Usually, when people talk about mental health therapy, they refer to therapy making things better. This is what all therapists and clients hope for. However, can therapy make OCD worse? The short answer is yes. Let’s look at the five different ways OCD can be made worse by therapy.

1. The therapist misdiagnoses OCD as Generalized Anxiety Disorder (GAD) or something else.

Unfortunately, it often takes years for a person struggling with OCD to receive a proper diagnosis. Oftentimes, it’s difficult for individuals struggling with OCD to open up about the thoughts they are having that they may label as “bad” or “crazy.” They may have obsessions or fears about going into a mental hospital. They often present with a complaint of being anxious. Unless further assessment is done such as a YBOC II, OCD may go undiagnosed. A proper diagnosis is crucial for proper treatment.

2. The therapist uses logic with OCD thoughts.

 If a therapist is not trained in OCD, they may challenge the thought or provide logic to a client’s concern. For example, telling a client with contamination OCD to remind themselves that they cannot get AIDS from using a public toilet or telling a client with relationship OCD to remind themselves that offending someone is not the end of the world. Individuals with OCD know how irrational their thought processes are when they are in a moment of clarity. However, intrusive thoughts don’t respond well to logic. When someone is dealing with OCD, using a public toilet or offending someone can feel intensely distressful. This type of approach will typically leave the client with more shame, frustration, and disconnection from the therapist.   

3. The therapist provides excessive reassurance.

Therapists naturally want to be a voice of calm and reason for clients. Even good therapists can fall into the trap of reassuring their clients too much. If a client tells a story about something hurtful they did towards their spouse and says, “Does that mean I don’t love my spouse?” A therapist without training in OCD might reassure the client that based on conversations they’ve had with client, it seems like they love and care for their spouse. Instead, therapists who specialize in OCD will help clients recognize thoughts as OCD and learn to sit with the discomfort of uncertainty. 

4. The therapist fails to be trauma informed.

Trauma amplifies OCD symptoms. Therefore, treating past trauma or childhood wounding experiences (attachment issues, lack of nurture received, etc) can lead to a reduction in OCD symptoms. I have seen this time and time again in my own practice and heard the same from other trauma informed therapists as well. I’ve treated clients whose PTSD from childhood was triggered by exposures completed in Exposure and Response Prevention (ERP) therapy. Once the PTSD became the focus of treatment, the clients deal with less intrusive thoughts and are able to dismiss them more easily.

Therapists who are strict behaviorists or strict ERP therapists may be so focused on changing present behavior that they fail to make a connection between global elements like the need for control, over dependency on others, or lack of confidence in decision making as being connected to past trauma and attachment experiences. When these global issues are taken into consideration and targeted, individuals will respond differently to intrusive thoughts. One of the issues with OCD is that the obsessional themes can morph and individuals can be playing exposure wac-a-mole if they don’t get to deeper level core issues. 

5. The therapist is insensitive to a client’s religious or spiritual beliefs.

As a therapist with Christian faith who sees many Christian clients, I have unfortunately heard stories about therapists banning clients from praying, asking them to state things they know are not in line with their belief system (for religious OCD), asking them to look at pornography (exposure for sexual obsessions), or dismissing/invalidating concerns about sin or hell. Clients who feel like their beliefs are not respected or understood are less likely to follow through with treatment recommendations. The International OCD Foundation contains guidelines for religiously sensitive exposures.

While therapy can make OCD worse, there is hope! OCD is treatable often by combining therapy and medications. When choosing a therapist, ask about their training in OCD, specific treatment approaches, and how often they see clients with OCD.

Carrie Bock, LPC-MHSP of By The Well Counseling is a Licensed Professional Counselor who specializes in helping clients with trauma, anxiety and OCD get to a deeper level of healing through EMDR via in person and online counseling across Tennessee and EMDR intensive therapy sessions. Carrie is the host of the Hope for Anxiety and OCD podcast, which is a welcome place for struggling Christians to reduce shame, increase hope, and develop healthier connections with God and others.