Is Liking Your Therapist Enough?

Personality and Psychotherapy - John Dollard a...

When Dan’s self-diagnosis of OCD was confirmed by his longtime pediatrician, the doctor suggested he see a therapist. So off he went to the most popular clinical psychologist in town, the one all the teens liked. Dan liked him too. He drove to his appointments alone, and while I spoke with the therapist on the phone a few times, we never met. Dan was sharing very little about his OCD with us at the time, but he did tell me and my husband that he was very pleased with his psychologist and thought he really understood him; he felt better after every session. What more could we ask for?

Eight months later our son was so debilitated by severe OCD he could not even eat. As I became more educated about the disorder and its proper treatment, I realized that not only had Dan’s therapist not known how to treat OCD, the “talk therapy” he used had exacerbated Dan’s illness.

His next therapist worked at the world-renowned OCD residential treatment program Dan attended. Our son spent nine weeks there and bonded big time with this psychologist, who definitely knew how to treat OCD. His stay at this program became complicated, one of the issues being Dan’s unhealthy dependency on his therapist. Our son became unable to think for himself, deferring instead to his psychologist’s recommendations as to how he should live his life, even when they conflicted with Dan’s lifelong dreams. When I tried to discuss the situation with Dan, he said, “It’s hard not to be attached to someone who has saved your life.”

I know bonding emotionally with health-care providers is not unusual, but I wonder if it might be more of an issue for those with OCD. We know OCD sufferers often deal with social scrupulosity, a type of hyper-responsibility. Those with social scrupulosity obsess over hurting others’ feelings, and often believe that giving their opinion, or being assertive in any way, will cause harm. Could this translate into excessive loyalty? How could you question your therapist, or even worse, leave him or her, if you think this way? How could you even think that this person, whom you probably really like and admire, might not be the best one to help you?

These are just two of many situations when I think it’s best to move on. While in the first example we were oblivious to this therapist’s shortcomings in treating OCD, I have no doubt if we’d suggested looking for another health care provider, Dan would have insisted on staying with his hometown one. In fact, when he first left for college fifteen hundred miles away, he opted for phone calls with this therapist instead of searching for a new one (another mistake). In the second scenario, we had to forcibly remove Dan from the residential program.

OCD is complicated. While it is easy to say, “Find a therapist who specializes in Exposure Response Prevention (ERP) Therapy,” you also want a health care provider who you trust and feel completely comfortable with. Of course this is true for all of us, not just OCD sufferers. And while it’s not easy, if the time comes when your therapist is no longer the right fit for you, it is okay, even necessary, that you search for another. Because, at least in my opinion, merely liking your therapist is not enough.

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35 Responses to Is Liking Your Therapist Enough?

  1. time2cher says:

    Our situationis opposite. My daughter does not like the therapist that she has right now because she is the first of five therapists that actually provide and have offered the ERP therapy for her OCD and she hates the anxiety that it makes her feel, hence making her hate her therapist. This is the best one yet, not the chatty therapist that just likes to “talk”. How to get her to see that and not want to give up? Any thoughts or ideas? Thank you

    • ocdtalk says:

      Thanks so much for sharing. I’m wondering how old your daughter is as that would certainly make a difference in her understanding of why it’s so important to feel the anxiety during therapy. Also, not having ever gone through ERP Therapy myself (as a therapist or as an OCD sufferer), I am thinking my readers might have more advice to offer you than I do. Anyone? I assume the therapist is aware of how your daughter feels and has explained to her how the therapy works. Has the therapist worked on a hierarchy with her so it’s not too much too fast? Maybe once your daughter sees some improvement in her OCD, she will feel better about the therapist. Again, I hope some of my readers will share their thoughts and experiences with you.

      • time2cher says:

        She is 15 years old and scared and uncomfortable about the whole ERP process. We are going to try starting at low levels of it to begin with. A lot of her thoughts came from being bullied for years calling her dyke and gay just because she is a female athlete, a tomgirl as we could say but her therapist presented her with writing “I am gay” to start and she is very uncomfortable as her ritual about the bully was always “I am not gay”. So I hope you can understand the feelings toward her therapist as this raises her anxiety at appointments. Thank you for your input. It is nice to have found a site and group that can relate.

      • ocdtalk says:

        Oh I can absolutely understand her anxiety and her feelings toward her therapist….ERP Therapy is so tough! Please keep in touch as your daughter moves forward toward recovery…..she will get there!

      • Abigail says:

        When I was a teenager, my mom took me to see a therapist, the goal being to help another family member. The therapist identified me as having OCD. Now I know that she was correct. She also talked about exposure, which I know now is correct, also. But at the time, I freaked out. I thought, if I can’t trust my mind, what can I trust? At that point, my mom disagreed wit the therapist, and we stopped going. But a few years later, I realized that, in fact, I can’t always trust my mind, and was ready to do something about it.

