0:04

A lot of body-focused behaviors do arise around

0:06

adolescence, and there usually is some kind of

0:08

a trigger that is one

0:10

of those attachment disruptions. But

0:13

one thing that I discovered only after really

0:15

being in the field and really studying, hearing

0:17

from the parents of teenagers I work

0:20

with, and also learning more

0:22

about the early lives of my clients, is

0:25

that a lot of times there was also

0:27

a disruption in those very, very early years,

0:30

zero to two. There's

0:32

also a sensory processing issue that

0:34

develops at a very early age.

0:36

And so I've really been studying

0:38

how sensory processing and

0:40

difficulties, disruptions in attachment all kind

0:43

of come together to lay the

0:45

ground for this to come out

0:47

later in life. Welcome

0:51

to Therapist Uncensored. Building on decades

0:53

of professional experience, this podcast tackles

0:55

neurobiology, modern attachment, and more in

0:58

an honest way that's helpful in

1:00

healing humans. Your session begins

1:02

now with Dr. Ann Kelley and Sue

1:04

Marriott. So

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com slash tu. And remember, by checking

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out our sponsors, you are helping to

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support the show. Some rules and

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restrictions may apply. Hey everyone, this

2:34

is Anne. You know, we can

2:36

all relate when we are under stress doing

2:39

certain things to help self-soothe ourselves, whether it's

2:41

biting our nails, hair pulling,

2:43

maybe skin picking, or biting

2:45

your cheek. These are all

2:47

behaviors we do unconsciously to self-soothe,

2:49

but sometimes these kind of behaviors get

2:51

out of control. And when

2:54

they do, they're really a painful source of

2:56

stress and shame. Today,

2:59

we're gonna bring you a new

3:01

attachment-informed psychodynamic model for treating these

3:03

type of painful, shame-associated behaviors. My

3:06

co-host, Sue Marriott, talks with our guest,

3:08

Stacey Nickell. So, for

3:10

the past 20 years, Nickell has worked

3:13

with people who struggle with body-focused, repetitive

3:15

behaviors. She is a certified

3:17

group psychotherapist and provides workshops and

3:20

institutes, both locally right here in

3:22

Austin, Texas, with the Austin Group

3:24

Psychotherapy Society, as well as nationally

3:26

with American Group Psychotherapy Association. So,

3:29

today, Sue and Stacey shed

3:32

light on these often-hidden patterns, and

3:34

they're also gonna discuss Nickell's new book, Treatment

3:36

for Body-Focused Repetitive Behaviors.

3:39

Hey, Stacey, welcome to

3:41

Therapists Uncensored. Thank you. It is

3:43

really good to see you. Why

3:45

don't we just start out by, kind of

3:48

if you'll orient everybody to who you are and your

3:50

perspective, and then we are

3:52

gonna dive into this super-interesting conversation. Yes,

3:55

okay, good. So, I'm Stacey Nickell. I'm

3:57

a licensed clinical social worker, and

3:59

I've been. been practiced in Austin, Texas since

4:01

2007. This

4:04

whole time I've been specializing in body

4:06

focused repetitive behaviors, like skin

4:09

picking, hair pooling, and cheek

4:11

cuticle, and nail biting, and

4:13

I've really worked on developing

4:15

a psychodynamic approach to working

4:18

with this population. And finally,

4:20

I was able to kind of get my voice

4:22

out into the world with my new book, Treatment

4:25

for Body Focused Repetitive Behaviors, an

4:27

integrative psychodynamic approach. So I'm

4:29

really excited to be here and to talk a little bit

4:31

about my book. Yeah, definitely. And

4:33

another thing that I just happen to know

4:35

about you, we are colleagues here in Austin,

4:38

Texas, and I've had the pleasure of working

4:40

together before, is that you're also a

4:42

boxer. A boxer, yes.

4:46

My history is an amateur boxer, and

4:48

I must say, I am now a

4:50

coach, an assistant coach for a

4:52

women's boxing team. And I have to say, I like it

4:54

better when I get to be on this side,

4:56

and I don't have to be hit ahead more.

4:58

But it was fun at the time. That's

5:02

just such a fun fact. So

5:06

tell us, how did you get interested? You

5:08

said that this has been your specialty, kind

5:10

of, that you've really focused on it. How

5:13

did you get interested? And then right away, because

5:15

this will be an unusual topic, body

5:18

focused repetitive behaviors. And we

5:20

can just jump in and talk about that specifically and what that

5:22

is. Sure. So one

5:25

of my first jobs out of grad school

5:27

at OutYouth which is an LGBT teen center,

5:29

I had a woman, a young

5:31

woman, come to me and tell me that she

5:34

was pulling out her hair. And she

5:36

asked if she could join my self-harm group that

5:38

I was starting. So I told her,

5:40

of course you can join the group, but let me find

5:42

out more about hair pulling. And then

5:44

that's how I even discovered the term trichotillomania.

5:47

So as I was doing that initial research, I

5:50

found that there was really only one perspective. It

5:52

was all cognitive behavioral. So

5:55

since I came from a psychodynamic perspective,

5:57

I had to start kind of developing.

6:00

helping my own way of treating her from

6:02

that very first moment. And

6:04

she actually really did

6:07

get better through our time together, both her

6:09

time in the group and our

6:11

individual work together through about six months.

6:14

And I was kind of hooked on this

6:16

ability to kind of follow her

6:19

hair pulling journey told me

6:21

so much about what was happening in her

6:23

life at each time and in her relationships

6:26

at each time. It was a really fascinating

6:28

journey for me to help her work through

6:30

some of those attachment pieces and early

6:32

divorce of her parents and how

6:34

that affected her. And then

6:36

to also notice that when she

6:38

was feeling really supported and really connected

6:41

in her life, her hair pulling started

6:43

to disappear. So that relational connection fascinated

6:45

me and I just kept going. Yeah,

6:48

and it wasn't there. As you looked for

6:50

things, you know,

6:53

nobody had given us attention related to the

6:55

unconscious process or anything like that. Right.

6:58

And unfortunately, even though that was all the way back

7:00

in 2002, that still was really the

7:04

state of the field. There have been some

7:07

therapists who have written some peer reviewed

7:09

articles with case studies on

7:11

the psychodynamic approach, but this is actually the

7:13

first book on this

7:16

approach. And looking at a depth

7:18

perspective rather than looking at the

7:20

symptom itself as the symptom, which

7:22

I think is really important to

7:24

get into the roots and understand

7:27

what's driving the hands to

7:29

mess with the hair and skin. So this

7:31

is still state of the art right now.

