Obsessive compulsive disorder - OCD treatment and therapy from NOCD

How Megan Ocando’s journey to becoming an OCD expert began at home

11 min read
David Berreby
By David Berreby

Ten years ago, Megan Ocando thought she knew OCD.

She was in graduate school, earning her master’s degree in mental health and training to be a therapist. Her professors and textbooks claimed to tell her all she’d need to know about the disorder.

“They teach you a lot about depression and anxiety. And they tell you that OCD is part of the family of anxiety disorders,” she says. “That’s pretty much it—and that’s not even how OCD is classified today. They don’t go into any more depth about it.” 

Today, she really does know OCD, but only thanks to life experiences that weren’t part of her standard therapist education—plus the specialized training she got as a result. After a few years as a general therapist, she changed her career to focus just on OCD, and now Megan Ocando, LMHC, is one of NOCD’s specialized therapists. She had to pass a rigorous training program (“like an extra semester of grad school,” she says) that focused on the most effective technique for treating and managing all types of the disorder—as well as other conditions that often occur along with it, like anxiety, depression, post-traumatic stress disorder, and body dysmorphic disorder. 

That training with world-class experts, and the fact that she works exclusively with OCD patients, have qualified her to help people with OCD in a way that a select few therapists can. 

And it all began with a guy named Micky.

Ocando met him when she was starting graduate school. He was an attractive older man,  recently divorced, with a young daughter and a good job building airplane engines. They clicked, and began dating.

What it’s like to love someone with OCD

Micky had a few eccentricities—who doesn’t? But his behaviors seemed to have certain things in common, and they got in the way of his life. He needed everything around him to be just right. He was so fearful of disease and dirt that his hands were white and cracked from frequent washing. At work, he would imagine how a slight flaw in one of his engines could cause a plane crash—and then break down the finished product and rebuild it all over again. Sometimes he seemed odd and preoccupied as they walked along the street together.

“There was something off and I couldn’t put my finger on it, even though I was in grad school to become a therapist,” Ocando says. With little insight coming from her classes, it was Micky himself who told her what was really going on. 

After they had been dating a few months, he explained why he sometimes seemed distant as they walked along. He was counting up his steps, and if the number was off he’d have to go back and walk the same route all over. “And I do a lot of other things,” he told Ocando. “I think it’s OCD.”

Struggling to get an OCD diagnosis

Micky had been living with the disorder since he was a boy. But no one in his family considered that he needed help. “We both come from a Latin background,” Ocando says, “And in our upbringing and shared culture, talk about mental health was often nonexistent. So despite the fact that he’d take showers that lasted one, or two, or three hours, his family just thought he was a little odd.”

So Micky grew up “white knuckling”—telling himself he could keep it together, by clamping down and trying to seem as normal as possible. It was never easy. “OCD can make you feel really isolated and just so lonely,” Ocando says. But he was able to get through school and find work—building those airplane engines—even when his rigid, anxious perfectionism interfered now and then. 

Over the years, the intensity of his OCD symptoms would rise and fall. 

“OCD is like a wave,” Ocando says. “You’ll have trouble when it’s rising up, but then maybe you get lucky and you have a few years with no compulsions, or the compulsions aren’t debilitating for daily life. But then life gets more stressful, and it comes back.”

A few years before he met her, Micky found his OCD getting worse. It was the stress of divorce and making a new life. His family finally took note, and his mother told him he needed to get help. 

He’d hoped to find a therapist or a psychiatrist who would get him his life back. But he ran up against the same systemic issue that Ocando noticed in grad school: Most therapists have very little education in OCD. They may think they know what to do, and they probably mean well. Yet their approach to the disorder ends up doing no good—or sometimes, even making symptoms worse. In fact, current research estimates that fewer than 10% of OCD patients are receiving proven, evidence-based therapy. 

How the wrong therapist can make OCD worse

Micky found a psychiatrist—as many of us do—from a list of doctors who took his insurance. That therapist didn’t know the ins and outs of OCD treatment. Micky was given a prescription for a mood stabilizing medication. He soon decided it was making his life worse, rather than helping, and he stopped taking the pills. He was right: Mood stabilizers aren’t considered an effective intervention for OCD.

He also tried “talk therapy.” But talking about his troubles didn’t resolve them. In fact, some of the techniques talk therapists learn can exacerbate OCD symptoms. Trained to be empathetic, many therapists think the best way to help people with OCD is to teach them to cope with their anxiety. But what looks like a “coping skill” to an unknowing therapist can actually feed compulsions. For example, telling someone to reassure themself that their fears are exaggerated can encourage compulsive reassurance-seeking, which only feeds these same fears over time. 

In other words, not all therapists are alike. And very few receive extensive and rigorous training in the best treatment methods. As Ocando was going through her OCD training, she recalls that she’d sometimes think, How many people could I have helped if I’d had this training earlier in my career? “This is why it’s so important to find a therapist who is certified to work with OCD,” she adds.

By the time he met Ocando, Micky had given up on any form of treatment. He got by as well as he could for a few years, as they fell in love, got married and built a house to live in. Even the pandemic didn’t shake him. (After all, it was a time when he didn’t have to stress too much about coping with the world beyond his family.)

But then, a couple of years ago, some new stressors came along. 

Micky got a new job, and the couple had to move away from family and familiar routines. And Micky had new colleagues, who weren’t used to his compulsions. They noticed his perfectionism made him slow to finish jobs. 

