What if the exposure is also triggering for the therapist?

While running a therapist training in Exposure Response Prevention, the gold star treatment for OCD, I demonstrated an exposure of contaminating with saliva.  While there are many ways to do this that are not triggering the therapist's contamination fears, I chose to go the most uncomfortable route.  With my co-worker’s consent, I licked the palm of her hand.  Most of the training group gasped to watch this exposure, in the midst of cold and flu season.  One participant raised their hand and asked “Um, are you sick all the time?”  

As an OCD therapist, I would never ask my clients to do an exposure that I would not do myself.  In fact, I often prove that this is not an empty promise and do the exposure alongside my client.  

This participatory nature of ERP is critical for positive outcomes.  

We need to universalize the experience of being disquieted by exposure challenges.  

We are asking our clients to often go further than is healthy in order to recalibrate back to a healthy choice.  We are asking them to do something weird and socially awkward, in order to confront a fear.  Our parallel discomfort helps achieve compliance. 

ERP must be a collaboration.     

As a clinician, I cannot control when I will have an anxiety reaction to the exposure.  My nonchalant attitude towards licking my coworker’s palm is not an energy I can bring to every joint exposure. 

I am also an individual with OCD (in partial remission) and I have my own deep fears.  My imperfectly healed OCD normalizes self-compassion for my clients.    

As a child, I lived in the same apartment complex as Jeffrey Dahmer, at a time when he was actively murdering.  After he was caught (by which point I lived elsewhere), my mother and I watched all the news coverage and made the connection.  I have carried the terror of this closeness to cannibalism for my whole life.  In session this week, after my client was unable to watch the Dahmer netflix series (his homework), we watched 5 minutes together to unlock this particular exposure.  If his anxiety rating was a 6, mine was closer to an 8.  We both reflected on the cortisol churning through our systems during the initial scene where he was washing blood from an electric serrated knife.  As a former neighbor of Dahmer, I visibly cringed during his fairly normal interaction with his neighbor where he cited the PH levels of his fish tank.  

My client picked up on my reactivity and I was able to model the fundamental lesson of ERP: we can handle distress without doing our compulsions! 

A wave of anxiety is a healthy, normal human experience (especially in response to cannibalism!) and we can feel it without needing to neutralize our discomfort.  

My client and I are simply imperfect human beings recalibrating our nervous systems together.  ERP helps unlock the most fundamental truth of the human experience: we are not alone. 

If you would like to learn more about ERP, please contact Kairos Wellness Collective.