7:34

Just beginning to come into

7:36

more of the mental health field is

7:39

this idea that it might be actually more

7:41

complicated than just treating the behavior. Yeah, for

7:44

sure. So you're a pioneer. You're a

7:47

pioneer. Definitely. I am. I'm

7:49

sort of an unlikely pioneer. I really wanted to

7:51

find this book. And since I couldn't find it,

7:53

I just had to write it. And

7:56

I'm glad I did. But I really didn't know it

7:58

would take me 10 years. And

8:01

lots of blood, sweat, and tears. So that's where we are. Yeah,

8:04

as somebody also in the writing process same thing It's

8:06

like oh my gosh I cannot believe how long mistakes

8:08

and then you learn more you learn more so you

8:10

have to go back and you know

8:12

modify and Yeah, so that's

8:15

exactly was there anything

8:17

personally? That drew

8:19

you to this area because honestly, it's

8:21

a hard subject to talk about Like

8:24

I imagine like the feelings that it evokes

8:26

around the hair pulling and the skin picking

8:28

Not everyone would be drawn to that I would

8:31

imagine as a matter of fact I'm imagining just

8:34

even having this conversation. It's it can be hard

8:36

to but there's something about it that evokes Those

8:39

difficult feelings. Yeah, that's true a

8:41

lot of disgust and sort of

8:43

shame Really that

8:45

the people struggling with this also carry and

8:47

that the therapist have to kind of work

8:49

through in order to address it But yeah,

8:51

there there certainly was but I didn't realize

8:53

it when I had that first connection to

8:55

hair pulling with that client I

8:57

didn't realize it was connected to my lifelong

9:00

struggle, which is with skin picking And

9:02

so once I put that together and the

9:04

fields really hadn't recognized skin picking either so

9:08

Recently in the DSM

9:10

5 was the first time skin picking

9:12

became a diagnosis So as

9:14

I learned more and more about hair pulling I began

9:17

to connect it more to my own struggles

9:19

with skin picking and they're very similar Very

9:21

connected and so as I started to write

9:24

this book I was really also figuring out how

9:26

to heal myself and Through

9:28

the writing of the book is really how I was

9:30

able to let go of most of my reliance on

9:33

skin picking So I'm sort of

9:35

a case study number one of how finding

9:37

that narrative and getting that story Out

9:41

of myself really helped me let go of

9:43

this behavior. Oh my gosh

9:45

I really appreciate you sharing that in it But

9:47

is and isn't that almost always the case as

9:49

we're drawn to this that we've got

9:51

to look in the mirror first and do that

9:53

So you weren't aware that there was this competing

9:55

thing? So I'm imagining people are listening and they're

9:57

like, you know, I play with my

9:59

cuticles help us understand what

10:01

where it crosses over into a problem

10:04

or disorder? Yes, that's a great question.

10:06

So first of all, all of

10:08

us do engage in some kind of body focused

10:10

behaviors and partly we

10:12

are animals and all animals

10:15

groom and we groom like

10:17

all animals do and picking

10:19

at things and plucking hairs

10:21

and getting dead skin off as

10:23

part of the grooming process. So all of that

10:26

is very healthy and important and

10:28

natural. When it

10:30

becomes a way of coping with

10:32

emotions that are not

10:34

being dealt with then it can

10:36

really cross over into a way that harms

10:39

the body. So usually people don't

10:41

find it to be a problem unless

10:43

there's some real physical manifestation. So with

10:45

hair pulling it can be a bald

10:47

spot or with skin picking it

10:49

can be you know

10:51

really really bad scarring red

10:53

spots it can be infection.

10:57

So usually because of the shame

10:59

that kind of surrounds it until it gets

11:01

to a point that it's really

11:04

a problem in interfering with people's lives

11:06

they don't seek treatment for it. Well they

11:08

might not even recognize it just like what you were saying.

11:11

Right, right and it's also important I think

11:13

for therapists to know that even

11:15

at the level where it's not a

11:18

problem it can still be communicating someone's

11:20

distress. So if someone's in your office

11:22

and begins to pick at their cuticles

11:24

or feel through their hair or touch

11:27

their skin it may be

11:29

a really good intervention point to try to

11:31

understand what was the feeling that brought their

11:33

hand to that spot. So moving right

11:35

into the somatic to

11:37

that bottom-up processing really. Yes

11:39

it's kind of a as long as

11:41

you get the feel for it it can be

11:44

sort of a straight line in. The thing

11:46

we have to watch out for is the shame that

11:48

can come along with that. Oh man yeah I can

11:50

feel that even just as I

11:53

form questions and things like that. Is there

11:55

something about the nature of this that is

11:57

so intimate and personal?

12:01

It makes me think of like, you know, when you're

12:03

first having to learn to talk in therapy and stuff

12:05

and to get comfortable with sexuality, you know what I

12:07

mean? You have to almost like really

12:09

get yourself up to the table to say

12:11

all the words and get comfortable with them

12:13

and consider things, you know

12:16

what I mean? It's just hard. Do

12:18

you find that to be the case or am I just kind of

12:20

being weird about it? No, definitely, definitely.

12:23

And that's such an important thing for therapists to

12:25

begin to recognize because one of

12:27

our jobs is to take away the shame

12:29

for the clients and talking about it. And

12:31

so we have to work on our own

12:33

disgust and shame ourselves because

12:36

I'll find that one of the best ways

12:38

I can set the client at ease is

12:40

to talk about some of the things that

12:42

go along with the hair pulling in very

12:44

visceral terms. So I'll say something

12:46

like, oh, usually after someone pulls out a

12:48

hair, they might run it between their fingers

12:50

or they might like that little sticky, bulby

12:52

part and kind of rub it on their

12:55

lips or crunch it. You know,

12:57

which of those senses really is part of the

12:59

process for you? And when I

13:02

say that in a way that's really straightforward,

13:04

my clients are like, oh my gosh, I

13:07

can't believe you're asking me that. Well, I like that bulby thing.

13:10

But it took me having to get

13:12

comfortable with those kind of primitive elements

13:14

of this in order to

13:16

be able to be straightforward. Yeah,

13:19

that example is such a great example because

13:21

the minute you ask those questions, now a

13:23

whole world opens up about, oh, actually, no,

13:25

I saved my hair or I, whatever

13:28

it is, that it's just really beautiful. Now

13:31

what about just so that we're clear with

13:33

everybody what this is about? What about like

13:35

cutting? Is that considered

13:37

under this umbrella? Yeah,

13:39

that's a great question. So there's a bit

13:41

of controversy in the mental health field actually

13:44

about that question. In the

13:46

CBT world, they're very clear that they do

13:49

not think this is related to self harm. And

13:53

what I have actually found is that coming

13:55

back full circle to that client

13:57

who wanted to join my self harm group. had

14:00

some different characteristics than

14:02

the people who were cutting, but there were also

14:04

some similarities. And so what I've learned is that

14:06

it's a continuum of self-harm

14:09

behavior. So someone who's cutting

14:11

is maybe doing it in a way that's a

14:13

little bit more able to

14:15

be a cry for help and

14:18

maybe a little bit more about the

14:20

pain, whereas somebody who's picking is usually

14:22

trying to just express their feelings a

14:25

tiny bit by a tiny bit to keep it hidden also

14:28

more to relieve their stress

14:30

and comfort themselves more

14:32

so than the pain. But those pieces

14:34

of pain and comfort can go along with

14:36

either. And so I think it's really helpful

14:38

to think of it as a continuum. Yeah,

14:41

even self-harm, the picking, people wouldn't identify

14:43

necessarily that they're actually trying to harm

14:46

themselves. As a matter of fact, as

14:48

a more extreme grooming

14:50

behavior, there's something that might even

14:52

feel caring. Exactly. And it

14:54

does release endorphins and soothing. And

14:56

also a lot of times people

14:59

are actually trying to correct an

15:01

imperfection. So there's the

15:03

overlap with body dysmorphic disorder. So

15:05

they think they're actually attending to

15:07

their acne or whatever

15:09

it may be. And then once it's

15:11

over, it's clear that it really just made it worse.

