With the help of the Internet, my son Dan correctly diagnosed himself with obsessive-compulsive disorder (OCD) at the age of 17. After his diagnosis, his longtime pediatrician recommended he see a therapist, so off he went to the local clinical psychologist who often worked with teenagers.
They talked about Dan’s fears, thoughts, and feelings every other week for four months. That amounted to approximately ten sessions of the wrong kind of therapy, though we didn’t realize it at the time. Dan then left for college in worse condition than before he started therapy.
Dan’s therapist had employed traditional talk therapy, a type of psychotherapy that delves into the root of your problems. At the very least, it involves examining why you feel or act the way you do. As we now know, this type of therapy typically does not help those with obsessive-compulsive disorder and, in fact, often exacerbates the OCD. Why is this so?
I believe that talking to someone with OCD about why they feel the intense fear and anxiety that is characteristic of the disorder is like talking to someone with asthma about why they can’t breathe. “So why do you think your airways constrict like that?” Ridiculous, right? The answer is obvious. “Because I have asthma and that’s what asthma is.”
OCD is a neurologically-based anxiety disorder and that’s why those with OCD have anxiety. OCD, like asthma, is not something that can be talked away. While OCD sufferers’ experiences might help shape their obsessions or compulsions, talking about their past, or their fears, usually is not helpful, and often will increase their anxiety. Focusing on their distressing thoughts and then subsequently being reassured by a therapist only empowers the OCD.
Additionally, a therapist might even feed right into the OCD. For example, someone suffering from “fear of harm” obsessions (fear of harming loved ones, or anyone, for that matter) might have a therapist who wants to explore whether the patient really does want to hurt someone. (It is important to note here that those with OCD never act on these obsessions.) This approach can be devastating to the OCD sufferer; it only compounds his or her fear and uncertainty. OCD sufferers ruminate enough on their own; they definitely don’t need any assistance in that department.
That’s not to say there isn’t anything to talk about in therapy when it comes to OCD. There’s plenty, as this disorder and the therapy for it can be quite complicated. At times it might be beneficial to talk about general problems that arise from having an anxiety disorder. Issues pertaining to family, work, or school, as well as feelings of low self-esteem and isolation, are common examples of concerns OCD sufferers might have. Also, when establishing a list of anxiety-provoking thoughts and actions as part of an appropriate treatment plan, the sufferer’s fears will be discussed.
It is important to distinguish these matters from talking about the details of someone’s OCD and why they feel the way they do. The specifics of why one is compelled to drive around the block 50 times to make sure he or she hasn’t hit someone, or why sufferers must mentally review their entire day to make sure they didn’t say anything wrong, are not significant. Therapists must realize that OCD is a disorder with a specific treatment, and not some character flaw that needs to be fixed by delving into a person’s life.
I have heard first-person accounts from OCD sufferers who have found themselves in the midst of talk therapy, and have realized it’s not what they need. While some end this therapy because they find it tormenting or see that it is making them worse, others will continue with it because they believe the experts know best.
I find this heartbreaking — those who seek help are harmed instead. We need to keep spreading the word to OCD sufferers and therapists that Exposure Response Prevention (ERP) Therapy is the front-line treatment for OCD, and the ticket to freedom for those who suffer from this disorder.