Her voice has the smooth, deliberate cadence of a favorite schoolteacher, “Tell me on a scale of 1 to 10 your level of anxiety.” Dr. Shana Doronn is asking this of her patient, but the knife, clenched in the patient’s fist, is at Dr. Doronn’s throat, right to the skin. The woman visibly trembles, tearful, agonized. Her hand shakes as it holds the knife. But Dr. Doronn is cool as ice.
Shana Doronn, LCSW, PsyD, was arguably the most memorable of the therapists shown on the A and E Network series Obsessed which aired from 2009 to 2010. The documentary series featured people afflicted with severe anxiety disorders, particularly obsessive-compulsive disorder (OCD), and chronicled how they progress with the help of home visits from mental health providers and therapy sessions. Each episode featured two different stories, with each case treated by one of four different therapists, including Doronn.
Dr. Doronn performed some of the most jaw-dropping examples of exposure therapy on the show. She visits the home of a severely germaphobic male and calmly informs him after a visit to his bathroom that she has put a used tampon in his trashcan. The look of horror on his face is a priceless TV moment, but ironically, a true step towards his recovery.
Exposure therapy involves bringing a person to the scene of their worst fears, and recontextualizing that fear. In theory, once a person realizes that the object of terror is harmless, their level of associated anxiety gradually dissipates. But it takes trust and firm support from the therapist to help an afflicted individual learn to feel safe.
The prior female patient is afflicted with a phobia of knives due to uncontrollable thoughts of attacking people. She has become paralyzed with fear, staying at home, terrified of going near anything that may contain or have anything to do with knives. Although she looks (and likely is) timid and harmless, she constantly thinks that she could become a violent murderer. Remarkably, after the exposure exercise, her anxiety improves; it is the bold level of faith from Dr. Doronn that has restored the woman to health.
On the show, Dr. Doronn appears completely nonthreatening, with the casual, easy air of a native Californian. She is petite, with dark blonde hair, sweet-faced like a dormouse. Yet her manner belies an iron will, confidence balanced with kind sincerity that is the essential combination within a successful therapist.
In our initial email correspondence, it is clear she has a down-to-earth humor and warmth, as she jokes that she will end up admitted to my psychiatric ward soon. At the time she was about to join filming for the second season of Obsessed, which unfortunately was cancelled midway. Having moved to the Chicago area shortly before the first season aired, she says her schedule ended up being grueling. The show flew her out round-trip to Los Angeles each week to visit her patients for the show.
She joined Obsessed on impulse. She was affiliated for many years with the prestigious Obsessive Compulsive Program at UCLA, where she trained with some of the most noted experts in the field. (She has since returned to join the UCLA program in 2013.) When some of them turned down offers to participate in the show, the producers knocked on her door. “At first I turned them down too, but I got to talking with some of my friends and colleagues, and they told me I would end up regretting it if I didn’t give this a chance, so I changed my mind.”
Despite the inherent “wow factor” of being on national TV, she dismisses any glamour or uniqueness to being a reality television “star.” She says she found the experience rather unremarkable, in that she pretty much did what she is used to--seeing and caring for patients. She would sometimes visit them in their homes, which is often done to help patients with on-site exposure exercises. The only difference was the additional presence of a cameraman beside them.
She acknowledges she was accused afterwards of hamming up her techniques for TV. In her characteristically matter-of-fact way, she elaborates, “That couldn’t be further from the truth. That day, with the bathroom, I had been having issues with my period; it was unexpected but it really happened. And I think that’s crucial; that is what people encounter on an everyday basis, and that is what people have to face in order to get better.” She does note though that she had no idea that segment would actually be included in the final show.
It isn’t completely clear if Doronn’s seeming humility about the show is genuine, or a way to skirt the idea that some exhibitionism lurks beneath her tactics and reasons for going on the show. Has she herself become “desensitized” by her line of work, so that what seems bizarre to the casual viewer means little to someone whose mission of fighting OCD matters more? Or is she rationalizing away some of her own agenda for going on TV?
Some clues to her inner rationale become evident later on as Dr. Doronn discusses her career path. In discussing her motivation for her line of work, Dr. Doronn tends towards facts rather than inward musings. This manner fits her style of treatment, the hands-on techniques of Cognitive-Behavior Therapy (CBT), developed in the 1950s by Dr. Albert Ellis, a psychologist, and in the 1960s by Dr.Aaron Beck, a psychiatrist. They created CBT as a way to streamline and pragmatize the dominant therapy of the time, psychoanalysis.
The therapy focuses on task-driven assignments and worksheets that break down “automatic thoughts” and their associated behaviors, and how one feeds into the other. Automatic thoughts are overgeneralized ideas that jump into people’s minds, such as “I am always terrible at doing things” or “These people don’t like me” or in the case of OCD, “I’m contaminated.” At best, these thoughts are like bad habits, but at worst, they border on delusional.
