written by: Dr. Erika Vivyan
Last month, a few of my colleagues and I attended the annual OCD Conference put on by the International OCD Foundation. We participated in training sessions, attended presentations, and spoke with folks in the Exhibition Hall. I came away from the conference with an entire notepad full of ideas, reminders, and new knowledge! I wanted to share a few tidbits for those who are working to break the chains of OCD (and anxiety disorders too!).
Lesson 1: An incorrect diagnosis can make the correct treatment inaccessible.
In the first presentation I attended, I heard from several individuals with OCD who had received a misdiagnosis that led professionals towards the wrong types of treatment. For example, one presenter noted that OCD is sometimes misdiagnosed as Borderline Personality Disorder due to the demanding, controlling nature of a person’s OCD (e.g., “I can’t take that lunch plate from you, but I can take it from John.”). The medical and psychological treatment for different diagnoses are dramatically different, and therefore a misdiagnosis can lead to weeks, months, or even years of the incorrect treatment.
Lesson 2: Therapy does not “get rid of” a person’s symptoms.
One great reminder that stood out to me in several sessions is that mental wellness is a lifelong journey. A person can never completely rid themselves of stress, anxiety, worry, or any other symptom. What we can work towards is tolerance of these uncomfortable symptoms. These goals should be discussed from the very beginning of treatment, so that clients are never given false hope that the symptoms will simply go away.
Lesson 3: Show, don’t tell.
We’ve all heard it before. Show your audience what they need to know. Telling them (especially in a lecture kind of way) simply isn’t as fun or as effective. So much of our work as therapists is didactic – that is, we need to teach our clients about what they are experiencing so that they know how to manage these symptoms in their lives. However, it is so much more useful when we show them rather than tell! Showing a client that they are safe even after touching a germy client is so much more effective than simply saying, “You’re fine.” Showing a client how to calm a worried mind is so much more tolerable than saying “Just stop worrying!” When we demonstrate new ideas in hands-on, experiential ways, the learning sticks better.
Lesson 4: A truth is only useful if it is truly believed.
During a particularly powerful role-play therapy session in front of an entire ballroom of people, a young man told the presenter something like, “I know that my thoughts aren’t realistic, but I can’t seem to implement that knowledge.” Folks who struggle with OCD as well as anxiety disorders often know that their worries are not logical. Telling them that they are not logical isn’t always the best strategy. Helping them to fully internalize the truths they learn in therapy (through experience and practice) is absolutely critical to guiding them towards more freedom.
Lesson 5: Reassurance is incredibly harmful to the healing process.
I attended a session specifically about family accommodation, which includes the many things that parents, spouses, and other loved ones do to try to reduce the anxiety of a person with OCD (and/or an anxiety disorder). Reassurance is the most common form of family accommodation, and it includes saying things such as “You won’t get sick” or “You are safe.” These things certainly reduce worry in the short term, they are inhibiting the brain’s learning that we are well and safe without those statements from people who care about us. While most treatment is focused on the individual presenting with a problem, therapists can and should help family members to reduce reassurance, particularly between sessions.
Lesson 6: The purpose of therapy is to learn something new.
Traditional therapy for OCD and anxiety disorders includes exposure and response prevention. Many therapy manuals focus on the reduction in anxious feelings when exposed to something scary or worrisome. For example, if you hold a spider for long enough, your body’s fear response is expected to go down (even if you’re really scared of spiders). This model of habituation is often emphasized, but I was reminded this weekend that this is not always how therapy goes! The purpose of every exposure is to learn something new, and the therapist and family’s role is to allow the person who is healing to do the learning.
Lesson 7: Always set therapy goals based on the client’s personal and family values.
Goals set by a therapist and goals set by a client may be entirely different. Using a person’s personal and family values (especially those set by a cultural or religious group) can be an excellent way to increase motivation and buy-in for therapy. This practice also allows both therapists and clients to feel more fulfilled in their work together. The therapist is successful at helping the client, and the client is successful at meeting their goal – it’s a win-win!
Overall, my experiences at this year’s OCD Conference were excellent personal and professional reminders and new ways of looking at old problems…much like our clients might describe therapy sessions! I’m excited to incorporate these new insights into my practice, and I hope that these lessons ring true for other mental health professionals, parents, and clients too.