When OCD Walks Into the Therapy Room: Lessons From My Own Journey
It often feels like what is happening in my own life shows up in my sessions. Years ago, when I was eight months pregnant and only a few weeks from maternity leave, I was doing intake assessments for an agency and helping assign new clients to therapists.
One afternoon a woman came in who was living with severe postpartum OCD. She described horrifying, violent intrusive thoughts about harming her baby. These thoughts terrified her and left her frozen. She did not understand why they were happening.
In an attempt to protect her baby she avoided being alone with her infant. She had family members perform routine caregiving tasks. She checked on the baby every twenty minutes at night and scanned constantly for danger, whether from the outside world or herself.
I had never seen someone so distressed or so vulnerable.
Recognizing Postpartum OCD
Fortunately, I had recently learned about postpartum OCD. I recognized that her thoughts were against her values and that she posed no danger to her baby. When I staffed the case with a seasoned therapist at the agency they looked alarmed and initially believed I should call Child Protective Services.
After I provided education about postpartum OCD, they were willing to learn. But that moment stayed with me. If such a knowledgeable and compassionate therapist did not know about postpartum OCD, how could I expect most therapists to?
Later, after giving birth, I discovered I had postpartum OCD myself. That experience changed me. It deepened my empathy and gave me a burning commitment to treat OCD and to advocate for better training so that no parent sits terrified in a therapist’s office wondering if they are a danger to their own child.
The Scope of the Problem
Obsessive-Compulsive Disorder is one of the top ten disabling conditions worldwide. Yet it is still misunderstood and often missed entirely. Research shows it takes an average of 14 to 17 years for someone with OCD to receive appropriate treatment after symptoms first appear (García-Soriano et al., 2014). Postpartum OCD is especially overlooked. Intrusive harm thoughts are frequently misinterpreted as actual risk rather than distressing, unwanted symptoms (Abramowitz et al., 2010).
In my training, I realized how many therapists are unintentionally mishandling OCD. Well-meaning reassurance, which is a staple of traditional talk therapy, can actually make symptoms worse. Arguing with a client’s “irrational” beliefs may be helpful for some anxiety disorders but is counterproductive for most people with OCD. In fact, the clients I have met with OCD tend to be highly analytical, logical, and insightful. They do not need more arguments in their heads. They need support in learning to live with uncertainty.
What Generalist Therapists Can Do
If you are a generalist treating someone with OCD you do not need to be an expert, but you do need to know the basics to avoid doing harm. Here is a starting point:
Recognize the signs. Intrusive, ego-dystonic thoughts, especially violent, sexual, or morally taboo themes, along with compulsions, are the hallmarks of OCD.
Differentiate OCD from OCPD and other anxiety disorders. OCPD is a personality pattern. OCD is an anxiety disorder driven by obsessions and compulsions.
Use appropriate interventions. The gold standard is Exposure and Response Prevention (ERP), often combined with Acceptance and Commitment Therapy (ACT) techniques to address uncertainty and values.
Avoid over-reassurance. Reassurance can reinforce the OCD cycle. Instead, support clients in tolerating uncertainty.
Consult or refer out. If possible, refer to a clinician trained in ERP. If that is not an option, seek consultation and at least learn the basics to avoid reinforcing symptoms.
Moving Forward
OCD is an incredibly disabling but highly treatable condition. With proper training and support, therapists can dramatically improve outcomes for people who are suffering. My hope is that more of us will get trained, consult with experts, and feel confident identifying and responding to OCD in our practices.
If you are a therapist looking to deepen your skills in this area, stay tuned. I will be offering a training soon on how to recognize and treat OCD effectively, including postpartum and other less-recognized subtypes. Together we can close the gap between suffering and effective help.
References
Abramowitz, J. S., Schwartz, S. A., Moore, K. M., & Luenzmann, K. R. (2010). Obsessive-compulsive symptoms in pregnancy and the puerperium: A review of the literature. Journal of Anxiety Disorders, 17(4), 461–478.
García-Soriano, G., Belloch, A., Morillo, C., & Clark, D. A. (2014). Symptom dimensions in obsessive–compulsive disorder: Differences between obsessions and compulsions. Behavioral and Cognitive Psychotherapy, 42(5), 539–554.
International OCD Foundation (IOCDF). (n.d.). https://iocdf.org/
When a Client Has Nothing to Talk About
The Early Days
Note: Details in this vignette have been changed and blended from multiple experiences to protect confidentiality. What follows is not a description of one person, but a composite of common therapy moments that highlight what many of us encounter in practice.
