February 9, 2011

Changing ERP Therapists

So – I’ve done it.  I’ve changed ERP therapists.  It was a difficult decision.  I was worried that I was making the decision for the “wrong” reasons.  I was worried that my new therapist might not be any better, and that will prove how defective and hopeless I am as a human being.  I might as well give up trying. 
I had some legitimate concerns about my therapist though, which I had almost from the beginning.  First of all - our sessions had very little structure to them.  She did not give me homework.  We never once spent any time analyzing my compulsions.  She never once discussed the idea of "feared consequences", and we didn't even put together an exposure hierarchy.  I don't know - is this common for those of you who are in therapy for OCD?  I was expecting something different I guess.  I was expecting someone who would hold me accountable to.....SOMETHING.  Though I realize that I have to be my own therapist - I also have to learn HOW to become my own therapist.  I do feel that at this point I need some "guidance". 
Secondly, we didn’t discuss compulsions AT ALL.  I remember asking her about it once when we first started working together, and she said not to worry about compulsions, to just do the exposure.  I can appreciate that simply doing exposure can have some sort of therapeutic benefit, and I think for me, it has.  However, the hallmark feature of OCD isn’t having disturbing thoughts, it is the compulsing that we do to “undo” the thought or make it more palpable.  Any progress that I made recognizing my rituals was due from reading Dr. Grayson’s book.  Not once did she ask “What are you avoiding?” or point out any rituals that I was doing.  This caused more of a problem in the Relationship OCD than it did with my gay obsessions.  In fact - I don't think she even believed that I had ROCD at the end.  She said to me that ROCD was wondering if the relationship was right for you because the person has a big nose, or brown hair vs blonde hair.  Yes - I agree - that can be how ROCD presents itself.  But again - that is focusing on the thoughts - not what the person does in response to the thoughts!  I know - from all of the reading that I have done - that I have ROCD.  I am not saying that was the ONLY problem in my relationship.  But my therapist's lack of experience and skill at recognizing compulsive thoughts/behaviours has not helped me to make any progress in this area - boyfriend or not. 
Another concern that I had about her is that she didn’t want me to “externalize” my OCD.  At the beginning of therapy, I wrote myself an exposure script that was based on the examples from Dr. Grayson’s book.  It mentioned things like “I am uncomfortable doing X – but I want to overcome my OCD and learn to live with uncertainty….”, and she asked me to take the part about my OCD out.  I never understood this.  Of course – I understand the goal of therapy is to learn to live with uncertainty.  However, I think that in order to learn to battle this disorder it is very important to have a good handle on how OCD works, and what thoughts/behaviours represent the disorder.  From all of the reading I have done – many of the specialists say that it helps immensely to think of OCD as some sort of monster – an “entity” separate from who we truly are as people.  She didn’t want me to do that and I am not sure why. 
Finally and most importantly, we just didn’t click.  She was a very nice person, but her way of operating didn’t meet my expectations for how I wanted to proceed in therapy. 
Today I am happy to say that I Skyped with my new therapist, and so far I am pleasantly surprised.  He seems to have a really good handle on the Purely Obsessive mind and our rituals.  I am actually EXCITED to work with him!  (I can’t believe I’m saying that – wait till we start exposure….) I “pre-screened” him quite well I think – I have read some of the things he has written about mental rituals, and I emailed with him my concerns about past therapy prior to us starting to work together.  I am cautiously optimistic. 
I sent an email to my old therapist today and let her know that I was going to discontinue therapy.  That was exposure for me!  What if I'm wrong??? I did it though and I feel pretty good.  I haven't heard back from her.  Who knows if I will. 


  1. I changed psychiatrists, and yes, that was scarey. Good for you finding a new therapist! I've actually done that, too, and it was hard..., but I'm on my first therapist that was listed on the International OCD Foundation website. I do like her, and I think it would be hard for me to leave her.

  2. Congratulations, I hope that your new therapeutic alliance helps you!! I've been meaning to respond to the message you sent me earlier this week - I've been super busy, but I wanted you to know that I received it and hope to have the chance to reply soon!

  3. Abigail - thanks for the encouragement!
    Fellow - You too!
    So far so good everyone! :o)

  4. Congratulations on making your decision! Never take lightly how much of an exposure it is to just exist in the world when you have OCD. You did a normal human thing, changing therapists, as scary as it seemed. And I will say that if your therapist didn't want to talk about compulsions, that's a serious problem! It's the compulsions that keep us in the cycle of damping down the anxiety of the obsessions, and escalating and rebounding, and needing more and more compulsions to keep from freaking out.