We frequently hear that a patient's symptoms feel more manageable as a result of EX/RP treatment. Despite a decrease in OCD symptomatology, and a solid understanding of EX/RP treatment, clients may still experience some apprehension about discharging from individual therapy.
As patients near discharge from treatment, some of the frequent questions and concerns are:
- What if I start having compulsions again and I’m not in therapy?
- What if a new obsession or compulsion pops up? I haven’t had this much freedom to do things or think clearly, I feel unsure of myself.
- What am I going to do with all my time?
These questions are common and the answers are always dependent upon the situation. However, there are some common themes of concern as OCD treatment ends. Therapy coming to an end can mean something different for each person. Anxiety, caused by OCD, can have a significant impact on daily functioning and relapse prevention.
One common theme patients express is the fear that they will not have the resources needed outside of therapy to deal with a possible event. Creating a relapse prevention plan will help identify potential resources needed in the future. This plan is the result of a collaborative effort between the therapist and patient. A relapse prevention plan may include the following: strengths, future goals, goals of EX/RP, future obstacles and a plan to handle those situations, and a plan to manage spikes in OCD symptoms. There are also evidence-based OCD workbooks that can be helpful for clients outside of sessions. Finally, having “check-in” sessions monthly to titrate down to every 6 months, etc. can be very beneficial as well.
Another theme to consider is the uncertainty about the freedom that compulsions once stole. Some clients experience OCD as near constant, so when compulsions are no longer performed
there may be questions around, Who am I? What do I enjoy? This is normal, and it can be helpful to reflect on values and start doing the things that may have once held an individual back.
The last theme stems around the concern about what their new “norms” look like. Patients may be confused about how to behave in target situations. For example, someone who may have been practicing refraining from checking their appliances excessively can now return to checking once if they feel unsure. Another scenario may be an individual who has been doing exposures surrounding excessive cleaning. That individual should be encouraged to clean the amount of times they would before the presence of OCD. If that amount is unknown, it is recommended to use societal norms as a measuring stick e.g., using the CDC guidelines for handwashing.
Conclusion
The end of OCD treatment can be a time of rumination, but by addressing any concerns, and cultivating self-trust it can be a time of celebration, reflection, and growth. Some anxiety about the end of any treatment is normal and should be validated. Talk to your provider if the anxiety is excessive or debilitating. One of our specially trained clinicians can help you with the resources and skills needed to manage anxiety or OCD. If you or a loved one would like to work with one of our clinicians specializing in the treatment of OCD, please click here.
- Brittany Steiner, LPC