15:14

So what about overlap with

15:16

other diagnoses? OCD, anything like

15:18

that? Yeah, so actually, this

15:21

condition is comorbid with so many

15:24

other mental health conditions. So

15:27

depression, anxiety, PTSD,

15:30

as I mentioned, body dysmorphic disorder, OCD,

15:33

it's under the OCD and

15:36

other related behaviors umbrella at this

15:38

point. But it also has impulsive

15:40

features. And back in

15:43

DSM-3TR, hair pulling

15:45

was under the impulse control disorder category.

15:48

So it's been really hard to understand, I

15:50

think, in some ways, because it does overlap

15:53

so much with so many of

15:55

those disorders. And the way that I've come to

15:57

understand that is that skin picking

15:59

can regulate emotions

16:01

in all directions. So

16:04

it can actually let

16:06

somebody kind of zone out in the

16:08

dissociative way to help cope with the

16:10

intrusive trauma thoughts, or

16:13

it can bring somebody into focus with

16:15

ADHD and be able to

16:17

concentrate. It can really relieve

16:19

anxiety and it can also lift

16:22

up from depression. So I think

16:24

because it's so effective at regulating

16:26

emotions, it ends up being hand in

16:28

hand with so many different struggles that people

16:30

are working through. And you

16:33

mentioned dissociation. Is that commonly

16:35

experienced? Is that part of it and

16:37

overlap? Yeah, so again, this

16:39

is part of what I had to clarify

16:41

in the book because the

16:43

traditional CBT approach has been very resistant

16:46

to the idea that there's any connection

16:48

between trauma and body-focused

16:51

behaviors. And that's even though they've done

16:53

research since 1999 that showed that these

16:57

behaviors usually do develop when there's some

16:59

kind of attachment disruption.

17:01

So divorce or the

17:03

loss of a loved one, even though

17:05

it's clearly connected to some kind of disruption

17:08

that's been sort of put on the back

17:10

burner. But there are two different

17:12

subtypes of picking and pulling. One is more

17:14

focused, which is more like going in and

17:17

picking at something that seems imperfect and

17:20

trying to make that better. And the

17:22

other kind is really unconscious, where maybe

17:24

someone's hand starts to do the twirling

17:27

and then they dissociate and

17:30

then come back maybe hours later after

17:32

having done some serious damage. And that

17:34

seems to really be connected

17:37

with that underlying post-traumatic stress disorder

17:39

as a coping mechanism. Oh, wow.

17:42

That is interesting. So I'm

17:44

thinking about self-soothing behaviors in

17:46

general, whether that be, you

17:48

know, maybe even rubbing. It's very individualized,

17:50

right? It's kind of what we

17:53

stumbled upon as kids that

17:55

helped us soothe. So it feels

17:57

like this is like, especially because it's, you know, you're

17:59

always have your body with you. So

18:01

it would be, you know, using your body

18:04

and using repetitive motion to self soothe,

18:07

but then that going awry or that

18:09

going taken to an extreme or

18:11

causing damage. Is that, does that

18:13

fit? That fits exactly. Yes.

18:16

And one way to think

18:18

about it is as grooming

18:20

gone wild, like you were sort

18:23

of indicating this healthy behavior kind

18:25

of taken out of context

18:27

and used in a different way that

18:29

then becomes problematic. Well, and

18:31

who can't identify something repetitive behavior

18:34

that one does, right? Like when

18:36

we open it up like that,

18:38

there's, I mean, it's a good thing, you

18:40

know, we need to be able to self soothe. So

18:42

it really takes the shame out putting it

18:44

in this context of no, this is, you

18:47

know, everybody has had to find something. And

18:50

it just sort of sucks if you ended

18:52

up with something that would, or that it

18:54

that went astray and that then became problematic

18:56

for you, but, but that the seed of

18:58

it is so normal. And like

19:01

you said, not just in humans, but

19:03

across mammals, I imagine the grooming

19:05

behavior, things like that. Right.

19:08

Right. And that part is so fascinating

19:10

because there's also been many studies of

19:12

animals who engage in over grooming behaviors.

19:15

And I find that so fascinating that

19:18

they tend to engage in those behaviors

19:20

for the same reasons that humans do.

19:22

And so we're really parallel. They found

19:24

that animals are triggered by boredom,

19:27

by isolation, by frustration, and

19:29

by the feeling or experience of

19:32

being trapped in too small of a space. And

19:35

most of my clients can relate

19:37

to. I was just going to

19:40

say, what a great

19:42

entry into getting more

19:44

insight around it. Cause certainly

19:46

I'm thinking of birds that

19:49

pull their feathers understimulated. And,

19:51

you know, we've seen, we have a rescue

19:53

zoo here and it's just so painful. The

19:56

monkeys and the, oh, very

19:58

painful, but it's all, you know, remember

20:00

seeing one with a stuffed

20:02

animal and he was grooming the stuffed animal.

20:05

But so many times you see the bald

20:07

spots, you know, just it seems so clear

20:09

when you think of it as an animal

20:11

that that is a sign of distress, that

20:13

that's not just the cognitive bad

20:16

habit. Exactly and also

20:18

that it's related to the

20:20

environment. That's something that a lot of

20:22

my clients, you know, they come in and they think

20:24

what's wrong with me and

20:26

sometimes it's really we'll wait. Maybe

20:28

this is some things in your

20:30

environment that haven't been working for

20:32

you. And the exciting thing is

20:34

that veterinarians have found that when

20:37

they change some of the circumstances

20:39

in the animal's environment, they

20:41

can actually let go of those behaviors. So

20:43

that also gives us the

20:45

idea that we can also let go

20:47

of behaviors. But it's not

20:49

just by changing ourselves, it's by changing our

20:51

environment and the way that we relate to

20:53

other people in our environment. Oh

20:55

I love that and so this is where your work really

20:57

picks up is really interpreting

20:59

it. So in order to change the

21:02

environment we would have to figure out

21:04

what what's wrong or what we need.

