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5 Ways Therapy Can Make OCD Worse

Written by Carrie Bock on . Posted in Counseling, OCD.

Usually, when people talk about mental health therapy, they refer to therapy making things better. This is what all therapists and clients hope for. However, can therapy make OCD worse? The short answer is yes. Let’s look at the five different ways OCD can be made worse by therapy.

1. The therapist misdiagnoses OCD as Generalized Anxiety Disorder (GAD) or something else.

Unfortunately, it often takes years for a person struggling with OCD to receive a proper diagnosis. Oftentimes, it’s difficult for individuals struggling with OCD to open up about the thoughts they are having that they may label as “bad” or “crazy.” They may have obsessions or fears about going into a mental hospital. They often present with a complaint of being anxious. Unless further assessment is done such as a YBOC II, OCD may go undiagnosed. A proper diagnosis is crucial for proper treatment.

2. The therapist uses logic with OCD thoughts.

 If a therapist is not trained in OCD, they may challenge the thought or provide logic to a client’s concern. For example, telling a client with contamination OCD to remind themselves that they cannot get AIDS from using a public toilet or telling a client with relationship OCD to remind themselves that offending someone is not the end of the world. Individuals with OCD know how irrational their thought processes are when they are in a moment of clarity. However, intrusive thoughts don’t respond well to logic. When someone is dealing with OCD, using a public toilet or offending someone can feel intensely distressful. This type of approach will typically leave the client with more shame, frustration, and disconnection from the therapist.   

3. The therapist provides excessive reassurance.

Therapists naturally want to be a voice of calm and reason for clients. Even good therapists can fall into the trap of reassuring their clients too much. If a client tells a story about something hurtful they did towards their spouse and says, “Does that mean I don’t love my spouse?” A therapist without training in OCD might reassure the client that based on conversations they’ve had with client, it seems like they love and care for their spouse. Instead, therapists who specialize in OCD will help clients recognize thoughts as OCD and learn to sit with the discomfort of uncertainty. 

4. The therapist fails to be trauma informed.

Trauma amplifies OCD symptoms. Therefore, treating past trauma or childhood wounding experiences (attachment issues, lack of nurture received, etc) can lead to a reduction in OCD symptoms. I have seen this time and time again in my own practice and heard the same from other trauma informed therapists as well. I’ve treated clients whose PTSD from childhood was triggered by exposures completed in Exposure and Response Prevention (ERP) therapy. Once the PTSD became the focus of treatment, the clients deal with less intrusive thoughts and are able to dismiss them more easily.

Therapists who are strict behaviorists or strict ERP therapists may be so focused on changing present behavior that they fail to make a connection between global elements like the need for control, over dependency on others, or lack of confidence in decision making as being connected to past trauma and attachment experiences. When these global issues are taken into consideration and targeted, individuals will respond differently to intrusive thoughts. One of the issues with OCD is that the obsessional themes can morph and individuals can be playing exposure wac-a-mole if they don’t get to deeper level core issues. 

5. The therapist is insensitive to a client’s religious or spiritual beliefs.

As a therapist with Christian faith who sees many Christian clients, I have unfortunately heard stories about therapists banning clients from praying, asking them to state things they know are not in line with their belief system (for religious OCD), asking them to look at pornography (exposure for sexual obsessions), or dismissing/invalidating concerns about sin or hell. Clients who feel like their beliefs are not respected or understood are less likely to follow through with treatment recommendations. The International OCD Foundation contains guidelines for religiously sensitive exposures.

While therapy can make OCD worse, there is hope! OCD is treatable often by combining therapy and medications. When choosing a therapist, ask about their training in OCD, specific treatment approaches, and how often they see clients with OCD.

Carrie Bock, LPC-MHSP of By The Well Counseling is a Licensed Professional Counselor who specializes in helping clients with trauma, anxiety and OCD get to a deeper level of healing through EMDR via in person and online counseling across Tennessee and EMDR intensive therapy sessions. Carrie is the host of the Hope for Anxiety and OCD podcast, which is a welcome place for struggling Christians to reduce shame, increase hope, and develop healthier connections with God and others.

Five Signs It May Be Time to Get a New Therapist

Written by Carrie Bock on . Posted in Counseling.

You’ve waited a long time to get help, finally gotten the nerve to go to therapy, but just aren’t sure about your therapist. Is this really helping? How do you know when it’s time to keep working with your current therapist or walk away? Here are five signs it may be time to get a new therapist:

1. You don’t feel heard.

Sometimes, you may feel like your therapist just isn’t getting it. They try to summarize or reframe what you’re saying, but get it wrong. You may just have a gut feeling that there is no way they can empathize with the story you are telling. Now don’t get me wrong, it would be impossible for me to have gone through everything my clients have gone through. However, it’s important for me to be able to empathize with feelings of sadness, anger, shame, or disappointment they have had in a particular experience. In my own experience of receiving therapy, I’ve been to therapists who were cold or kept steering the conversation to what they wanted to talk about instead of what I was coming in for. It didn’t feel good, and I didn’t go back.   

2. Your therapist doesn’t have experience treating the issue you’re bringing in.

If he or she knows in the beginning, the ethical therapist won’t take you on as a client. Unfortunately, many therapists say they treat OCD without specific training or experience working with it. They may treat the OCD thoughts like they treat anxious thoughts, by challenging them or providing reassurance for them. This is problematic. While arguing with the thoughts or attempting to reassure them provides short term relief, it only ends up strengthening the OCD. 

In addition, therapeutic issues evolve over time. Destructive behaviors over time may rise to a greater level of concern than when therapy started. What isn’t a problem today may become a problem in three months. I’ve had clients in the past be referred to inpatient or intensive outpatient for substance use issues. Sometimes, clients do not reveal all their issues up front due to shame or lack of awareness that the issue is even a problem. 

3. You aren’t able to attend consistently.

Your therapist’s schedule may be so full that he or she cannot see you as regularly as you would like. Maybe your schedule has changed and no longer aligns with your therapist’s availability. You may be fighting to stay for a while because you dread starting over with someone else. However, in order to avoid losing momentum in therapy, you typically need to be seen at least every other week. 

Another reason people are not able to attend consistently is financial. If you were paying cash, but then had a change in financial situation, you may have to find a therapist who takes your insurance or is willing to work for a lower fee.

4. You aren’t reaching the goals you and your therapist have set together.

Counseling goals initially tend to be broad such as a client saying, “I want to feel less anxious” or “I want to be happy again like I used to.” To turn these more general goals into action steps, additional questions need to be asked such as: What would you be doing if you were less anxious that you are not doing now? What skills might you need in order to be less anxious? What does happiness look like for you? What is one small step you can take towards happiness today?  

If you have completed several sessions of therapy and don’t sense that anything is getting better in terms of your education/awareness regarding your issues, perspective on the issues you brought in, or how you are coping, it may be time to examine why. If you come into your therapy sessions rattling off everything that happened to you that week, you might want to examine if this is the best use of the time with your therapist. Think through what you would like to get out of your sessions or what topics are most important to you. Come with questions from time to time. 

I challenge my clients not to see therapy as part of their routine. While they may see me every Tuesday at noon, I don’t ever want that to be just something they do on Tuesdays. I want them to progress beyond where they are today, so they don’t have to continue seeing me each week. If you’re not sure if you’re making progress, ask someone in your life such as a spouse or a best friend if they have noticed any differences in you. Ask your therapist as well. Frequently, my clients have high expectations of themselves and feel like they aren’t making progress when they are.    

5. You want more out of the experience than you are getting.

I have a question on my intake asking if people have been to therapy before. The next question has them rate that experience as positive, neutral, or negative. The neutral responses are the most interesting. Clients will say, “My therapist just nodded and validated my feelings. I needed more.” I’m a big proponent that clients should advocate for themselves in therapy if they don’t feel they are getting what they need. If you aren’t happy, let your therapist know what you would like to be different and see if they can accommodate your requests.  

Other clients have reported a desire to “go deeper,” but their therapist didn’t ever dig deeper. There may be many different reasons for this. Good therapy is supportive; however, it’s also challenging. Your therapist’s job is to push you towards things you wouldn’t do on your own. If you could have figured out how to manage your problems or issues by yourself, you probably would have done it. Unfortunately, some therapists have not done enough of their own work to go into the deeper waters with you because they have never been there themselves. I’ve probably had hundreds of continuing education hours after graduate school at this point, but the most transformative thing I have done to become a better therapist is to go to therapy myself. Working on my own issues prevents them from coming up in the therapeutic relationship. I am able to show up more present and compassionate for others because I chose to show up present and compassionate for myself first. 

What now?

If you found yourself in one or more of the above categories and have been attending for several sessions, try talking to your therapist first. They are there because they want to help you. Talking about your experience with your therapist and the process is important. Give your therapist the opportunity to be on the same page you are on. If it doesn’t work out for some reason, move forward, knowing there is another provider out there for you.   

Carrie Bock, LPC-MHSP of By The Well Counseling is a Licensed Professional Counselor who specializes in helping clients with trauma, anxiety and OCD get to a deeper level of healing through EMDR via online counseling across Tennessee and in person intensive therapy sessions. Carrie is the host of the Hope for Anxiety and OCD podcast, which is a welcome place for struggling Christians to reduce shame, increase hope, and develop healthier connections with God and others.