that's one of the wonderful benefits of IFS is that when we look at these firefighters, as we call them, behaviors, if we look at them in a new way with compassion and curiosity, rather than something that we need to get rid of, it's understandable we want to get rid of them, they're causing us problems, but we need to open in a way, if we can do it with the help of a therapist, to how these parts are trying to help us as I do with people with addictions, whether it be heroin, alcohol, most people say “I hate that part of me, or I hate that I can't stop.” But if we get curious about it and we show, you know, we help these clients see how that part's trying to help and help those parts become more moderate rather than extreme, then things start to happen.

Aníbal: Yeah. Beautiful.

Robert, you say also that OCD clients will do anything to avoid an intrusion. And you say intrusions may mimic intrusive thoughts from parents. Can you say more about this?

Robert: Yeah. Some of these things have come to me just only in the last year or two, believe it or not. Intrusions are debilitating for clients with OCD, as well as myself. They have been. Intrusions for me were often thoughts, like “What if I can't? What if I'm not good enough? What if, what if I'm inept as a therapist? What if I'm shameful?” One such intrusion happened after I had a panic attack in 2010, when my OCD hit a head, I had a panic attack in front of a couple. And from that point on, I thought “What if I can never focus again because I'm so worried about having it happen again?” And what Dick taught me was, if you don't fear the part - was the statement - If you don't fear the part and one has to fill in what the part is, then it can't hurt you. And for me, the part was shame. If you don't fear that you're shameful or that I am shameful. If I don't fear that, then that doesn't own me. It doesn't run my life. So, you asked about intrusions, one such intrusion was “What if I am not good enough? What if I'm, what if I have another panic attack and someone sees that and judges me?” So, in a way it's kind of like going back to exposure therapy. “What if I accept that if I make mistakes, what if I do have a panic attack?” And I learned to almost say “So what? I'm still a decent person. I may even be still a decent therapist.” So, intrusions, if we almost start to not fear them, then they don't run our lives. Now, my parents, as loving as they were, I always couldn't get their thoughts out of my head and that was kind of an intrusion, what they thought. And I even at one time yelled out loud when I was so frustrated in 2010, I wish I could get my father's comments out of my head. So that was a form of an intrusion. And then, in a way, it's like I didn't have, I think, enough boundary between my folks and my parents for whatever reason and I was trying to get that space from those intrusions. And I think obsessions and compulsions mimic sort of that lack of boundaries in a way. It's kind of like, we fear them taking over once, like an exile.

Tisha: When you hear your parents voice in your thoughts, does it feel like that is a protector that has evolved to mimic the voice? Or does it feel like it's like the parents' energy in you that needs to be separated and moved out? What have you discovered around that?

Robert: Yeah. Good question. Let me think about that because I'm not sure right away. Let me see.

Tisha: I think about it in terms of like critics, like hearing that like critical mom's voice or...

Robert: You just made me think of something. So, here's an example to give some information that might help. So, in two thousand 16 or so, I started after a good six years for my lowest moment in 2010, I started feeling like things are coming around. My practice is going well. And my parents visited my office in Woburn where I work and they were so happy for me that I was doing well, but my mom with good intentions said “You know, Rob, your shoes could be shined a little bit more and you could straighten things up here in the office a bit more...

Aníbal: Moms.

Robert: Because people make judgements based on what they see. There was my mom trying in a way to help me, but her, the critical voice was what I took in and internalize. And that's an example where I would hear that inner critic. The fact one of the hardest things I had to work with was my own inner critic. So, learning that inner critic is there to help, that part is trying to help, but if it's too extreme it can take over and almost overwhelm. So, I've learned to do that over the years. My latest thing is now that I've worked with my own inner critic is how do I work the inner critic of my partner or the critic part of my partner, because she's there too. She probably has good intentions, but it's hard.

Aníbal: It’s hard.

Are you in your highest moment in healing from OCD?

Robert: My highest moment in my healing from OCD or life itself is finding this community of IFS practitioners and therapists, as well as just feeling like I'm in a way home. I don't have to run anymore from feeling judged, or it's also a way of life for me now where I bring sort of like a humble sense to things or what they call a beginner's mind. I try to look at it as we're all, just trying to go through life here and learn. And when I first got out of grad school, I always thought, well, I'll never show the parts of me to other therapists that are inside, all my demons and exiles and all that. I don't want them to see all that. So, I would never share. And when I realized it was a community of therapists that were welcoming and they also have their own stuff and that we could talk about it and work with it in a really sweet way, it was like a breath of fresh air that I didn't have to hide under a shell anymore.

