You Must Be Some Kind of Therapist

Swell AI Transcript: 123. Elliot Kaminetzky FINAL.mp3
Dr. Elliot Kaminetzky:
This idea of identity-based OCD, when it comes to the fears associated with OCD, you have fears around the idea of what may happen to me. Am I going to get sick? Am I going to get injured? Am I going to feel terrible? Am I going to be rejected? Whereas identity-based themes are, what may I be? Like, who am I? And I'm afraid that I may be something that I fear. A very well-known subtype of OCD relates to gender identity. Fear that you may be in the wrong body. Fear that you might be trans. You must be some kind of therapist.

Stephanie Winn: Today I'm speaking with my friend Dr. Elliot Kamenetsky. He is a child and adolescent psychologist specializing in parenting-based interventions for child anxiety, obsessive-compulsive disorder, and behavioral challenges. He is also one of those brave therapists who has blown the whistle on the scandal known as so-called gender-affirming care. So today we're going to talk about how it's going several months after making that brave decision to blow the whistle. And we're also going to talk about his insights into what obsessive compulsive disorder has to do with your child's gender issues, perhaps something he calls identity based OCD. So I'm excited to talk. Elliot, welcome.

Dr. Elliot Kaminetzky: Thank you. I'm so excited to be here.

Stephanie Winn: Me, too. I feel like we're overdue for this conversation. You told me before we started rolling that it was OK if I let people know that I was one of the people you reached out to when you were gathering your strength for coming out with your concerns to the public. I have to say that I'm so happy you did. It's just been awesome to see you out there having a voice in the community and overcoming your fear. Honestly, you're quite funny on the other side of your fear. Even as I was getting ready for this appointment today, I texted you, still doing my makeup, and you said, same.

Dr. Elliot Kaminetzky: Yes, I was actually using power tools.

Stephanie Winn: Power tools. Oh, wow.

Dr. Elliot Kaminetzky: Yes, adjusting the basketball hoop.

Stephanie Winn: Oh, cool.

Dr. Elliot Kaminetzky: Yes.

Stephanie Winn: Well, I'm really glad that we're here today. I've had several episodes now where I talk to someone who blew the whistle at some point in the past and then just check in on how that's been going for them, like with Jamie Reed and with Tamar Petsky. Yes. No, Tamar Petsky.

Dr. Elliot Kaminetzky: Yeah, Tamara.

Stephanie Winn: Yeah. So, so I just I know it took a lot for you to gather the strength in this current sort of political and social cultural climate to express your concerns about this issue. Can you tell people how that's been going for you since you've been public with your concerns?

Dr. Elliot Kaminetzky: Sure. Well, first, in response to our dialogue and what led up to our dialogue, you've been very influential for me through the whole process. I think we were both in that huge, crazy Facebook group during the pandemic and we're like, something is up, which I'm currently banned from.

Stephanie Winn: Can we name it? Are you okay with naming it? We can name it. Therapists in private practice.

Dr. Elliot Kaminetzky: AKA tip, it was a place where there was only one opinion therapists were allowed to have for every topic. If you had any question about anything, everyone prefaced it with, don't pile up on me, please. I'm so sorry for asking. Also, here's a very benign question. It was crazy. Then I heard your story of how you were piled up on for the very reasonable wet hair question.

Stephanie Winn: The wet hair question.

Dr. Elliot Kaminetzky: The white hair question.

Stephanie Winn: There were like three moderators in that group that were these woke bullies and they had this rule against dirty deleting. They called it dirty deleting. If you posted something that you thought was innocuous enough and then you got ganged up on and all these people piled on telling you how racist and sexist and homophobic and transphobic your question was and how it was a reflection of cis white heteronormativity. If you got the pile on and then It overwhelmed and frightened you, and you're like, oh, never mind, and you delete your post. The next thing that happens is you get bullied for dirty deleting because you're not ever allowed to delete anything because you need to be held accountable for your sins.

Dr. Elliot Kaminetzky: Oh, my God. Yes, for a group of therapists who use the word trauma, like every other word they say, and they're trauma-informed, trauma, trauma, trauma, they traumatize therapists and make them live through public shaming. It's bizarre.

Stephanie Winn: You know what? I know we have a lot to talk about today and this is not one of the topics on the agenda, but I have to share a story because this reminds me of the hazing ritual that they welcomed me to grad school with. I should have recognized at the time that that was a warning sign about what was going to happen to the mental health field, but I got raked over the coals as my welcoming to grad school in a similar ritual except in person. We were all on retreat. and we did this thing called T-groups. Have you ever heard of a T-group? It's like an encounter group.

Dr. Elliot Kaminetzky: Yes, it was basically like group therapy mandated as part of the- Yes, except the people running it were not therapists, which should have been a red flag.

Stephanie Winn: This is a therapy counseling program. All of our teachers were therapists except the T-group facilitators. They were very woke. We divided into three groups and it's like, you have to talk about what's happening relationally in the present moment with the other people in the group, and you're not allowed to leave the room. And there was like 40 hours of this over the course of a week. I might be exaggerating slightly on the numbers, but yeah, I like said one wrong thing. And looking back, it was so innocuous. It was someone uttered some concern about racism that she was perceiving. And I said something like, I'm really sorry you feel that way. I wouldn't want for you to feel that way." Or maybe I said it like that I didn't see the thing that she was seeing or something, and I said it in the most innocent way. And then there was this like, the white lady just denied your experience of racism. Let's get her. And, and I had a history of childhood bullying, including over race issues. I mean, I'm a little seven year old Stephanie was being bullied for being white, like so, you know, for I was having this like trauma response. And I kept going to the instructors like, please help please get me out of here. This is too like I was having a meltdown because everyone was targeting me. they saw that as evidence of my emotional immaturity. That was my introduction to grad school back in 2010. I managed to have some good experiences in grad school, but I should have seen it coming then, honestly, all this nonsense. It's just at the time, I felt like it was my fault.

Dr. Elliot Kaminetzky: Yes, and I think it's good that you made it through because then you were able to start your therapy career and ultimately really influenced so much psychologists and mental health professionals like myself. I was watching your career unfold from someone who was getting bullied by this group of therapists, which sounds so bizarre if you think about it. Therapists are supposed to be the nice people who totally understand. They're such bullies.

Stephanie Winn: It's the drama triangle. They're not always the nice people, they're the people with the savior complexes.

Dr. Elliot Kaminetzky: Yes, precisely.

Stephanie Winn: All you have to do is do something to trigger their heuristic, their mental shortcut to perceiving you as the persecutor, and next thing you know, you are definitely the victim.

