Meeting Clients Where They Are: Jon Hershfield

Jon Hershfield sitting

Welcome back one of your favorites and mine, Jon Hershfield! Not only have Jon’s books on OCD helped countless people, he always has incredible insight into different obsessions, and he makes some of the funniest OCD memes I’ve ever seen. All this gushing is starting to feel weird, but he really is cool. (Would you knock it off already, Jon?) Jon is here to tell us about a new edition of a classic, a brand-new book for teens (available for pre-order!), and his new role at Sheppard Pratt in Baltimore.

Jon Hershfield with first and second editions of Mindfulness Workbook for OCD
Jon posing with both editions of The Mindfulness Workbook for OCD

As usual, you’ve been busy! The second edition of your popular book The Mindfulness Workbook for OCD is out now. What can readers expect in this new version? 

This was my first experience writing a second edition of anything and I have to admit it was a very strange and challenging process. I was seven years younger when the first edition was written. I’d meditated, a little, but most of what I knew about mindfulness was from my own experience in therapy or what I read from other books about mindfulness. Since then I’ve spent some time on silent meditation retreats and developed a meditation practice that’s part of my everyday mental hygiene. So I don’t know what readers of the first edition will think, but I think I paint a more textured picture of mindfulness in this version, hopefully one that makes even more sense. 

When a publisher asks you to write a second edition, they want 25 to 30 percent of the book to be different content, but you don’t get significantly more of a word count. I’ve been wanting to add chapters for all kinds of OCD themes over the years, but the more I tried to add, the more I had to cut in the first edition! In the end I settled for new chapters on existential and emotional/mental contamination OCD, and a chapter covering “real event,” stuck thought, and false memory obsessions. Perhaps the third edition will make space for more themes. Throughout the book, there are updates on research and techniques for treating OCD. Inhibitory learning, for example, gets woven into the workbook and the broader theme of developing mastery over OCD. In other words, it’s first and foremost an ERP book, but it’s about tackling OCD from every angle, not just getting anxiety to go down. I think this edition does a better job articulating how mindfulness is both the result of doing ERP well and the catalyst for doing it well.

Book cover
Available for pre-order!

But that’s not all! You’ve also written The OCD Workbook for Teens, which comes out in March. Why is it important to have a workbook especially for teens? 

Many adults I see in clinical practice have had OCD since childhood, and many of them suffered the most during their teens. I suffered, let’s say, more than necessary during my own teens. I knew I had OCD, but I really didn’t know how to explain it to others because I really couldn’t make much sense of it myself. I didn’t have the words. I didn’t know what to look for, what to expect. So this was on my mind throughout the writing process. What would I have benefited from understanding at that time?

Do you envision teens using it on their own, or with their therapist as a part of therapy?

It’s written directly to the teen OCD sufferer and I’ve done my best to channel the inner voice that still feels 16 (turns out he’s quite alive inside this 43-year-old brain). Similar to When a Family Member Has OCD, which I wrote thinking about what an OCD sufferer would want a family member to read, my vision for The OCD Workbook for Teens is them flipping through it, realizing it’s about them, then actually reading it from beginning to end. I really tried to avoid both the sugarcoating of life with OCD and the doom and gloom of “something is wrong with me” that no teen wants to read about. I partnered with OCD advocate Sean Shinnock, who provided brilliant illustrations that capture the tone I was shooting for. So it’s something a teen could use on their own, but it’s also full of exercises that could make for good homework assignments in a therapy setting. So a therapist could definitely use it as a guide or supplement to treating a teen with OCD.

You’re the director of the Center for OCD and Anxiety at Sheppard Pratt in Baltimore—a whole new job after working in private practice. Can you tell us more?

Yes, it’s been a year of changes for all of us, but this change has been an exciting one. For the last few years, I had been running a small but thriving private practice, and while we were helping people get mastery over OCD, I often felt limited by the one-session-one-person-at-a-time model. We had to say no so often when people would call. Not enough clinicians, too many co-occurring disorders we weren’t trained to treat, financial barriers, need for higher level of care, the list goes on. Sheppard Pratt, a well-known institution in mental health and social services, approached me and basically said, “We’d like to do more for the OCD community.” Then I said, well, I’d do this and this and this and this, and they said, “You’re hired!” It’s going to take some time to make all of these ideas a reality, but things are already moving in the right direction. Over the past few months, my team and I have continued to provide the same outpatient care we did in private practice, but I’ve also been working closely with the Retreat (Sheppard Pratt’s private pay residential program) to build in an OCD track for severe and complex cases. But wait! There’s more! I’ve also been setting things in motion to increase OCD treatment competence throughout the larger system, through trainings, consultations, and lecture series. More on that later, but I want to see a world where OCD sufferers of all financial means and levels of severity can get the help they need.

How has COVID-19 changed therapy in the past several months? Has anything valuable come out of relying more on virtual therapy, insights you plan to apply even when you can meet patients in person again?

There are some obvious advantages to teletherapy. No traffic getting in the way of arriving on time, no awkward waiting room experiences, and, of course, the ability to do ERP in the home environment where so many of our OCD symptoms can be the most challenging. Of course, from a therapist’s perspective, ear, eye, and compassion fatigue are definitely worse when you’re spending all day meeting people on the computer. What I really miss, and I’m sure many of your readers with OCD experience too, is feeling like I’m in someone’s presence. Something about being in the room with someone just makes it easier to give and receive validation. I’m not sure it changes the outcome or the efficacy of treatment necessarily (or at all), but therapy is a relationship and there are some forms of relating that are just more powerful in person. So maybe I’ll push for more home-based tele-visits for some ERP sessions, but at the same time, I’ll remember the value of face-to-face in the bigger picture.