Tisha: I so appreciate you naming that because there is just a level of authenticity that is in this community where you really can be your faulted parts, your broken parts, your ambitious parts, there's permission.

Robert: Thank you for saying that. I never imagined being here, right with you guys, talking about OCD. Something that I never wanted people really to know about at one point. And here I am talking on a program that will be aired, you know, essentially to the world, if they are able to, you know, if people have interest, you know, there'll be able to be vulnerable and still feel safe in a way.

Tisha: Yeah, it's a gift.

Robert: A very much one.

Tisha: Yeah, I appreciate it.

Robert: This model of therapy is unbelievable in that way.

Aníbal: Robert, you say that most clients don't make a connection between their obsessions or compulsions and their exiles; you say it's dissociated. How can we help clients with this?

Robert: I'm working with clients who say, I got to just do what I got to do. And with the compulsions and obsessions. And, you know, as a therapist, as a person, I just have to be gentle with it. It takes time. It took me many years from when I started doing IFS to really make the connection. It just takes time. And, you know, I will say I do add in another therapy, EMDR, Eye Movement Desensitization and Reprocessing, when some of these things are so dissociated, I do add that in as well. It helps clients sometimes make connections between different memories in a safe way...

Aníbal: Ok, makes sense.

Robert: But it does take time. I mean, people have asked me “Well, how long did it take once you discovered IFS?” It took me a while. I mean, it takes work, but compared to other things that I had done for 40, 50 years, it's relatively short.

Aníbal: You also say that shame plays a big, big role. What is the role of shame when it comes to OCD?

Robert: Well, you know, it's one thing to say I did something wrong. We that I feel guilt if I did something wrong, whereas definition of shame is I am wrong, I am bad at my core. Some people define it that way, which I tend to agree with. That's how I often felt. I felt shame from the OCD itself, because think of the word Obsessive Compulsive Disorder, you know, we have this disorder. What's nice about IFS is it's a non-pathologizing model, but there's shame from just having the disease or disorder or the condition. And then I had shame of feeling bad about things unrelated to the OCD. Shame is a beast. It leads us to cower, to not want to be vulnerable. But the key to sort of working with shame is actually to allow ourselves to be vulnerable. That's what we're doing right here.

Tisha: That’s right. Is there anything that you would like to share with some of our listeners who I know there's a number of them who struggle with OCD? Is there anything that you'd like to have out there?

Robert: Well, I want them to know that there's hope because when I was riding on that van at the hospital, I was like “Wow, I'm a therapist and I'm struggling with this condition.” So, I want them to know there's a path to this healing that we need that really works. And to just keep trying, if it's not the right therapist, it takes time to find one who you feel comfortable with. Safety is so important to feel safe with. I've been to many where unfortunately was not feeling very safe. I was told by one psychiatrist when I was 15 to just grow the F up or man up. Looking back now, I know it sounds maybe like I'm being too easy on him, but he probably had good intentions thinking that was the way to get me better. But I remember as a 15-year-old, having heard that, that I needed to just grow the F up, that that hurt so deeply, but there's other ways as we know now, compassionate ways to be with clients. So, keep finding, keep trusting yourself to find the person, the therapist who uses an approach that brings more compassionate and humanity to this psychology in our healing. I want people who are suffering to know that from me, that trust your gut and find someone whom you feel safe with and comfortable.

Aníbal: Robert, OCD can sometimes really cause severe harm in our lives. Some say OCD is a form of mental illness, a chronic one with no cure. Do you want to comment on this?

Robert: Well, there's definitely a treatment for it. I wouldn't say I'm ever cured. It's always a work in progress. I want people to know that there is treatment for it, that it is so workable. It just requires someone who gets it. And someone who understands that these parts of us that are at times obsessive or compulsive are parts that are just really trying to help. They're not, as I was taught many years ago, when I would talk about my obsessions and compulsions, there was, I remember very distinctly a therapist would put them on a list and say, these are meaningless. These don't have any purpose. We just need to label them and say, these are just something that happens that we need to just identify as not having much of a purpose. They do have a purpose. It is parts trying to help us. So, there is a lot of help for them.

Aníbal: Thank you so much, Robert, for having us and for being so open and sharing so much of your personal struggles, it was really special to be here with you and Tisha and I hope we can keep meeting, sharing this model, our work, our lives. Thank you so much.

Robert: Thank you. It's been quite a journey and it's still going on.

Tisha: I so appreciate meeting you and speaking with you today. And I know this is going to be a valuable episode for so many people. Thank you.

Recorded 18th February 2021
Transcript Edition: Carolina Abreu