I’m thrilled to share a guest interview with Denise Rickenbach, a licensed marriage and family therapist. Together, we’re diving into topics (like OCD and perfectionism) that many of you face daily! If you’ve ever felt unsure about where to turn or what might work for you, this episode offers tips, tools, and encouragement to help you on your journey. It’s especially helpful for moms and parents seeking guidance or new strategies to support themselves and their families.

We will cover:

• Religious OCD struggles
• Dealing with symptoms from childhood
• Navigating these challenges as a parent

Let’s get started!

Meet Denise Rickenbach

Denise Rickenbach is a licensed marriage and family therapist (LMFT) based in the Minneapolis-St. Paul area, specializing in anxiety and OCD. As a therapist, Denise brings a unique perspective, having transitioned into this career after decades of running a restaurant with her husband.

Her journey with OCD and perfectionism is deeply personal—she didn’t realize she had OCD until her forties, an experience that shapes her compassionate approach to helping others navigate their own struggles. With her wealth of life experience and professional expertise, Denise provides invaluable insights for those working through anxiety and OCD.

I would love for you to talk about how you knew you had OCD and perfectionism

I didn’t realize I had OCD until my forties. While training to become a therapist, I brought a case to supervision involving a client struggling with what I now know as scrupulosity or religious OCD. Using the skills I had at the time, like challenging cognitive distortions, I wasn’t making progress.

My supervisor suggested I explore OCD, which made me realize it’s not just about contamination or orderliness—it can latch onto anything important. For this client, it was her faith. As I learned more about scrupulosity, memories from my childhood resurfaced. I was about 10 when I experienced my first intrusive thought.

I had a difficult relationship with my dad, who was harsh and angry, leaving my sisters and me walking on eggshells. One summer day, I felt a deep sense of dread before he came home, and a thought struck: You don’t like your dad. This led to spiraling thoughts: Why would I think that? The Bible says to love your parents. Would I cry if he died? I ruminated for weeks before the thoughts passed.

I didn’t struggle again until I became a mom in my twenties. After bringing my first son home, intrusive thoughts about being a good enough mom overwhelmed me. Without the internet, I sought reassurance from books, which often made things worse. After a few months, the doubts faded, and I chalked it up to hormones and sleep deprivation.

The cycle repeated with my next two children, but by the time I had my third, I began using what I now recognize as ERP. I let intrusive thoughts surface without reacting and kept busy. Surprisingly, when I had twins 15 months later, I had no OCD symptoms. By then, the doubts and intrusive thoughts about motherhood had eased.

You also talk about OCD and perfectionism, can you share more about that?

I kind of all feel like these are branches of the perfectionism tree of the perfect Christian abd being the perfect mom. No matter what my job was, I always knew I was going to be managing a certain amount of imposter syndrome, feelings, making mistakes and upsetting people. My perfectionism kind of circled around things like that, but it never reached high distress levels, I was able to function with it and I wasn’t functioning well with these other themes. I have found that people who score high in conscientiousness tend to also be more susceptible to perfectionism anxiety and OCD because I believe the OCD would kind of hijack that conscientiousness and start getting into perfectionism.

A lot of my clients with ocd and perfectionism feel a lot of guilt if they’re not solely transparent with people because that equals dishonest. And that can get people into a lot of trouble by being more honest or transparent than is wise in certain circumstances. For me, perfectionism kind of correlates a lot with just conscientious types of individuals and interacts with honesty and responsibility.

When did you know it was time to seek out additional resources for your OCD?

I honestly did not. I did a lot of work behind the scenes learning about it. One of my biggest themes with anxiety and perfectionism was false responsibility. I read voraciously through the codependence literature, which really does teach you what you’re responsible for, what you’re not responsible for. The psychoeducation on my own through my twenties and thirties was really the way that I learned how to let go of some of the things that were not as much engaged with intrusive thoughts.

What would you say have been some of the most helpful things to help you disconnect and get out of that cycle?

I read a lot of books about boundaries and I read a lot of books about codependency. “The Power of Detachment” was big for me, “Codependent No More”. Those were a lot of things that really held me with my perfectionism. Finally, the most recent work I’ve done is acceptance and commitment therapy which was great for me and helped me accept what I could and couldn’t control. I started to recognize when I was shifting into judgment.

More of my recent work is just  focusing on my tendency to be kind of judgmental and that’s also a part of rational emotive behavioral therapy. I think ACT has borrowed a little from that in that you will get yourself into a bit of trouble with anxiety and depression if you are a judgmental person. And so part of that is no ranking and no rating of yourself, others or the world. So that’s my current work is catching myself when starting to shift into those behaviors.

How do you think detachment relates to OCD?

I think detachment is common. The whole idea of codependency got popularized during the recovery movement. But I also feel like the biggest feature of it is when an over-functioning person pairs up with an under-functioning person and they have a codependent relationship. They’re attached to some kind of outcome, whether it’s the relationship, whether it’s something else. So you get really attached to control and trying to control a situation.

