I’ve Been in Therapy for OCD. Why Am I Not Getting Better?
We see this all the time. Someone comes to us after months, sometimes years, of therapy and says some version of: “I understand my OCD. I know what I’m doing. So why am I still doing it?”
Usually, it’s not because they haven’t worked hard enough. It’s because understanding OCD and actually treating OCD are two very different things.
A lot of traditional therapy is built around talking through what you’re afraid of, figuring out where it comes from, looking at the evidence, and finding ways to feel better when you’re anxious. All perfectly reasonable things for a lot of problems. OCD, unfortunately, has a nasty habit of taking perfectly reasonable things and turning them into compulsions.
If your fear is “What if I hurt someone?” and therapy repeatedly helps you establish all the reasons you probably won’t, you may leave the session feeling better. Great. Except three hours later the thought comes back with one tiny new detail and your brain goes, “Okay, but what about THIS?”
And off you go again.
More evidence. More Googling. Ask someone. Replay what happened. Check how you feel. Try to remember exactly what you were thinking. Maybe bring it back to therapy next week so you can finally get to the bottom of it.
Spoiler: you are probably not going to get to the bottom of it.
That’s the part we’re trying to change.
So what is ERP actually supposed to do?
ERP, or Exposure and Response Prevention, isn’t primarily about making the scary thought feel less scary. It’s about learning to have the thought, feeling, urge, image, or uncertainty without doing all the stuff you normally do to resolve it.
And that “stuff” can be surprisingly hard to spot. Most people recognize checking the stove 12 times as a compulsion. They don’t necessarily recognize spending 45 minutes reviewing a conversation to make sure they didn’t say something offensive, checking whether they feel attracted to someone, Googling symptoms, confessing something to their partner, or asking their therapist the same question six different ways.
Your brain doesn’t particularly care whether the compulsion involves a doorknob or an elaborate internal investigation. If you’re doing it to get certainty or make the anxiety go away, we probably need to take a look at it.
But I already tried ERP
We also meet plenty of people who tell us they’ve already tried ERP. Sometimes they absolutely have. Other times, when we ask what treatment actually looked like, they talked about doing exposures more than they actually did them, spent a lot of time challenging their thoughts, or did exposures while simultaneously reassuring themselves through the whole thing.
That can look like ERP on paper without really changing the cycle.
This isn’t necessarily a criticism of the therapist. OCD is a specialty, and it’s a particularly sneaky one. A therapist can be excellent at what they do and still not have enough experience treating OCD to catch all the ways it can sneak into the therapy room.
So if you’ve been in therapy for a while and you’re still spending a ridiculous amount of your day negotiating with your own brain, it may be worth looking at what you’re actually practicing in treatment.
Are you getting better at proving OCD wrong?
Or are you getting better at letting OCD ask the question without feeling like you have to answer it?
Those are very different skills.
What if this sounds familiar?
If you’re wondering whether your current treatment is actually targeting OCD, learn more about how we treat OCD using ERP and other evidence-based approaches.
Beyond Borders CBT specializes in OCD and related disorders, and all treatment is provided virtually. We work with clients who are brand new to OCD treatment as well as plenty of people who have already spent a long time in therapy and are frustrated that they’re still stuck in the same cycle.