Dr. Elliot Kaminetzky: I remember you speaking out on all of the issues that so many think about but therapists aren't allowed to talk about. I was a little jealous. I'm like, why is Stephanie able to do this? She's so lucky that she's actually able and has the bravery to speak her mind about really important issues. I would like, listen to all your podcasts. and certainly about the gender issue. Ultimately, it was super helpful to join your local's community. She didn't tell me to advertise it, but it's great. I actually consulted with her about these current concerns that I had. She gave me, and I still had questions, like struggling with this issue of true trans, for example. What is that? really mean and she walked me through it really well. I got the answers I needed and it was ultimately, I remember when you weren't feeling well because of the long COVID health issues you're experiencing. I remember having this thought like, oh no, if Stephanie is at a commission, there'll be no one left to resolve or to address this issue. Then I had this aha moment of like, what's wrong with you? Why can't that be you? Why can't you speak about it? I think that's where I got the ball rolling. The previous excuse I had of like, I have a mortgage or like, my family or whatever garbage I was giving, I realized was just so that I wouldn't have to face whatever may come my way. Ultimately, I was feeling really down and I wasn't able to sleep so well because I was just thinking about just censoring myself all the time. Then finally, you had that tweet about therapists arguing about CBT versus psychoanalysis, and you compared it to rearranging the deck chairs on the Titanic. I thought you were calling me out because I was part of that debate, but it turns out you weren't even referring to me, but that's when I'm like, you know what? This is the time. If I'm not going to say it now, I'm not going to say it. I just said that whatever people are saying about this issue, almost no therapists who are well-trained, who are based in research, actually believe lockstep with the things you're allowed to say. First, I was talking to my safe people who I knew also had some concerns in some way. Then I started expanding talking to other psychologists, and these are like head of departments, like people with over 300 publications and books under their name, and they're like, yes, there's something up here. Then I'm like, oh, cool, we're going to just expose this and then people are going to start approaching this with a more sober lens. It was a little disappointing that it's not that easy, but yes, you were a huge part of this process and helped me get where I am now.

Stephanie Winn: Oh, well, you flatter me too much. But thank you for giving that information to other people to understand what's going on here that that there is this overwhelming amount of therapists who definitely aren't 100% on board. They're somewhere in the middle, but the vast majority of it are just ignoring it. They're just trying to steer clear of it somehow. The thing is, I will say, let me take the devil's advocate position that I have permanently given up my ability to do family therapy with this population, and that really stinks because I would love to do family therapy with this population. I was a good family therapist, I like to think. And I see things in a systemic way. And so now the work I do as a parent consultant and as someone who's developing resources for parents, it's like I'm still thinking in that systemic way. And I'm looking at what parents can do to change the family dynamics. But I'm doing it as more like in the context of creating educational resources. I mean, I do appreciate the fact that there are therapists who have chosen to stay quiet in the sense that it still allows them to work with people and not be Googled because there's a generation of people that has been brainwashed into thinking that those of us who are trying to help are out to get them, that they will be harmed by talking to someone like me.

Dr. Elliot Kaminetzky: Absolutely, and it's a problem that I experienced as well, but I would say of all the people I spoke to, the amount of them who are not speaking so that they could work with this population effectively is very small. That's the minority, huh? Yes, it's mostly people who are like, oh, I have tenure, and if I spoke about this, I would be I would totally lose that. It's the reason of, yes, I would have to deal with the discomfort of being honest. I think I really relate to what Jordan Peterson speaks about, that importance of telling the truth or at least not lying. The gift you get for that is you go on an adventure and life becomes adventure because you're actually putting yourself forward and that's who you are. It's been an adventure and I've enjoyed it.

Stephanie Winn: It's funny that you admitted that, I can't remember if the word you used was jealousy or envy, that you felt that toward me. I appreciate your honesty about that because it's funny to me because I guess the thought that first went through my head is like, That's nothing to be envious of. That's my childhood trauma. This is how I deal with stress is that my fundamental orientation to life is, is there an adult in the room? Is there a competent adult in the room? Is anybody going to do? No, I'm the adult. Oh, shit. Okay. I'm driving this car. If I could go back, I'd appreciate feeling a little bit more secure in life, but I think my courage is more like, it's like, well, somebody's got to do it.

Dr. Elliot Kaminetzky: Shit, I guess it's me. Would that be post-traumatic growth, given where it's gotten you?

Stephanie Winn: It's just character development. I think people are too quick to try to ascribe psychiatric labels to things these days, and it's because everyone's afraid of just being a little weird in their own way. but also afraid of being ordinary in some ways. There are things that are perfectly ordinary and mundane about most people. I think this generation has been conditioned to fear and loathe their ordinariness, the things about them that aren't special, the things that are just like, you want the same things everyone else wants. You want a secure relationship and a roof over your head. It's like people are trained to fear their ordinariness but also to fear just the little things that make you quirky. For me, I'm joking about it's my childhood trauma. It is my childhood trauma. That's true. At the same time, I'm okay just admitting that this is just the kind of person that I am. Maybe it's a little problematic in some ways. It's got its strengths and its weaknesses. The way I react to danger is I get really hyped up. It's just the way I am.

Dr. Elliot Kaminetzky: Yes, I think reflecting on what you're saying, the part that's going to be most unique about us is our ideas, our soul, our humor. Yes, there are these universals that are common, but if you have to self-censor, I think the whole package is going to be mundane or seem a lot of time, but to the extent that you could actually say what's on your mind, go to ideas, or just really think and say, that's going to be what makes you unique. It's interesting that someone once said, I'm an Orthodox Jew, and in the more, whether it's ultra-Orthodox or, quote unquote, Yeshivish world, you'll see them all dressing the same. They'll all wear, let's say, their black hats, white shirt, Then someone says, doesn't that seem so weird? You're all just a bunch of copies from each other. In response, they said, it's not our clothing that's going to make us unique. It's our mind. It's our ideas. It's our passions. and don't get distracted by wearing a cool shirt, that's what makes it unique.

Stephanie Winn: I think this gets into the identity issues that we're going to talk about today when we talk about the gender stuff. I've noticed in therapy and consulting with people who are in some process of trying to sort out what is really me, what do I really think, feel, want, and believe as opposed to the cultural influences that I've been told about what it is to be a good person. And traditionally in therapy, we're taught that a lot of that messaging comes from the family. But I think increasingly, it's not so much the family, it's the culture that people are internalizing those norms from. And it gets really toxic when young women, for instance, are made to feel like their desire for marriage and children is antithetical to feminism or something. I mean, there are real consequences for that. Being out of touch with their own desires, sacrificing their needs, trying to convince themselves that what they want or what's going to make them happy is having casual sex until they're 40 and then having to go through IVF to get pregnant because they spent 10 years in denial of the things that are actually very ordinary about them. because they were in a part of a culture that tells them these things that are ordinary about you, like the desire to love and be loved and be secure. That's not cool enough. It's not progressive enough. It's like there are people wasting years of their life because of these toxic ideas.