Certain other OCD-related behaviors puzzled them, too. For example, he once called one of his new co-workers to ask for a lift to work the next morning—because Micky thought his car might not start. The co-worker said sure, assuming Micky had an unreliable old clunker. He found it weird when he drove up the next day to find Micky had a shiny new car that worked fine.

The toll of OCD

Micky could see that these new pressures were making his OCD worse. He made a list of all his fears and the compulsions they caused—and how much time they took.  “I remember his face was so sad,” Ocando says. “He’s very family oriented. He wants to spend time with us. Instead, he told me, ‘This is taking all my time.'”

As he looked once again for treatment, Micky was determined to find a therapist who really specialized in OCD. An online search led him to NOCD. 

Meanwhile, Ocando was asking around on his behalf. One of her former colleagues texted that she’d just joined NOCD as a therapist. Knowing firsthand how few therapists really know how to treat OCD, and witnessing the impact of this shortage on real people’s lives, Ocando decided to apply for a position at NOCD herself.

So as Micky began his journey as a NOCD Therapy member, Ocando started the months-long training process to become a NOCD Therapist, where all clinicians must undergo even more extensive training on things like exposure and response therapy (ERP). This is considered the gold-standard therapy for OCD. It’s an extremely effective process that takes time and expert guidance for therapists to learn. It doesn’t make OCD go away. But it takes OCD out of the driver’s seat, helping people like Micky live life on their own terms, rather than according to the fear and rigid rules of OCD.

It wasn’t easy. Ocando says it was a demanding process of study and practice that only the most dedicated applicants pass. And after they begin to work with patients, NOCD therapists continue to work on their skills, consulting regularly with senior experts and going through practice sessions, where their supervisors act out the role of patients, to test and improve their abilities

What this means for therapy members like Micky is that they get the absolute best quality of care. And that makes all the difference—providing people with the tools they need to manage the condition long-term, and giving them their lives back. 

How specialized therapy works for OCD

As Megan received expert-led training on the finer points of OCD treatment, Micky was becoming an expert on his own symptoms and behaviors. To begin, he worked with his therapist to plan a course of action. He identified all his OCD fears, anxieties, and worries, and ranked them from least to most distressing. Then, bit by bit, he steadily began to work through that daunting list, facing each fear with the help of his therapist (the “Exposure” part of ERP). Each time he’d be asked to face or imagine a thing that filled him with anxiety or discomfort, he’d practice not responding with a compulsion—that’s the “response prevention” part of ERP.

With the therapist’s constant guidance, he’d learn, for example, that he could live with seeing a row of jars not in line, and out of order. But the only way to gain this confidence and comfort was to resist the urge to straighten them out. A bit later on in treatment, he applied the same lessons to more difficult situations—for example, learning that he could get by with washing his hands for just a minute, once every few hours. 

The key is not to “white knuckle” these moments of fear, disgust, or anxiety. Instead, the point is to lean into the distressing emotions, in order to learn that you can actually tolerate those feelings, despite what OCD wants you to believe. “It’s a bit like going into a pool and the water feels really cold,” says Ocando. “But when you sit with it, eventually, it’s not that cold anymore. The temperature hasn’t changed, but your body’s gotten used to it.” 

Ocando also learned that a key piece of helping someone with OCD happens at home. In earlier years with Micky, she’d developed habits that seemed to help him, but actually made his OCD worse. She’d made time and space for his compulsions. As his wife, she naturally wanted to do things that helped him avoid uncomfortable feelings. And her limited, non-specialized OCD education had reinforced the notion that a distressed person should be told their feelings are valid and try to find ways to mitigate them.

Her heart was in the right place, but was all wrong for Micky—and for anyone with OCD, for that matter. Accommodating compulsions helped Micky feel better for a few moments, but it actually tightened OCD’s grip on his life over time. 

Bringing her expertise home

Here’s the reason that accommodating compulsions—like letting Micky double back on their walks—can do more harm than good: The worries and fears of OCD are never satisfied with these types of reassurances, and they end up feeding the vicious cycle of OCD symptoms. Fears and compulsions become stronger and more ingrained.

Changing that habit, Ocando says, was hard. “You feel like it goes against everything your instincts tell you, which is to be empathetic and, you know, be kind and hold their pain with them. But the truth is that by not accommodating their compulsions, you’re being empathetic in a way that actually helps. You’re giving them back that independence and freedom over OCD, where they are OK with sitting with this uncomfortable feeling, instead of being controlled by it.

Today, Ocando watches out for accommodation, and Micky, having worked hard in ERP, is doing much better. For example, he and one of their children recently got sick—an event that would once have caused him to exile everyone to separate rooms, amid a frenzy of cleaning. Instead, he was able to ride it out, despite the contamination obsessions, anxiety, and worry that crept up now and then. 

“There are still some bumps now and then. This is a lifetime disorder,” Ocando says. “But now he’s living a life that isn’t dominated by the disorder.”

Seeing what ERP has done for her husband and her patients leaves Ocando certain that she made the right choice to become one of the growing number of OCD therapists with rigorous, specialized training. “I always explain to a new member that I don’t have OCD. So I’m never going to tell you, I know exactly how you feel. Because that would be disrespectful. But I can share tools to help you with your OCD, and also offer tools to your family on how to decrease accommodations,” says Ocando. “And I can understand from the point of view of someone who loves a person who has OCD. I want you to know that you can connect with me in a deep, personal way.”

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