Obsessive compulsive disorder - OCD treatment and therapy from NOCD

ERP As a Family Lifestyle

By Susanne Haase

Apr 20, 20224 minute read

OCD is a pernicious disorder that affects not only the person suffering from it, but their family and loved ones as well. Just as the struggles of a person with a medical illness may affect their family, the encouragement and support of the family in that person’s physical recovery is a critical component of their treatment. This is especially true of OCD as well.

Consistency is key in helping a person recovering from OCD. For this reason, it is important that all family members have a clear understanding of the person’s symptoms and pain, as well as the interventions that will help – or hinder – their progress. This is not always obvious, and while family members might have the best intentions in caring for the sufferer, they may unwittingly contribute to maintaining the disorder instead of combating it.

An understanding of Exposure and Response Prevention (ERP) – the effective, evidence-based treatment for OCD – is important for family members to help their loved one recover. Further, when incorporated into the family lifestyle, rather than left only to therapy sessions, it can greatly contribute to supporting the treatment that their loved one is working through. ERP therapy can feel counter-intuitive; the things that family members may naturally want to do to help – provide reassurance, present evidence against OCD fears and doubts, submit to requests to align with the sufferer’s compulsions – may provide temporary relief but ultimately serve to feed the disorder. 

Family members can take an active role in their loved one’s recovery by following these steps.

1. Understand the symptoms

Family members need to have the same understanding of what their loved one is struggling with. OCD is a fear-driven disorder that cannot be rationalized or wished away. The sufferer is plagued by recurring doubts, unwanted images, and strong urges that drive their behavior. Often, they have terrible fears of unwanted outcomes from which they can only get relief by engaging in rituals. This is not their fault, and it is not something they feel they can stop. They are trapped in an unending cycle of “what if” thoughts that can make peace, contentment, and even basic functioning impossible for them. Feeling understood by family and loved ones goes a long way toward helping them.

2. Fight the OCD, not the person

Paradoxically, trying to fight OCD with reassurances, rationalizations, and factual evidence is not helpful in treating OCD. Family members might naturally engage in this behavior to try to help the sufferer feel better. However, this type of response to a person’s OCD thoughts and urges maintains them; it confirms the notion that there is something that requires attention and response. Withholding reassurances and rationalizations may seem hurtful, even cruel, especially when the sufferer is desperately looking for that relief. Yet, it is critical for the family and their loved one to understand that doing so is aimed at fighting the OCD, not fighting the sufferer. If the family’s attitude and response to requests for reassurances is: “not important, no need, there is no answer or guarantee for that,” they will be asserting that there is no real threat present. Refusing to engage in their loved one’s compulsions and living life on the family’s terms, not OCD’s, will help the sufferer strip OCD of its power. 

3. Model life without OCD

Often, family members will accommodate a person’s OCD-driven rituals, such as excessive cleaning, avoidance of triggers, checking and re-checking, etc. When this occurs, the whole family is living with, and sustaining, the person’s OCD. Family members can be more helpful by modeling life without OCD, going about their lives naturally in confident and positive ways. This will not eliminate the sufferer’s OCD, but it will showcase how life can and should be experienced: with tolerance for uncertainty and reasonable risk. When a person’s OCD becomes central to the whole family, the sufferer has no objective view of life without OCD. Modeling life without OCD can help provide that more balanced view.

4. Living life according to values

For the person with OCD, normal, everyday activities can feel like exposures. As they work through their treatment, they are learning to respond differently to their intrusive thoughts, doubts, images, and urges. The family can help support their treatment by exhibiting belief in them – acknowledging when they are struggling but reminding them that they have a choice in how they respond. Engaging in activities and behaviors that they value as a family is helpful in highlighting that there is a much more satisfying way to go through life than chasing an illusion of safety that compulsions provide only momentarily. The family, and the sufferer, can live according to their values, what most matters to them, and thereby reinforce the notion that OCD thoughts, images, and urges are only that – unwanted perhaps, but not worthy or hijacking their behaviors and attention. When the family directs attention to living in alignment with their values, the sufferer can learn that this is possible for them, too. 

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