Helpful therapy for OCD: How ERP can help clients

As an OCD sufferer and a qualified therapist focused on working with clients with OCD, I encounter a variety of conversations on the subject of how to treat this condition with my fellow therapists. There are many opinions on this topic, though not many focus on the gold standard treatment, which is Exposure and Response Prevention (ERP). This method has been researched for many years and is evidenced to work well with this condition.

I run a busy therapy practice and I often see clients who have received other forms of therapy before they come to me. What they tell me is that this hasn't been helpful to them and they, therefore, stay stuck in endless and exhausting OCD cycles.

Sometimes they have been encouraged to engage with regular CBT methods, which have asked them to analyse their thoughts; to test out the validity of them, to check how other people feel about them, keep thought diaries etc. This method, while useful for some types of anxiety, forms the opposite of helpful therapy for OCD. It encourages a person who already spends a huge amount of their time analysing their thoughts to do more of the same.

Some clients have been urged to go back to their childhood in search of the root cause of their issues. Again, this can be incredibly useful if you want to look at your life as a whole and to figure out where your reactions to the world come from. However, for clients looking for help with managing OCD, this approach can push them further into analysis, which might enable their problem to escalate over time.
These are just a couple of examples of unhelpful ways to manage OCD. There are many more.

In my experience, clients often stay in the wrong type of therapy for some time before they realise that it's not as effective as they had hoped. Occasionally, I believe, they are also inclined to stay because although it's not bringing about the kind of change they had expected - it's better to have some form of therapy than none.

It sometimes feels to me as though the individual therapist's desire to be able to solve every problem overrides their professional duty to do their absolute best to help their clients, and to avoid causing them possible harm. This attitude can have serious repercussions for our clients.

Another aspect of this situation is where the therapist mistakenly believes an OCD sufferer's obsession presents a safeguarding risk. Clients with OCD are usually extremely sensitive to other people's opinions of them and often carry a deep fear of being viewed as a bad person.

When a professional without the correct knowledge about OCD conveys to the client that they believe they may pose a risk to others, this can feel traumatic to the client. They are now in a situation where not only have they failed to receive understanding and support to manage their obsessions and compulsions, but where their worst fear is being realised. This can serve as proof to them that they are in fact a bad person and that their intrusive thoughts do not form part of their OCD. The repercussions of a situation like this are immense for the sufferer.

As an OCD sufferer myself, I fully understand the enormity of the stress, exhaustion and despair experienced by my clients. The last thing they need in this situation is to be seen by a professional who only has partial knowledge of how to treat OCD in an effective way.

It may also be the case for some clients that they have been suffering for many years, unable to find the right help. An encounter with yet another professional who lacks experience in OCD treatment may lead them to give up hope that anyone will ever be able to help them. What might be the ultimate consequence of this situation?

I would urge any therapist thinking about working with clients with OCD to embark on a journey to learn more about this condition; to spend some time volunteering with this client group in order to gain a real understanding of the issues they face and to find a thorough training in how to work with Exposure and Response Prevention. In addition, it's essential to receive regular supervision from another professional with expertise in this field, who is able to help you expand your knowledge and skills over time.

Please, fellow therapists, before you add 'OCD' to your areas of expertise on your profile, ensure that you have the knowledge and skills to back this up. If you don't, your clients may suffer.

For informal support and information about OCD, please consider reaching out to the charity, OCD Action. If you're looking to try ERP therapy for OCD, reach out to me via my profile.