Dr. Elliot Kaminetzky: Yes, and I do think that is part of what led to the ROGD situation in adolescent females is that There are differences between men and women that are real. I guess modern Western society has really just lauded all the things that are more typical to men, like being captains of industry, or being much stronger, or things like that. while totally mitigating and even insulting things that are anything feminine, anything that that are unique to women. Seeing, I don't know, being nourishing, raising a family. I know someone who's a stay-at-home mom, and when people ask her what she does, she feels embarrassed to say it. She feels embarrassed to admit that she doesn't have a job. She's raising this awesome family, and she's running her home, and it's awesome, but in the society, you're seen as lesser than because that's the choices you've made. I think identifying out of it, identifying into the man who maybe exemplifies more of these modern, the epitome of these whatever is emphasized now, I think really led to what we're saying.

Stephanie Winn: For sure. Remembering my own adolescence and I'm one of those people who says that I would have been one of these kids. I think I hated my femaleness. I hated the weakness that I associated with it. I wanted to be tough. I'm sitting here making jokes in this conversation with you today about my childhood trauma, but part of that pattern was I'm the one who has to be strong. And strength is a quality associated with masculinity. And I was a fatherless girl without enough protection in the world. And so, of course, I despised my femaleness. I mean, my body was all wrong according to the beauty standards of the time. And that is a perennial problem. I mean, the beauty standards have changed slightly. But the constant, as far as young women are concerned, is that there's always something wrong with your body. And so I hated that vulnerability. And then I hated the emotional vulnerability that came with not feeling protected enough in the world. OK, but tell us about this idea of identity-based OCD.

Dr. Elliot Kaminetzky: When it comes to OCD, there's a lot of terms for the different subtypes and different categories of the subtypes. We'll hear about contamination OCD. We'll hear about symmetry-related OCD. I think a helpful categorical term that I've been toying around with I actually googled it. I think it's been used a few times, so I'm not the first person to say the following words. But this idea of identity-based OCD is when it comes to the fears associated with OCD, you have fears around the idea of what may happen to me. Am I going to get sick? Am I going to get injured? Am I going to feel terrible? Am I going to be rejected? Whereas identity based themes are what may I be? Who am I? And I'm afraid that I may be something that I fear. Right? Yeah, so this idea, you know, so you'll have what used to be called HOCD, like homosexuality OCD, which got renamed to sexual orientation OCD. But this idea of like you have someone who is straight, like heterosexual, you know, just, you know, he may be married. Then he gets this thought, he walks down the street and sees a good-looking guy and he's like, oh, what did that mean? You have this intrusive thought of what if I'm gay? For a married guy with kids, let's say in a Catholic community, that's a very scary thought. Included in this is what if I'm a bad person? That would be more in the moral scrupulosity category. What does it mean to be a good person or a bad person? Let's say they'll just be having a regular conversation and then they'll go home and they're like, did I insult that person? What would be so bad if I insult people? I'm a bad person and that would be terrible. They may do a half an hour of mental review, running through that whole conversation, thinking about all the facial expressions and whether or not they were insulted, asking other people who are part of that conversation whether or not you may have said something, and then maybe calling back again and asking if they're sure you didn't say something. That's all part of the compulsive rumination, but at its core, it's like, who? I am afraid I may be something at its core, and I'm doing all these compulsions to make sure I am not that. A very well-known form, a subtype of OCD, relates to gender identity, like fear that you may be in the wrong body, fear that you might be trans and not cis, as they would say. If you go to whether it's the Reddit, you'll see these themes emerge very commonly of like, I was walking past this store and I saw my reflection. From the reflection, I looked feminine and then I thought I might have liked that. Does that mean I'm really trans right so so so you know and then they'll be like they'll they'll have their tests to make sure you're not and you know they'll be like oh but what if that test is wrong so like it's very hard to logic your way out of OCD. So this idea of identity-based OCD, like I said, has to do with that fear of, who may I be? And to help that, I think it's helpful to conceptualize identities in terms of social contracts. Kind of like, what does it mean to be a good person? probably varies based on the society you're in. Maybe in one society means giving a ton of charity and I don't know, in another society it means you do land acknowledgments before you say anything. So I think understanding identity in terms of a social construct can be very helpful. And social constructs doesn't mean they're not real per se, but that there's no consensus as what it means to be that particular identity. And it can be very empowering for you to be able to choose the standards by which you could be a particular identity that you want to be. What does it mean to be smart? Right? Like you decide what it means to be smart. And I think there's value in realizing these are not objective things. Our identities and people will have different standards and you decide what works for you.

