Understanding OCD
Obsessive-Compulsive Disorder (OCD) is a chronic and often debilitating condition marked by intrusive, unwanted thoughts (obsessions) and repetitive behaviors or mental rituals (compulsions) aimed at reducing distress. Research has consistently shown that OCD rarely resolves on its own. Left untreated—or improperly treated—it tends to become entrenched, consuming hours of a person’s day and severely limiting their quality of life.
Examples of OCD vary widely and often surprise people. A common one involves checking—like making sure the stove is off or doors are locked dozens of times before leaving the house. Others may involve excessive handwashing due to a fear of germs, or mental compulsions such as silently repeating a phrase or prayer to “undo” a bad thought. Some children and teens may seek constant reassurance from parents, while others avoid certain numbers, colors, or even people due to irrational fears. OCD isn’t just being overly neat—it’s the exhausting feeling of being trapped by your own thoughts and rituals.
The Gold Standard: Exposure and Response Prevention (ERP)
Decades of rigorous research have identified Exposure and Response Prevention (ERP), a form of cognitive-behavioral therapy, as the gold standard treatment for OCD. ERP involves systematically confronting feared situations (exposure) while resisting the urge to perform compulsions (response prevention). This process teaches the brain that anxiety naturally declines over time, breaking the obsessive-compulsive cycle.
For example, someone with contamination fears might be guided to touch a “dirty” surface like a doorknob without immediately washing their hands. Over time, the anxiety decreases naturally—proving to the brain that the feared outcome doesn’t occur. ERP is structured, collaborative, and incredibly effective. Unfortunately, not all therapists are trained in ERP. Some may offer talk therapy or general coping techniques, which feel supportive but don’t actually reduce OCD symptoms. In fact, this can delay proper care and unintentionally make the condition worse. That’s why it’s important to find a psychologist with specific training in ERP.
Numerous randomized controlled trials and meta-analyses confirm ERP’s effectiveness. In fact, ERP is endorsed by organizations such as the American Psychological Association, the National Institute of Mental Health, and the International OCD Foundation.
Why Supportive Psychotherapy Alone Falls Short
Many individuals with OCD first present to clinicians who do not specialize in the disorder. Well-meaning therapists may use supportive or insight-oriented psychotherapy, which focuses on empathy, validation, and exploring underlying stressors. While these interventions can provide comfort, they do not interrupt the obsessive-compulsive cycle.
In fact, supportive psychotherapy can inadvertently reinforce compulsions:
- Therapists may reassure patients in response to obsessive doubts (e.g., “You’re not a bad person,” “That won’t happen”), which functions like a compulsion and strengthens OCD.
- Time spent processing emotions without targeted behavioral interventions delays effective treatment, allowing symptoms to worsen.
- Clients may become discouraged when months or years of therapy provide little relief, reinforcing hopelessness.
Think of it like trying to treat a broken bone with just conversation. You can offer comfort and support, but until the bone is set and healed properly, the pain continues. OCD requires more than empathy—it requires an active, evidence-based intervention like ERP to truly improve.
The Harm of Delayed or Misguided Treatment
When ERP is delayed or replaced with less effective approaches, the consequences can be severe:
- Symptom Entrenchment: Neural pathways associated with obsessions and compulsions become more rigid, making later treatment more difficult.
- Functional Impairment: OCD can erode relationships, academic or occupational performance, and daily living skills.
- Increased Comorbidity: Untreated OCD often leads to depression, substance use, or heightened suicidality.
- Loss of Trust in Therapy: Clients may come to believe that “therapy doesn’t work for me,” reducing willingness to seek or engage in evidence-based care.
For families, this delay often means watching a loved one become increasingly consumed by rituals, fear, and avoidance behaviors. Children may fall behind in school, withdraw socially, or develop eating or sleeping problems. Adults may struggle to hold a job or maintain relationships. The cost of ineffective treatment isn’t just time—it’s years of life and potential lost.
The Ethical Imperative
Therapists have an ethical responsibility to use treatments supported by scientific evidence. Offering only supportive therapy for OCD, when more effective options exist, is not benign—it is a form of therapeutic neglect. Just as we would not treat bacterial pneumonia with comfort measures alone, we cannot treat OCD with supportive therapy in place of ERP.
If you’re seeking help for OCD—whether for yourself or a loved one—it’s okay to ask your therapist what methods they use. Ask directly: “Do you use ERP?” Being informed about your treatment options is not pushy—it’s essential. Your mental health is too important to leave in the hands of guesswork.
Integrating Support with ERP
This does not mean support has no role. Empathy, validation, and therapeutic alliance are crucial for ERP’s success. The key is that support must be in service of evidence-based treatment, not a substitute for it. The most effective care integrates compassionate support with the structured, skill-based interventions of ERP.
Many people feel nervous about starting ERP—it sounds intense at first. That’s why pairing it with a supportive, trained therapist is so important. ERP is done in manageable steps and at your pace. The goal is not to scare you—it’s to empower you to take your life back.
Conclusion
Treating OCD without ERP is not just less effective—it can be actively harmful. By prolonging suffering, reinforcing compulsions, and delaying access to life-changing care, supportive therapy alone fails to meet the needs of individuals with OCD. Clinicians, clients, and families should advocate for evidence-based treatment, ensuring that ERP remains the cornerstone of OCD care.
If you or your child is struggling with OCD, don’t settle for well-meaning support that leads nowhere. Seek out a licensed psychologist trained in ERP, especially one who understands how to integrate empathy with evidence-based care. Help is not just possible—it’s proven. You deserve treatment that works.