        But back to ERP therapy. I think it is a very good thing. But I think that the patient/client needs to be the one driving it. This would be complicated with a child, so I don’t know how that works. But with my counselor now, yes, she will help me come up with exposures. But I’m the one who chooses to do them. I know better how hard a given exposure will be. Actually, sometimes I’m surprised, too, and have to ease off to an easier exposure to start with. Sometimes tiny exposures turn out quite helpful as a start. But knowing that I’m the one choosing to do the exposure, I feel like I have some control even while I’m dealing with anxiety. The mere thought of being forced to do an exposure scares me alot, above and beyond what the actual exposure would require.

        So I don’t know if there is a way for your daughter to be more involved in choosing the exposures and in planning how to carry them out, a way for her to feel more in control. Also, for myself, I have bribed myself; i.e., if i do such-and-such exposures, then I can buy something that I really want. This way, I’m still in control choosing to do the exposure, but I’m also doing the exposure and dealing with the anxiety that it causes.

        I think it is a great thing that you are supporting your daughter in seeking therapy and ERP.

      • ocdtalk says:

        Abigail, Thanks so much for your insight! You bring up a good point, how it’s helpful to have the exposures client driven. In addition to everything you say, I would think there would be more chance of success without someone feeling trapped or coerced into doing a particular exposure.

  2. Ann says:

    I definitely agree. I really liked my last therapist, and she was very well trained in ERP. However, she did not push me at all, and eventually I just came in every week to chat. At almost $100 per session, all self paid, it was an expensive chat that didn’t accomplish much.

  3. ocdtalk says:

    Yes, Ann, that’s a lot of money to spend on a chat! Glad you realized that and moved one. Thanks for sharing!

  4. Emily says:

    Time2cher, please look up ACT therapy. It uses some elements of ERP but it doesn’t force you to follow the strict rules but rather allows you to deal with thoughts and obsessions in a more natural way.

  5. Abigail says:

    At least part of the kind of dependence on a therapist that you are talking about sounds like transfering the responsibility to the therapist. While this was suggested as a solution in the book “Can Christianity Cure Obsessive Compulsive Disorder?” by Dr. Ian Osborn, in that he suggests turning responsibility over to God, my counselor and myself as well see it as potentially another compulsion. If OCD Client A is afraid of being responsible for spreading germs, but is able to fall back on Therapist B’s command to go ahead and touch something, Client A can tell their OCD that the germ spreading is no longer their own fault, but Therapist B’s fault. And if Client A is like me, we wont actually blame the therapist, since we judge others much more leniently than we judge ourselves. But it is almost like reassurance seeking to depend entirely on what your therapist says. I agree with you there!

    Currently, I’m very comfortable with my therapist. Maybe to a fault. But I’m not ready to move on yet. Actually, right now, in many ways, I feel like I already know what to do, I just need a professional cheer-leader to help me along. But I don’t think that is all wrong; non-professionals don’t always need to hear my super depressed thinking – i think it disturbs them. But my counselor has also been good about making it clear that I could express my oppinions and disagreements and even change therapists if I ever need to. That she WANTS me to be that honest.

    • ocdtalk says:

      More great insight. Thanks, Abigail! I agree, transferring your thoughts and feelings over to your therapist can be a compulsion. I’m not sure that was what was going on with my son in the residential program, though. I just feel he was overly attached to his therapist and put him on a pedestal.At one point Dan actually expressed a desire to stay at the program “forever.” It was comforting for him to be with people who he felt really understood what he was going through.

      I think if you stay with the same therapist for a long time, your relationship obviously evolves. Dan’s last therapist was great, and he saw him for four years. Dan’s needs changed and toward the end of their time together they rarely even talked about OCD. You seem to have a good handle on what works for you and what you need. That’s great!

  6. time2cher says:

    May I ask since I am new to this blog and site is there also a blog for teenagers to post with other teens with OCD too?

  7. Tina Barbour says:

    Insightful post, Janet. I agree-it’s not enough to just like your therapist. Your therapist (in my opinion) has to make you do some work on the OCD, depression, etc. Just talking has not made either my OCD or depression go away. I spent a year in just talk therapy before I was ever formally diagnosed with OCD. After a year, I was still depressed, and my OCD was unrelenting. I needed different kinds of help.

    • ocdtalk says:

      Thanks for your comments, Tina. It’s too bad so many people (including you and Dan) have to go through the wrong type of therapy before getting the right help. Hopefully getting the word out to others will help them get the right therapy earlier.

