What to Expect in OCD Therapy
Hi y’all! I’m the therapist behind this blog post, and my name is Sidney Claire Lampon, LPC. I joined Andover Family Counseling after moving to the Wichita area 3 months ago. I lived in Birmingham, AL for 25 years, but Wichita and Andover are growing on me!
I specialize in treating obsessive compulsive disorder and operate from my own experience with OCD. I’ve found that while the media has done a great job at portraying mental health lately, OCD is usually depicted as hand washing/being a germaphobe. And a lot of folks that struggle with OCD experience it in a much different way. OCD can be focused around taboo subjects and it takes bravery to seek help. It can often take years for someone to receive an accurate diagnosis, and then it can be hard to find a therapist that is equipped to treat it.
It is my mission to demystify OCD in the hopes that people can get diagnosed and treated sooner. Often my clients have little information on what their therapy will look like to treat OCD, or that there are options for treatment. Usually people have only heard of exposure and response prevention therapy or expect regular talk therapy will be their treatment. I’ve seen clients time and time again who participated in talk therapy and their OCD symptoms worsened. As I continue to consult and be supervised by seasoned OCD therapists, I’m reminded how important it is that we advocate for our clients, and emphasize the importance of specially trained therapists treating OCD.
To begin, I wanted to touch on why traditional talk therapy is usually not a good fit for OCD treatment. While cognitive behavioral therapy (CBT) is super helpful for anxiety, OCD is characterized by obsessive doubts followed by compulsive behaviors. CBT involves examining thought patterns, which could lead to rumination for someone with OCD. The goal in obsessive compulsive disorder treatment is not to “figure out” or change thought patterns, but to stop the cycle of obsessive doubt leading to compulsions. To get clients to a place where they can have an obsessive doubt and mindfully choose to not invest any more into this thought. An OCD doubt hooks you by convincing you that there is a solution to it, or a deeper answer. It wants you to believe if you think through it one more time, the thought will go away! But for anyone with
OCD, we know this isn’t true.
A common compulsion is seeking reassurance. Someone with OCD might have obsessive doubts that they are a pedophile. This doubt is the complete opposite of what they believe and value, in fact it causes extreme distress and shame. It’s common for a client in therapy with a non specialized OCD treatment to spend their sessions getting the reassurance that they are in fact not a pedophile. This reassurance makes them feel better for the hour they sit in counseling, but the thought quickly returns and tells them the lie: you need to make sure during the next session too. And so the cycle continues.
You may be wondering, then how in the world do we treat OCD? If someone is having intrusive thoughts of being a pedophile, shouldn’t their therapist remind them that they aren’t? Short answer: no. Most of the time, people with OCD know their obsessive doubts aren’t true, but need help stopping the cycle of doubt and compulsions leading to more doubt. And if they truly can’t distinguish between OCD and the truth, the therapist can begin treatment by teaching the client the exact mechanisms of OCD: the ego dystonic nature of it. AKA thoughts that go against everything you stand for and care about. This is where the cycle stopping comes in.
Exposure and response prevention is an evidence based treatment for OCD that involves facing the situations or thoughts that trigger your obsessive doubts and practicing not doing your compulsion that usually follows. For those of us with OCD: this sounds down right horrifying. The good news is, an ERP trained therapist knows how to assist you in this process and systematically help you “work up” to trickier exposures. Therapy for OCD begins with your therapist gathering background info, family history, medical history, all the usual intake things. Once the therapist has a better idea of your OCD, they will
work with you to create what we call the OCD hierarchy: a list of all your triggers. Using a SUDS scale (subjective units of distress), each trigger is ranked. Typically treatment begins by getting a clear idea of all of your triggers, and the compulsions that usually follow them. It can be shocking to learn how many triggers you actually have, to notice how many compulsions you might be doing a day; but this is just another step toward recovery. Next up exposures are generated, and depending on the client’s comfort, you might start with a lower level SUDS exposure or pick at random. Exposures for someone who obsesses about getting sick might look like: “touch a doorknob and delay handwashing by 30 minutes”,“shake hands with a stranger & not wash hands” or “read an imaginal script about getting sick without ruminating”.
This might sound terrifying to someone with contamination OCD, but your therapist is there to walk beside you.
ERP is the treatment that helped me as a little girl, so it’s an honor getting to see this therapy heal others now that I’m the therapist. No OCD therapy is a miracle, but it has helped me live my life not dominated by obsessive thinking. It is possible to no longer meet diagnostic criteria for OCD and there is hope! Check back in for another blog post on inference based CBT very soon!
-Sidney Claire Lampon, LPC
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