21:06

So you know beginning to like interpret

21:09

it and so tell us more about

21:11

kind of how you have taken the

21:13

field in the direction of kind

21:15

of how you work with it and your findings

21:18

basically. Sure. Well one

21:20

thing that comes to mind is

21:22

that when we start to look at

21:24

the environment and some contributing

21:26

factors, one personality

21:29

characteristic that is very

21:31

common in people who

21:33

pick polar bite is perfectionism. And

21:36

it goes along with people pleasing and

21:38

sort of this overachieving. And

21:40

myself I can relate to all of those words

21:43

and can see myself how

21:46

some of those perfectionistic tendencies

21:49

meant that I was actually

21:51

hiding certain things from myself and from

21:53

the world. And so looking at well

21:55

what what are those things? What does it mean to be

21:57

a perfectionist? Or people pleasing? Well,

22:00

for me what I discovered is that

22:03

the thing that gets left behind is

22:05

usually anger and

22:07

frustration. And so a

22:09

lot of my clients come to me without

22:12

any awareness that they are angry at any

22:14

time. And then what we

22:16

find is that anger has to come out somewhere.

22:18

It kind of gets pushed down into sort

22:20

of aggressive energy. And

22:22

that energy is what fills those

22:24

hands. And so oftentimes, actually

22:27

working with people on getting in

22:29

touch with their frustration, anger, and

22:32

being able to express it is

22:35

really what's transformative. Then

22:37

there's not so much of that energy building up in

22:39

the body. And of course,

22:42

there's any number of challenges to expressing

22:44

your anger and being more assertive in

22:46

the environments that you're in. So

22:48

that's the whole process too. And a lot

22:51

of times people are used to you

22:53

being a people pleaser and a perfectionist

22:55

and don't necessarily feel comfortable when

22:57

you start to express your anger. Yeah,

22:59

I was wondering that about the role of aggression

23:02

because there is a way because this, you

23:04

know, we're talking about it more mildly, but

23:07

this can take very, very severe forms. And

23:10

I've certainly had some clinical experience with that or

23:13

that it's very, very destructive. And

23:16

then the notion of anger and aggression and

23:18

being able to study that, even

23:21

just the exploration of like, what does

23:23

this behavior mean? And beginning to get

23:25

curious about that, that just opens up the whole

23:27

world. Opens up a whole

23:29

world. Yeah. Yeah.

23:32

So aggression is a big piece of it. Aggression

23:34

is a big piece of it. Takes time to get to. The

23:37

other pieces that I would say really

23:40

I've discovered once going down into

23:42

the roots of the behavior are

23:45

these pieces of attachment

23:47

disruptions and some difficulties

23:50

in development. So

23:52

usually, as I mentioned, a

23:55

lot of body focused behaviors do arise around

23:57

adolescence and there usually is some kind of

23:59

a trigger. that is one

24:01

of those attachment disruptions. But

24:03

one thing that I discovered only after really

24:06

being in the field and really studying,

24:08

hearing from the parents of teenagers I

24:10

work with and also learning

24:12

more about the early lives of my clients,

24:15

is that a lot of times there

24:17

was also a disruption in those very,

24:20

very early years, zero to two. There's

24:23

also a sensory processing issue that

24:25

develops at a very early age.

24:27

And so I've really been studying

24:29

how sensory processing and

24:31

difficulties, disruptions and attachment all kind

24:33

of come together to lay the

24:35

ground for this to come out

24:38

later in life. So

24:40

you said that it typically emerges

24:42

in adolescence. If

24:44

we just kind of create a story, if you'd be

24:46

okay with that, we'll make

24:49

up a story. Someone, let's say, gets

24:51

referred to you pulling out their eyelashes.

24:54

Or what would be the most common thing that you would see? Let me ask

24:56

you that. Yeah, that's definitely a

24:58

common one. Yes, and sometimes that'll

25:00

happen all at once. So

25:03

somebody discovers that they

25:05

might be able to pull out an eyelash, maybe even

25:07

make a wish on it. And then

25:09

maybe they're in a math test and all of

25:12

a sudden they come home and their

25:14

eyelashes are gone. And their mother is

25:16

like, what? Where are your

25:18

eyelashes? And that's where the crisis kind of comes into

25:20

play. So would that

25:23

be something like, Les, if she had

25:25

just discovered that as something that was

25:27

soothing or useful, would that fit

25:29

this disorder? Or would

25:31

it have to be persistent? Would it have to continue?

25:34

Yeah, so that would just be the beginning

25:36

of it, right? It might not develop into

25:38

a habit and a behavioral kind of, something

25:41

that someone relies on behaviorally right away.

25:44

So if actually, if mom

25:46

brings the client to me right then, sometimes

25:48

we can figure it out and really

25:51

let it go and find other

25:53

soothing mechanisms. And it's

25:55

kind of once it goes on, people don't

25:57

usually come the very first time, usually.

26:00

They also pry a lot of behavioral

26:02

strategies, and that can

26:04

lead to actually its own problems

26:06

because then people are kind of

26:09

struggling with, mom's telling me I

26:11

have to keep putting on band-aids. I don't want

26:13

to put on band-aids. Now I'm rebelling against mom,

26:15

and it can get really complicated if you go

26:18

too quickly to try to just take it away.

26:21

So then if we just follow

26:23

that story through, so mom refers, and what

26:25

would kind of a course of treatment look

26:27

like for someone like this? First

26:30

I have to set the stage with a number

26:32

of pieces. One is that I'm not

26:34

going to try to take this away from you right away.

26:36

We're not going to fix this. We're not going to try

26:38

to get rid of it. I'm

26:41

going to give you some early behavioral

26:43

strategies like fiddle toys. That's

26:45

fine. We can use those from the beginning,

26:47

but they're not going to really probably stick

26:50

until we look at what

26:52

is going on under the surface here. So

26:55

we have to understand what you're

26:57

coping with in order to understand more

26:59

about other ways we can meet those

27:01

needs. And fiddle toys. Can you,

27:03

I'm sorry, fiddle toys. Yeah, sure, fiddle toys. So

27:07

I have plenty in my office.

27:10

My favorite are thinking putties, so

27:12

Crazy Aaron's thinking putty. And

27:15

this is my personal stash, so

27:17

I use these, especially when

27:19

I'm on Zoom all day long. My fingers get

27:22

restless, and that's one way that I cope.

27:25

There's also rocks or stones

27:27

that can be worry stones. And

27:31

even those passets, can I have my hope?

27:34

My hope? So these are

27:36

really popular with youngins these

27:38

days. But I'm where you pass them.

27:41

Yeah, I see that with the checkout

27:43

stand. Exactly. So I do tell my

27:46

clients that they're going to be fiddlers.