I remember my first year of therapy so vividly. The faces of those early clients will stay with me forever. Their confusion, hopelessness, and vulnerability are etched into my memory. My own emotions are equally clear: the fear of failing them, the pressure to have the “right” intervention, and the desperation to prove my worth as a new clinician.
Many of my sessions followed a similar pattern. A client would sit down, weighed down by heavy emotions, and tell me they had nothing to talk about. When I asked for updates, the responses were short and flat: “I don’t know. Just work and stuff.” Nothing to work from.
I came prepared. I researched interventions. I brought mindfulness exercises, but they dismissed breathing practices as unhelpful. I introduced values work, but they brushed it aside: “I have already thought about that.” Their stated goal was to find hope in a world that felt abandoned and aimless, but the sessions gave me nothing to anchor onto.
A Turning Point
One day, instead of pulling out another intervention, I decided to name what I was noticing in the moment. I told them: “I see you coming back each week, even though you say nothing is helping. I notice that when I offer ideas, you often shut them down.”
Then I asked: “How does it feel for you when that happens here, between us?”
And then, I stopped. I did not try to fill the silence. I let the space breathe, even though it felt like hours.
Eventually, something shifted. Irritation surfaced, then sadness, then grief. Tears followed. And through that moment of silence and raw emotion, clarity began to emerge about where they wanted to go and what really mattered.
Lessons for Therapists
1. Name What Is Present
Sometimes the most powerful thing we can do is call out what is happening right there in the room. Reflecting the pattern such as “I notice you are shutting down my suggestions” can bring the invisible dynamic into awareness and create movement.
2. Allow the Silence
Silence is not failure. It is often the space where truth emerges. Our discomfort as therapists can push us to rush in, but sometimes sitting with silence communicates trust and creates room for the client’s experience to unfold.
3. Match Effort to Motivation
We are often told “Do not work harder than the client.” I will admit that I resisted this advice early in my career. Working hard felt like control, like proof of my commitment. Over time, I have learned that real change happens when my effort aligns with the client’s readiness, not when I outpace it.
4. Flex Between Guiding and Following
Some clients need more direction such as a grounding exercise, a structured prompt, or a concrete tool to engage them. Others need space to sit with what is happening in the here and now. The art of therapy lies in knowing when to lean into structure and when to loosen it.
Finding Your Style
Every therapist eventually develops their own style. For some, structure is a steady compass. For others, flexibility and presence guide the work. Both approaches have value, and what matters most is attunement: knowing when to step forward with guidance and when to step back and trust the process.
What I have discovered is that even in sessions where a client says they have “nothing to talk about,” there is always something in the room. The blank spaces are not empty. They are full of possibility. When we can slow down, name what is present, and tolerate our own discomfort, those “nothing” sessions often become the ones that matter most.
Bringing It Into Practice
If you have ever sat across from a client and felt the weight of silence, you know how unnerving it can be. You may find yourself thinking: Should I structure this session more tightly? Should I trust the silence? Should I redirect with a tool?
The truth is that there is not one right answer. What matters is your awareness of the process, your ability to experiment, and your willingness to bring yourself back to the here and now. Some days, that looks like offering a scaling question or guiding a DBT skill. Other days, it means letting the silence speak until the client finds their own words.
That balance between guiding and relying on the client is a muscle we all build. It is what makes our work both humbling and endlessly creative.
Invitation
In my upcoming Therapist Toolbox Course 3, we will dive into these very challenges: how to respond when a client has “nothing to talk about,” how to weave in Solution-Focused prompts, and how to integrate DBT tools in real time without forcing them.
We will also practice what it looks like to balance structure and flexibility, so you leave with strategies that fit your unique style as a clinician.
If these reflections resonate with you, I would love to have you join me live on Friday, October 15th at am.. You will leave with practical scripts, interventions you can use right away, and the reassurance that “nothing” sessions are not wasted. They can be turning points.
How to Navigate Politics in the Therapy Room Without Becoming Political
Talking about politics in therapy can feel like walking on a tightrope. Clients, colleagues, and friends are carrying grief, fear, and outrage from today’s headlines. As therapists, we are called to hold these feelings without turning the focus onto our own political leanings. That is not easy work.
Recently, I shared a meditation of love and compassion for those suffering in Gaza. Some colleagues told me they felt alienated because I had not named the pain and fear of others, particularly those impacted by Hamas’s attack in October. Their response made me pause. It reminded me that even in communities rooted in empathy, politics can divide.
The truth is that compassion does not have to be selective. It is not “either/or.” It is “both/and.” I can hold grief for everyone who has suffered because of violence and loss.
