Whether you started working with your current therapist when you were already aware of obsessive-compulsive disorder (OCD), or you began identifying symptoms and received a diagnosis during the course of your therapy, or you’re still figuring out whether you might have OCD, there may come a time when you start to wonder if there’s a way your therapy could be more focused on treating OCD symptoms.
And we have good news: There is! Exposure and response prevention (ERP) is a type of therapy that’s specifically designed to treat OCD. While other forms of therapy, including CBT, can be unhelpful or even counterproductive for those with OCD, ERP is the most evidence-based approach to reducing obsessions and compulsions.
Of course, you might think, shouldn’t your therapist already know about OCD? And frankly, that’s a great point! But multiple factors—from a lack of dedicated training about OCD to a misunderstanding on the part of your provider—can leave you in a situation with a therapist who doesn’t understand why ERP is so important for treating OCD. Even if they have learned about OCD, not all therapists are trained to provide ERP, and many have not received training in the many ways that OCD symptoms can show up.
If you have an established routine with your current therapist, working with a specialist who is trained in ERP can be a difficult topic to raise. Maybe you’ve felt deeply supported by your therapist, or they’ve helped you have meaningful realizations, or they actually take your insurance (or, if you’re really lucky, all of the above). If any of these things are true, it can feel daunting to tell them that you need to leave or pause your therapy with them in order to pursue ERP. But it can also be extremely worthwhile. And a good therapist will not only understand, but support you in seeing someone who can help you manage your OCD better.
Specialized OCD therapy can make a significant difference in your well-being and quality of life. If you’re trying to figure out how to tell your current therapist you’re ready for ERP, here are some tips that may help.
How ERP helps treat OCD
If you want to explain to your current therapist why OCD-focused therapy is so important, it can help to understand it yourself. Of course, your therapist should have learned about OCD and the most appropriate treatments during their own training, but unfortunately, many therapists do not get in-depth training on OCD. And, knowledge is power—you deserve to understand as much about your treatment as possible.
Traditional talk therapy, which you may have been engaging in with your current therapist, is a method of therapy in which you discuss your thoughts and feelings with a licensed mental health professional to understand and resolve emotional and psychological issues. It can be helpful with a number of problems. But, unfortunately, OCD is not one of them. In fact, talk therapy can actually make OCD worse.
This is because traditional talk therapy does the opposite of what is actually needed to effectively identify and address OCD symptoms—drilling down in areas where OCD requires a light touch. A well-meaning talk therapist might encourage someone with OCD to explore the origins of an intrusive thought extensively and, in doing so, imbue it with deep meaning, which makes it stickier and more distressing, or encourages the compulsion of verbal rumination. They might take great pains to reassure you that the intrusive thought isn’t true, which can teach you to rely on reassurance in order to try to overcome anxiety, thereby making the intrusive thought seem even scarier and the reassurance seem even more necessary. And while exploring the origins of your thoughts or pursuing reassurance might provide relief in the immediate, these approaches often cause harm in the long run if you have OCD.
By contrast, ERP is designed to teach you how to tolerate upsetting intrusive thoughts without engaging in compulsions like rumination, or other rituals. It’s also designed to emphasize that your thoughts do not carry a vital message that you must analyze and decode in order to understand yourself. Instead, you can come to understand that your thoughts are not you. No matter how distressing they may be, your intrusive and obsessive thoughts can wash over you and recede, and when they’re gone, you’ll remain.
Telling your therapist you need to try a different approach
Deciding you want to pursue ERP doesn’t have to mean cutting your current therapist off entirely. In fact, your current therapist may have meaningful insights about you that they can share with a qualified ERP practitioner (with your permission). And if you like the way your current therapist is helping you navigate a co-occurring condition—like ADHD or depression, for example—you may even be able to continue seeing them while you’re also seeing an ERP therapist. This possibility is especially valuable to remember if your current therapist is focused on treating something specific aside from OCD, like depression, anxiety, or C-PTSD. These conditions often occur alongside OCD, and if you feel like the help you’re currently receiving with one or multiple or them is helping, you don’t have to forgo it in order to treat your OCD.
Your current therapist and an ERP provider can work together to create a treatment plan that addresses your specific needs. They’ll start by evaluating which symptoms are having the most disruptive impact on your life. For example, if you have C-PTSD, you may find that working with an OCD therapist helps decrease your obsessions, compulsions, and intrusive thoughts enough that undertaking a trauma treatment like prolonged exposure (PE) with your current therapist becomes much more viable and effective.
OCD is often characterized as a doubting disorder, and it can try to get its claws in any major life decision—including and especially the decision to pursue a new type of therapy. This can make it hard to tell your therapist, an expert whom you trust, that you want to try ERP and that you’ll need to work with a different therapist to do so. OCD might even try to convince you that you’re making the wrong choice. If so, reminding yourself (and your therapist) of this particularly frustrating facet of OCD can also help contextualize the possibility that you’ll feel doubtful while pursuing ERP.
OCD can also push you to engage in people pleasing, or the effort to do things you think will keep others around you happy, even to your own detriment. If you’re worried that telling your therapist you want to try ERP might upset or disappoint them, the urge to people please might make it difficult to broach the topic. But remember, your therapist is there to help you, and they want to help you. They should support you when you decide to pursue evidence-based OCD treatment. You are not letting them down by pursuing ERP.
Exploring your long-term options
If you think it’s the right choice for you, you can also plan on returning to your current therapist’s care after a set amount of time. One of the key differences between more general talk therapy and ERP is that ERP is structured, and it can be easier to measure tangible results within a relatively short period of time. When done correctly, it doesn’t typically last indefinitely, though the skills you’ll learn will be ones you can use throughout your life—and if you ever feel like you’ve been managing your OCD effectively for a stretch but then need to return to ERP after a challenging life event or unexpected flare, you can do that, too. OCD loves to rear its head when you’ve let your guard down, and having a care team in place for that possibility can even help to reduce the anxiety, and therefore the intensity of a flare.
Learning about ERP is an opportunity to improve your wellbeing, not compromise on it. You might decide to transition from your current therapist to an OCD specialist, take a pause in your current therapy, or see both providers concurrently (depending on what each is treating). Ultimately, therapy of any kind should help you feel in control of your choices—including the choices you make about the therapy itself.
If you’re looking for an ERP-trained therapist, NOCD can help. Our licensed therapists deeply understand OCD and are specialty-trained in treating OCD with ERP. They’ll work with you to create a treatment plan personalized to your unique needs and help you regain your life from OCD. You can book a free 15-minute call with our team to learn more about getting started with OCD treatment.