Stephanie Winn: Today's sponsor, Cozy Earth, is offering my listeners 40% off their selection of luxurious bedding, bath sheets, lounge apparel, and skincare products. Transform your space into a sanctuary of serenity and renewal. Check out their best-selling bamboo sheet set and plush luxe bath sheets. Visit CozyEarth.com slash Some Therapist and use promo code Some Therapist to take 40% off your purchase. If you get a post-purchase survey, say that you heard about Cozy Earth from this podcast and they'll send you a free set of socks. All right, now back to the show. Okay, so when you were talking about identity-based OCD just now, you said someone gets the thought, am I trans? And there's fear around what I could be. And you sort of made it analogous to this idea of the heterosexual man with the intrusive thought, what if I'm gay? And then he becomes so obsessed with this intrusive thought that it it becomes impossible to know that, no, he's still a heterosexual man who just noticed that another man was a good-looking guy for a moment and that this man has OCD. So there's a reaction. And maybe you could explain that a little bit more about what happens in a person with OCD when they get an intrusive thought and how to tell what's real and what's intrusive. But there's something that was occurring to me when you said that about the idea of being Which is, what if it's the other way around? What if the fear is this fear of being ordinary? Because there's this culture around social justice and oppression and all of this stuff. And a lot of the people who are falling into this are ordinary people, or they would be ordinary. So when I give myself as an example, I'm a pretty quirky person, but the thing that makes me special is not my gender or sexual identity, right? And yet, I think as a young person, I experimented with those outward signs of difference because that's what you do when you don't have that sense of identity. Like you were saying, for instance, with the men in the Jewish community, they all dress the same because they recognize that what makes them unique is their intellect and their spirit. Right, so as a young person, I dyed my hair every color of the rainbow. I experimented a lot with my look. I was a punk. I was a raver. I was a hippie. I was, you know. And that's all normal adolescent experimentation, because that's what you do when you don't have a strong sense of self yet. Those are things that you use to scaffold a sense of self. So I'm thinking, here are all these young people who don't know what makes them special or unique. They haven't had enough life experience yet. And they have a lot undermining their sense of self. So for example, the pandemic lockdowns interfered with them having certain life experiences that would have built a sense of identity through meaningful experiences with other people and out there in the world, right? Then you have the social justice climate that tells people that you're an oppressor and there's all this stuff. So to me, it seems like maybe for some young people, it actually starts with the need to feel that there is something special or unique about me, or that at least I'm not one of the bad people, right? So we're looking at, you know, you talked about like, am I a bad person? And you have adolescence, this like moral rigidity, this black and white thinking, I want to make sure I'm at least not one of the bad people. And so then I wonder for some people, it's not, am I trans? Oh, no, I might be trans. Oh, no, I might be trans. I think it's this fear that I'm just another cishet white kid, or cishet whatever kid. I mean, they're not all white, but a lot of them are, and a lot of them are middle class, right? But it's this fear of being ordinary, this fear that I actually don't have this thing that makes me special and unique, and actually the things that are quirky about me, I'm going to have to find some other explanation, or I'm just going to have to own them. Like I was saying earlier, I just have to own that I'm a little intense sometimes. And I could claim a label, I could claim a psychiatric excuse for my intensity, or I could just say, I'm intense and I'm weird, and I'm not everybody's cup of tea. And that takes courage, and I don't think a lot of young people necessarily have that courage to just be like, this is me, I'm just weird, and it's not my sexuality or my gender identity that makes me weird. It's just, I'm an awkward teenager, and I'm one day going to develop into an interesting person, but I don't know who I am yet.

Dr. Elliot Kaminetzky: Yeah. There could be like you have like the more superficial fears and then you have kind of the core fears. And this like one superficial fear of like what if I'm trans could be related to two separate core fears. When it comes to individuals who fear they may be trans, Very often, the core fear is what if I'm living inauthentically? You'll see a lot of trans influencers talking about finally living their true selves and never being happier in their life. Even Jack Turban will write, imagine living your life as truly you. Think about that. You have someone who's just a person, and they have their bad days, and their good days, and they have their friends, and they have their problems. And then they see like this idea of living your true self and never being happier. And I think that's so alluring. And then they have a situation where like, They really wonder, they saw their reflection and they're like, oh, I look feminine and I kind of like that. They're like, uh-oh, what if I'm trans, I'm just living my whole life in the wrong body when I could really be happy. But if I'm not trans and I medicalize, then that would also be bad. I think that could be one form of core fear when it comes to trans-related OCD. Alternatively, like you were saying, I think that fear of being basic, now it's like this insult, like calling someone a basic something. I think that can manifest in how can I make myself stand out? The sense I get when it comes to that OCD element to it, I often find that it's based in this fear of being living inauthentically and kind of like pining for this true happiness that can only come from living the right way.

Stephanie Winn: That's such a good point. I was really, really appreciating the sort of granular detail you got into there with what might be going on in the psyches of some of the people with this affliction and it resonates I think we're both bringing up valid points here. There's the, what if I'm trans? What if I'm not living authentically? I think that's a path for some people. I think this other thing that I articulated is also a path for some people of, well, I don't want to be cis. I don't want to be cis. I don't want to be cis. I love the way that you broke that down, this like, I'm afraid that I'm living inauthentically. And I've been introduced to this idea that some people have this trans experience and they realize that that's what was holding them back from being authentic. I've seen, because in my parent consulting work, sometimes parents show me texts or email exchanges. with their kids, and I get to read their kids' own words, or I get to look at their social media posts, and it gives me so much insight into what's going on in their minds. And I've seen exactly what you're describing. It's this story that a person has concocted about their experiences of how it all adds up, that I haven't been living for myself, I haven't been authentic. And it's like, I believe there's something true in there. And if we're going to be effective at helping parents restore connection and understanding with their kids, they're going to have to, in some cases, find a way to reach this part of the kid that's saying, I don't feel like I know who I am, or I don't feel like I've been living for myself. And so then it's like, we look at how else could that be true, right? So I'm thinking of a family where we looked at how the kid always felt a lot of pressure to perform academically. And that maybe in the process, they lost some other aspects of the process of getting in touch with themselves. And so now they're pinning the whole thing on this trans idea.

Dr. Elliot Kaminetzky: Right. I think OCD, it's a more extreme form of a very reasonable fear that many people have. Also, it's based on something that's very important to them. Adolescence, being authentic is the most important thing to them. You want to be your true self and you're authentic. I think you could have a very reasonable fear, but when the OCD takes hold to it, it becomes like now I'm going to check the mirror every day to sometimes dress more feminine, other times more masculine and see when I'm happier, or I'm going to check and recheck. I'm going to ask my friends whether they think I'm more trans or more cis because it's like I want total certainty. about something that's genuinely important to me. Just like those who have contamination OCD really want to be healthy and not sick. It's like OCD takes it, hijacks it, and it becomes all about gaining total 100% certainty. and that's where it becomes pathological and maladaptive. I think different ways we view our identity, like there are maladaptive beliefs about identity that kind of get people stuck. And I think part of it is this idea of objectivity, like that there's this objective, like almost material biological truth that is trans. And your goal is to know whether or not you are almost like a blood type. Am I cis blood type or trans blood type? If I'm a trans blood type living as a cisgender person, I'm wasting my whole life. That's what's being fed to these people. It's almost like a blood type and you have to know who you are. When it is a social construct, we as a society, agree that there's this term and what does it mean to be that? Even that evolves over time. What does it mean to be trans? Does it mean someone who has transitioned? Does it mean someone who has gender dysphoria? It used to be more about dysphoria, but then they're like, you don't need to have gender dysphoria to be trans. You just have to know. What does that mean? That could be a really maladaptive belief for individuals with this form of OCD, because then they're just on this mission to know the truth. That's even similar to your sexuality. I gave a talk about this recently for Therapy First, and I brought up this article called Budsex. And it's basically like men who identify as straight and they just like to have sex with men. And the reason why, you know, like just some friends, you know, they could be married, have kids. you know, conservative and they're just like, you know, sometimes me and Jim like to have sex. But that doesn't make me gay because Jim's not gay. Right. Like they almost for them. Right. In their society, among their group, homosexuality is more about femininity versus masculinity. Right. So there you have someone who has you know, totally comfortable with their sexuality and will just say like, yeah, I'm straight, but you know, sometimes I have sex with men, whereas someone could be like really heterosexual, but the fact that they found one person, one guy slightly attractive, suddenly they are hyper concerned of what that may mean, right? So even something like sexuality is determined by your culture and it is subjective. I think empowering people to determine what standards do they want to use to assume the identity that they want to be, recognizing its objective. Does this identity work for you? Is it meaningful to you? I think that's really important to correct the maladaptive beliefs around their identity and their thoughts about identity.

