How the journey began

About 1999, another therapist in Omaha referred a young man to me – with the hope that I might help him with his fear of germs, body fluids, and other things that distressed him greatly. He washed a lot, avoided many places and things, and had a hard time visiting friends or having anyone touch his stuff. On top of that, he was deeply depressed.

My office

My office

The original idea was that I would employ hypnosis to help improve the anxiety response that was so pervasive in this fellow’s life. On the surface of it – that plan made some sense. Hypnosis does have the potential of helping people reduce their reaction to fears, places and things [such as phobias]. We worked for several weeks, and got……………….nowhere.

He was taking medications, under the care of a compassionate psychiatrist. Clearly, his family was loving and patient. But, we needed to turn the situation around; we needed fresh ideas.

The Search for Solutions

Today, of course, we would just pull out a smartphone and do a quick Web search. Back then, medical databases were just coming online for the average citizen. Serendipitously, this fellow had a family member who had access to just such a resource. When mother and client came for their next appointment, mom asked, “What do you know about Exposure & Response Prevention Behavior Therapy?” Nothing, I had to admit. “Would you be willing to learn about it,” she wondered? Yes – I was.

Looking back, I still marvel at the turn of events. I needed input beyond my training, and I had – originally – no idea where to get it. I was so fortunate that this young fellow’s family was resourceful and collaborative. That enabled us to find out what might work, to change directions, get some training, try some ideas – and see the success unfold.

Still learning

Edna Foa, PhD, and Reid Wilson, MD had published a book on their work with OCD. It laid out a new plan for intervening with OCD. I read; I attended a seminar that Dr. Foa taught at in Kansas City. I kept reading. Later, I attended the Behavioral Therapy Institute [often referred to as the BTTI] that the OC Foundation sponsors for therapists to learn about this approach. I continue to be a professional member of the Foundation, and do my best to follow developments and advancements in the field. The OC Foundation supports, encourages and funds research efforts to develop more insights into OCD – and to determine better treatment approaches.

Exposure Therapy

… in the beginning

Slowly [and clumsily, in retrospect] we incorporated the ideas from the BTI. We took up the strategies of facing what had been avoided [exposure] and learning to tolerate the discomfort without depending on a anxiety-reducing action [response prevention]. Eventually, what had been provocative loses its power – the textbooks call that habituation. You might call it freedom. There is a lot to learn about this form of therapy. It’s worth it, I think.

Over time, this young fellow was able to incorporate what he learned in therapy into everyday life. He could use public restrooms. He could play with his dog without compulsive washing. He could have friends visit his house.

… and now

Today, I move with more speed to prompt a response to the intrusiveness of OCD’s tactics. I often think of OCD as an unscrupulous blackmailer. He has inside information about your values, your attachments and commitments, along with your most feared or triggering places/things/thoughts/images. And, this blackmailer is both ruthless and insatiable. On top of all that – the ransom is not money or jewels. [that would be easier, really!] The ransom demand becomes your compulsive urges and the compulsions are the payoff.

Our task, together, if to learn how to stop paying the ransom.

Keep in mind: this is a simple analogy. Tackling OCD takes time, commitment, energy, courage. It can be daunting work – but virtually everyone can function more successfully.


acknowledgement to yourself that thoughts and actions are creating suffering

a willingness to share what’s going on with a therapist who can help

a desire to learn about how OCD works – through discussion, reading, and trying new approaches to deal with anxiety and compulsive urges

if medication is used, patience with finding the right one, the right dose [this often takes some time]

bring plenty of courage – you’ll have to face being uncomfortable for a while. You’ll find out later that it was worth it.

Be willing to tell your therapist what is working, and what’s not. Slowing down the therapy if you get overwhelmed.


Beyond OCD’s description of Cognitive Therapy

Fred Penzel’s comments on the toughness of the therapy approach, and why it must be that way

Residential/intensive programs for those who need a higher level of care

Here’s a link to a brief resource collection you can access online – curated by me. Updated periodically.