Choosing ERP Therapy


For the rest of December I will be sharing some of my older posts. This one first appeared on my blog in 2011:

Exposure and response prevention (ERP) therapy, as I have mentioned before, is the treatment of choice for OCD.  Though it is intensely anxiety provoking and difficult to do, the results are often dramatic. I have always credited this therapy for saving my son Dan’s life.

In a thought-provoking post entitled “No one should do exposure and response prevention!Dr. Jonathan Grayson argues that nobody should engage in ERP therapy just because the experts say it is the right thing to do. Rather, for it to work, the person with OCD needs to really believe that this therapy is the best way to proceed. In short, the desire to participate in ERP therapy needs to come from within.

Though this advice can apply to many therapies for many disorders, it can get complicated with OCD (so what else is new?). Even though they know it is illogical and their sense of security is false, some people with OCD find it too hard to give up the “safety” of their rituals. It is a risk they are either unwilling or unable to take. In addition, those with OCD are often steered by what they perceive is right and therefore may agree to engage in ERP therapy because it is the “right thing to do,” and not because they truly believe it will help them.

When Dan spent nine weeks at an intensive residential treatment program for OCD, he learned a lot about how OCD operates, and quickly came to the realization that ERP therapy was his ticket to freedom. In my experience, those with OCD understand better than anyone what their disorder entails. They know they act irrationally, but they are rational people. Just read any first-person blogs written by those with OCD, and you are bound to see a phrase such as, “I know this sounds crazy but….”

It is far from easy to muster the courage to fight OCD, but it is possible. Empowered with knowledge, strength and desire, those with OCD can take the necessary responsibility for their recovery. And while the battle may be long and torturous, the choice to keep fighting is what really matters.

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4 Responses to Choosing ERP Therapy

  1. Doris says:

    We have mixed feedback from the hospital my where my son is completing his first 90-day session.

    He has made some progress but has been guarded about prolonged exposures. Things happen quickly – all of a sudden this became a go/no-go for ostensible insurance coverage and he became willing, granted for mixed reasons. However, the hospital advised against it, indicating he’s not ready yet. He is 17. I️ think it’s possible to start with mixed motivation, what do you think? Or better to wait but the next opportunity may not come?


    • Hi Doris, I’m not a therapist, and I don’t know your son’s situation, but in general, it’s not uncommon to go into ERP therapy with mixed emotions. Dr. Gillihan and I both discuss motivation for treatment in our book. It sounds as if your son is not refusing treatment all together, so that is a good thing. I would think an OCD specialist would be able to work with him to move forward with ERP at a pace that works for him. Again, I am generalizing and I think it’s important to get your son’s opinion as well as talk to any of his health-care providers who you trust. Good Luck!

  2. How nice to read one of your posts from before I entered the blogging world! I always appreciate your insights and it’s nice to see how far back they go.

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