Stephanie Winn: So we're going to back up a second and just spell out some things about OCD for those who maybe don't have a background in this. I did do an episode with Johan de Souza where he explained how OCD works. But some of the things you have said I think it'd be really helpful for listeners to understand just the OCD mind and this idea of an intrusive thought. And how is it that an obsession or a compulsion develops?

Dr. Elliot Kaminetzky: Sure. Right, so like you said, OCD stands for obsessive-compulsive disorder. Obsessions are recurrent, intrusive, unwanted thoughts, images, impulses. And compulsions are repetitive behaviors or very commonly thought meant to reduce the distress caused by the obsessions. That could have a lot of different surface. That's the structure of it and it becomes a disorder when the frequency, intensity, and duration of these obsessions and compulsions are so much that they're causing severe distress and functional impairment. And it could be extreme distress, like there's a high suicide rate among individuals with OCD. So, you know, I think there's a lot of these very common media portrayals of OCD just being about, you know, concerns about cleanliness or being very, very neat. When in reality, most often it's about just these intrusive, scary thoughts of like you're, you're cutting, you're making salad and you're cutting with a knife and you just have this image of thrusting that knife into your chest, like extremely violent and scary. That would be like harm OCD. You could have a person who's not suicidal at all. What's so scary about it is that they could end their life with a simple move of their hand. They could end their life. If they're going on a hike and they see to their right, there's a long way down, what if I jump? That's the obsession like that, what if? People without OCD might be like, that would be crazy if I jumped off. I'm not going to do that. They'll go along their way and eat their chill mix. or they'll continue chopping their salad. If you have OCD, it's the appraisal of that thought as something that's meaningful and something that I need to address. so they'll be engaged in compulsions. It might just be hypervigilant. They might cut very slowly and make absolutely sure that they're not going to stab themselves. They may think about that day and whether or not they had any depressive thoughts thinking that that would make them much more likely to stab themselves. they may walk away all knives and will cut salad with a little plastic knife. The outward behavior of individuals with OCD can vary significantly for the same fear. This could be very disabling. It's a really, really challenging disorder and luckily there's treatments that work for it. such as exposure and response prevention is what I focus on among other treatments.

Stephanie Winn: Thank you for spelling that out so clearly. You just differentiated that it's the appraisal of the thought. I think that we all have thousands of thoughts a day, and some of those thoughts might feel intrusive or misaligned with our character, our intentions, our motives, and that a person without OCD just sort of dismisses, well, that was a weird thought. I would never do that, right? But it's a person with OCD attributes a certain amount of meaning to that thought, like it tells them something about who they are or something of that sort. You know what's coming to mind? Have you seen this Netflix show, The Decameron?

Dr. Elliot Kaminetzky: I haven't.

Stephanie Winn: It's so good. If you like dark humor- The Decameron? The Decameron. It's a medieval show, but it's dark humor. It's really funny, but also there's a lot of death and gore.

Dr. Elliot Kaminetzky: I totally see it.

Stephanie Winn: I love dark humor. It's so funny. and also really dark. But okay, good. One of the characters is this zealous, young religious woman. And of course, it's taking place in the 14th century. So you know, religion is everything and plagues are caused by demons. And you know, everything is evil spirits. And, and so there's this young woman who she keeps having intrusive thoughts about sex because she's young and fertile, and she's married to a man who's secretly gay. And so they have a vow of abstinence, which on the surface is supposed to be about her love of God, her chastity, right? But really, it's that he doesn't want to have sex with her because he's gay. And meanwhile, she's not all that attracted to him anyway, but she keeps lusting after random attractive men And she's incredibly pious. And so she spontaneously drops to her knees and starts praying really fervently throughout the show like anytime you know anything about the plague comes up because it takes place during the plague. But it's also you could clearly see it's a reaction to her intrusive thoughts. It's that so like she obsessively goes to the priest and confesses her sins or her sin of lustful thoughts. It's very entertaining depiction, but it was just like I was connecting those dots. I was like, oh, yes, this is actually like a form of OCD that's being depicted because this woman is afraid of her thoughts. She's afraid that her natural attraction to men is basically the work of the devil and the plague is also the work of the devil. The neutralizing ritual is praying 20 times a day in response to everything.

Dr. Elliot Kaminetzky: Yes, and that's what you'll see today as well.

Stephanie Winn: How does that manifest today in people who, let's say, for whom it's not religious? Are there things that are akin to prayer rituals that people do?

Dr. Elliot Kaminetzky: Yes, absolutely. Similar to what I said about the case of what if I insulted someone? Some people will be like, what if I got the wrong amount of change or I paid the wrong amount of money? may take a subway back to the store and double-check the prices on everything, double-check that no extra money was that I didn't underpay for something. There is morality outside of religion. Whatever your moral code is, people could obsess over whether or not, or I should say compulsively ruminate about whether or not they violated their moral standards. Maybe instead of confession, they'll confess to their friends. Instead of a boost, they'll have saying like, I think I did this. Am I a bad person? or how do I know I didn't insult someone, things like that.

Stephanie Winn: Do you think that therapy, let's say with someone who's not been diagnosed with OCD, because I'm not an OCD specialist and I think I've probably had patients with mild OCD that didn't have a previous diagnosis of OCD and where I missed that. And I'm just recalling past instances where one dynamic that sometimes plays out in therapy is that the therapist is also kind of treated like the priest that the person goes to confess to in order to neutralize their sins, or as the authority figure who deems whether what that person did is acceptable or not. Because sometimes patients come to us as therapists looking for our approval or our condemnation, our judgment of them. you know, when I've seen that dynamic play out in therapy, I usually address it relationally. Like, it seems like you really want me to be this authority figure in your life and that, you know, maybe that is taking the place of the way that a certain parent acted when you were young or the role that you were told God should play. And it seems like there's kind of this theme in your life around authority. And then you bring that to me and you're looking to me to be the ultimate authority on whether your actions were correct or incorrect or something like that. But do you really imagine that? I mean, first of all, that I have that power, that anybody has that power. And do you imagine that that would actually truly alleviate your anxiety? Because it seems like the anxiety sort of has this endless nature to it. And, you know, might it be a better use of your energy rather than looking to me or looking to anyone to approve or disapprove of you and your actions? to kind of look for that authority within, and what's the fear of looking for that authority within? But thinking about that same relational dynamic in therapy, I'm wondering, when I have experienced that, was that maybe some mild OCD that I didn't catch?