So the detachment literature is really working on what I can control, what I can’t control, and really the serenity prayer is, “God grant me the serenity or peace to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference”. For me detachment is really starting to be mindful of where my attention and my control is starting to go and asking myself, is this something I just have to accept? Which is a piece of the radical acceptance of ACT. Is this something that I can affect some change? And then really the wisdom to know the difference between the two, sometimes not as straightforward as we would like. 

What else has been helpful for you from the perspective of Acceptance and Commitment Therapy (ACT)?

There is this thing that happens that’s subconscious when we’re stuck in these should’s and musts. What happens is whatever the situation might be, it should not be like this. But what’s also usually subconscious that I work with myself and my clients is this subtle belief that “I can’t stand it”. It really fires the limb system when you have this feeling that it shouldn’t be happening and I can’t stand it. So a big chart of the REBT and probably acceptance and commitment therapy is I can tolerate what I don’t prefer.

So when you find yourself getting ramped up with your anxiety and the adrenaline and you kind of stop and think what’s going on here? I’m thinking they shouldn’t have done that and I can’t stand it. That is a perfect recipe for just jacking your system up full of adrenaline and cortisol. So if you can just do this jujitsu move, like you know what? I don’t like it. I don’t prefer it, but I can tolerate what I don’t prefer. That to me is one of the biggest pieces of ACT and our REBT that they’ve been super helpful to me. That mantra of “I can tolerate what I don’t prefer”.

What is your experience with Willful Tolerance? 

I will give a shout out to Josh Fletcher. He goes by anxiety Josh on Instagram, and I listen to a podcast of his on the OCD stories. One of the big things that I work with myself and my clients is the sneaky little things that will happen in your brain. Even something like, “I hate having this” or “I hate these intrusive thoughts”, or “I hate feeling like this”, which actually exacerbates because anytime your brain understands you hate something, you can’t stand something, it will give you more adrenaline because it’s going to try and fix the fact that this thing that you hate is here. That is what Josh was talking about with willful tolerance. 

For example, in August I had some big obligations I had agreed to do at work. I was doing a bit of a transition on my job, and then I had gotten served a subpoena for some of my records for a client. I was so overwhelmed, and when you’re overwhelmed, you have a lot of adrenaline in your system. So I was really having to practice willful tolerance. I have a lot of activity in my system, but I’m purposely putting my attention on whatever client I’m seeing right now. Whatever my documentation, whatever I’m doing. I’m really tolerating a lot of discomfort in my system while I’m kind of moving forward.

What did you find most beneficial about Dr. Reed Wilson’s work, and how has it helped you?

I heard him on the OCD Stories, where he shared eight principles for self-help with OCD. One thing he said stood out—I had avoided some OCD topics because I was too overwhelmed by hierarchies and the complexity of exposures. On the podcast, he said one principle was no hierarchies because it gives OCD too much credit. I loved that. So I tried his OCD in the Sixth Moment game.

When I break it down for clients, he explains the six moments of neuroscience. The first three moments are outside your control. The first moment is when your subconscious sends the threat message about whatever you’re seeing. For example, someone with relationship OCD might see a church while thinking about taking the next step with their partner, and the threat message gets sent.

The second moment is the limbic system, wired to keep you alive, responding with, “I’m on it.” The third moment is when adrenaline and cortisol flood your body. Without ERP, you’re likely to fall into compulsions and overthinking until you reach some sense of release.

The cycle restarts when the next threat message comes. Moment four in ERP involves externalizing the disorder. You recognize, “This is not me; it’s the disorder hijacking my voice.” Externalizing helps create distance. Moment five focuses on degrading the message, and moment six involves redirecting attention to something meaningful, like what you were doing before the intrusive thought, whether it’s driving or doing dishes.

This willful tolerance is key. In a nutshell, this framework helps me guide clients through exposure response prevention for their specific themes or struggles.

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Struggling with OCD and anxiety? Join my Seven-Day Breakthrough Challenge starting January 1, 2025! For just $17, you’ll get daily video and email guidance to build tools, shift your mindset, and take control of intrusive thoughts. Sign up by December 30th to join an exclusive live Q&A and kickstart your success with personalized support. Don’t wait—step into 2025 feeling confident and empowered!

Wrapping Up: OCD and Perfectionism

This conversation on OCD and perfectionism has been full of practical tips and tools for tackling OCD and anxiety. We covered so much—from understanding why standard approaches like breathing exercises and challenging cognitive distortions don’t work for OCD, to diving into game-changing strategies like detachment, Dr. Reid Wilson’s “six moments,” and willful tolerance. It’s a reminder of how important the right resources are, especially since OCD is still so often misunderstood. I’m so grateful for everything shared here, and I hope it helps more people feel supported and ready to take on these challenges.

If you loved Denise and would like to connect with her, you can reach her personally at deniserickenbach@gmail.com or professionally through her practice at Omni Mental Health in Blaine, MN, at drickenbach@omnimentalhealth.com.

Keep doing all the hard things. Bye for now.

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