These thoughts then feed into the tortured rituals, the compulsions of OCD, where patients wash their hands until they are cracked and bleeding from dryness, where they spend hours rearranging items in their closet or scrubbing their kitchens, throwing away clothes worn once, then felt to be ruined. The Martin Scorsese film The Aviator vividly portrays Howard Hughes’ struggles with the illness, as he locks himself in a room, refuses to shave, and urinates into a row of glass jars, since he fears contamination if he ventures outside. With similar extremism, another female patient on Obsessed inserts toothbrushes and tubing into her rectum to clean it, which actually causes bleeding and more infections.
Dr. Doronn, as a CBT practitioner, embraces this more directive, collaborative approach to therapy, which differs from the more classic psychoanalytic style. Instead of sitting quietly while the patient talks on a couch, a CBT therapist gets their hands dirty, literally, with them. The therapist assigns homework assignments (like showering only twice as opposed to five times a day) and worksheets to outline ways to take control of one’s anxiety. He or she brings patients to the toilet bowl and has them touch the rims; the therapist tosses out your piles of papers if they’ve been hoarded at home.
Doronn says she didn’t start out wanting to become a therapist. She was trained initially as a social worker. Although some social workers specialize in talk therapy, she was more oriented towards medical case management, where one helps a patient navigate access to social services and resources. She worked in an HIV research center for many years at UCLA and enjoyed the proactive, solution-oriented nature of her job.
She views her switch to psychotherapy as a happy accident. In order to complete some therapy training as part of postdoctoral requirements for her degree, she joined the UCLA OCD Program. She was trained by some of the most noted experts in the field. “CBT and me just clicked. The treatment made sense.” She felt a sense of direction marrying with her set of interests and skills. Eventually, in addition to her Masters in Social Work degree, she completed a doctorate in psychology.
With some uncharacteristic reserve, she alludes to her own issues with anxiety. Somewhat breezily, she says that on the research scale of OCD symptoms, the Yale-Brown OCD Scale, “I score higher than my patients sometimes.” But she uses her own struggles as a way to bond with and inspire them. “I’m not shy about telling them I have anxiety too; it helps them realize I can really understand what they’re going through, and how they can get better.” In this sense, Dr. Doronn’s approach to therapy reflects her own sense of courage, her toughness in mastering her own demons.
While some have accused Obsessed of exploiting the individuals on the show, in a circus freak show way, Dr. Doronn doesn’t see it like that at all. “Our intentions were always pure.” She views publicity from the show in a therapeutic light. “The more exposure the disorders on the show get, the more attention and resources can be directed towards research and treatment.” One wonders then if another reason for her frank tactics on the show are a form of exposure therapy for herself, of showing to the world what she herself secretly endures, and what it takes to fight OCD.
She says much of the communication she has received about the show has been overwhelmingly positive. “I’ve received hundreds of emails praising the show, and even better, having people come forward asking for help.”
She has taken a greater role with a national organization, the OCD Foundation, in advocating for more access to care for people with these conditions. She has found the show and its associated dialogue a terrific way to network patients with providers across the country. In that sense, her social work skills have been applied on the largest scale possible.
Controversies persist in the world of therapy about how best to treat different conditions. In the past, psychoanalytic talk therapy was used for everything, including OCD. While useful for many situations, this type of therapy is usually less successful in the case of OCD; many research studies over the last few decades have repeatedly shown that CBT’s more directive approach works for OCD’s acute phase. Other bizarre schools of therapy also have cropped up in the field for OCD. According to Dr. Doronn the only negative feedback she received from the show was from practitioners of the recent “acceptance” movement. These therapists advocate sitting back and letting people continue to experience their symptoms without confrontation. She expresses frustration at what she feels is actually harmful to people with OCD. “It’s terrible, just garbage really.”
She hoped that the second season would correct some misperceptions about treatment that the lay public might get from Obsessed’s initial run. “Therapy is hard work, it isn’t instantaneous; I think the second show is filmed in a way that reflects more of that struggle.” She notes that it is difficult to help someone who isn’t motivated to get better. Also, the use of medications, blatantly omitted from the original season, comes into play. With the severity of OCD, medications are often necessary but carry their own stigma, and she notes that their use needed to be reflected more accurately on the show.
She finally notes the importance, as a therapist, of keeping yourself healthy as well, so that you can better help your patients. In this vein, she once again demonstrates the bravery of her approach to her own struggles with anxiety. She has become a triathlete, participating in Ironman competitions, and is particularly proud of a recent one she qualified for. “It’s about keeping focused and doing what’s helpful for you.” One notes how the intense, determined nature of triathlete training becomes a different, more positive outlet for the often tortured drives behind anxiety disorders like OCD.
It’s a struggle Dr. Doronn faces head-on. Her role on Obsessed reflects some of the ambiguities behind using a public forum for battling your own issues. Perhaps her seeming naiveté over the way she discusses her “vaginal fluids” on national TV comes across as slightly oblique. Whether unconsciously or not, she glosses over the ethical dilemmas inherent to showing patients and treatment on television. Like the CBT approach, she tends to stick to the surface of things. But ultimately, she is also brutally honest and used her approach on Obsessed to reveal the full degree of private suffering OCD causes. And most importantly, she helped her patients improve. She knows what it takes, firsthand, to fight fire with fire.
Copyright 2016-Jean Kim