Obsessive compulsive disorder - OCD treatment and therapy from NOCD

How to Tell a Therapist Your Scariest Thoughts

10 min read
Patrick McGrath, PhD

Have you ever thought about doing one of these things?

  • running car off the road
  • insulting strangers
  • hurting strangers
  • fatally pushing a friend
  • jumping in front of train/car
  • causing a public scene
  • stabbing a family member
  • choking a family member
  • getting a fatal disease from strangers
  • giving a fatal disease to strangers
  • exposing yourself to strangers

Do these experiences sound familiar? Learn how you can overcome them.

Here at NOCD, we know how overwhelming OCD symptoms can be—and how hard it is to open up about your experience. You’re not on your own, and you can talk to a specialist who has experience treating OCD.

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These come from a well-known inventory of the intrusive thoughts faced by 293 “normal” students. Just about everyone deals with some of these thoughts. Most people either don’t really notice the thoughts or don’t spend much time worrying about them. They’re just part of the passing strangeness of everyday life in a confusing world.

But for people with obsessive-compulsive disorder (OCD), some of these thoughts will stick, launching an agonizing cycle of questioning oneself and trying desperately to get rid of the unpleasant feelings that result. OCD isn’t about the content of your thoughts, because everyone has strange and unpleasant thoughts. It’s about the amount of distress you feel in response to those thoughts, and the ways you try to get rid of (or avoid) that distress. People with OCD tend to have a few types of thoughts that they feel completely unable to ignore. And those thoughts can start to dominate their life.

(A brief pause to note that not everyone with OCD deals with this same experience of having certain thoughts and trying to convince themselves things are alright. Studies suggest a majority do, but there are other types of OCD that don’t involve these exact symptoms. More on these in future posts, but telling your therapist about symptoms might be tough even if they’re not linked to specific thoughts so most of this should still apply.)

At this point you might be thinking: Yeah, but my thoughts are much worse than the ones you listed. The examples above are just a few of the thoughts from one study, and research studies probably don’t dive into the strangest or most disturbing thoughts we can experience. (Another pause: When I say strange or weird throughout this article, I’m trying to capture the experience of having those thoughts, not saying people who have them are strange or weird.) We tend to avoid talking about it, but your brain will throw just about anything at you– and it’s often at the worst times, like when you’re with family, at a funeral, in a meeting, around kids, and so on.

Nobody is quite sure what causes it, but something about OCD makes it much harder for people to accept the uncertainty at the core of these thoughts:

Would I really do something like that?
Am I the type of person who might do that?
What’s wrong with me?
How can I make sure I don’t do that?

All four of these questions are troubling, but it’s the last one in particular that drives people to compulsive behavior. Making sure of something means getting rid of any uncertainty, and if we think about it for a minute we’ll realize this is an impossible task. Let’s look at what Dr. Jonathan Grayson, a leading expert on OCD, has to say about this in his helpful book Freedom from Obsessive-Compulsive Disorder:

For some of you, the failure of logic and the resulting vicious circle of endless questioning and anxiety have left you feeling that you are no longer able to discern whether or not something is safe: that not washing your hands really may harm your family, that you did run someone over on the way to the office, or that you don’t know whether or not the door you are staring at is locked. You know what you are feeling, but you don’t understand why… It is hard to separate how you feel from what you know, when you don’t have the language to communicate what is happening inside.

If you think about it, nobody is ever completely sure that they won’t do any of the things that pop into their mind. How do you know that you won’t spontaneously “lose it” and hurt someone you care about? How can you be sure you won’t contract a fatal disease from someone you meet? Nobody gets to have total certainty, but most people are able to tolerate this lack because telling themselves “I’m pretty sure it won’t happen” is good enough. So how does someone with OCD start to learn how to accept uncertainty as an inevitable part of our lives that can be tolerated, and even appreciated?

One of the best places to start is in therapy. As Dr. Grayson explains, just having the language to tell someone what you’re going through can open up a life-changing separation between you and the “vicious circle of endless questioning” that you’ve found yourself in.

But, of course, this involves telling your therapist about the thoughts that have been bothering you. So many people get stuck on this because they’re afraid their therapist will be disgusted by them. Because this is such an important first step if you’ve chosen to try therapy, here are a few things to keep in mind:

Your therapist isn’t a friend or family member

Or at least they shouldn’t be. All the hangups you understandably have about disclosing your most frightening or disturbing thoughts to someone in your personal life don’t need to apply here. It helps to remember that your therapist is a professional whose job is to help you as best they can. Your therapist will know better than to judge you for your thoughts, but the goal is not for them to like you or see you in a certain light anyways. Whatever is bothering you, tell your therapist. That’s the whole point of working with them.