Why This Feels So Hard
Part of the challenge is that our own nervous systems are activated. We are living in the same world our clients are, and often we feel the same fear or anger. We do not want to cause harm, and yet silence can feel like complicity.
I also hear from my conservative friends and colleagues that they often feel misunderstood or afraid to speak up in therapy communities. In some professional groups, they fear that voicing their beliefs could cost them relationships or credibility. That isolation is very real, and I believe it is something our field needs to address with compassion. If therapists feel they cannot share openly, it is not surprising that clients with conservative views often feel silenced as well.
Both sides carry a fear of being judged. Both sides have known what it feels like to keep quiet. Just like we remind clients to notice when they are stuck in black-and-white thinking, we as therapists have to watch for the same tendency in ourselves.
The Role of Self-Disclosure
Here’s where I want to be honest. I am not perfect with self-disclosure. Sometimes I share my views when they align with a client’s, especially if I believe it might help them feel less alone. Other times I have shared and later questioned whether it was more about soothing my own discomfort than supporting the client. My practice with disclosure is evolving, and I am learning to pause and ask myself, “Who is this for?”
The research shows I am not alone in this struggle. Solomonov and Barber (2019) found that most therapists report political discussions in sessions, and many acknowledge some level of political self-disclosure. Interestingly, when therapists and clients perceived shared values, the therapeutic alliance was often stronger. Yet context and timing mattered greatly. Patients themselves have reported that implicit disclosures, when handled carefully, helped them feel understood (Solomonov et al., 2018).
Other scholars remind us that self-disclosure is both inevitable and under-examined. Johnsen (2021) described how many therapists feel underprepared for these moments, despite how common they are. I find that comforting. None of us will get this perfectly right. What matters is that we stay reflective, open to repair, and willing to grow.
How I Try to Navigate These Conversations
Name the grief, not the side. I focus on the pain, fear, or loss, rather than aligning with or against a political figure or party.
Stay curious. Instead of shutting down a belief that differs from mine, I ask the client to share how it feels to hold that view.
Validate the fear of speaking. Clients often tell me they feel they cannot say these things anywhere else. A simple “I hear you” can mean the world.
Practice compassion that is non-partisan. Suffering is not political. Naming that suffering is one way we can be steady, safe containers for clients.
Check my limits. I notice when my own bias creeps in and take responsibility for not letting it overshadow the session.
Why This Matters
In times of turmoil, anger and hatred feel louder than ever. Policies affect real people. Lives are at stake. Many of us saw the same dynamics in 2020, when conversations around COVID brought fear of judgment from every angle. Therapy has to remain one of the few places where people can breathe, speak honestly, and feel safe. My role is not to convince a client of my views but to help them feel less alone inside theirs.
And within our professional communities, we need to extend that same grace. Therapists with conservative viewpoints should not feel they have to hide or fear professional isolation. Our work is to model curiosity and compassion, not to mirror the polarization we see outside the therapy room.
An Ongoing Journey
I am still learning how to balance disclosure, compassion, and neutrality. I am sure I will make mistakes again. What helps is remembering that therapy is not about being perfect, but about being present and willing to repair when needed.
So I am curious about you. How do you handle politics in your sessions? What guides you when the line between being human and being neutral starts to blur?
A Short Grounding Practice for Political Conversations
If politics comes up and you notice your chest tightening or your body bracing, here is a quick exercise you can try before responding.
Pause and notice. Bring your attention to the sensation in your body. Name it quietly to yourself: “tight,” “heavy,” “shaky.”
Take three slow breaths. Inhale gently through your nose, exhale a little longer than your inhale. Imagine softening the space around your heart.
Widen the frame. Remind yourself: “This is one person’s experience. My job is to hold the container.”
Return. Come back to the present moment, now steadier and more able to respond with compassion instead of reactivity.
Even two minutes of grounding can make a difference in keeping the session safe and open.
Resources
Solomonov, N., & Barber, J. P. (2019). Conducting psychotherapy in the Trump era: Therapists’ perspectives on political self-disclosure, the therapeutic alliance, and politics in the therapy room. PubMed link
Solomonov, N., McCarthy, K. S., Keefe, J. R., & Barber, J. P. (2018). Patients’ perspectives on political self-disclosure, the therapeutic alliance, and the infiltration of politics into the therapy room in the Trump era. PubMed link
Johnsen, C. (2021). Therapist self-disclosure: Let’s tackle the elephant in the room. PubMed link
Knox, S., & Hill, C. E. (2003). Therapist self-disclosure: Research-based suggestions for practitioners. Journal of Clinical Psychology, 59(5), 529–539.
Managing Countertransference as a Therapist: How to Identify It and Stay Grounded
It all begins with an idea.
Countertransference is one of those topics that doesn’t get enough air time in our field. We talk endlessly about client care, treatment planning, and interventions, but what about the moments when our own stories show up in the room? When our histories, wounds, or fears collide with what a client brings in?
I want to share a story from my own practice.
When Grief Came Too Close to Home
Three years ago, my dad passed away tragically. His death anniversary was just last month, so grief is never far from my mind. Early in my career, grief work was one of my specialties. I chose it intentionally, part exposure and part calling. I had fears around death, but I also knew I could sit with others in their pain and hold space with compassion.
But shortly after my dad died, I had a client whose story was almost identical to mine. She had just lost her father. She described advocating for him in the hospital, the sounds of the machines, the tubes, the frustration with the system, and then the moment of watching him pass. Sitting across from her, it was as if I was transported back into my own hospital room.
In that moment, I knew I could not fully show up for her. I was struggling to focus. My mind drifted back to my own experience. I felt myself zoning out, fighting back tears, and working so hard internally just to stay seated in the chair. I realized that my energy was going toward managing my own emotions instead of being present for hers. That was the moment I knew I needed to refer her out.
At the time, I wasn’t sure how to communicate this, but I chose honesty. I told her that her story was very close to my own recent loss, and that I didn’t feel I could show up fully for her in the way she deserved. She was understanding. That moment of authenticity, reminding her that I am also human, was humbling and beautiful. And it was absolutely the right choice.
Fast Forward: A New Chapter of Grief Work
Now, three years later, I am in a different place with my grief. Recently, I had another session that mirrored my own experience. As she shared her story, I again found myself in the hospital with my own dad and family. The smells, the sounds, the raw heartbreak were vivid.
But this time was different. I noticed the memories rising up, but I did not get lost in them. I felt the wave of emotion, and I grounded myself with my breath and posture. I was aware of my own experience, but I could redirect back into hers without struggle. I was able to keep my focus on her words, her tone, her body language. I could tell that I was fully present with her story instead of slipping into mine.
That is how I knew I could handle it. I could remain emotionally regulated while still being compassionate. I was not fighting back tears or zoning out. I was listening, tracking, and attuning. The memories were there, but they no longer took me over.
This was a powerful reminder of what it looks like to hold space when countertransference shows up, and to use self-awareness as a guide.
Signs You May Be Experiencing Countertransference
If you’re a therapist, countertransference will happen. Here are some ways to notice it:
You feel unusually activated, emotionally flooded, or transported into your own memories.
Your focus shifts from the client’s narrative to your own internal images or associations.
You find yourself avoiding, over-identifying, or wanting to fix the client’s pain faster than usual.
You feel yourself zoning out, holding back tears, or struggling to concentrate on the client’s words.
The key isn’t to avoid countertransference. It’s to recognize it.
How to Manage Countertransference in the Room
Stay self-aware. Notice your body cues and internal shifts. Awareness is the first safeguard.
Ground yourself. Simple techniques like pressing your feet into the floor, deepening your breath, or naming something in the room can pull you back.
Refocus on the client. Remind yourself that this is their story. You can acknowledge your internal response without acting on it.
Seek consultation. Talk it through with a trusted supervisor or peer. Processing countertransference reduces its power.
Refer out if necessary. Sometimes, the most ethical and compassionate choice is to step back.
Why This Matters
We don’t need to hide from countertransference. Pretending it doesn’t exist is dangerous because it sneaks in and shapes the therapy in unconscious ways. Instead, we can normalize it, name it, and manage it.
For me, these moments have deepened my empathy and reminded me of why I do this work. My dad’s death is part of my story, and it inevitably influences how I sit with grief. But by staying aware and grounded, I can ensure my clients’ stories remain the focus, not mine.
Countertransference is bound to happen. What matters most is how we hold ourselves accountable when it does.
Therapist Toolbox Takeaway
Countertransference is not a failure. It is part of being human.
Awareness is your strongest tool. Notice body cues and emotional shifts.
Use grounding techniques in the moment to stay present.
Talk about it in consultation or supervision to process and gain perspective.
Know when to refer out. Protecting the client’s care is the priority.
Has this ever happened to you? You’re in session and suddenly your own story sneaks in, bringing up memories or emotions you didn’t expect. How did you handle it, and what helped you get grounded again? Feel free to comment below!