Dr. Elliot Kaminetzky: Yes. I think if it were OCD to the point where it would be useful to treat it for being OCD, even after you had that relational discussion, they may totally ignore you and say, okay, fine. Let's just discuss whether or not what I did was wrong. Then you can be like, okay, fine. Everyone does that. I do that regularly. You're fine. Then another minute later, How do you know for sure though? Let me describe it to you a little clearer. I think if you have this meaningful relational discussion and it sits with them and they reflect on it, I think maybe it wouldn't be OCD. I think usually when it's OCD, it pops out at you and you're like, this seems like you're not hearing what I'm saying or it's just not sinking in.

Stephanie Winn: I have had that with a patient where no matter how many times we had that conversation of what makes my judgment of your actions or your thoughts any more relevant than your own judgment or anyone else's judgment, Am I your mother? Am I God? What's being projected here? Because I'm just a person. My expertise is mental health, not moral authority. No matter how many times I had that conversation and talked about what do you imagine it would be like to find within yourself a part of you that could tell you whether that was okay or not okay every week, the same conversation. And I remember the patient almost developing a sense of self-effacing humor about it. Like, I know I'm going to do this to you again, Stephanie. I'm going to put you in this position again where I'm going to demand that you tell me whether what I did was right or wrong. And I'm like, and I'm not going to do that for you, right?

Dr. Elliot Kaminetzky: Yeah. So you were doing a technique an OCD therapist would do, like exposure and response prevention. The response prevention is not engaging in the compulsion. So let's say the compulsion was to ask, but you weren't accommodating her. and giving her the reassurance she was seeking. So you were helping her with response prevention and not giving her that information. And what you were saying about helping her trust herself is an important outcome of OCD therapy most explicitly in an increasingly popular form of therapy called Inference-Based Cognitive Behavioral Therapy or ICBT, where you're not really trusting your senses. In the course of therapy, really the end goal is to learn to trust yourself. As someone who, using your five senses and common sense, you have what you need to make decisions.

Stephanie Winn: How would a therapist guide a patient through that process?

Dr. Elliot Kaminetzky: There is this idea of OCD being part of inferential confusion, like you're in a bubble. It's based in this idea of a feared self. Everyone has a certain self that they're afraid that they may be. I am afraid I might be a very irresponsible person and therefore their OCD will manifest. What if I leave? What if I drop something and someone slips over it and dies? That hyper-responsibility. Recognizing you take chances The chances of that is near zero. You accept that uncertainty in every other aspect of your life. For this one thing related to your fear itself, you have these standards that are totally inconsistent. Helping them realize that, and helping them identify when they get stuck in that bubble where they're no longer using their senses, including common sense, and then helping them get out of that. In exposure and response prevention, you help them purposefully do the things they're afraid of, purposefully dropping little things on the street, and then accepting that uncertainty of what may happen realizing your life goes on and then you don't have to respond to these thoughts in such a maladaptive way. You could withstand that uncertainty. People don't just slip and die because you left your gum wrapper on the floor and they learn to accept that uncertainty and then ultimately in that process, they do begin to trust themselves more because they're not taking those intrusive questioning of themselves seriously. They'll just take it as part of the noise.

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Dr. Elliot Kaminetzky: Right. That's a great question. I think by the time they see me, having a lot of specialty in it, they generally know what OCD is and know the treatment. It's like, let's do it right this time. I feel like maybe if they were totally unfamiliar with it, then that could be harder. I used to have a form of OCD called sensory motor OCD, which is hyper- it's not very standard, but it's hyper-focus on one particular thing, such as a bodily process, such as swallowing or blinking or breathing. These are things that are supposed to be in the background, then why am I noticing it? It could drive you absolutely crazy. I got past that, thankfully, and I think In doing so, I really understood what acceptance meant and didn't mean. Because everyone's like, yeah, you have to accept that sometimes you'll notice it more, sometimes you have to notice it less, and go on. But it could drive you totally crazy. It could destroy your focus. It could make you feel like, oh, I'm going to feel this way forever. So how could I possibly accept this? So they're like, OK, 1, 2, 3, I'm going to accept it. Like, uh-oh, I didn't accept it. I'm accepting things wrong. I think acceptance, the challenge with acceptance very often is that when we say we're accepting, What we're really doing is we're saying like, I want to feel comfortable, so I'm going to accept discomfort so I could be uncomfortable. I feel like that cancels itself out because your real desire is comfort and you're not accepting the discomfort because it's uncomfortable and you're just trying to accept as another means of getting comfort. And I think what true acceptance it needs to be is you're accepting discomfort for the sake of something else. And sometimes I use the analogy of like a twisted ankle getting to, you know, you have your best friend's wedding and you're like going, you need to catch your flight and you twisted your ankle. Like I think like when you say, okay, I need to catch my flight and I realize this is very, very painful, but it's worth the pain because it's so important for me to get to my best friend's wedding and I'm not going to miss it. I think that's what acceptance looks like. There has to be something honestly bigger than the comfort, than your desire for comfort that's worth it to to experience that discomfort. That got me into existentialism, realize it's not just about values. I value being a good family man or value giving charity, but you have a specific mission here in the world. that only you could do that has to do with your history and who you are as a person and the problems that you're sensitive to. If you really focus on that and you identify what your mission is, then acceptance becomes meaningful because you have something to actually accept for.

Stephanie Winn: That is such a good point. It makes me think of how I would guess, of course, I'm not an OCD expert, but just having seen people with high levels of neuroticism, your world tends to shrink, right? I've worked with plenty of people who are agoraphobic or somewhere on that OCD spectrum, because I think phobias and OCD have a lot in common. OCD has a lot in common with certain levels of neurotic anxiety. And whenever I see that, it's like the person's world shrinks. And I know exactly what you're talking about when you say that you have to play mind tricks on yourself to convince yourself that accepting discomfort is a good idea when actually what you want is comfort. There's just this cognitive dissonance where you're kind of shooting yourself in the foot, and it's just moving in both directions at the same time, not really getting anywhere. But if you have some… bigger motivation that makes it worthwhile to accept the discomfort, and we can tie it into whistleblowing, right? You and I aren't here trying to tell everyone, join us in the whistleblowing party. It'll be fun. We're not saying that your life will be free of problems. It's hard. It's stressful. It cost me my health in a number of ways. We haven't gotten into exactly what you had to sacrifice, but I'm sure there are some really scary moments where I felt like you were taking a leap, but we do it for a higher purpose. We do it because there's something more important than our personal comfort. And I can imagine that maybe the thing that gets in the way for some people with OCD would be that their world has shrunk so small because of their neurosis that they've lost touch with what does make things worthwhile.

