Top Three Treatment Interfering Behaviors for OCD

As an OCD and Anxiety specialist, I am always assessing what could hold back my clients from getting better.  If both therapist and client openly discuss these three common pitfalls to OCD treatment, we are likely to make a lot more progress.  Like with all things, self-awareness, communication, and a good sense of humor help make these sticking points smoother.  

1. Appointment Avoidance.

This treatment-resistance behavior is fairly obvious but deserves attention because with OCD individuals, it can present differently than traditional cancellations.  For some people with OCD, the anxiety pre-session can be so overwhelming that they end up no-showing and then feel spiraled with guilt.  A client might worry that a therapist has judged them or is personalizing an absence.  While this is rarely the case, this shame cycle can then lead to further absences or “ghosting” a therapist.  This is a common behavior when a client feels uneven emotional readiness.  Appointment avoidance can also look like chronic lateness, constant changing of appointment times, or other unconscious means of taking away from therapy time.  

With appointment avoidance, the most effective approach is holding a space of non-judgment and perseverance by both therapist and client.  Flexibility and self-advocacy is key – as clinicians we do not take appointment avoidance personally!

2. Reassurance seeking.

Clients experiencing OCD may take up session time asking for and receiving reassurance from their therapist.  In this way, the therapist becomes a type of compulsion.  This pattern feels very natural for many therapists, as we are trained to soothe and support.  We want to build our clients’ self-esteem and can easily fall into a dynamic where our clients ask for reassurance and we give it.  

Unfortunately, reassurance seeking from a therapist can be very problematic for treatment progress.  On the surface, the client appears to be highly engaged in therapy, attending sessions, feeling connected with their therapist.  However, the reality is that the OCD will in fact be reinforced by this type of treatment behavior.  

   3. People Pleasing your therapist, also known as “I’m cured now! You did such a good job!”  

Chronic people pleasing is a common feature of OCD, and can be both a helpful feature in the therapist-client relationship and a deep detriment.  Sometimes, a therapist is missing the correct treatment, but a client nonetheless allows them to believe that they are making progress.  The emotions of a therapist can and should be an unimportant factor in treatment, but nonetheless, clients with OCD can be incredibly intuitive and aim to make others happy.