VH1's OCD Project premiere with Dr. David Tolin was hard for me to watch. Not because of the shoe licking, but because Exposure and Response Prevention Therapy(ERP) is portrayed as something to be inflicted on people with OCD in a boot camp manner, with a dose of "all or nothing" thinking thrown in--ie. either fight your OCD or get out. If my therapist demanded I do exposures "for my own good" I would flee.
Leonard often says that if clients don't agree to the goal of learning to live with uncertainty, they are not going to want to do any exposures, and his job is work in partnership with clients to understand the nature of OCD and of the need to accept uncertainty. OCD isn't happy with 99.9% assurance that my health symptoms aren't dangerous. It wants 100% certainty, and this can make my life hellish. This is not to say that Leonard isn't frank. He'll tell me that I could worry about one symptom and then have a completely hidden disease kill me, but if a therapist feels their job is to push their clients off a cliff into dramatic exposures, this is inappropriate.
ERP is about starting with what you can and *will* do. What is the first step you can take to fight the OCD? I was often paralyzed with making perfect decisions. I started with a small exposure of choosing something by flipping a coin, at least once a day. Should I wear a green shirt or a blue one? Flip a coin. This created a wave of anxiety in me, but not so much that I was unwilling to do the exposure. Then I moved on to choosing something that didn't feel "perfect." If you find yourself thinking your therapist is crazy for suggesting certain exposures, you need to talk about it--and that in itself is an exposure, if you fear even verbalizing what you are really afraid of. If my therapist yelled at me, or goaded me into an exposure, I wouldn't get the benefit of treatment, because I don't respond well to this style. People with OCD have a range of temperaments, just like all humans.
The irony is that all things considered, if the participants in the OCD Project aren't scared off, and stay in therapy, and do the exposures and don't secretly do rituals to "undo" them, they will be better off than if they went to a traditional therapist who wants to talk about the reasons for the content of their fears. Arine's story is particularly poignant, with her fear of harming someone while driving, after her father and grandfather were killed in horrific car crashes, but making the link between this event in her life history and the manifestation of her OCD is not enough in and of itself to help her break free of the anxiety. There are many ways in which each of us can cause harm to our fellow beings, but to consistently eliminate all risk is both impossible and the attempt erodes our ability to do good in the world.
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