Friday, February 26, 2010

Talking to OCD: The Hazards of Talk Therapy

12 ways of talking
Before I started Exposure Therapy with my current therapist for my OCD, I had been in psychodynamic therapy for 6 years with Molly. She was a good therapist. I changed my life in many ways while seeing her. I started driving again. I began making art. I became closer to my husband. I began to believe that I mattered, and joy was possible. I wouldn't have recognized myself if I could've seen into the future.

But the OCD persisted. Although Molly was the first therapist, among the 8 previous ones I had seen, to recognize I had OCD, her strategy was to encourage me to avoid my triggers, and to offer reassurance. She had a down to earth grittiness mixed with intense compassion, and enough of this quality allowed her to provide some Exposure Therapy inadvertently by guiding me to do things rather than intellectualize everything. She had no training in Exposure and Response Prevention Therapy, but most therapists are lacking in this training.

There are aspects of my therapy that dragged on in excruciating barrages of OCD. It was like running a race through quicksand, expending great amounts of energy and getting deeper and deeper into obsessing. This can happen with any therapist, but Molly's inexperience with treating OCD contributed to a feeling of hopelessness. If she could help me with so much of my life, but the obsessing remains, then what was I doing wrong? My perfectionism said, "You are defective. Just try harder. Obsessively research OCD."

When I finally joined an OCD support group a couple years ago, I was saddened and angered by the number of people who had been in psychodynamic therapy for years as they progressively became more entangled in their OCD. One woman had intrusive thoughts that she might hurt a child, and after 12 years of therapy, had quit her job as a teacher, was terrified of having a child of her own, and sinking deeper and deeper into depression.

Telling someone over and over that they are not a dangerous person, and feeding the OCD desire for absolute certainty is not benign. Directing a sufferer to dig for the roots of why they are having these thoughts, and what they mean is not benign. The harder the search, the more room for the OCD to escalate as the brain gets the message, "These thoughts must mean I am a bad person, since I am trying so hard to disprove them."

The OCD needs to be addressed directly, or it will go underground and the unraveling of lives will continue. It's one thing as a starting point to tell someone that research shows that people who have intrusive thoughts never act on them, but it's another to expect that that will magically make the OCD go away. OCD isn't about rational thought; it's unalloyed fear.


  1. I've suffered for over 10 years with harm-OCD. My heart really goes out to the woman mentioned in this article about quitting her job. So sad! Anyway, I am in the finishing stages or ERP with my awesome Doc. Although ERP will continue for the rest of my life.

    1. Thank you for sharing this encouragement LEP! I am so glad you found an ERP therapist for your harm OCD!