Q&A with an OCD Expert
For the next few weeks, I'll be sharing one question and response from my interview with Jon Hershfield, the author of the Mindfulness Workbook for OCD and director of the OCD and Anxiety Center, Sheppard Pratt. This interview was audio recorded and then transcribed. Because this is now a text, some paraphrasing was done. Q&A will be posted every Wednesday.
Interview: October 4, 2019 Transcribed: August 2, 2020
What would you say to people who are being instructed in ERP but are not seeing results so they may want to quit?
There’s a lot that could be unpacked in that question, because it really depends on 1) what do they mean that they’ve been instructed in ERP. Sometimes, I see people that have been seeing another therapist and were being told that they were doing ERP. As it turns out, they weren't really doing ERP. They just thought they were doing ERP. They were doing something that was sort of ERPish but wasn't really ERP. So maybe that's a reason why you're not seeing progress, is that it’s not being implemented in the right way. The other part of this of course is you're very likely to feel worse before you get better, which is true of pretty much everything that’s worth working at right? Like with exercise, you're going to feel out of shape before you sort of feel in shape. Now you’re not doing compulsions and on top of that you are egging on the OCD, so you should feel pretty messed up for a little while. It’s the OCD coming out of the woodwork. Some of it just requires patience and seeing the bigger picture. Then of course, what I see the most in people that are believing that they are doing ERP, but they are not seeing progress, is that they are engaging in covert rituals that are not being addressed. For instance, they are not washing their hands, but they are mentally reassuring themselves that they can remember everything they touched, and they read some articles about what gets you sick and what doesn't. They are doing other kinds of rituals that are essentially compensating for the ones that they are resisting, and they might not even know that they are doing it. They may just think well I’m just thinking or I’m just coping but they are actually still doing compulsions. An OCD specialist should be able to help them tease out those hidden more covert compulsions.