Because the intrusive and unwanted thoughts, images, urges, and feelings that characterize obsessive-compulsive disorder (OCD) are often disturbing, it can be very difficult to tell anyone about them. And even once we take the huge first step of starting therapy, it’s confusing to sort out what to share.
Lots of people write to us with questions about what they should share with their therapist:
- Should I share everything with my therapist, no matter what?
- What does my therapist have to keep confidential?
- Is it okay to share intrusive thoughts about harm or self-harm?
What can I tell my therapist?
The short answer is that you can tell your therapist anything – and they hope that you do. It’s a good idea to share as much as possible, because that’s the only way they can help you. There’s no denying the courage it takes to tell them about your most unwanted thoughts, but their job isn’t to hear only pleasant things. Only by explaining the things that bother you will you be able to work toward solutions.
You should know that therapists are required to keep the things you tell them confidential– with a few exceptions. For example, if they have reasonable cause to suspect you’re a danger to yourself or someone else they may need to involve a third party to ensure everyone’s safety.
Because confidentiality can be complex and laws may vary by state, your therapist should discuss it with you at the start of your first appointment and anytime thereafter. Once you understand the role of confidentiality in your therapeutic relationship, you’re ready to tell them what’s going on.
What you should never tell your therapist?
There’s not much in this category—as we discussed above, your therapist will be more able to help you when they have detailed information about you.
To put it bluntly, the success of your therapeutic relationship rests on a willingness to disclose information that’s difficult to share. It’s okay to tell them you’re finding it hard to share something. Therapists have been there with other clients, and will work with you to help you feel comfortable.
Taking the difficult first step to overcoming OCD
Tons of people are in therapy. It’s hard to measure exactly how many, but according to one small survey, 42% of American adults have seen a counselor or therapist at some point and an additional 36% would be open to it.
We wrote a more detailed post in February about the difficult but important process first step in telling your therapist your scariest thoughts. You’ll find lots of tips on how to actually do so.
Even if you’ve never told anyone about the intrusive thoughts that you have, sharing them with a specialty-trained therapist who has experience treating OCD can get you on the road to recovery. The most effective, evidence-based for of therapy for OCD is called exposure and response prevention (ERP) therapy, and its effectiveness has been proven through decades of clinical research.
In ERP, you are purposely exposed to the things or situations that trigger your intrusive thoughts and obsessive fears, giving you the opportunity to resist engaging in compulsions for quick relief, with the guidance of your therapist. In ERP, it’s crucial that you share the thoughts that cause you the most suffering, because without facing these fears and learning to accept uncertainty about your obsessions, you’ll remain trapped in the vicious cycle of OCD.
Finding the right therapist for you and building a strong therapeutic relationship is key to the success of treatment, because identifying your most distressing thoughts and fears is the necessary first step to overcoming them.
ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP. At NOCD, all therapists specialize in OCD and receive ERP-specific training. I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment.