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What Years of Working with OCD Has Taught Me

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October, 2021        

Written by, John Fischer, LPC (Wisconsin)

John holds a master’s degree in professional counseling from Marquette University in Milwaukee Wisconsin.  He is an active member of the NBCC (national board of certified licensed professional counselors) in the state of Wisconsin and has spent the past 13 years working for a national nonprofit behavioral health organization.  John also has previous experience providing care in an acute residential program that specializes in serving adults from all over the country with depression and anxiety related disorders.


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When many people hear OCD…

images of perfectly labelled pantries or color coordinated closets pop into their head. They may even reference a parent who always keeps the house clean or a roommate who can’t stand to have dirty dishes in the sink. While these things can be true, what many people often don’t realize is that OCD encompasses much more than a perfectly made bed or a clutter free living space. 

At its core, OCD is a psychological disorder that causes repeated unwanted thoughts or sensations (known as an “obsession”) and/or the urge to do something over and over again (known as a  “compulsion”). Often, these compulsions are performed in an attempt to provide relief from an obsession. For example, someone may become hyper fixated (or “obsessed”) on getting contaminated by germs and in turn wash their hands 5 times every time they touch a doorknob in an attempt to find relief. These obsessions and compulsions can become debilitating and interrupt an individual’s ability to function within their work, family, and social lives. Some people may even become trapped in their homes, paralyzed by the fear and anxiety surrounding their obsession.

As a licensed therapist I have spent nearly 9 years now… 

working closely with individuals suffering from severe OCD and anxiety, and trying to find the best way to provide them with the relief and help they need and deserve. Throughout my time working with these individuals I have noticed a consistent theme. By and large, these individuals are incredibly kind, thoughtful, and intelligent, and truly want to be free of OCD and the burden it carries on themselves and those around them. By understanding these typical characteristics of individuals with OCD I have been able to approach therapeutic treatment in a much more effective way.  

For many people with OCD…

they have heard time and time again that there’s “nothing to worry about” and have been told over and over that they’re being irrational, dramatic, or knit picky. But what people often don’t realize is that this does nothing productive in actually providing them with relief or comfort, because it essentially isn’t true. Let’s take a person whose obsession is being contaminated with germs for example. By trying to convince someone that there’s “nothing to worry about” in regards to germs I would essentially be saying that germs pose no risk to them. This would not be true because germs do, in fact, pose a risk – they can cause viruses, illnesses, infections, etc. 

So rather than trying to convince a very intelligent and logical person that their logic is wrong when it isn’t, I instead agree with them and address that there is something to worry about. 

(Now I’m not saying that I agree with how worried they are about something, but I agree that there is some worry). This can be really unsettling for a client at first, but it ends up being productive because it helps them get used to being ok with something posing a risk – a skill that is essential in their journey towards healing. 

If I were to focus on convincing them there is no risk (when there is) I would not only be unsuccessful, but I would also have to do this every single time for each different obsession that comes about. Even if this method was successful it wouldn’t be sustainable. 

So instead, I meet the client where they’re at , agree with them that there is some risk associated with their obsession, and then use conversations to help the client get more comfortable with this risk. This is hard because OCD likes certainty – the more certain someone is the more comfortable they are.

But what I work with my clients to realize…

is that humans essentially aren’t ever really 100% certain about anything. Even the most ordinary activities, like crossing the street or eating food, carries some risk (and therefore uncertainty). So while there are a few specific areas where they don’t accept risk (their obsessions), they are naturally accepting risk on a daily basis in every other area. 

This is much more motivating for a client because it provides some validation for their thoughts and feelings. It shows them that they can be, and already are in most ways, comfortable with risk. From here a client is much more willing to engage in exposure therapy which is key for OCD clients because it is the most efficacious approach to OCD. 

Other approaches, such as talk therapy (or psychotherapy) which work to help the patient gain “insight” into their problems are much less effective, and can even make OCD symptoms worse. This is because it leads people to repeatedly over analyze their thoughts and attempt to solve them, essentially reinforcing their obsessions and compulsions. Instead, with exposure therapy, clients are exposed to their obsessions in a controlled and safe environment, and practice preventing these compulsions. Over time clients are able to encounter an obsession and no longer engage in their compulsion. 

This approach has allowed so many of my clients to live more comfortably, rebuild their relationships, and set outside of the thoughts, feelings, and behaviors that have trapped them for years.

If you or someone you love is struggling, please reach out for support. Synergy eTherapy has therapists trained in OCD that can help.


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