It might also help you to know that your therapist can’t tell anyone what you tell them, unless they think you’re going to harm yourself or someone else. A trained clinician will be able to tell the difference between thoughts and intentions, so you needn’t worry that they’re going to tell anyone else or report you to the police. Not that you’ve done anything wrong by thinking.

This isn’t the first time your therapist has heard it

A woman saying she wants to talk with therapist

It may seem like you’re a uniquely horrible person for having thoughts like I could hurt these kids I’m babysitting, but as your therapist will likely explain to you, they’re pretty normal. And not just for people with OCD, as we saw above. The difference is that people with OCD might latch onto these strange thoughts and start asking themselves unanswerable questions about them. Don’t quit your babysitting job. Tell your therapist about your thoughts, because they’ve heard much “stranger” and “more alarming” things before. (There are quotation marks because they probably won’t think you’re strange or see any reason to become alarmed.)

It’s the only way to start getting proper treatment

Whatever your therapist doesn’t know about, they can’t help you with. Unless you go rogue and start treating yourself, you’re not going to be doing exposures to one of your obsessions unless you work your therapist to come up with them. Lots of people are afraid that acknowledging their thoughts will make something bad happen, or will mean that things will never be the same once they start along the whole path to treatment. These are understandable concerns, and they might be good things to mention to your therapist. Know that having extra violent or “messed up” thoughts doesn’t mean your OCD is more severe, so try not to avoid your most alarming thoughts simply because it feels like admitting them means you’re a worse person or a more difficult case for your therapist.

Not to be too repetitive, but remember that the difference between someone with OCD and someone without OCD is not the thoughts you experience but the way they respond to them. So tell your therapist about your thoughts and the way you’ve been responding to them, and you’ll be on your way to becoming less burdened by OCD.

Your therapist can help you see your thoughts differently

If you look back at Dr. Grayson’s quotation from above– don’t worry, I forgot it too– he talks about the importance of having “the language to communicate what is happening inside.” The clinical approach your therapist takes will help you reframe what’s been happening to you. You might arrive at your first therapy session telling yourself that you’re a horrible person, bound to eventually act out the horrible things that pop into your head.

Your therapist will listen, and then they’ll tell you about things like thought-action fusion, a fancy psychological term for the belief that thinking about something is basically the same as doing it, or that thinking about it means a specific behavior will inevitably follow. This isn’t an especially adaptive belief, because it tends to make people take their thoughts far too seriously.

Let’s say you’re cruising along on the highway and you suddenly think I could just drive off the road into that barrier. When thought and behavior are fused it feels like you’ve already done something as bad as driving into the barrier: even considering it. Or it can feel like you’re bound to actually drive into the barrier now that you’ve thought about it. Maybe you can hold out for now, but eventually it will really happen, right?

In this scenario, your therapist might help you learn to react differently whenever the thoughts appear. You might tell yourself “Wow, there goes that thought again. It’s really bothering me.” This is using language to distance yourself from the bothersome experience. And the more you do that, the more natural it will become over time.

Also, if you or someone you know is struggling with OCD, I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment and how NOCD therapists help people with OCD get their life back. NOCD therapists specialize in OCD and receive training in Exposure and Response Prevention therapy, the gold standard treatment for OCD. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP. Thanks for reading!

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Today’s post was suggested by one of our readers– thanks to our anonymous friend for the great idea. If you want to submit an idea, or even a completed blog post of your own, we’d love to hear from you.

NOCD Therapists specialize in treating OCD

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Taylor Newendorp

Taylor Newendorp

Network Clinical Training Director

I started as a therapist over 14 years ago, working in different mental health environments. Many people with OCD that weren't being treated for it crossed my path and weren't getting better. I decided that I wanted to help people with OCD, so I became an OCD therapist, and eventually, a clinical supervisor. I treated people using Exposure and Response Prevention (ERP) and saw people get better day in and day out. I continue to use ERP because nothing is more effective in treating OCD.

Gary Vandalfsen

Gary Vandalfsen

Licensed Therapist, Psychologist

I’ve been practicing as a licensed therapist for over twenty five years. My main area of focus is OCD with specialized training in Exposure and Response Prevention therapy. I use ERP to treat people with all types of OCD themes, including aggressive, taboo, and a range of other unique types.

Madina Alam

Madina Alam

Director of Therapist Engagement

When I started treating OCD, I quickly realized how much this type of work means to me because I had to learn how to be okay with discomfort and uncertainty myself. I’ve been practicing as a licensed therapist since 2016. My graduate work is in mental health counseling, and I use Exposure and Response Prevention (ERP) therapy because it’s the gold standard of OCD treatment.

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