I often stress the importance of sharing our experiences and talking about obsessive-compulsive disorder in the hopes of raising awareness and understanding of this illness. But is it possible to talk about OCD too much? In certain contexts, I believe the answer is “yes.”
“Traditional Talk Therapy,” is a type of psychotherapy that delves into the root of your problems. Think Freud, lying on the couch, and discussing your earliest memories. At the very least, it involves examining why you feel or act the way you do.
Dan’s first therapist employed this technique, and over the four months that Dan saw him, his OCD got progressively worse. Why?
Because 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.” In fact, not only does Traditional Talk Therapy not help those with obsessive-compulsive disorder, it often exacerbates the OCD. Talking about their fears repeatedly and subsequently being reassured by a therapist only empowers the OCD. OCD sufferers ruminate enough on their own; they 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, and many of the first-person blogs out there give us a glimpse of how complicated treating OCD can be. But the specifics of why you feel compelled to drive around the block fifty times to make sure you didn’t hit someone, or why you must review your entire day in your head to make sure you didn’t say anything wrong, are not significant. What’s important is realizing you are dealing with obsessive-compulsive disorder, and then finding a competent therapist who utilizes Exposure Response Prevention (ERP) Therapy, the frontline treatment for OCD.
ocdtalk 
Excellent post! I liked the comparison to asthma, which I thought really brought home the point. Thanks as always for your clear thoughts about OCD and its treatment.
Thanks, Seth! I appreciate your support.
You bet, Janet! I was reminded that we had included a section in our paper (http://sethgillihan.com/common-therapist-pitfalls-in-erp-for-ocd/) on a similar issue entitled “Spending Inordinate Time Exploring the ‘Root of the Problem'” and decided to cut it because our assumption was that ERP therapists aren’t doing a lot of that kind of exploration. I hope we’re right! And we certainly would concur that many forms of traditional talk therapy play OCD’s game, so to speak. Again, I’m really glad to see this message so nicely articulated.
Thanks Seth, for this information. I agree. I would think therapists who use ERP know that exploring the “root of the problem” is not the way to go. Dan’s first therapist (the one I refer to in my post), to my knowledge, was not familiar with ERP Therapy at all. He absolutely had no clue that there was a specific treatment for OCD.
Is there ever a time where talk therapy is OK? Boosting their confidence at least?? Along with CBT and ERP? Right now my 17 year old is doing much better. He’s only had CBT and ERP lately, but earlier he had a little bit of talk therapy. He thought he needed to be heard. But, really I think you are right it made him ruminate more. Thanksfully the only talk therapy he does is thought challenge and problem solve. That seems to help more.
Question: How is life with an adult child with OCD? I feel like we may never get our child out of the house because he has no plans after graduation. He doesn’t want to face it. He told me that he’d rather flunk High School and re do his Senior year. I know he’s missed out a lot and I can’t blame him. But, I think it’s more of an avoidance factor about his future. My son has severe OCD and social anxiety disorder. Those two combined are tough. He’s doing much better. He’s been to High School every day this year and he goes to FCA club and Youth Group. But, it is such a struggle still and I can easily see him slip back to being at home all the time doing nothing. I wonder sometimes if he’s going to be 30 and living at home. I so want him to be self-sufficient. Can anyone relate?
Thanks so much for your posts and information. You are wonderful!!! It’s comforting to know there are other parents that have struggled with this too and have gotten through it fine!
– Lori
Hi Lori, I’m not a therapist so I’m reluctant to answer your questions about therapy, but my main point is the way to treat OCD is NOT by sitting around and talking about symptoms. The fact that your son is doing CBT and ERP is great, and if you have a therapist who knows how to treat OCD, and you trust him/her, I would suggest bringing up your concerns/questions with the therapist.