  8. COMPLETELY AGREE!!!! It was my hard-ass therapist who helped me most, not my sweetie-pie one. I blogged about this almost a year ago: http://jackieleasommers.com/2012/03/24/therapists/

  9. kris says:

    Oh Janet, OCD is so complicated, going so far as to effect our ability to ask for help, choose our therapist and accept the therapy we are offered. My heart ached as I read this post and the comments following it. Such a long and difficult path for those with OCD and their families. As with many mental illnesses, it can be so difficult to advocate for yourself and even the call to set up an appointment with a therapist can take years to do. Leaving a therapist to find another also means telling your story all over again and the entire process can feel so overwhelming. This is where a family member could step in and be helpful and supportive, I certainly needed someone at that stage to advocate for me to step in and do the research to find a doctor/therapist, make the appointment (that first phone call can be really hard to make) and maybe even drive me there.
    It took me so many years to feel educated in OCD and confident enough to know when a therapist was helping me. I feel such empathy for the 15 year old girl because I cannot imagine how this whole process must feel for her. And this story could be complicated because while ERP is uncomfortable (and I personally believe that if you are not feeling uncomfortable or anxiety then how can it be classified as an exposure?) , there is a hierarchy to exposures and I have found climbing up slow produces the same result but is not as overwhelming. I agree with you that “liking” your therapist is not enough, the proper therapy has to be in place. I only had one therapist who did ERP with me and there where times when I did not like my therapist at all, but I did respect him and I knew he was trying really hard to help me.

    • ocdtalk says:

      Thank you for your thoughtful comment, Kris, and I think you bring up some great points. Leaving a therapist, even when it’s the right thing to do, can be absolutely overwhelming, as you say. And I agree that this is an area where family members can be a big help. Also, as you say, an OCD sufferer may not even know if a therapist is helpful or not, if they don’t have a good understanding of their own OCD, or OCD in general. So many obstacles to overcome, but as we know, it is possible to fight, and overcome, OCD. Thanks for your insight!

  10. 71º & Sunny says:

    Really good post, Janet. Yes, it’s certainly important to like your therapist, but it’s more important that your therapist actually helps you reach your goals of wellness. I was lucky in that I found a psychologist who met both criteria. I can so relate to Dan’s feelings of attachment to his therapist. I literally love my psychologist as if she was a cherished family member. In a way, I guess she kind of is a cherished family member – and she did save my life. But she was also very attentive to what I wanted out of life and she helped me to stay true to my own beliefs and goals. I really respect her for that.

  11. ocdtalk says:

    I think I love your psychologist too, Sunny 🙂 She sounds amazing. Wouldn’t it be great if everyone had a therapist like her?

  12. cate says:

    My son is 15 and began therapy a few months ago. It has been a really slow go — he is very anxious about the ERP and it has taken a while for him to share with the therapist many of the symptoms he has been having — it’s a lot more than he originally shared or that we knew about. Although we just recently (this fall) became aware of his OCD, she says that he has been dealing with it for some time without really being aware that something was wrong.

    My problem is that I don’t know if this is the best therapist for him. She initially tried some exposures that he reacted badly to, so she has backed off and is looking for some “baby steps” so he can better tolerate the anxiety. Which makes sense, but I wonder if he also needs a little push to get going. I asked her how long she anticipated him needing to be in treatment, and she said she wouldn’t be surprised if it’s a year, which sounds like a long time for ERP based on what I’ve read. I hate to think of him suffering needlessly when a different therapist may be able to help him faster. Would appreciate any advice.

  13. ocdtalk says:

    Hi Cate, Wow, that’s a great question, and I wish I had an answer for you (readers…..anyone?). I’m wondering how much contact you personally have with your son’s therapist. While you don’t need to know all the details of his obsessions if he’s not comfortable sharing with you, I think it’s reasonable to know how things are going in general, what exactly goes on in therapy sessions (for example, are they working on a hierarchy, doing “easy” exposures, or perhaps just talking and doing some deep breathing?) I would think the more informed you are the easier it would be to know whether she is right for him. I’m hoping some readers will chime in as well. Good luck and please keep me posted!

    • cate says:

      Thanks so much for your response. I’ve talked with the therapist several times on the phone and this week my husband and i met with her for an hour to learn more. She is doing some very “easy” exposures to try to build his confidence and his tolerance for the anxiety, and talking with him about anxiety and coping strategies, and also doing some talk about relationship issues that he wants to talk about as a sort of “hook” to get him to buy in more to the therapeutic relationship. She said it’s like peeling back an onion — she keeps discovering more OCD issues than he initially presented with.

      She feels he’s very defensive and wary about doing ERP, and even suspicious about relaxation strategies she was teaching him.