27:48

They're people who need more sensory stimulation

27:50

in their fingers. And so no matter

27:52

what we do, no matter what

27:54

we process underneath, there's still going to be

27:56

extra need for stimulation. And we just are

27:58

going to have to have... Something

28:00

else in our repertoire to help with

28:02

our restlessness. Oh I

28:06

can so identify with this related to like I've

28:08

looked I have looked down before and I Had

28:11

torn up tiniest tiniest little things, you know I

28:13

mean just where that it was like this Repet,

28:16

you know I just got it smaller and smaller

28:18

and smaller and smaller or Certainly

28:20

holding things during a session or like

28:23

I have wood little pieces of wood

28:25

that I you know Like from a

28:27

let's say it's hike or something from a beautiful

28:29

tree I collect stuff like that

28:31

or rocks and end up I've

28:34

actually had a client one time say, huh I wonder what it

28:36

means you picked up your You

28:41

know thing that you fiddle with Yeah

28:56

Stacey and I'm there

28:58

right to say something Yeah,

29:02

my body communicates to you Okay,

29:05

so you're not gonna take it away from them. No you

29:08

you might divert some or you know find it

29:10

find more More

29:12

maintainable ways and then and then

29:14

what happens? I have a whole

29:16

chapter in the book about a safety phase because

29:19

I feel like that is important for everyone

29:21

but one thing I'm doing there is also

29:23

assessing for trauma and Trying

29:26

to understand how complicated those

29:28

roots are and that'll really guide treatment

29:30

So I'm I'm really doing

29:32

a full assessment in that first

29:35

phase. However long that may take We're

29:37

also setting realistic goals. So

29:39

most of my clients want to get rid of

29:41

this completely and so we have to work on

29:45

What's realistic? What about if we think

29:47

about moderation and what if we imagine

29:49

a moderate level? Where it

29:51

doesn't interfere with your life and

29:54

that way we aren't setting ourselves up

29:56

for this perfection Relapse cycle that is

29:58

so common when people do engage

30:00

in the CBT world, a

30:03

lot of times they're very successful at

30:05

first, partly that people pleasing and perfectionism,

30:08

but then all that tension is building up

30:11

and then a relapse can be devastating. So

30:14

I teach people about kind of, I use a

30:16

lot of metaphors, so there's a stress cup that

30:18

we think about that's inside of us building up

30:21

with all those four different stressors than anything else

30:23

that may be in the way. And

30:26

I like to think about how to reduce the stressors

30:28

in the stress cup so that the

30:30

urges aren't so strong rather than trying

30:32

to resist the urges. You

30:35

said the four different stressors? Yes,

30:38

that isolation, frustration, sense of

30:40

being trapped, and boredom. Boredom

30:43

is kind of the easiest one to address because of

30:46

course, just like animals, we're not

30:48

sort of doing as much during the

30:51

day as is in our nature, right?

30:53

Like the animals who become our pets. So

30:55

when we provide them of their stimulation, we have to

30:57

think about, well, how am I sort of suffering

31:00

from sitting at a desk all day long and

31:02

what am I not giving my body

31:04

as far as my body is bored,

31:07

even if my mind is stimulated? So

31:09

that's sort of the easiest one, but all of the other

31:11

ones kind of come in and are

31:13

more complicated to tease out. Yeah,

31:15

okay. No, that's good. And going back to

31:17

that, because I heard you mention it related

31:19

to the animals. Yeah. But

31:22

it's always really nice to have, you know, like, here

31:24

are four things that you can check in

31:27

with yourself about. So that's

31:29

definitely. Then another piece

31:31

of the sort of psychoeducation, because what

31:33

we're working on here is we're

31:36

working on breaking the cycle of shame where you

31:38

pick and pull and then you feel really bad

31:40

about yourself and then you pick and pull. And

31:43

so another piece of the psychoeducation

31:46

that helps is connecting us to

31:48

the animals and just exploring what

31:50

you and I just went through in terms

31:52

of how much it makes sense when people

31:55

begin to engage in these behaviors

31:57

and how we have to understand them as

31:59

coping mechanisms. and not just something

32:01

to hate. And then once

32:03

we get through that and we can

32:05

start to at least have some compassion

32:07

for the behaviors, people

32:09

do find that once

32:11

that cycle is broken, that's the first

32:13

step. They tend to engage, even

32:16

if they engage in their behaviors, it won't last

32:18

as long and it won't be as destructive. So

32:20

that's really the first step. We're

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35:10

So now you've got the behavior kind of

35:13

interrupted to some degree. What

35:15

would be the next step? Yeah.

35:17

So then we begin. So just like

35:19

any psychodynamic process, we're

35:22

in the moment, right? People come in with

35:24

what they have on their minds and

35:27

we work on that therapeutic

35:29

alliance. And my nervous system

35:31

is also connected to their nervous system. So

35:33

I signed that a lot

35:35

of those first months is me using my

35:37

nervous system to maybe have some clues to

35:40

what they might be feeling that

35:42

they aren't recognizing. And

35:44

so maybe somebody is smiling as they're telling

35:46

a story and I'll start to

35:48

feel choked up in my throat and

35:50

then begin to help them own what

35:54

feeling might be in our throats. Because usually

35:56

if my throat is feeling a

35:58

lump, their throat is feeling a lump. and then

36:00

we can start putting words to some of the things that

36:02

have been under the surface. And

36:04

that's where all that therapeutic work

36:06

of processing trauma and letting it

36:09

go and processing some of the

36:11

stories we have about ourselves from

36:14

our early lives that lead us

36:16

to pick and pull and really

36:18

being able to change the story

36:20

with a different

36:23

viewpoint. So that's that beautiful

36:25

therapeutic dyad moving into

36:27

new ways of understanding what

36:29

one is feeling and then how to cope with those

36:32

feelings. So I guess I would say

36:34

a big part of that is helping people begin

36:36

to express anger toward me in

36:38

ways that they haven't been able to do. And

36:40

then when they find that that relieves their urges to

36:43

pick and pull, then that becomes a motivator to try

36:45

to do that in the rest of their life. It's

36:49

always so fun when that can actually

36:51

begin to happen. You know what I mean? Yeah.

36:54

I get to, you know, sometimes I'll say,

36:56

well, if I'm analyzing you, you get to analyze me,

36:59

and then, you know, when people really take

37:01

me up on that, it's like so exciting.

37:04

So really then you're just

37:06

doing kind of deeper level

37:08

trauma work and developmental attachment

37:10

work and really kind of

37:12

the unconscious process and making

37:14

the helping them create their

37:16

narratives, update their narratives to

37:18

healthier, more secure narratives. So

37:21

then it proceeds in kind of a, what

37:24

a kind of a deep psychotherapy process would

37:26

look like. Exactly, exactly.

37:29

So I think that's a really important piece just to understand

37:31

is that working with this

37:33

is so similar to working with

37:35

any kind of behavioral manifestation of

37:37

internal distress, whether it's substance abuse

37:39

or eating disorders or whatever it may

37:42

be. And it's always

37:44

helpful just to know more about

37:46

the specifics of

37:49

each population so that you can speak someone's

37:51

language and really have themselves

37:53

understood. So for example,

37:55

just even knowing that

37:57

there's sensory processing issues. early

38:00

in life can really be a way in like just

38:02

asking someone, you know, did you happen to

38:04

have some skin sensitivities maybe where you didn't

38:06

like the tab on the back of clothing

38:09

or the line on socks and

38:11

my clients are like wait you know me

38:13

and that's like oh that's an

38:15

end so even though we're working with something that

38:18

is similar to so many other processes once

38:20

you notice more of the details you can

38:22

really form the alliance much more quickly. Oh

38:25

man I can see that totally taken off and

38:27

I like then putting it back in context of

38:30

we end up developing this these symptoms that

38:32

at some point were a solution to something.

