The Most Powerful Moments I Witnessed As a Therapist Treating People With OCD

Therapy can be such an influential part of someone’s life. As a therapist specializing in obsessive-compulsive disorder (OCD), I can recall countless times I was personally touched by the bravery of the people I worked with, the incredible things they overcame, and the positive changes I saw in them. 

The idea that someone can open up about the deepest wounds from their experience with OCD, placing their confidence in me to help, is something that I do not take for granted. I’m forever grateful that they entrusted me with the most sacred parts of themselves. The things I saw each person accomplish were a powerful source of inspiration during my own recovery journey, and I believe that the hope their stories offer can change lives beyond my own.

While I’ve witnessed many impactful therapy experiences, here are two that stand out in my memory. (Note: Names have been changed to protect the privacy of individuals)

1. Tori’s biggest exposure

Tori’s life before treatment

Tori had what was by far one of the most severe cases of OCD I have ever worked with. Her story tugged at my heartstrings on so many levels and her strength amazed me.

Even though she had reached out for help in every way she could and tried many other therapies and treatments, no one seemed to know what Tori was dealing with or how to help her. She was experiencing numerous OCD themes and her case didn’t fit “neatly” into one box. As a result, she had suffered for years, being psychiatrically hospitalized numerous times and misdiagnosed with both schizophrenia and psychosis.

By the time we started working together, Tori’s life was utterly consumed by the multiple layers of obsessions she was dealing with and her days were spent lost in rituals. But despite all of this, she was still ready to dive in and do the at-times difficult work of therapy. It helped that Tori was a highly intelligent, charismatic, and friendly young woman who was easy to get along with and hungry to learn more about OCD and treatment. She was determined and willing to do whatever it took to feel better and to stop the cycle she had been stuck in for so long.

Dealing with multiple OCD themes

Tori primarily struggled with POCD, a subtype of OCD that involves unwanted, anxiety-provoking thoughts about being attracted to children or interacting with them inappropriately. I want to emphasize that POCD is highly misunderstood, and Tori in no way wanted to act on these thoughts. It was exactly the opposite: She was so uncomfortable with these thoughts that they made her feel sick.

Even more frightening to Tori was the recurring thought that maybe she had already done something horrible to a child while babysitting as a young girl, and had forgotten or somehow buried the memory. This false memory had taken root in her mind as another OCD theme. Tori would replay her past babysitting experiences over and over, searching for any sign that her fear might be true and questioning every encounter she had with that child. She knew that she didn’t even have these thoughts back then, but now that she was older, they haunted her.

Adding to Tori’s pain was a long-held dream of having her own children someday. She had been happily married for several years, and she and her partner both wanted to be parents. Things were finally falling into place for them—they had even bought their dream house recently—and yet she couldn’t bear the possibility of having these same thoughts about a child of her own.

Tori also struggled with extremely frightening fears that she may have accidentally poisoned others. She would have guests over and find herself secretly emptying all of the open bottles that they drank, “just in case.” It became exhausting to come up with excuses for why their plates of food or drinks suddenly went missing but for Tori, the risk was too great to stop. If there was even a possibility in her mind that something could be contaminated, then she needed to get rid of it. Over time, this behavior became more and more complicated to hide from those around her.

What therapy looked like for Tori

Because there were so many different themes of OCD going on in Tori’s life, in therapy, we started exploring what might be at the root of her distress. Of course, doubt and uncertainty played a role, but Tori’s sense of hyper-responsibility was even more significant. She felt it was up to her to keep herself safe and ensure everyone around her was safe.

Once we began to dig in and explore these feelings, the core fears behind them—fears of being “evil” or unloved—became more of a target of treatment. To tackle these fears, Tori would have to work on accepting uncertainty and allowing herself to “sit with” some very scary feelings. She would need to accept the possibility that she could someday be unloved by those she loved so much, or that could think of her as “evil.”

A common phrase that I would use was, “Just because something is possible doesn’t mean it’s probable.” The idea behind exposure and response prevention (ERP) therapy, the most effective treatment for OCD and the type of therapy I practiced, is not for a person to accept that they are what they fear or any other harmful belief about themselves. Rather, the idea is to learn how to accept that OCD will not allow you to ever feel “certain enough.” This is why we must learn to allow uncertainty and doubt to be present, and learn that they don’t point to some hidden meaning about our true identities.

Tori’s exposures

I still remember the first time Tori was able to do exposures regarding the POCD. She would update me weekly on her progress, each time feeling a little more confident. It was amazing how quickly she was seeing the results of her hard work. That said, it was still a long process, but she stayed focused and determined the whole time. The harder the task, the more she went for it.

One day, Tori called and told me that she was going to start volunteering at a school. I was shocked (and thrilled) as I recalled that just months before, she couldn’t even walk past a school, let alone go inside one.

