Around 2-3% of the population meets criteria for Obsessive-Compulsive Disorder (OCD) (about 1 in every 40 people). That means, between those who have the disorder, and the loved ones that are impacted, many many people are impacted by the oftentimes devastating consequences of the disorder. How can loved ones support their loved ones with OCD?

Get a better understanding of the disorder and how it works. 

Here are some blogs and resources that can help shed some light:

https://www.oakheartcenter.com/obsessive-compulsive-disorder-ocd.html
What to Expect in CBT Treatment Series: Obsessive Compulsive Disorder (OCD)
​OCD and “Unacceptable” Intrusive Thoughts : You are Not Alone
Thinking Errors in Obsessive Compulsive Disorder
Thought-Action Fusion in OCD
Exposure and Response Prevention for OCD
​The Role of Avoidance Learning in the Development of Anxiety-Based Disorders, OCD, and PTSD
Challenging Shame in Obsessive Compulsive Disorder

Briefly, OCD is a disorder characterized by obsessions and compulsions. Obsessions are persistent unwanted thoughts, images, impulses, or doubts that are intrusive and distressing. People with OCD interpret these internal experiences as being dangerous, intolerable, or shameful, and therefore do not want to have them and try to resist them. In other words, they interpret normally occurring and benign internal experiences as being potential signs of threat/danger and as therefore important and in need of monitoring, pushing away, confessing, etc. These obsessions then tend to elicit feelings of anxiety, fear, disgust, uncertainty, and frustration. Obsessions can revolve around essentially any content area, but most of the time, obsessions involve thoughts/images specific to making mistakes, contamination, violence, sex, religion, morality, and the possibility of being responsible for or causing har (either by losing control or negligence). 

Unfortunately, obsessions usually take the form of a content area that actually represents what matters most to the individual. If an individual values kindness, compassion, and taking care of others, then they may be more likely to be alarmed in response to a random, non-sensical, ego-dystonic thought about potentially harming someone. Or a new mother who is elated to have a baby and wants nothing more than to love and protect that baby, may be extremely afraid in response to an intrusive thought about something horrible happening to the baby. Because the intrusive thought is interpreted as being dangerous, the thought ends up taking on a life of its own and becoming more repetitive.

In response to these obsessions, individuals with OCD employ compulsions. Compulsions are strong urges to engage in a behavior and/or mental act to try to reduce the frequency of, or distress associated with, the obsessions and/or to try to keep a specific feared outcome(s) from happening. Compulsions can be overt (e.g., washing hands repeatedly, checking to make sure a mistake hasn’t been made, asking a loved one for reassurance) or covert (e.g., completely avoiding triggers, mental rituals such as saying a specific phrase in one’s head, praying to oneself, or suppressing thoughts). The problem with compulsions is that engaging in them does not allow the individual with OCD to re-assess their beliefs and learn that they are in fact safe, that their thoughts are not dangerous, that what they are afraid of is unlikely to happen, and that they can handle feelings of anxiety and uncertainty. 

How Are Loved Ones Affected by OCD

There are many ways that loved ones are affected by OCD. The stress and distress caused by the disorder may impact the quality of relationships in many ways. Watching someone whom you love experience immense turmoil may be painful to watch and create feelings of helplessness and hopelessness. 

Loved ones are also often pulled into compulsions/rituals. When loved ones give in and do what the OCD wants them to do, this is called accommodation. For example, an individual with OCD might have intense fears of being contaminated with germs. As a result, they may start showering every time they come home from being anywhere public. They may change out of their “outside” clothes and immediately wash their clothes in a very specific ritualized way. They may not be able to touch certain objects in the house. Eventually, the individual with OCD may ask their loved one to start doing these compulsions too since they may believe that their loved ones are contaminated as well. The loved one may initially object, but as a consequence, the individual with OCD may deteriorate and express intense displeasure or despair. So the loved one may acquiesce and agree to also shower when they return home, change out of their “outside” clothes and avoid touching certain objects in the house. 

This accommodation is motivated to “help” the individual with OCD to not feel so distressed. However, the loved ones must realize that compulsions (and accommodations to compulsions) are in the long run perpetuating the OCD and creating more distress in the long run. In fact, research suggests that accommodation can actually feed the severity of OCD symptoms and reduce the likelihood that an individual with OCD will be motivated to change and participate in treatment. Accommodations can also create a lot of stress on the loved ones resulting in conflict and resentment.

Support your loved one in obtaining mental health treatment with a provider who specializes in OCD

Exposure and Response Prevention (ERP) is a first-line, highly effective treatment for OCD. It is a form of Cognitive-Behavioral Therapy specifically designed to support people with OCD and their loved ones. In ERP, the individual with OCD is taught to confront/sit-with the thoughts/images/doubts/urges (exposure) and to not engage in the compulsions (response preventions) so that they can retrain their brain and fight/flight/freeze system. 

Here are some resources for finding good treatment options for your loved one with OCD (or suspected OCD):

How To Find The Right Therapist For You
Levels of Care in Mental Health Care
International OCD Foundation (IOCDF) including their IOCDF Provider Directory

Attend sessions with your loved one to learn more about OCD and partake in treatment planning and response prevention

OCD treatment often includes loved ones/support systems when appropriate so that their loved ones can learn how to support without accommodating. Parents specifically will learn how to assist with ERP implementation and practice to set their children up for success (being a cheerleader). Loved ones will learn what behaviors are specially accommodating behaviors and which are not (e.g., reasonable reassurance giving versus problematic reassuring giving), the best way to start eliminating those behaviors (e.g., identifying a start date and plan of action) and communication around response prevention (e.g., statements and phrases that may be helpful if asked to participate in a compulsion), and how to troubleshoot when situations arise that can be difficult for all involved to navigate (e.g., how to respond if the individual with OCD becomes extremely distressed or starts to bargain when told no to accommodations). For parents, the therapist may help provide training around reinforcement systems to reward/motivate their child’s participation in exposure work. 

Engage in self-care

Having a loved one with OCD can be an incredibly difficult experience to go through for many reasons and may warrant separate individual therapy. For example, a loved one of an individual with OCD may feel like their life has been taken over by accommodating compulsions/avoidance. They may feel that their time for self-care or their own responsibilities has dwindled significantly. The loved one may feel that conflict and high-stress interactions have changed their relationship with their partner/child/family member. Part of self-care is learning to communicate effectively and set healthy boundaries. Setting healthy boundaries, especially around accommodation, will be imperative to best support your loved one. 

Loved ones of individuals with OCD are incredibly powerful sources of support, engagement, and motivation and can make a big difference in the trajectory of an individual with OCD. 

If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

Finding a therapist who is well-informed about gender, gender-affirming care, and the infinite varieties in gender experience and expression can be difficult. Progress has been made over the years in terms of education about and acceptance of transgender (trans) and gender non-conforming people. However, it can still be daunting to find a therapist who you can feel safe with being honest about your gender. And, even when you are able to find a therapist that you might feel safe with as a trans or gender non/conforming person, not knowing what to expect in therapy with a gender-affirming therapist may be scary. My hope through this blog post is to explain some of the things you may see in your work with a gender-affirming therapist, and share a little bit about the way that I practice as one of these therapists. 

What to Expect at the Beginning of Treatment

When you begin therapy, you will likely be asked to fill out what is often referred to as an “intake form”. Typically, in these forms, you are asked to share a little bit about yourself, what brings you to therapy, and other relevant information. (Of note: the specific questions included on these forms can vary between practices.) Sometimes, these forms ask you for the sex you were assigned at birth and/or what your current legal sex is, how you refer to your gender currently, and what pronouns you use. As a therapist who has worked with the queer and trans community for several years, there are various things that I prioritize at the beginning of treatment with my trans clients. 

First, if you filled out this intake form prior to your actual intake appointment, I will likely confirm this information with you by asking the pronouns that you use, as well as ask you to describe, in your own words, why you’re coming into therapy. I will likely share the pronouns that I use (which are she/they!) as well. I may also ask you if you have any other names that you like to be referred to as, whether they are related to your birth/legal name or not. I will never refer to you by your birth name (sometimes referred to as a dead name if you no longer use it) unless you request me to. One thing to note, however, is that if you are using your insurance benefits to help pay for sessions, it will be necessary to provide your legal name and sex in order for us to submit insurance claims. This is an unfortunate and unavoidable part of the process if your legal name and sex are not what you would like them to be, but know that this is one of the only times this would be a consideration. 

Throughout Treatment

When working with minors, I often collaborate with their parents to a certain extent to ensure that lessons and strategies learned in treatment are implemented outside of session at home, but I never share details of our sessions unless it becomes absolutely necessary. An example of this may be if the minor reports to me that they have been engaging in self-harm or are having active suicidal ideation. Of course, if it ever gets to a point where I feel this is necessary to communicate to the caregiver(s), I try my best to have a conversation about this with the minor before doing so. 

There are some things I keep in mind when working with minors who identify as trans/gender-nonconforming. One of the most important things is that I will have a conversation with the minor at the beginning of treatment to make sure I’m referring to the client how they would like to be referred to when I speak with their caregivers. This is especially important if the minor is not out to (i.e. hasn’t shared their trans identity with) their caregivers. Additionally, part of doing therapy with trans minors is providing education to caregivers about their child’s trans identity, how to support their trans child, and more, and I will always discuss this with the child beforehand to make sure I’m doing my best to have conversations with their caregivers that they are okay with. 

When working with clients who identify as trans, I sometimes support clients with identifying any gender-affirming care goals they may have. This may include things like hormone replacement therapy, gender-affirming surgeries, voice training and more. These interventions would require medical professional oversight, but I am happy to play a role in providing referrals and collaborating with providers throughout the process (with consent, of course). We may also talk about gender affirmation without medical intervention, such as exploring how clothing, body modification (such as piercings and tattoos), binding, tucking tools, and more may be incorporated into your life to express yourself and your experience of your gender. These conversations often include myself pulling from elements of Narrative Therapy and Solution-Focused Therapy as you discover more about yourself. I always approach these conversations with enthusiastic curiosity, supporting clients on their journeys to discover what makes them feel most at home in their bodies. 

When Looking for a Gender-Affirming Therapist

There are many things to keep in mind when you look for a gender-affirming therapist, and these can vary widely based on a person’s preferences. However, there are some things to keep in mind that a gender-affirming therapist will never do. One thing that a gender-affirming therapist will never do is force you to use your birth/dead name if you don’t want to. If I am aware of a trans client’s dead name, such as in cases where their chosen name is not their legal name, I do my best to ignore that information as much as possible and only use their chosen name unless otherwise specified by the client. (Again, it’s important to note that legal names do need to be used to file insurance claims.) Additionally, a gender-affirming therapist will never tell you that you need to change who you are, how you should express yourself, or how you should refer to yourself. Therapists, especially those who are trans themselves, may provide suggestions at times, such as potential ways to manage gender dysphoria. That being said, these suggestions should never be made in an attempt to tell you how you should experience your identity or express yourself, but rather to offer alternative options and resources. The process of discovering yourself can be a sensitive one, and it should be approached and discussed with care, acceptance, and support. 

Final Thoughts

Ultimately, it is up to each individual person to decide what is best for them and their goals when choosing a therapist. It sometimes takes people a few tries with more than one therapist to find the one that they feel comfortable with, and although this can be a frustrating process, know that it is not out of the ordinary. You deserve to work with a therapist that you connect with, who sees you for who you are, and who is committed to supporting you in working towards your goals. 

​If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.