Couples therapy for OCD: Does it help?

Relationships take work, no matter how strong your bond is. And being a part of a couple can be particularly challenging if you or your partner has obsessive compulsive disorder (OCD), a mental health condition that affects about 2.5% of the global population, says Nicholas Farrell, Ph.D., Director of Clinical Development and Programming at NOCD. 

OCD is characterized by intrusive, distressing thoughts (obsessions) that trigger intense anxiety, resulting in repetitive behaviors or mental acts (compulsions) aimed at alleviating those distressing feelings. 

The condition can appear in a lot of different ways, depending on the person. Some subtypes include Harm OCD, involving fears of causing harm, Pedophilia OCD, with unfounded fears of inappropriate thoughts, Relationship OCD, marked by persistent doubts about one’s partner or about oneself as a partner, and Contamination OCD, featuring excessive fears of germs or contamination. 

OCD can take a huge toll on those grappling with it, as well as the people closest to them. So tailored interventions and support are important if you or a loved one is affected.

Couples therapy explained 

Couples therapy, also known as marriage or relationship counseling, focuses on improving communication and resolving conflicts between partners. A licensed therapist can help you explore and address issues such as trust, intimacy, communication, and effective problem-solving. By fostering understanding and empathy, couples therapy aims to strengthen your relationship and create a healthier emotional connection between you and your partner. It’s also been proven to reduce the negative impacts of OCD.  

This type of therapy was born in the mid-20th century. It emerged from the work of pioneers like Virginia Satir and Carl Whitaker. Influenced by psychoanalytic and family systems theories, they aimed to address relational dynamics. However, it was the groundbreaking 1949 book The Intimate Enemy by D. D. Jackson, that cemented couples therapy in the cultural lexicon. 

The 1960s saw a surge in interest, with therapists like Salvador Minuchin and John Gottman refining approaches. The 1980s witnessed a broader acceptance of couples therapy, fueled by the rising divorce rates and a growing societal shift toward recognizing the importance of relationship health. Today, it’s a mainstream intervention, adapting to diverse cultural and relationship structures.

Couples therapy provides a vital space for partners to navigate challenges, fostering open communication and understanding. Therapists guide people in recognizing and expressing their needs, breaking down communication barriers. By exploring patterns and addressing underlying issues, couples can cultivate empathy and rebuild trust and closeness. Or the process may unearth irreconcilable differences tha prompt a parting of ways. If that’s the case, therapy can facilitate a respectful separation and help you gain insights for future relationships. While challenging, this awareness can lead to personal growth and a clearer understanding of your needs and values.

How couples therapy can help people with mental disorders 

In addition to helping you cultivate a better relationship in general, couples therapy could play a pivotal role if you or your partner are grappling with a mental health disorder, including OCD (we’ll dive into this more in a moment). Here are some conditions that couples therapy has been shown to help.  

Depression:

Couples therapy can provide support by addressing communication breakdowns, fostering emotional connection, and helping partners understand and navigate the challenges of living with depression. Collaborative efforts in therapy can strengthen the overall support system.

Post-Traumatic Stress Disorder (PTSD):

For couples affected by trauma, therapy can create a safe space to process experiences, rebuild trust, and improve relational dynamics. Joint efforts in therapy can contribute to the healing process.

Substance Use Disorders:

Couples therapy plays a crucial role in addiction treatment, addressing underlying relationship issues that may contribute to substance abuse—or damage done to the relationship due to substance abuse. It promotes joint commitment to recovery and establishes healthier patterns.

Bipolar Disorder:

Couples therapy helps partners navigate the challenges of bipolar disorder by improving  communication, establishing routines, and collaboratively managing mood fluctuations. It supports both people in understanding and adapting to the unique dynamics of the relationship.

Eating Disorders:

Therapy aids couples in understanding and addressing the complexities of eating disorders. It encourages open communication, dispels misconceptions, and promotes a supportive environment crucial for recovery.

Anxiety Disorders:

Couples facing anxiety-related issues benefit from therapy by learning coping mechanisms and improving communication. Therapists assist partners in creating a supportive environment, minimizing triggers, and enhancing understanding of each other’s struggles. OCD is classified as an anxiety disorder, however, there are distinct differences in how couples therapy may be used to help. 

Couples therapy for OCD 

“While OCD is an anxiety disorder, the way we approach it as therapists is very different from how we’d treat, say, generalized anxiety disorder (GAD) in a setting with two people, as opposed to a one-on-one session,” explains Dr. Farrell. ”It’s human nature to want to alleviate the suffering of the people we love, but that impulse can lead the partner of the person with OCD to enable their compulsions. Partners can—and often do—facilitate avoidance behaviors, reassurance-seeking behaviors and can even take part in ritualistic actions to help quell their loved ones’ anxiety, not realizing that they’re strengthening the hold that OCD has over them.” 

In the context of OCD, couples therapy emphasizes communication and understanding, ensuring both partners actively contribute to breaking the patterns that perpetuate symptoms. “It can prevent the affected person from getting sucked into arguments over what rules should or shouldn’t be followed,” says Dr. Farrell. “Psychoeducation for the non-affected partner is also crucial. Human nature often leads us to unintentionally exacerbate our loved one’s suffering through well-intended accommodations. In order to allow the partner with OCD to confront their triggers, therapy should also implement exposure and response prevention therapy (ERP), which is the gold-standard treatment for OCD.”

A partners’ role in the success of Exposure and Response Prevention therapy (ERP) 

Exposure and Response Prevention (ERP) is a therapeutic approach designed to help people with OCD regain control over their lives by systematically confronting anxiety-inducing triggers and resisting the associated compulsions. 

In ERP, the goal is to safely but deliberately expose the OCD sufferer to triggers that typically evoke obsessive fears, while refraining from engaging in the compulsions that are done to alleviate the anxiety. This process helps break the cycle of obsessive thoughts and compulsive behaviors, promoting a gradual reduction in the intensity of anxiety over time, and eventually freeing the person living with OCD from that cycle.

In the context of romantic relationships, partners of people with OCD play a crucial role in integrating ERP principles during couples therapy. They are shown how to resist the urge to assist with rituals or facilitate avoidance, allowing the other person to confront and overcome their triggers independently. 

“By creating a supportive environment that encourages facing fears without resorting to compulsive behaviors, partners can become instrumental in the ERP process,” says Dr. Farrell. He adds that while ERP is traditionally implemented on an individual basis, it can be adapted to accommodate couples experiencing OCD together. “This shared approach can enhance mutual understanding, strengthen the couple’s bond, and prevent the unintentional reinforcement of each other’s compulsions,”says Dr. Farrell. 

Whether ERP is done as a couple or individually, research shows that it can significantly reduce OCD symptoms in the majority of people, restoring a sense of control and normalcy to their lives.