Around this same time, Tori also began to purposefully bake items and give them away. This was another huge moment for her, and a big step in taking the power away from her fears of accidentally poisoning someone. There were times she wanted to go back and retrieve the things she baked because she couldn’t be sure they weren’t somehow tainted or contaminated, but she refused. She began to get back into her love of baking, which she had almost forgotten.

Eventually, Tori’s time in treatment was coming to an end. She had come so far, and it was all due to her own hard work and dedication to regaining her life from OCD. She had done some of the hardest things—things that her OCD told her couldn’t possibly be done—and as we said our goodbyes, she left me with the best news: she was expecting a baby, and she was no longer concerned about the POCD. She knew she would likely have unwanted thoughts from time to time, but things were different now. She wasn’t afraid anymore. She knew that she could handle anything OCD tried to throw at her, and that she had built the skills to tolerate even the scariest of feelings.

2. Paul’s breakthrough with Health OCD

Paul’s life before treatment

When I first met Paul, he was extremely concerned about his physical health. The fears had started innocently enough: He had fallen ill and been hospitalized during the COVID-19 pandemic. It was a scary time. Everything around him was changing and the future was unknown, making the experience full of uncertainty.

Paul was able to recover, fortunately, but after he got home from the hospital, he continued to worry about his health—only now, he had a lot more than COVID on his mind. Anything and everything that felt “off” in his body would trigger intrusive thoughts. The what-ifs flooded his mind day and night. He constantly worried about having a heart attack and every beat of his induced panic. Was it beating too quickly? Too slowly? Did he have an arrhythmia?

The uncertainty was too much for Paul to bear and he was convinced that there was no way anyone could know what was going on inside his body without frequent testing. He began visiting his doctor regularly. As they ran test after test, with the results coming back clear every time, he began to sense his their frustration but kept insisting that something had to be wrong. He monitored his blood pressure throughout the entire day, checking it frequently even while he was at work. Eventually, his checking became so intensive that he took a leave of absence.

And when Paul wasn’t terrified of heart problems, he was consumed with fears of cancer. Even though Paul had been healthy throughout his life and his family’s medical history was pretty healthy as well, he was fixated on the idea that something really bad could happen to him at any moment. He went to great lengths in his attempts to alleviate these concerns, googling every potential symptom and spending hours researching what might be going on.

One day, ironically enough, Paul stumbled upon Health OCD during his research. While it seemed to explain what he was going through, it was hard to wrap his head around the idea that his concern about his health might be unwarranted. After all, the symptoms he was experiencing felt very real. His heart did race. His face got flushed. He felt pain in areas of his body that he hadn’t before. It seemed as though everywhere he looked, new symptoms were surfacing—and yet, every medical test continued to come back negative. 

But the more he learned about Health OCD, the more Paul could see the similarities. Eventually, he decided it was time to seek out therapy.

What therapy looked like for Paul

Treatment began slowly for Paul. When we started working together, he still believed the doctors may have missed something. He had been going to the emergency room frequently, trying to get an answer that could help him feel certain about his health concerns—and incurring a great deal of medical bills in the process.

Eventually, I could see things begin to click. As ERP started to address the feelings he experienced, Paul realized that just because OCD could make his distressing thoughts feel very real, it didn’t mean that they had meaning. He began to acknowledge that eventually, his heart rate would lower, his face would cool off, and he would be able to survive his uncomfortable feelings. They weren’t pleasant, of course, but he could manage them.

Through the many exposures we practiced, Paul learned how to respond differently and eventually began to live in recovery. He stopped monitoring his health symptoms every single day. Instead of going to see his doctor for non-emergencies, he started to “wait it out” and found that the symptoms he was feeling would often subside on their own. He could allow feelings of anxiety to pass, knowing that he didn’t need to “do” anything about them.

Paul’s choice to pursue his values

These changes opened up a new world of possibilities for Paul. In our last session, he told me that he had signed up for a marathon. He knew his heart might feel “funny” at times during the training process, and that he would probably worry a bit, but he was choosing to do it anyway. It was important to him—he wanted to do something he valued.

You’re capable of more than you know

There are so many more therapy experiences like these that I could write about. If there’s one lesson I took away from all of them, it’s that no matter how all-consuming your struggle with OCD might feel, you can get through it. You’re capable of so much more than you know. I worked with many people who thought therapy wouldn’t work for them, that they didn’t have the strength to fight their OCD, or that they would just have to feel this way forever, and every time, they went on to surprise themselves.

If you are ready to take your life back from OCD, I hope you’ll reach out. There is hope and help available.

At NOCD, we specialize in treating all types of OCD, no matter what core fear or theme you’re experiencing. Our licensed therapists deeply understand OCD and are specialty-trained in treating OCD with ERP. We work side-by-side with the OCD experts and researchers who designed some of the world’s top OCD treatment programs to provide world-class care for the OCD community.

If you or someone you know are in need of OCD treatment, please don’t hesitate to book a free 15-minute call with our team. On your call, we can answer any questions you may have and help match you with a licensed OCD specialist. We’re always here for you, and it is our goal and our privilege to help you in any way we can.