Dr. Elliot Kaminetzky: That's 100% it. I think that's the biggest price the OCD costs is it takes you away or it could take you away from who you want to be. We only have a couple of years here. We don't have a lot of time in the world. I think when we're really brought down by the discomfort and it's real. I don't judge anyone for losing sight of that. Also, recognizing the value and the convalescent capacity that finding your purpose in the world has is a gift that they too can be a part of. Even with getting obsessions right? And, you know, getting intrusive thoughts and dealing with that. And I think like, I think that's really a key for a lot of OCDs. I just realized that with the sensory motor experience.

Stephanie Winn: of reminds me of that saying, if you want to get something done, ask a busy person. And it also reminds me of the times that I've, because I've had a number of guests who this was their first or second or third time being on a podcast and they were pretty anxious. And I remember what that felt like because there, you know, there was a first and a second and a third for me too. And, you know, sometimes that those are the ones who are, I appreciate them very much for their bravery in coming forward. But they also need the most tending of their feelings of self-consciousness and self-scrutiny. And oh, did I sound right? Did I look OK? Can we do that over? And at some point, I just have to say, I'm pushing you off into the deep end. And you're just going to swim. Because I can't coddle all of your worries as a first or second time podcaster about exactly how you looked and sounded. You just have to trust the process. We're going to make you sound good enough. And I found myself saying to someone recently who had that fear, that in my experience as a podcaster, you just have to keep doing it. Because once your stuff is out there, it's out there. And if you guys all think that I actually think I look and sound good all the time, and that that's what's fueling this podcast. No, I am just as human as anyone else. I think I look and sound ridiculous just as much as anyone else. But I've recognized that the value that my podcast brings the world, despite its critics, despite the people who don't want to listen, I get enough good feedback about the good that is coming, even from those episodes where I think I looked or sounded ridiculous, that I've just had to get over myself. And so I end up saying the same thing to those guests who are so afraid because it's their first or second time. And they're worried about how they sound. And at some point, it's like, it's not about you. Like, yes, it's about you. Yes, you're sharing your life experience or your wisdom on my podcast. But at the same time, no matter what your inner critic thinks of you, some listener is getting something completely different out of that episode. And so podcasting is like a it's like a type of exposure therapy. There's definitely times that I go back and listen to myself. I'm like, I don't want to listen to my own voice right now, but it's just like you just have to get over yourself. Having a podcast is just your stuff is out there in the world and it'd be very inconvenient to take it down. Yeah, anyone who's got a little bit of OCD, like just go on like five or ten podcasts and you will hate the way you look and sound and then at some point you'll just be forced to get over it because you gave someone the right to publish the way you look and sound and it's not about you anymore.

Dr. Elliot Kaminetzky: Do you trust yourself more now in the process of like, I kind of got this and those concerns aren't? I do.

Stephanie Winn: I mean, I've done over a hundred, well over a hundred long-form interviews now and I'm now at the point where I can actually record solo. I'm actually working on a course that's going to be released this fall where I've recorded solo. You know what I've learned? First of all, software makes it so easy. What I do is I just pause. I will say a sentence or even half a sentence and I'll just pause for as long as it takes to collect my thoughts or collect my breath because I just have to push a button to remove all the pauses in the post-production for the video series or I'll just talk and then I'll say erase. And then that flags it for me to go and erase it because with the course I'm working on, I'm doing all my own editing. This podcast is professionally edited, but I didn't have time for that with the course. So exposure therapy, you just have to, you just, you know, just think of something bigger than yourself, right?

Dr. Elliot Kaminetzky: Yes, that's exactly it and you don't even need to be a CBT exposure therapist to do it. There is something you want and there's something in the way and you got to move towards what you want and that thing that's in the way will make you uncomfortable until it doesn't.

Stephanie Winn: I did want to make sure I picked your brain about this one thing before we go, and I think I did ask Johan de Souza something similar, but I want your perspective, because as someone without particular expertise in OCD, I have this sort of working model for what I think is going on, because a lot of the youth of the parents who consult with me do either have a prior diagnosis of OCD before the gender stuff came up, or they have behaviors that sound pretty OCD around the gender stuff. So I had this lesson in my course called Neuroplasticity, Addiction, and OCD. Maybe not in that order. And I sort of explained the three concepts all together. And I'm not going to try to recreate that right now. But in short, the way I think about it is like this. And I just want to know, as an actual OCD specialist, where you think my model is accurate or inaccurate. So it's that like with addiction, let's take a common addiction like food addiction in somebody with binge eating disorder or obesity. Food is a thing that they turn to for comfort in response to a distressing emotion. And the more this continues, the more food is the response to everything. Even happiness is celebrated with food. You know, any emotion, any life experience, it's just the go-to is the food or the substance of choice, whatever the addictive behavior is. And the way I think about it is the more you do that, the less you're leaning on any other appropriate response or coping mechanism, the more you are sort of cementing the neural pathways of everything leading to the behavior, and you're atrophying or failing to build the neural pathways of any other response to those emotions or stressors. So then it's like water rolling down a hill, carving out channels, where every time a new experience happens, it's just more and more likely to follow this predictable path. So that's how I think about addiction, for example. And then I think of OCD as like, well, I think of gender-related OCD, this idea that I'm trans, or the behaviors around pursuing social or medical transition. And some of these behaviors are like staring in the mirror. I've heard of stories of young women putting mascara on the soft little hairs that grow where our mustache area is, trying to paint a mustache on themselves. There's just so many little obsessive behaviors that these young people are doing in their rooms by themselves. And so I think that there's some kind of distressing life experience, some kind of anxiety or uncertainty or shame or whatever. And then the thought, I'm trans, and the thought of, I'm going to move toward transition in whatever number of ways, gives some kind of comfort or relief or distraction or hope in the moment. And then the same thing happens as with any other kind of addiction, where the more they go towards those particular thoughts and those particular actions for comfort, the more they're sort of carving those neural pathways deeper so that it's more likely that everything's going to lead in that direction, and the more they're failing to build other ways of interpreting and responding to those emotions in life experiences. And then something happens. After thousands of iterations of these obsessive and compulsive patterns on a micro level, something happens like a waitress using that person's preferred pronouns, saying sir or ma'am in a way that the person likes. And then they get this so-called euphoria, right? They get this, like, Oh my god, I feel so wonderful. I just got recognized for my proper gender. And to them, it's confirmation. The fact that they feel this elation is like confirmation that they're correct about their gender identity and that this is truly what's going to make them happy. Whereas my interpretation of that is there's a significant amount of placebo effect going on and that they've primed themselves through these obsessive compulsive patterns. They've primed themselves to think this is what's going to make me happy. So it's actually a testament to the power of their own brain, the power of their beliefs to shape their experience. But then everything ends up getting fed back into this feedback loop. So that's my working model on how all of this fits together. And I just want to know what you think of it.