As far as life with an adult child with OCD goes, my son is now 23 (I guess that’s an adult? 🙂 ) and is doing very well. He is going through, and dealing with, all the same problems as most recent college graduates. The main thing to me is OCD is not ruling his life…..he is. I can certainly relate to being concerned
about your child’s future, but it sounds as if your son has a lot going for him, and really, it DOES get better. If you’d like to talk more, feel free to email me at ocdtalk@yahoo.com.
It’s a great question, Lori. My view as a clinician is that non-ERP talk therapy for a person with OCD can be very beneficial under some circumstances. First, I don’t think it should (or can) take the place of effective OCD treatment, as Janet so nicely spelled out. Second, if a person is doing ERP and regular talk therapy at the same time, the latter mustn’t interfere with the ERP. Some people with OCD get conflicting message from their general and ERP therapists–for example, being told on the one hand to “try not to think about” obsessions versus being instructed to do exposures to feared consequences. Many ERP therapists are happy to consult with other therapists about what is helpful in treating individuals with OCD. Additionally, it can be useful to have someone to talk to about the issues that often surround OCD, like feeling isolated, having social fears, family dynamics. Having an outside therapist to talk with about these issues can save valuable ERP time for doing exposures. Finally, some individuals prefer to tackle the OCD first in ERP and then afterward, once they have a little “breathing room” from the overwhelming obsessions and time-consuming compulsions, to enter into general psychotherapy to deal with other issues.
Great post, Janet. I like the analogy to asthma. If my doctor started asking me why I thought my airways constricted, I think I’d start to worry! 🙂
Haha! Absolutely, Tina..you’d find another doctor immediately, right? That’s what we should have done for Dan.
Absolutely on track and far too many think talk therapy solves all. Makes money for many and gives those with the need to talk to a safe place, but so wrong for so many other things. And about asthma, imagine being a mother and told you were creating it because you were smothering your child with your worries. That was the theory when I was in graduate school. Thank goodness things are a bit better now, but not in every therapist’s office. Think I will reblog this later in the week if you do not mine?
I’d be honored if you reblogged my post..thanks! Also, what a great point you make of parents being blamed for illnesses…..so yes, we have definitely made progress in that area, but still have a long way to go.
Excellently put, and so true. Very insightful, thank you.
You’re welcome, and thanks for commenting!
Janet, as always, a wonderful post. I completely agree about the talk therapy without any other tools for OCD doing more harm than good – in fact, my son’s psychiatrist kept trying to tell him to keep a record of how much time he spends each day obsessing about things. He would come out of her office saying “mom, she is literally asking me to obsess about obsessing”, it was a horrible experience. What worked much better for him was talking to a brilliant therapist who recommended “Brain Lock” which I am sure many on this site have probably read and also he introduced him to an ACT therapy which I would say includes the elements of ERP but looks at it from a slightly different perspective – it doesn’t ask the patient to deliberately create an OCD inducing situation but rather allows things to flow on their own and teaches how to react to them and not be afraid.
Thanks for sharing, Emily. Even though I have heard similar stories before (and have lived through it myself), it never ceases to amaze me how many psychiatrists/therapists do not have a clue how to treat OCD. Really, that was one of the main reasons I started a blog. Your son knew obsessing about obsessing wasn’t the right thing to do; shouldn’t the psychiatrist have known that also? I am so glad you and your son found such a wonderful therapist.
Amen! Such a great post. I always like to point this out on my blog too, that the right form of therapy is essential. I worked with a Freudian psychotherapist for 3 years 2x per week before I was diagnosed with OCD. Makes me shake my head every time I think about it…
I know, Lolly….I’m shaking my head right now! .Hindsight is a wonderful thing.
Bravo, Janet! Totally agree with you. The funny thing, is that I actually have a pretty good idea of why I have OCD (in addition to the faulty brain wiring!) and honestly, it doesn’t do me any good in getting better. CBT/ERP is what worked for me. Sure, I’d love to know for sure exactly what took place in my brain to cause me to have it, but in the meantime, I’m just going to enjoy my much improved life after treatment!
Exactly, Sunny! The “whys” don’t help in the treatment of the disorder. So glad you have your “much improved life” after getting the right help.
