How to Support Someone going Through OCD Treatment

Obsessive Compulsive Disorder (OCD) is incredibly stigmatized and misunderstood, even among mental health professionals (I know, I mistreated it once). It has been estimated that 1 in 100 people in the US have OCD, but I’m confident this number is much higher given the percentage of clients I see who have been living with OCD in secret.

So - let’s get to it. Your loved one opened up about their OCD and you want to support them through treatment.

First, here are some things you should know about OCD:

OCD is an incredibly debilitating mental health condition. It has been stripping your loved one of time, money, energy, relationships, sleep, confidence, mental clarity, and peace.
You cannot fight OCD with logic. Your loved one knows their obsessions are not logical, but they feel and behave like real thoughts that require action.
OCD feeds off of fear, doubt, and uncertainty. Learning to live with doubt - not eliminating it - is the key to successful treatment. There is no such thing as 100% certainty with OCD.
OCD compulsions are not always observable. Mental compulsions such as investigating memories, counting, and reassuring oneself are invisible to the naked eye - yet just as disruptive as behavioral compulsions.
Your loved one is NOT defined by their OCD. Their OCD thoughts are NOT reflective of their identity and their compulsions are NOT attached to personality traits. For example, if your loved one has OCD thoughts about stabbing someone, this does NOT mean they are violent and does NOT mean they will actually hurt someone. It’s incredibly important to see your loved one’s OCD as separate from who they are.

The gold standard treatment for OCD is called Exposure and Response Prevention (ERP). The good news: it works. The bad news: it can be incredibly difficult.

At first glance, ERP sounds like the complete opposite of what most people think therapy entails. It requires clients to purposefully spike their anxiety for extended periods of time by confronting their obsessions and/or fears (exposure) and refraining from their compulsions (response prevention). When they’re in this state of high anxiety, they should not do anything to calm themselves down - no deep breathing, no fidget toys, nothing. They also should not receive any reassurance from others, including the therapist. The therapist will not say anything like “everything’s okay”, “you’re safe”, “this isn’t real”, etc. In fact, the therapist may say things to make the client’s distress worse, such as “you might die”, “you might be a pedophile”, “your partner might break up with you”. See what I mean?

The only way to tackle the fears associated with OCD is to directly confront them in a supportive, systematic way over and over again until the client learns they are safe when thinking about the fears and safe when emotionally responding to them.

This segues nicely into some crucial steps you can take to support someone going through OCD treatment:

1. Learn more about Exposure and Response Prevention. It can take a while for even a seasoned clinician to get comfortable practicing exposure therapy and certainly takes time for a client to be fully invested in the process. Do your research. Here are a few good places to start:

2. Attend a therapy session with your loved one. This is a helpful step especially when you live with or spend a lot of time with this person. Remember that they’ll need some time to establish a trusting relationship with their therapist before asking you to join because this is such a private and vulnerable space. I typically use this session to clearly define what kind of support your loved one needs, troubleshoot any obstacles to you providing this, set expectations for what might arise during the course of therapy, and answer any questions you have about your role.

3. Stop enabling their compulsions. THIS. This is the hardest yet most important way you can support someone with OCD. It’s second nature to accommodate your loved one’s compulsions in order to ease their distress. Maybe you allow them ample time to touch the doorknobs before leaving the house. Maybe you clean the bathroom sink with Clorox wipes after each time you use it. Maybe you avoid saying certain words or phrases, watching certain movies, driving certain routes home, or touching them in certain ways. All of these things placate your loved one in the short term, but keep them (and you!) at the mercy of their OCD. It’s worth noting that you can expect some type of emotional reaction from your loved one when you stop enabling their compulsions, so it’s helpful to explicitly tell them that’s what you’re doing and give them space to react.

4. Do not try to “do exposures on them” unless they specifically ask you to. It may be confusing to distinguish doing an exposure from not enabling their compulsions (see above). If not enabling their compulsions looks like using the bathroom sink without cleaning it with a Clorox wipe afterwards, an exposure would look like purposefully making the bathroom sink dirty and hiding all the Clorox wipes. Unless your loved one specifically asks you to practice exposures with them (and they might!), resist the urge to “throw them into the deep end” - especially if this is fueled by your own desire to speed up the treatment process. Check yoself!

5. Don’t take it personally. Your partner might have Relationship OCD and constantly doubt your compatibility. Your sibling might have Harm OCD and have thoughts about killing you. Your roommate might have Contamination OCD and think any belongings you bring into the home are carrying life threatening diseases. Even if the content of the obsessions are about you, it’s not actually about you. It doesn’t mean your loved one thinks negatively about you or wants to harm you in any way, you just happen to be the target of their OCD thoughts. In fact, usually the reason the thoughts are so distressing is because you’re the last person they would want to harm.

6. Be a good human to them. Be patient, be kind, and have empathy for what your loved one is going through. There can be intense feelings of shame and self-loathing that come with an OCD diagnosis. You may never realize the impact a small act of kindness can have on someone who is hurting.

7. Engage in fun and meaningful activities together. Remember, your loved one is so much more than their OCD. Spend time playing together, engaging in a shared hobby, working on a project, going for walks, or breaking bread.

8. Take care of yourself. It takes emotional and physical energy to support someone with a mental health issue. Make sure you’re validating your own experience, finding your own spaces to process what’s happening, and filling your own cup.

You’re already supporting your loved one by reading this article and expressing a willingness to help. When in doubt, directly ask your loved one what they need and be upfront about what you can or can’t do.