Dr. Elliot Kaminetzky: It sounds right. I think there's overlap with body dysmorphia, where you have a perceived flaw and you notice it and it causes extreme distress. What do you do to alleviate that distress? Let's say you'll camouflage it, which temporarily reduces that distress. but builds that connection of stimulus response of perceived flaw, distress, and then production of distress through camouflage.

Stephanie Winn: Like binding or baggy clothes.

Dr. Elliot Kaminetzky: Yeah. Oh, totally. I think there is certainly the bones of OCD and BDD. You do see it. With the distress you feel when you are misgendered and the elation you feel when you're gendered the way you want to be, the pronouns you get. I think It's very hard to watch people who are experiencing that to have that degree of sensitivity to the behaviors of other people. It really gives away your power to just let people say what they want to say and I'm going to live my life. I think you really like so much power is given up when it's when they're told that this is a real aggression and a human rights violation. I think the model is like does overlap with OCD, particularly in the negative and the positive reinforcement. The brain is plastic and throughout your whole life, you're pruning and you're creating those synaptic connections and you're reinforcing the ones that work. It does get heavily entrenched to everything masculine causing positive reinforcement anything feminine causing negative reinforcement and removing negative reinforcement.

Stephanie Winn: And that last part you said is especially a trip when there's reason to believe that the individual's underlying temperament is actually gender typical. Because I hear a lot of these stories of boys who are very boyish or girls who are very girly prior to rapid onset gender dysphoria, and then they go fighting their nature. They go like girls who are always obsessed with looking pretty, and then suddenly they're cutting their hair short and binding and wearing baggy clothes, and they just get more and more distressed. I think it's because this thought has entered their brain that this is who they are because it's a cope for something, but now they're fighting their own nature too. they're denying, like the girl is denying that actually feeling pretty is important for her. I don't know. There's so many layers to it. But while you mentioned body dysmorphic disorder, before we wrap up, I'm glad you brought that up because I know BDD is considered like maybe a subtype of OCD. And I've been wondering how useful it might be in some families for them to reframe their kids' issues as just another form of body dysmorphia.

Dr. Elliot Kaminetzky: Yes, I think the real challenge is that oftentimes the parents are no longer seen as the experts in the room. They're given this information that if they say it's BDD, they don't understand. I feel like so much of the parental responses are filtered through the sources they find most reliable like on Discord or anything else. And I think really the environmental change I think is very important because that behavioral reinforcement schedule works in a particular context for the child. In these ROGD cases, like whether it's their peer group or their online world, It's working for them and I just have to deal with my parent while I still have to deal with them. But I think environmental change, like bringing, kind of helping expose an individual or, you know, how can I put this? kind of bringing a new context where, where kind of the identity is less important, where it's not as, as reinforced, could be very valuable. And I think like, the more I'm learning about trans and trans identity, you realize how different the presentations are, whether it's males or females, whether there's the extent to which it's a social component versus a sexual component, the reasons why they got in there and will really predict what's going to be most helpful for resolving dysphoria and for not engaging in medical procedures that don't have evidence behind them that they help with gender dysphoria even, or help with your mental health. I think that's important.

Stephanie Winn: It feels like we're just on the cusp of some cultural changes regarding this incredibly irresponsible, dangerous narrative that people are at higher risk of suicide if they're not affirmed when we know the opposite is true. I know there's been some recent changes in the UK that are very much welcome. So it feels like here in the US, hopefully, we're really on the cusp of dismantling this really harmful way of speaking to impressionable young people as any kind of acceptable norm in the mental health field. So Dr. Elliot Kamenetsky, thank you so much for the work that you're doing. I'm really glad that you've decided to come out and be a voice in the community. Also glad that you've started offering parent consulting. So why don't you go ahead and tell people where they can find you and what services you offer?

Dr. Elliot Kaminetzky: Sure. So I have a OCD and related disorder practice across a lifespan called myocdcare.com. So I'm Elliot at myocdcare.com. I have a child, I have the Center for Child Behavioral Health, so it's childbehavioralhealth.com, which is child therapy very much focused on empowering parents to help their own children. And then I have Serenity Parent Consulting for all consulting, both for private practice and also for, for parenting through, through the unique challenges that parents face today.

Stephanie Winn: As far as therapy goes, you're licensed in New York, correct?

Dr. Elliot Kaminetzky: New York, New Jersey, and soon to be Florida. Then hopefully, I'll get side-pacted so that I could see people- Nice.

Stephanie Winn: Oh, man. I just had a request from New Jersey the other day, and I wish I'd known that you were going to try to have to remember who that is. Okay. Well, thank you so much for joining me, Elliot. It's been a pleasure.

Dr. Elliot Kaminetzky: Thanks so much for having me.

Stephanie Winn: I hope you enjoyed this episode of You Must Be Some Kind of Therapist podcast. To check out my book recommendations, articles, wellness products, guest episodes on other podcasts, consulting services, and lots more, visit SomeTherapist.com or follow me on Twitter or Instagram at SomeTherapist. If you'd like to go deeper, join my community at somekindoftherapist.locals.com. Members can dialogue with other listeners, post questions for upcoming podcast guests to respond to, or ask questions for me to respond to in exclusive members-only Q&A live streams. To learn more about the gender crisis, watch our film, No Way Back, The Reality of Gender-Affirming Care, at nowaybackfilm.com. Special thanks to Joey Pecoraro for our theme song, Half Awake. If you appreciate this podcast and want more people to find it, kindly take a moment to rate, review, like, comment, and share on your platforms of choice. Of course, just because I am some therapist doesn't mean I'm your therapist. This podcast is not a substitute for medical advice. If you need help, ask your doctor or browse your local therapists online. And whatever you do next, please take care of yourself. Eat well, sleep well, move your body, get outside, and tell someone you love them. You're worth it.