Great post Janet one of the most horrible experiences I had was being sent to someone at Vanderbilt that assured me that talk therapy was going to make me fine. Now considering I was in my 40’s and never had treatment just told by a family physician in my 30’s I was OCD I was willing to try anything I thought would cure me at the time. WOW I got so much worse at the time I have never been officially been diagnosised that my OCD was the type called pure O. So everytime we would get through with the sessions I was a wreck would come home and deal with obcessing so badly I could not sleep or eat or do anything. I was just absorbed with fear and thoughts racing. I finally broke down in my 5th session running out saying I cannot do this it is making me worse. At the time I was being treated by a wonderful dermatologist for a brown recluse spider bite (which ruined my health) and when I told him what was going on he said don’t go back really this just does not work for most people and your worse now than I have ever seen you. He hooked me up with another thearpist who treated me with ERP and then in a group session with others in time and it made such a difference for me. Yes I still have OCD and I still obcess but it is not nearly like it was I now live with it and it does not control me. Even though I am in terrible health other ways I actually feel happy now and free that is the way I explain it. So yes there is life with OCD!!! We must never give up on that. Love reading your post.
Hugs and Caring,
Vivian
Thanks for sharing, Vivian! You are a perfect example of how detrimental talk therapy can be for those with OCD. Thank goodness your wonderful dermatologist steered you in the right direction. It is unacceptable to me that there are so many health-care providers who do not know the proper treatment for OCD..
If I had one wish for those of us with OCD (other than OCD disappearing from the planet) it would be that more doctors would learn how to treat OCD. In 29 years, I have had one doctor who did ERP. No others even mentioned ERP and when I gave a couple of them the info from my own research they thought it would be too time consuming for them to do with me. ugh.
When I first saw your post I thought you were going in a different direction with this topic; probably because sometimes I wonder if talking about my OCD in my blog is helping or hurting me. ? I have kinda went with the theme of” I am more than my OCD” for that reason, I don’t always write about OCD because I don’t want it to define me.
As an OCD therapist it’s an issue I’ve been struggling with–not only I but the field of evidence-based therapists and researchers. How do we get these treatments into the hands of those who need them? With OCD it seems especially important since so few therapies are actually effective, and even ERP can be ineffective if not done right. It seems like great progress could be made even by making physicians aware that ERP exists and can be really effective. Disseminating effective treatments is a big challenge that many people are trying to address and from the experiences described in this blog we still have a long way to go.
I agree, Seth, we still have a long way to go!
Thanks for sharing, Krystallyn. Unfortunately I think your story is all too common. We have to keep spreading the word about ERP Therapy. I also definitely get what you are saying about not wanting to only blog about OCD. For me, it’s different, as I don’t have OCD, so it’s not a big deal if I blog about it all the time :). But I think Dan really wants nothing to do with the blog for the same reason you state……OCD does not define him.
I think one reason Freud-style therapy can make OCD worse is that it can suggest the very thing feared, handing over to the OCD more reasons to worry. I guess that would be exposure without response prevention, kind of like you said. For example, I had/have harm issues, so with Freud, suddenly the therapist could ask me things like, “So do you really want to hurt this person? Maybe early in your childhood something happened that made you really mad at them. Maybe you’ve never given voice to the part of you that is jealous of them. You might really want to hurt them.” Only, the therapist would be serious, not like an ERP therapist addressing a fear. Instead, OCD ERP therapists tend to FIRST explain that OCD people are generally not dangerous, and we aren’t alone in our fears, and THEN teach about exposure and response prevention.
I do think, however, that experiences can influence which obsessions and compulsions afflict us, though they are merely a background, not the actual disorder.
