I can vividly recall the event that led to me finally getting help for what I later learned was OCD. I was an undergrad. I was standing on top of a multi-story building and I had no idea what was going on inside my head.
For me, OCD has often been very visual. At that time, I had mental images of harming myself. At this particular moment, I had a mental image of jumping off the edge of the building, falling through the air, and hitting the pavement below. I could see it all so vividly. It was powerful and frightening. I’d been diagnosed with depression some years before and started to wonder if I must want to harm myself, even though I didn’t feel that way.
After about two or three days of struggling with this distressing visualization, I started to think that there must be a part of me that wanted to kill myself. I went to the counselor’s office at my university. I had just enough psych classes under my belt to articulate what I thought was going on. I told them that I needed to talk to someone about suicidal ideation, which simply means thinking about suicide or wanting to take your own life.
The counselor told me point blank that he’d hospitalized people who’d come in with suicidal thoughts or imagery. The only reason he didn’t hospitalize me was that the psychology program I was in had given me the vocabulary to provide him with a little more context. I was able to convey that while these images of my suicide were intense and coming up frequently, I didn’t want to do it and didn’t have a plan to do it.
However, because I’d mentioned thoughts of suicide, the person I spoke with wanted someone to see me immediately. Within a week of being assessed, I met with another counselor. Initially, he did talk therapy. But after about two or three weeks of sessions, that person identified what was going on as OCD.
Realizing That it Was OCD
As a teen, I’d known some people who had OCD, but their experience looked very different from mine, so I didn’t make the connection. Nevertheless, the diagnosis came as a relief. It gave me a different lens through which I could interpret my behaviors. As I learned more about how the OCD brain works, I acknowledged that I was having upsetting intrusive thoughts, but that didn’t mean that I was likely to act on them.”In fact, was probably less likely that I would act on them than if I had those same thoughts but didn’t have OCD. That’s because OCD latches onto an outcome that you really don’t want.
The university had a pretty strict limit on how many times you could see a counselor, and so, after a few weeks, I was transferred to someone else. That person used a form of the gold-standard treatment for OCD: exposure and response prevention therapy. It works by exposing people to the triggers that provoke their obsessions, habituating them to the discomfort they feel so that they no longer need to respond by performing a compulsion.
The ERP that other therapists and I use at NOCD is more structured, targeted, and robust than the type that I was treated with. I was treated with exposures I was asked to imagine. I’ve since learned that real-life exposures are likely to be more effective. Even so, for me, this form of ERP was enough.
I began to see pretty early on that the exposures I was doing weren’t hurting me. That made it easier to engage in more exposures. So, as it does for many people, my recovery picked up speed as it went along. After about four months, the vast majority of my distress was gone.
Putting My OCD Experience To Work
I was already on a path to becoming a therapist when I was diagnosed with OCD. About a decade earlier, when I was around 11, I got counseling because I was in a pretty bad patch. I was engaging in behaviors I didn’t want to be engaging in. I wasn’t able to be the person I wanted to be. Getting effective care helped me move closer to being the person I wanted to be. That was all due to someone being there who could help me. Following that experience, I decided that I’d like to be that person for others.
My decision to specialize in OCD came about because of my own lived experience. I’d already lived with OCD for around 12 years by that point. I’d seen firsthand how debilitating it can be. Being both a counselor and a person who received counseling, I know that people with OCD can respond very quickly to behavioral interventions. OCD treatment typically yields very tangible progress, pretty consistently. As a therapist, it’s very gratifying to see how your work can change members’ lives over a relatively short amount of time.
I Can Relate
OCD specialists don’t want to provide too much reassurance in treatment because seeking reassurance is a safety-seeking behavior. But I often tell folks a little bit about my own experience, especially if they’re struggling to share the themes they’re dealing with. I’ll often volunteer, “Hey, I had a diagnosis, and here’s kind of what I struggled with.” For me, it’s a show of good faith.
People have different reactions to me sharing a bit of my own experience, but they are often curious and ask me questions. They ask me:
“What was the hardest thing for you?”
“Where did you see turning points?”
Again, we’ve got to watch that we’re not engaging in reassurance, but I can tell them a little about my experience with the caveat that their mileage may vary, and their recovery may not look exactly like mine.
Sometimes, people express concern that ERP won’t be enough to make a significant difference. I can answer that concern by telling them that I was treated with a much milder form of ERP, which was more than sufficient to change my entire life. From there, it’s easier to say: ‘Let’s give it a shot and see what happens.”
From session one, I emphasize that any exposures we do will be collaborative. I’m never going to point my finger at the member and say, “You have to do this to get better.”
No. We’re going to figure out what things you’re willing to do that match the criteria for a meaningful exposure. We’re going to start out where you’re willing to lean in. After those initial sessions, some people ask, “Does it ever become less work?” In my experience, it does get to a place where it’s less work, because the work comes down to figuring out what to do with OCD thoughts.
Figuring out if I need to sift through this thought and see: is it dangerous? If it’s dangerous, what do I need to do with it? And there is a lot of work involved in that. So eventually, you get to the point where you don’t have to do anything with the thought, where you can simply acknowledge, “Oh man, that’s an uncomfortable thought.” And then go about your day.
