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/
