1.) Is what I'm experiencing OCD?
Some clients will come to me as their first therapist, without formally receiving an OCD diagnosis. They may have done some independent research, noticed they related well to the description of OCD symptoms, and are interested in a professional's opinion. Others may have been in treatment for months, or years, and still feel unsure whether their diagnosis is accurate, especially if they have not yet found relief. After engaging clients in a thorough intake assessment, I think it's important to share whether they meet criteria for OCD. However, I prefer to focus more on explaining the treatment model and rationale, as a way to instill hope that they can get better, and are not defined by a label.
Side note: Some clients with OCD will consistently question their diagnosis, which is really just another way their OCD is stirring up doubt. As clients will learn in treatment, it never helps to reason with an OCD thought, so I may encourage them to sit with the uncertainty of their diagnosis, and focus their efforts on the evidenced-based treatment used to target their specific symptoms. As clients progress in treatment, I will reiterate, "All we know is that the treatment you've been engaging in has been working to reduce the intensity of your symptoms, so let's keep going, regardless of whether you have OCD."
2.) How long will it take for me to feel better?
The length of treatment varies for each individual. The good news, however, is that you have more control over the speed of your progress than you might think. If you are committed to engaging in a treatment called Exposure and Response Prevention (ERP), which requires a strong willingness to tolerate high levels of discomfort, you will be on the best road to success. ERP is challenging, and everyone proceeds at their own, individual pace; but, if you are dedicated to engaging in your specific, ERP exercises daily, you will proceed at the rate that is right for you. No one enjoys feeling uncomfortable, but remember, OCD has probably made your life pretty uncomfortable so far. The discomfort you will experience from treatment is your winning ticket to feeling better, while the discomfort of remaining caught in the OCD cycle will only lead to more discomfort.
3.) How do I make these thoughts go away?
The answer I'm about to give is probably not what you want to hear - we can't make these uncomfortable thoughts go away completely; but, we can certainly work to turn down the volume of those thoughts, so they are not as intense, intrusive, and annoying as they currently are. Everyone experiences unwanted thoughts from time to time, and we will work as a team to help you learn skills to become less entangled with them, and instead, treat them like the annoying background noise they truly are.
4.) Will I need to take medication?
I understand everyone has their own personal views on taking medication, and I want to respect that. While I will never force someone to comply with a medication regimen, I will provide psychoeducation on the benefits of doing so, especially if you find yourself struggling to engage in treatment. Exposure and Response Prevention (ERP) therapy is challenging, and requires you to experience, and tolerate, high levels of anxiety. This treatment is critical to your long-term recovery, so if we notice that despite your best efforts, you find it difficult to engage in the specific exercises that are part of your ERP treatment plan, I will encourage a medication consult with a psychiatrist. The goal would be to help bring your overall anxiety level down just enough, so that engaging in treatment can feel more manageable, and you can feel more successful. These successes will keep you motivated to continue further in treatment, so that you can ultimately reach a point where your OCD symptoms are no longer in charge - you are!
5.) Am I crazy?
This is the one area in treatment where I can provide you with reassurance that you are not crazy. You are experiencing symptoms that are in line with a condition called Obsessive-Compulsive Disorder. Just like fatigue, a fever, and body aches are symptoms of the flu, intrusive thoughts and associated compulsions are characteristic of OCD - a treatable condition. It is important to be kind to yourself during the treatment process, and recognize that just because you feel crazy, does not mean you are crazy.
6.) Have you seen other people like me?
Yes. I treat individuals with OCD all day long. While every case is different, I see individuals struggling in a very similar manner to you all the time. I also see individuals get better all the time, so my first piece of advice is to remain hopeful - there is a light at the end of the tunnel.
7.) How did all of this start? Why is this happening?
This is a common question that, unfortunately, we may never know the answer to, outside of knowing OCD is a result of both biological and environmental factors. The good news, however, is that we don't need the answer to help you feel better! ERP is a treatment method that operates independently of how your symptoms all started, so my advice at this point is to focus more on the specific treatment steps, and put your curiosity about how it all started to the side. It may be helpful to consider the example of someone diagnosed with cancer - their treatment does not focus on why the cancer started, but instead on the specific steps necessary to help the patient feel better.
8.) I've seen other therapists before and nothing has helped.
Typically patients comes to me after trying talk-therapy with several therapists - sometimes for many years. Traditional talk therapy is not an effective treatment for OCD, and the reason patients will often report poor progress, and feel discouraged. Sometimes, patients will even report feeling worse. You are not alone. The good news is that in our sessions, you will be engaging in a treatment you have never tried before - ERP. According to research studies, ERP is the most effective treatment for OCD, and unlike talk therapy, you will be engaging in specific exercises, every day, that challenge your OCD symptoms head on. Simply talking about your symptoms, trying to figure out why they all started, or trying to rationalize and "make sense" of your thoughts does not work. I commend you for not giving up on treatment, and for continuing to pursue new options!
9.) This is so embarrassing to share...
I hear this from nearly every patient I treat, so if you feel this way, you are definitely not alone. I know it may feel embarrassing, but being open and honest (and vulnerable), will help me better understand your personal struggles, so that I can help design a highly individualized treatment plan to help you find relief. My office is a safe environment to share what is troubling you most, and because I specialize in treating OCD, I hear countless stories of intrusive thoughts, images, and compulsions, every day. You are not alone, and there is hope.
10.) I know my thoughts are illogical, but I can't stop thinking them!
One goal we will work on in treatment is not falling into the trap of believing you need to stop thinking these illogical thoughts in order to feel better. I understand they are uncomfortable, intrusive, and highly upsetting, but if you trust the process, you can absolutely find relief, even while having these thoughts! It's hard to believe, I know, but hang in there. It will all be worth it when the volume of these thoughts becomes lower, and you recognize you no longer need to fight them.
-----------------------------------------------------------------------------------------------------
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.