38:35

Yeah. So the symptoms can

38:37

look all these different ways

38:39

but ultimately once those

38:41

very specific things are addressed then we can

38:43

get to those underlying things and

38:45

that's one of the things you've been able to contribute to take

38:48

this further than the CBT literature has been

38:50

able to do is really yeah. Yeah

38:53

that's right because I think you know

38:56

I personally was somebody who I was

38:58

never interested in just a quick fix

39:00

of sort of dealing with the surface level

39:02

of my problems. I was somebody who always

39:04

wanted to follow the roots

39:06

to the bottom and excavate and and I

39:08

found that that's where transformation comes from so

39:10

that's what I believe in. Mm-hmm

39:14

and you mentioned something in your book as far as

39:16

we're kind of talking about treatment now

39:19

but the healing herd. Yeah.

39:21

Could you say more about that? Yes

39:24

well and so I'll just

39:26

mention a lovely book Zoo

39:28

Obiquity by Barbara Datterston Horowitz

39:30

and Catherine Bowers and

39:33

they introduced this idea. They did

39:35

some of the research that I mentioned in particular

39:37

with horses who are over grooming and

39:40

what they found is that that

39:42

isolation that's a part of the behavior they

39:44

found that you could even put a chicken

39:47

in a horse's pen and it didn't even

39:49

have to be the same species and the

39:51

horse might be relieved of some of its

39:53

behaviors and so they they thought

39:55

about it. So touching. Yes so sweet so

39:58

sweet. So

40:00

they imagined in this chapter that

40:02

they had about over grooming, they

40:04

imagined a healing herd coming together

40:07

where people would could relate to

40:09

one another and almost do

40:12

that positive grooming of one

40:14

another more through words than touch, but

40:16

that that could be healing force. And

40:19

I have definitely found that group psychotherapy

40:21

has benefits way beyond just what I

40:24

can do individually. In that people develop

40:26

a herd, they develop a community of

40:28

people like them, and they

40:30

feel less isolated and less, you know, of

40:32

course, that relieves the shame to when

40:35

they realize that other people who they like

40:37

and respect are also engaging

40:39

in these behaviors. My

40:41

heart actually feels really touched, I think, from

40:43

the chicken and the horse. The idea of

40:45

a healing herd, one association I have to

40:50

that is that it's not healing anything

40:52

specific because each little individual in the

40:55

herd has their own individual

40:57

histories and their own issues. So

41:00

the herd, it's like it's whatever it

41:02

is that's wrong. It's

41:05

not just healing the one thing and somebody

41:07

needs, you know,

41:09

boundaries and somebody needs to

41:11

be able to set them, somebody needs

41:13

to be able to respect them. But

41:15

like that, the healing herd, you just

41:17

figure it out. And by having that

41:19

interpersonal contact and group therapy,

41:22

I cannot agree more. It's like

41:24

providing nutrients, providing nutrients. And we

41:26

don't know kind of what our

41:28

deficits are, but it lifts

41:30

everybody up. And now we're all having

41:32

more, have more nutrients and whatever that

41:34

is. Yeah, it's an association I had

41:37

around it. And I love, love, love the

41:39

idea of the healing herd. Yeah, yeah, definitely.

41:41

And I think being able to

41:43

start to put words to feelings

41:45

is really what, what my particular

41:47

herd tends to struggle the most

41:49

with and tends to be able

41:51

to help one another the most

41:53

with. In the book, you talked about the idea of

41:55

psychic skin. Yeah. Can

41:58

you say a little bit more about that? Sure.

42:01

So that takes us back to that fascination I

42:03

have with those early years. And

42:05

Esther Bick actually, who was a modern analyst,

42:08

she was writing in 1968 and

42:12

she came up with the idea of the psychic

42:14

skin and it really hasn't been

42:16

picked up very much in more modern

42:18

literature but it's it's such a key

42:20

component. She was working with children at

42:23

the time and babies and so she was

42:25

really looking at development and what happens to

42:28

create secure attachment and what can get in

42:30

the way. And she was

42:32

noticing that if a parent can do

42:34

a couple of things, very

42:36

important things. The first is relax

42:41

his or her own body while

42:43

holding the baby and usually in

42:45

a feeding moment. So whoever

42:47

happens to be feeding the baby it

42:49

doesn't have to be breastfeeding but all

42:51

of the senses need to be involved.

42:53

So someone needs to feel held and

42:55

that gaze has to be there and

42:57

the taste, the smell, all of those

42:59

things combine to create deep relaxation. So

43:02

that deep relaxation is one of the ingredients

43:04

of the psychic skin and the

43:07

other one is that a parent

43:09

has to be able to contain

43:11

all of the feelings that a

43:14

child had, a baby has. So a

43:16

baby can't really regulate her own feelings

43:19

so that despair and

43:21

rage and helplessness, all

43:23

of that a parent needs to be able to hold

43:26

the baby and contain those

43:28

feelings and calm the baby from there.

43:30

Now if a parent can't do either

43:32

of those that's oftentimes not a fault

43:34

of the parent. The parent

43:36

may be trying as hard as they can

43:38

but it may be that the

43:41

parent has never gotten that ability

43:43

to fully relax or it may be that the

43:45

parent is just in a situation where they've

43:48

lost a parent all of a sudden and

43:50

they can't really cope or

43:52

it may be that they never learned how to

43:54

handle their own anger so they can't

43:57

tolerate when their child is angry. If

44:00

those pieces are in place, that

44:02

psychic skin kind of forms a container for

44:04

the developing self. And

44:06

if those pieces are not in place, that

44:09

container develops holes and

44:12

then the way that Esther Bick

44:14

kind of understands it is that then

44:16

we need to create compensatory behaviors

44:19

to fill in those holes. And that's where a

44:21

false self comes in. And that's

44:24

where I kind of connected in that

44:26

perfectionism with some of those early wounds

44:28

because it's a way of compensating

44:31

for something that feels

44:33

off where you don't feel comfortable in your own

44:35

skin and you can't name it and it's

44:37

hard to work through, but you

44:40

have to compensate for it. I

44:43

just love that. And even the

44:46

instruction, the specifics

44:48

about the holding feel

44:50

like it could be so because somebody

44:53

who didn't know, you know what I mean, wasn't held

44:55

that way. You know, feeding

44:57

is more task. Hurry, hurry, hurry. I've got

45:00

to get out the door. You know, not

45:02

that I've ever done that in my entire life. It's

45:06

always hard, you know, to learn

45:08

some of these things and think back. But

45:11

yeah, but so you

45:13

weren't held that way. But just hearing those

45:15

words and being able to imagine like, oh,

45:17

okay, that I can see that I can

45:20

see the value of that. I would like

45:22

to do that. It cannot

45:24

slow me down so that I'm connecting.