      • ocdtalk says:

        Cate, it sounds like you are doing all the right things and your son is lucky to have you in his corner. Good for you for starting therapy right away. I’m not a therapist so I can’t really advise you, but as a mom it certainly sounds as if there are a lot of positives…..maybe give it some time and see how things evolve? Keeping in touch with the therapist for updates should help you make decisions down the road….

      • time2cher says:

        Hi Cate, I am in the almost exact situation with my 15 year old daughter as I had posted previously and I can relate to your concerns and hopes that someone can comment to ease your mind. I sometimes think I am becoming obsessed with my worries about her suffering, how long will it take, will she ever have peace of mind again, will she ever be truly happy and without thoughts, and as a mom am I finding the right help for her, and educating and researching enough myself as a parent? I hope so and this blog has been a Godsend in our lives.
        As far as the anxiety of ERP for her appointments she goes in at a level 10 and probably comes out a level 15. She has writing homework to do as a baby step and she even finds that most difficult to do. I try to think of the age of 15 and when we were and what we didn’t want to do, but unfortunately they have the teenage phase as well as the fear of doing the work almost a double whammy:) keep listening to him, the communication part is key as parents, work with him as I do with her. I figure she is halfway committed and not all on board with the ERP yet byt in time I pray that she will commit fully, move up a step and down a level to peace and happiness. Everyone deserves that:) I hope this helped. Please be reassured that you and your husband seem to be doing everything right

  14. cate says:

    Thank you both very much for your comments — it’s good not to feel alone with this. Time2cher — I really relate to your thinking you are becoming obsessed with your worries — me too! Unfortunately, my son won’t let us work with him and doesn’t want us to talk with him about the OCD — he wants to keep it all private between him and the therapist — so we feel pretty helpless.

    Of course, being a mom, I am finding many things to feel guilty about! I worry that we rushed him into therapy; within a week of becoming aware of his OCD we had him seeing someone. Our only thought was to get him help as soon as possible so he could start to feel better. So now of course I’m second guessing that, and wondering if we had given him more time to process things that he would have bought into the ERP better.

  15. ocdtalk says:

    Cate and time2cher, When my son’s OCD was severe, all I wished for was for someone to tell me he would be “okay.” Of course there are no guarantees for anyone, but you are both doing everything you can to help your children, and I feel strongly they will indeed be okay. If my son can overcome severe OCD, then your kids can also. Dan never shared details of his OCD with us either, but he always knew we loved and supported him and were there for him, just as you are there for your children. There is so much hope for those with OCD and you have both started treatment early, which is a huge plus. Thanks for sharing your struggles.

  16. bonnie says:

    As someone with OCD, I have had many doubts myself about my therapist. I thought she was asking me to do things that were impossible at times, and at other times I wondered why we were wasting our time and my money on assignments that were so ridiculously easy. But eventually I realized that just thinking you can do something or doing it accidentally is not the same thing as doing it intentionally. The “easy” exposures were often the hardest to follow through on.
    As for length of time, it’s unpredictable. Therapy can take a long time, especially if OCD pervades many areas of your child’s life. They can’t tackle everything at once. I still take medication and see my therapist every 2-3 months and it’s been 4 and a half years since starting. But it REALLY IS much better.

    • ocdtalk says:

      Thanks so much for your insights, Bonnie. It is always so helpful to hear from OCD sufferers. I think it’s interesting that you say the “easy” exposures were often the most difficult. I’d like to hear more about that at some point. I’m so glad that things are better for you now.

  17. My first year of college, when I crashed and burned originally from having OCD for 8 years, my first therapist was a psychologist who was determined to teach me the ropes of “rational emotive therapy” sort of an offshoot of cognitive behavioral therapy and mindfulness, by looking at my thoughts and then rationalizing why there were irrational. That was well and fine enough but I was only 18, frightened out of my mind, and unable to comprehend what was happening to my brain. In addition, it was taking several months for the low dose of Prozac I was on to make any big difference. When I could come in for sessions, he would practically get impatient with me and almost shame me for even having my fears. He would tell me things like, “Come on, you’re disorder really isn’t THAT bad. I have people who come in here 3 to 4 times per week to see me” (instead of 1 like I was). Or once when I raced in to see him because I was having panicking OCD thoughts that I was going to open fire on my college class, he chewed me out up and down for being so hysterical about it and demanded to know why I insisted on coming in when it wasn’t a big deal. Well, after a few more sessions, I dropped that therapist, ditched my Prozac after I started feeling better (due to the Prozac) and then went out on my own believing I had, had a “spiritual awakening”. I left school that year with the hopes of transferring to another college. Late that summer. . .guess what. . . RELAPSE. You think it would have helped me more if he had been more supportive than belittling?

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