While I offer general psychotherapy for many different types of issues, such as depression and anxiety, I am also a specialist for treating OCD. For over the past two years, the majority of my caseload has consisted of clients who have OCD. I previously served on a yearlong professional consultation team focused on OCD. I have provided clinical supervision and consultation to other therapists focused on OCD. It’s a passion area of mine for a few different reasons: I was particularly interested in learning about OCD when I was a graduate student and it’s something that both my wife and I have lived experience with (she gave permission for me to share this beforehand). This past fall, I was able to attend my first clinical conference focused on OCD at the New York State Psychiatric Institute. All that to say, it’s deeply meaningful for me to be able to support people with OCD.
To treat OCD, I use Exposure and Response Prevention (ERP or sometimes ExRP) therapy which is one of the most well-researched types of treatment for OCD. ERP is a specific type of Cognitive Behavioral Therapy (CBT). ERP supports people in a few different ways.
First, ERP teaches people about how OCD works. Simply having more knowledge about OCD can sometimes greatly improve people’s quality of life. OCD likes to get stuck on topics or themes that often make people feel embarassed or ashamed or guilty. A lot of my clients were relieved to learn that other people with OCD have experienced similar thoughts and feelings. I worked with people who believed they were “weirdos” or “creeps” or “crazy” (or some other negative label) because of their OCD symptoms when this couldn’t be further from the truth.
Second, ERP helps people identify what counts as an intrusive thought versus a compulsion. The intrusive thought is usually a “what if” worry that can activate a lot of stress and the compulsion is a behavior to bring relief from the intrusive thought. For example, someone with Contamination OCD might have the intrusive thought “what if the germs from touching the door never go away?” and then they do the compulsion of washing their hands 10 times in a row to get rid of the germs. This is an important part of treatment and the difference for certain people can be subtle and complex.
Three, building on the previous step, ERP helps people increase their ability to “hang out” with distressing intrusive thoughts and allow the thoughts to be there (this is where ERP can overlap with many types of mindfulness and acceptance-based treatments and practices). It can also help people resist the urge to engage with compulsions. One of the core aspects of the treatment, which is a part of the name, is exposure. When people with OCD are doing ERP, they will engage in planned exposure exercises for their specific fears and OCD themes. So, someone with Contamination OCD might do exposures of touching many objects in public spaces to address the fear of contracting diseases or becoming contaminated with germs.
Exposure therapy can be one of the most challenging types of therapy for anyone to do. Because people are asked to confront their greatest fears (under the careful guidance and support from a trained therapist, of course). However, I have witnessed how it can powerfully change people’s lives for the better. They can find so much more freedom and flexibility from OCD. Also, because doing exposures can be so intense,I often support clients in engaging in self-compassion and mindfulness practices to supplement the ERP treatment.
I’ve worked with many peope with different types of OCD, and I truly feel honored for being a part of their recovery stories. It is one of the most meaningful aspects of my work!