45:27

It's almost like we always are like

45:29

resonate, connect, you know what I mean,

45:31

mirror. But what does that even

45:33

mean? And there was something about that description

45:35

of the psychic skin that

45:37

feels like it's like, oh, that's what that

45:39

means. It kind of like

45:41

makes it really clear. It

45:44

feels like that it kind of puts it together around

45:46

like, because you can kind of go through

45:48

the list of your own senses, because some

45:51

of the stuff, it's so right brain,

45:53

you know, there's no words for it. But

45:55

these are words of like, you know,

45:57

what are your eyes doing? you're

46:00

talking about smell like tuning into the smell

46:02

of your baby. Just

46:04

all of these things that are all about prosody really

46:06

but but nobody knows what

46:08

being a prosody being like tone, pitch, rate

46:11

of speech, like all these not

46:13

just nonverbal but these signals of

46:15

safety. So when you're able

46:17

to get your body using

46:20

all of your senses into this comfortable

46:22

space and of course we're not

46:24

just talking about holding infants we're also talking about being with

46:26

your partner, being with

46:28

your therapist or if you are a

46:31

therapist being able to bring your all

46:33

of your senses online so it's so

46:35

interesting. And that's a great

46:37

point too because you know that's the exciting

46:39

thing we're not just discovering what might have

46:42

been missing as therapists we're

46:44

also in the position to be able to

46:46

create that kind of environment so that's where

46:48

my nervous system when I can

46:50

fully relax with a client when I can

46:52

relax with a client's intense

46:55

feelings and hold that space

46:57

that's where that earns secure attachment comes in

47:00

where we can repair even those early years.

47:03

So part of what we're doing with this

47:05

related to the podcast is like these are

47:07

all examples of being able

47:09

to use attachment related you know

47:12

updated attachment related work

47:14

that and by updated we mean

47:16

you know culture class all

47:18

of it like that the newer science you can

47:21

hear how much the relational neurobiology

47:23

is and everything that you're talking about

47:25

about the psychic skin is

47:27

that is that it's

47:29

right it's a bio regulation between

47:32

two people so it's

47:34

really great and so you've brought this

47:36

specific disorder into the fold

47:38

of okay no this is

47:40

this also fits around looking

47:43

at these unconscious processes right

47:45

right and I think a lot of people even

47:48

when they really include the body they leave out

47:50

the skin and so I

47:52

think that's true that's part of why I was

47:54

like I was even awkward at the beginning like

47:56

how do we talk about something like you know

48:00

But skin is where those first connections

48:02

are made, with touch. And so,

48:04

yeah, it's all sort of about

48:06

the skin. So yeah, it can

48:08

sort of add a dimension. Oh,

48:10

it's more than that. It's really, really

48:12

adding to the field. And I

48:15

can imagine, you know, this just being the beginning

48:17

of that. You showed you the

48:19

book, I'll show it again. It's

48:23

very small. So

48:25

it is very, I would

48:27

highly recommend getting in if you are a clinician or

48:29

if you're a parent, that is, you

48:31

know, or yourself, it's

48:34

very accessible. It's

48:36

not too, you know, jargony. That

48:39

was my goal. Yeah, yeah.

48:41

I think it's gonna be good for everybody.

48:44

Is there anything else that we didn't hit on that you wanna be

48:46

sure and say? Well, yeah, you mentioned,

48:48

I think you mentioned like race and ethnicity. And

48:50

I guess I will say too, there's

48:53

a lot of relevance to

48:55

all of those pieces with

48:57

these disorders and a lot more research could

48:59

be done. But if you think

49:02

about skin and hair, that's

49:04

where a lot of our ethnic

49:06

and like, even as

49:08

a person who grew up Jewish,

49:10

like I can relate to even

49:13

to sort of this waviness of

49:15

my hair that's different than other

49:17

Christian Caucasian people in my school,

49:19

right? I had different hair. And

49:22

so I know from a personal level.

49:24

And then I know from

49:27

just conversations with clients and others that

49:29

so much of the relationship that

49:32

is sort of unspoken around

49:35

how people feel towards you kind

49:38

of relates to your hair and skin.

49:40

And then if it's unconscious,

49:42

sort of how you process it, you can take it

49:44

out on your hair and skin. So

49:46

that's just another piece that I think I

49:49

touch on in the book, but could really be a

49:51

lot more developed and has

49:53

just huge relevance in terms of, you know,

49:55

if you think about what's good hair,

49:57

what's good skin in different cultures and...

50:00

families and all that plays into that

50:02

I think there's just there's a lot

50:04

there. Wow totally.

50:08

Totally. Just pushing this idea

50:10

of skin and hair forward

50:12

and and our consciousness

50:15

and our awareness and you know

50:18

when you're in more of the dominant culture

50:20

those are things necessarily that aren't as

50:22

primary. You take them for

50:24

granted you don't notice versus

50:26

if you are outside of any script

50:28

that you're wherever that you're raised

50:30

if you're outside of the script I mean

50:32

I certainly got totally I

50:35

mean I'm within the script most of the way

50:37

but I got terribly teased for my

50:39

red hair. I mean really I would get on

50:42

the bus and everybody would start going you

50:46

know like Woody Woodpecker. Yeah

50:48

so it's just it's such

50:50

a teeny teeny tiny example

50:52

of something that you can't

50:54

control that then

50:56

people have these responses to and

50:59

in that case you know teasing is one thing

51:01

but boy you know having

51:04

curly hair when people don't have curly hair

51:07

somebody had said something about like what makes where

51:10

you can identify if you are of color or

51:12

not is that if a police officer would

51:15

more likely pull you over based

51:17

on your physical appearance which is

51:19

just an interesting concept of what this what

51:21

we're talking about skin and hair

51:24

being the signal that somebody's responding to

51:27

for sure. And then all of the

51:29

external pieces that brings

51:31

in but then also the internalized

51:33

pieces. Oh totally.

51:36

Yeah in some of these behaviors. So

51:38

it makes me want to invite all of our

51:41

audience to just go and take such

51:43

great care of your skin like your

51:46

favorite lotion you know what I mean

51:48

like love yourself love your hair so

51:51

there was two other things one was

51:53

you had mentioned wanting to get in

51:55

a group dermatologist. Oh

51:57

okay sure yes I was just wanted to

51:59

mention just to mention them. Yeah, I wanted

52:02

to mention the field of psychodermatology and

52:04

some of your listeners may be fascinated

52:06

by even this idea like I was

52:08

when I first heard of it. But

52:10

actually, dermatologists are more at the

52:13

cutting edge of working with these

52:15

behaviors than the mental health field

52:17

has. In fact, dermatologists named

52:20

both dermatillomania skin picking

52:22

and trichotillomania. And

52:24

that was 100 years before they

52:27

really got into the mental health lexicon.