I totally agree with you, Abigail. A therapist skilled in ERP Therapy will explain to you exactly what OCD is, what needs to be done to fight it, and how ERP Therapy works. To me, anyone who uses traditional talk therapy to treat OCD must not really understand what OCD is, or they wouldn’t be using that therapy. I cringe just thinking about OCD sufferers being in that situation. I also agree that experiences often influence obsessions and compulsions (doesn’t OCD always go after what is most important to a person?) but that doesn’t alter the therapy that’s needed. Thanks for your insights!
Thank you so much for this post! If greatly defines OCD for people who aren’t sure of its true definition!
Glad you liked it. Thanks for commenting!
hey all, sorry im commenting a bit late, i hope someone can help me though. i’ve had OCD and its been consuming my life. i have great anxiety if i mess up a ritual and i am convinced something will go wrong. I never told anyone about my ocd, it is self diagnosed as i clearly have symptoms and have done a fair share of research. The first person i told is my boyfriend of about 2 years. Ever since i told him though i feel my OCD getting worse and although he is accepting of it and goes along with my crazy rituals i think telling him made me get worse. I felt so proud of myself for finally opening up after all these years but now i do not know what to do. I don’t know that a talking therapy will help now that talking about it makes me worse. are there any other ways to help my OCD? any anxiety medicine or anything? i hate living with this and it is honestly driving me crazy. please, please help me.
Hi Joanna, I’m sorry you have been suffering for so long. OCD is absolutely treatable and the fact that you want help is a good thing. The front line treatment for the disorder is a Cognitive Behavioral Therapy known as Exposure and Response Prevention Therapy. I write a lot about it on my blog. There are resources for finding help on my sidebar and I would suggest starting out at the IOCDF web site for information on finding a properly trained therapist near you. Good Luck!
Hi, Joanna. There are some medications that you could discuss with a psychiatrist. The first line of drug treatment is generally an SSRI (like Zoloft) at high doses. I think I understand what you mean about how talking about OCD seems to make it worse. I should point out that the best therapy for OCD–Exposure and Response Prevention–is more of a “doing” therapy than a talk therapy. Of course we talk in the sessions, and once the exposure part of the treatment begins there’s a lot less talking about OCD and more just doing the work that needs to be done. If a therapist mostly wants to talk about the OCD, where it came from, what it means to you, etc., then it’s probably a good sign that the treatment isn’t going to be very effective. Many studies show that good ERP is at least as effective as medication. I wish you all the best!
My son, 25, has been suffering from OCD for the last ten years. He has been to Lindner Center of Hope, Alexian Brothers, McLean Hospital, and the Amen Clinic in Reston, VA. He has been on several medications over the years: Effexor, Lexapro, Zoloft, Fluvox, and most recently, Risperdal. He either suffers severe side effects from the medication, or it is not effective after a certain period of time. His psychiatrist abruptly took him off Risperdal after blood work revealed elevated enzymes in his liver. He is currently taking Xanax to relieve the anxiety, but the absence of any OCD medication is causing severe OCD symptoms. He needs reassurance for almost any move he makes; his rituals have become more intense.
His psychiatrist seems to be clueless about what medications to prescribe. We have trying to find a different psychiatrist but there seems to be none in our area that know anything about OCD,
The problem with the treatment centers is that there needs to be followup once the person is discharged. If the ERP is not continued, then the person will slowly fall back into the old rituals.
These are some of the problems we have encountered over the years as our son struggles with OCD. Lack of OCD practitioners and behavioral therapists, financial assistance for treatment centers, and support groups for those dealing with OCD.
Right now our son seems to be waging a losing battle. He has become very discouraged and depressed. He has not held a job in over two years. Family and family support is very slim. Any words of advice or encouragement will be greatly appreciated. Thank you!
Hi Jane, I am so sorry your son (and you) have been suffering for so long. I get the impression your son found the treatment centers he went to helpful but then relapsed? If you don’t have OCD specialists in your area, maybe there are other ways for your son to get continued support with ERP Therapy after an intensive program? For example, he could Skype regularly with a therapist, use an ERP app or online program, or have weekly/biweekly phone calls with a therapist…just some kind of support to help maintain the benefits of an intensive program. As far as meds go, my son dealt with four psychiatrists and they all used the same method to prescribe meds…..trial and error. In his case, medication was not helpful.
