If you have obsessive-compulsive disorder, there is a good chance you have already sat across from a therapist (or two or three) who meant well, nodded at the right moments, and still left you feeling more confused, more ashamed, or more stuck than when you walked in.

Perhaps your sessions seemed more like the venting sessions you used to have with your best friend (until they began to seem irritated talking about the same obsession over and over). You question yourself, “where is this therapy going?” and “what skills am I actually learning here?”

For some, after venting and getting reassurance, they feel better immediately after leaving a therapy session, for a day or two. But, inevitably, all the same “What If’s” and doubts flood back in. Your only recourse is to make note of your thoughts to later bring back up to replay and rehash in the next therapy session.

Sound familiar?

OR...

You start seeing a therapist claiming to specialize in OCD and immediately you jump into doing exposure and response prevention therapy (ERP).

The exposures recommended may seem silly or sometimes they seem way too hard. Some exposures may be embarrassing or feel like they are not hitting the mark exactly.

You wonder if you are doing an exposure just for the sake of doing an exposure. How is this getting you closer to the life that you want to lead or the goals you are working towards?

You leave the session confused about how to handle the triggers that spontaneously cross your path during the week. You have little to no understanding of why your mind does this excessive looping and hyper threat detection.

You wonder how to break this cycle other than forever having to create and implement an exposure to counter every single triggering thought or compulsive urge that is going to come your way, and this feels exhausting.

Perhaps you consider, maybe ERP therapy just doesn’t work for you.

You may have quietly decided that this is just who you are and this is just how life is going to feel.

These are a few of the common experiences that I hear from clients who have spent exorbitant time, energy, and money on multiple sessions, often with multiple therapists, before realizing these tactics are not working for them.

Having spent over a decade working exclusively with clients who have OCD, I have sat with brilliant physicians, attorneys, entrepreneurs, seasoned performers, and academics. Despite their achievements, many shared a common and frustrating history: they had already tried therapy, understood the gold standard ERP method, and yet were still suffering, sometimes even being labeled as “treatment resistant.”

What I found, time and time again, was not that these clients were treatment-resistant. It was that they had never actually received specialized OCD treatment.

They had received something that looked like it from the outside, but wasn’t complete and was void of the nuances that make ERP effective.

This conversation can be challenging to have and the mental health system is not having it loudly enough. So let’s have it.

So What Went Wrong?

If any part of this resonated with you, I want you to hear this clearly: you are not too broken to be helped. You are not treatment-resistant. You did not fail therapy.

The system failed you.

Every year, thousands of mental health providers graduate with only a surface-level understanding of OCD, a couple of pages in one textbook, if that. Well-meaning therapists, genuinely caring clinicians, end up learning on the fly while you sit across from them, vulnerable and trusting. The consequences of that are not abstract. They cost people years of their lives.

Over the next few posts, we are going to cover:

• When your therapist answers “I use CBT” to the question “how do you treat OCD,” that answer is not enough, and some of what falls under that umbrella can actually make OCD worse
• What the research really says about ERP, and the newer approaches showing comparable results with far less distress
• Why one-size-fits-all treatment so often fails high-functioning adults, and what a truly individualized approach looks like

You have been given the wrong map. That is fixable.

And if you are ready to take action right now, I have put together a free guide with a set of questions worth asking a potential OCD therapist, including what to listen for in their answers, the difference between an informed and an uninformed response, and the signs worth noticing along the way.

Download the Free Guide: Questions to Ask Your OCD Therapist →