Stacy G. Smith, MS, LPC
OCD Therapy: 5 Signs I'm Getting the Wrong Treatment
According to the International OCD Foundation, it can take approximately 14-17 years from the onset of symptoms to get both an accurate diagnosis and effective treatment. That's 14-17 years of not knowing what you're experiencing or how to help yourself, 14-17 years of unnecessary suffering, and 14-17 years trying to figure out why you don't feel "normal."
If you or a family member are currently in treatment for OCD, I strongly commend you for taking that important step. With that being said, not all therapy is created equal, and it’s imperative that you or a loved one are investing your time, energy, and money into the treatment that will get you feeling better.
Below are 5 red flags that point to ineffective OCD treatment:
1.) YOUR THERAPIST CONSISTENTLY PROVIDES YOU WITH REASSURANCE REGARDING YOUR OBSESSIONS, OR ENCOURAGES SELF-REASSURANCE BETWEEN SESSIONS
Some examples of reassurance include:
“Im sure you didn’t hit someone with your car. You’re a good driver, you're smart, you would know if you hit someone.”
"Let's list all the evidence that you are a good person." After generating a list together.... "See, you’re a nice person and are always doing good for others. You wouldn’t engage in any inappropriate and/or sexual behaviors. That’s silly.”
"You won't get sick from touching that. Look at all the people who touch ____ every day and are okay."
Being encouraged to repeat mantras such as, "I'm a good person," "I would never act on my thoughts," "I would not cause harm," "I can trust myself," "No harm will come to me," among others.
No amount of reassurance will ever work. Why? Because your mind will consistently find a loophole to any logic you or your therapist might use. Ever think to yourself, "This won't happen," only to have the follow-up thought, "but what if it does?!" A skilled provider will encourage you to sit with, and tolerate, the uncertainty your obsessions bring up, and in turn, learn to walk away from the reassurance game that simply cannot be won. In other words, tolerating the feeling that perhaps you did hit someone with your car, perhaps you did (or will) engage in an inappropriate and/or sexual behavior, and that perhaps you can get sick from touching something you fear.
2.) THE MAJORITY OF YOUR THERAPY SESSIONS FOCUS ON TOPICS OTHER THAN YOUR OCD
This includes focusing on discovering, and resolving, any past traumas. While it’s true you might have had traumatic experiences, research consistently debunks the connection between using trauma-focused therapy to treat OCD symptoms. In general, trying to figure out the exact trigger and underlying cause for your symptoms does not work. Why? Because whatever might have triggered your symptoms in the first place (and often, we may never know!), is not what maintains those symptoms. What research does show is that working in the here-and-now to eliminate compulsions using Exposure and Response Prevention (ERP) is the most effective treatment option. If you find yourself wondering how ERP can be used with "Pure-O," where you believe no compulsions are present, click here to learn more.
In addition to focusing on trauma, some therapy sessions tend to become "talk therapy," in which you discuss your friendships, work-related stressors, or family interactions from the week in a story-telling format. While it can certainly be uncomfortable speaking about your OCD symptoms, and even more uncomfortable addressing them through ERP, straying off course will not promote progress with treating your OCD symptoms. That's not to say working on coping with general life stressors is not beneficial for your overall well-being, but remember that the less time you spend tackling OCD head on, the slower your progress will be. As a provider working specifically with individuals with OCD, I consistently come across clients who have been in treatment before, and say that while their prior therapists have all been incredibly sweet and caring, and have helped them cope with general daily stressors, their OCD symptoms have unfortunately remained intense, frequent, and unchanged.
3.) THERE IS A BIG EMPHASIS ON LEARNING RELAXATION TECHNIQUES
I can’t emphasize how detrimental this is for OCD treatment. Relaxation practices are compulsions, especially if their main goal is to reduce the anxiety and discomfort you experience from your obsessions. If you are learning breathing strategies, visualization techniques, or other calming practices to use in moments when your obsession is activated, you are unfortunately only learning new compulsions that will intensify your symptoms in the long-term.
4.) YOU'RE ENCOURAGED TO PRACTICE THOUGHT STOPPING, OR REPLACING A NEGATIVE THOUGHT WITH A POSITIVE ONE
These are quite common, but unhelpful, go-to strategies. Like relaxation techniques mentioned above, you are only teaching yourself new compulsions. Remember, a compulsions is any behavior (mental or physical) used to alleviate discomfort brought on by an obsession. The goal of ERP is to intentionally approach what you fear, intentionally bring on anxious and uncomfortable feelings, and to intentionally sit back and tolerate this discomfort without engaging in any behaviors to alleviate them. At first, this seems wrong, unethical, and completely backwards from what therapy is supposed to look like. There’s often the image of therapy being a place you go to feel calm, more relaxed, and free of any anxious thoughts and feelings. For OCD treatment, this is simply not the case. ERP therapy is hard work, and will certainly challenge you in ways you never thought were possible. Again, compulsions are used to avoid discomfort - if you've been engaging in compulsive behaviors for years, only to feel more frustrated and tormented by your OCD, the proof is right there that trying to avoid discomfort does. not. work. Thought stopping, and replacing a negative thought with a positive one, are just two additional strategies used to avoid discomfort. Don't fall into the trap.
5.) YOUR PROVIDER IS NOT WELL-VERSED IN USING ERP
If you're just starting treatment for OCD, you may wonder how you can tell how skilled your provider truly is. Here is a list of questions to ask a potential provider to help you gauge whether he/she will be the most appropriate fit.
Being familiar with ERP is not enough. OCD is sneaky and manipulative, and will attempt to find reasons why ERP is not necessary, is the “wrong” treatment for you, and why you may not even have OCD in the first place. A skilled provider will see through all of these traps and encourage you to remain focused, vs. buying into OCD's lies and steering off course. Furthermore, ERP requires specific, and individually crafted, exposure exercises. Assigning generalized, cookie-cutter exposures that do not target your individual symptoms and core fears, will not be effective, and unfortunately, give you the impression that ERP treatment is not the right course of action.
When looking for specific OCD treatment, not all therapy styles are created equal. If you have not yet started therapy for OCD, it is important to interview potential providers on their training and comfort level in using ERP. If you're already in treatment, and find your provider encouraging reassurance, relaxation techniques, the use of thought stopping or replacing a negative thought with a positive one, as well as encouraging the processing of past trauma and conflicts, as well as current general sources of stress/anxiety, as the sole source of treatment, consider these red flags. OCD is highly treatable, and with the right interventions, you can be well on your way to recovery.
DISCLAIMER: The blog posts shared on www.StacySmithCounseling.com contain the opinions of Stacy Smith, MS, LPC, and do not reflect the opinions of any organizations or affiliates. While Stacy is a licensed mental health professional, all blog posts on her site are for informational purposes only, and are never a substitute for professional advice catered to your individual needs. Stacy Smith is not liable for any diagnosis, treatment plans, or decisions made based on the information presented on this website.