Your son is lucky to have you in his corner, and there is still so much hope for his recovery. I’d suggest contacting the IOCDF for some additional suggestions, and maybe some readers will chime in also. Good luck, and please keep in touch.
Thanks for your helpful suggestions and support! Will keep you posted.
You’re welcome!
I know I have it, but I keep refusing it. I don’t want to hurt the feelings of my current therapist, or cut her off from the money I give her for the sessions… i know that sounds self deprecating. I didn’t know it was ocd for years and was treated for depression and got worse and worse until I started becoming depressed over this. Now I feel so torn, I don’t want to hurt the therapist but I know she won’t be able to help me. She specializes in gestalt. Is there anyway I can make this work?
If you do indeed have OCD, you owe it to yourself to get the proper treatment, even if it means changing therapists. I hope you will take this important step. I wish you all the best.
I agree with Janet. No therapist is an expert in everything, and one of the most stressful things for therapists is not having the tools to help people get better. My guess is that most therapists would support a person’s finding the right treatment. Even if a therapist would be (inappropriately) upset, it’s the therapist’s upset vs. your life, so there’s a much bigger cost to you!
I was diagnosed with major depressive disorder, not OCD. But I think I probably have OCD as well – the obsessive kind, not compulsive. I was seeing a therapist for depression a few years back but decided to quit because the sessions were causing me to obsess over various issues. Talking about problems does help me feel better for a brief time, but then it turns to constant rumination and obsession. I felt that therapy was detrimental to my mental state so I quit. Even though therapy gave me more self-confidence, I feel that it made my anxiety worse. My mind keeps going back to things I said in therapy several years ago, and then I start feeling guilty because I did a lot of venting about loved ones, and I am ashamed about that now. I’m still struggling to get over therapy, and it has been around three years since I last saw a therapist. So therapy sometimes makes things worse.
Thank you for sharing. If you do indeed have OCD, then the treatment you need is exposure and response prevention (ERP) therapy. You are absolutely right that traditional talk therapy can make things worse. I hope you will work toward getting a diagnosis and the correct treatment. Good luck!
Very new to the world of OCD and anxiety. My 11 year old son developed an acute and crippling case of OCD 2 months ago when he started middle school. He is extremely immature and also has ADHD. We started him on a very low dose of Luvox and also Risperidone to control his manic episodes and the OCD obsessions. We have now cut out the Risperidone and he is solely on the Luvox with an ADHD med also. His OCD is definitely showing itself again and he absolutely hates talk therapy. He is too young/immature to truly embrace the tools given him by our therapist and he comes out of each session worse than he went in, and also with new obsessions! He listens to examples given by the therapist about other kids’ obsessions, and he adopts them as well! It’s so upsetting to see that meds seems to be our only realistic path for relief right now. Can any of you speak to this? Were your kids or you diagnosed so young, and does age and maturity eventually help with acceptance/participation in talk or exposure therapies? Thanks for any advice
Hi Lauren,
I’m sorry to hear your son has been having such a rough time. My son was 17 when he was diagnosed with OCD, though in retrospect we realize he had it for many years. To answer your questions, age/maturity can definitely play a part in therapy. That being said, there are children as young as 5 who successfully participate in age-appropriate ERP therapy. I am not a therapist myself, but from what you write, it’s hard to know whether your son’s therapist is a good fit for him. What are his or her credentials? Have they had specific training in ERP? How many children/adolescents have they worked with? These are important questions to ask and you should feel satisfied with the answers. If not, it is time to move on.
In regards to medication, it differs from person to person. If you’ve read more of my blog and/or my book, you know that meds never helped my son and some of them exacerbated his OCD. I know medication helps a lot of people, but for him, it was not a good thing. I wish you and your son all the best and if you’d like to email me at ocdtalk@yahoo.com I’d be happy to discuss more.