52:30

So what a number of

52:32

dermatologists kind of realized is this is

52:34

complicated. And there are lots of psychosocial

52:36

factors, where the

52:39

environment both affects the skin conditions

52:41

and then the skin conditions then

52:43

affects mental health. So it goes

52:46

both ways. And so it's mostly

52:48

in Europe. But coming into America,

52:50

there are more clinics

52:52

that are psychodermatology clinics where

52:54

they have a psychiatrist, a

52:58

psychologist, or social worker

53:00

and dermatologists all working together

53:02

to address the whole person. And

53:04

I just love that field. And I'm

53:06

getting a little bit more involved as I kind

53:08

of learn more. And I'm really excited

53:11

about it. The psychodermatology

53:13

community also recognizes things like

53:15

the connection of trauma with

53:17

body focused behaviors and also identifies that

53:19

self harm continuum. So a lot of

53:22

the things that I've sort of been

53:24

on my own with in the mental

53:26

health community, I've found

53:28

partners in the psychodermatology community. Oh,

53:30

that's so great. I love anything

53:32

integrative like that, because they can

53:34

add so much. And of course,

53:37

you can add so much. And so

53:39

if somebody's listening, and they are like, Oh, my

53:41

gosh, you guys are talking about me or my

53:43

child, you know, speak to them directly right

53:45

now. Yeah, well,

53:47

I would say first of all,

53:49

really be aware that self compassion

53:52

is the most important first step.

53:55

And if you're a parent and your child

53:57

is struggling with it, really working on what

54:00

being able to work through your own

54:02

feelings about how hard it is

54:04

to see this visible sign of

54:06

distress in your child so that

54:08

you can really focus in on

54:11

what are you needing and what

54:13

is this communicating and what

54:15

can I take from this to learn about how

54:18

I can help you versus how can I get

54:20

rid of this, I think is

54:22

sort of the most important piece. And

54:25

I will tell people there

54:27

is a site, bfrb.org, and

54:30

it is the TLC Foundation for

54:32

BFRBs. They do offer a lot

54:34

of resources. Now, they also

54:37

only endorse the CBT approach,

54:39

so that's something to consider,

54:41

but they also have retreats,

54:43

conferences, and ways to

54:45

connect in, and lists of therapists and

54:47

support groups, so that's also a good

54:49

resource. Oh, that's great. Can you say it again? Sure.

54:52

So, it's the TLC Foundation for

54:54

BFRBs, and it's bfrb.org. Okay,

54:57

great. So, we'll for sure catch that

54:59

in the show notes. And then, what

55:01

about you? Somebody's excited about your energy and

55:04

what you have to say and want to learn from

55:06

you or work with you. What's

55:08

the next steps there? That's a great

55:10

question. So, I'm actually, I'm starting a training

55:13

group in September that is based on

55:15

the book, so we'll go through the

55:17

introduction and the nine chapters in the

55:19

10 weeks. And

55:22

it's an opportunity to learn

55:24

kind of in vivo more about

55:27

what it's like to be in the room

55:29

with me when I'm working with people who

55:32

are picking and pulling. So, we'll go

55:34

into a depth approach and look

55:36

at both personal and professional connections to

55:38

the material and have time for case

55:41

consultations. But in the training group, we'll

55:43

be paying attention to what comes up

55:45

in our own bodies and

55:47

be talking about that. So, it'll be a really

55:49

integrative training group approach. I

55:52

have that on my website at staceynakel.com

55:54

and I also can be

55:57

reached at [email protected] for more

55:59

information. And if you do

56:01

go to my website, I have a whole lot

56:03

of blogs on there that I

56:06

wrote that helped me as I was writing the

56:08

book. So a lot of the information that we've talked about

56:10

that can be found in my book was

56:12

also first written on my blog. So

56:15

that's great. So can you spell your name

56:17

so that people can really? Sure.

56:21

So it's stacynakell.com is

56:23

my website. Okay,

56:32

great. That's really wonderful. And

56:34

just another thought I had just as you were

56:36

talking about to the parents or to someone

56:39

themselves as far as self compassion. And

56:42

I was thinking about that, the idea of like

56:44

the beginning of the thing about like getting comfortable

56:46

in your own body about beginning to address some

56:49

of this stuff is really I mean,

56:51

you know, you guys heard me, you can

56:53

witness it like it's you have to almost

56:55

get into a different state

56:57

and us talking about

56:59

disgust early on just the word disgust.

57:02

For those of you that are wanting to address this or

57:05

you maybe you have a client, you maybe your therapist, you

57:07

have a client that you want to be able

57:09

to do better at talking about

57:12

this, that there is something about like, it's

57:14

just disgust, like something about getting okay

57:16

with the feeling of disgust. Like

57:19

sometimes I think of it like a keyboard of

57:21

feelings, right? And it's like just a note, it's

57:23

just disgust. It's there for a reason. And

57:26

it's especially evoked when

57:29

around bot like anything that is ejected

57:31

from the body. I mean, less so if

57:33

it's our body, or our body stuff is

57:35

a little bit less gross than somebody else's.

57:38

Yeah. Right. And

57:40

it's probably designed that way as far as

57:42

like keeping us safe. So that disgust and

57:45

that pull away and that aversion is just

57:47

it that's all it is like it's

57:50

morally neutral. So that

57:52

as you kind of belly up and it's like, oh, that's, you

57:55

know, my I can feel my face making the

57:57

face or whatever, the cringe of disgust. It's like,

57:59

oh, that's That is a most

58:01

normal thing that is wired in to

58:03

feel the feeling and I

58:05

could tell over the course of the conversation. It's like, oh,

58:07

okay, wait, wait. That's just that, no, that's all it is.

58:10

That's a great way to put it. Yes.

58:13

And I guess I will just add that for me, this is

58:15

just something that I actually am

58:17

a bit squeamish and just like you

58:19

said, I have my own behaviors,

58:22

but I actually can't handle

58:24

witnessing someone else's. So that's one

58:27

way that I sort of came up

58:29

with this rule that we can talk

58:31

about behaviors in here, but we can't

58:33

do the behaviors in here. So if

58:35

I see your hand going to your

58:37

skin or your hair, I'm going to

58:39

ask you to pick up something sensory

58:41

because that way I can work with

58:43

you and also be honest

58:46

with myself that I really don't

58:48

want to watch you picking

58:50

at your skin. That's

58:53

where the level of disgust for me would go

58:55

over the edge, but talking about it I'm

58:57

quite comfortable with. Oh, Stacey,

58:59

I think that's so like those kinds

59:01

of concrete things are,

59:03

it's so helpful. And you're also

59:05

modeling like you, it's the whole

59:08

idea. You have to take care

59:10

of yourself first. If you're distracted

59:12

and can't, you know, you're having

59:14

this big reaction about not what they're talking about,

59:16

you know, and you lose contact with the rest of, you

59:19

know, what you're feeling. It's like you have to,

59:21

that has to come first. And so that was

59:23

such a great example of being

59:25

realistic about bellying up to some of

59:28

these very difficult and painful behaviors. Yeah,

59:30

that's good. I'm glad that

59:32

helped. Yeah, really smart.

59:35

Okay, well, totally recommend it, treatment

59:37

for body focused repetitive behaviors. Stacey

59:40

Nikkal, and thank you very much

59:42

for joining us. Thank you so much. This

59:45

was really fun. Be sure and check out the show

59:47

notes. We'll have all of these

59:49

references there. So we'll see you around the bit.

1:00:00

Ann Kelly and Sue Marriott. This podcast

1:00:02

is edited by Jack Anderson.