I once came across a movie that opened with the villain, an evil therapist.
A stereotypically anxious, spindly young man comes into his office and gives an explanation of his claustrophobia. In the next scene, the evil therapist ushers him into a false elevator, closes the doors, and laughs as the young man’s muffled screams fill the clinic.
“Don’t let him out until he stops screaming,” he tells his secretary.
And that was the point where I switched the movie off.
As someone who has personally had OCD and who helps other people work through it, I’m sensitive to seeing inaccurate media depictions about anxiety disorders and treatment.
The evil therapist was implementing Exposure and Response Prevention Therapy, also known as ERP. It’s one of the most effective interventions for OCD, phobias, and some other kinds of anxiety disorders. But a forced exposure, as the evil therapist in the sitcom demonstrated, is neither ethical nor standard procedure. Unfortunately, the vision of an “evil therapist” lies behind some of the most self-sabotaging behaviors in OCD-dom.
In this article, I want to give you 4 reasons to let go of faulty beliefs about your therapist so you can stop sabotaging your scrupulosity treatment.
The Vision of the Evil Therapist
How do you view therapists?
- Are they “out to get your money?”
- Do they “not know how to help you?”
- Do they “make you feel triggered?”
I get it — your therapist isn’t always available, she may ask you to do things that feel very uncomfortable, and she may occasionally have issues with booking or billing. You don’t always feel good when you leave her practice, so it must mean that she’s an evil therapist, right?
Well, hold on — not so fast.
Although I recognize there are some toxic, unethical, and downright rude therapists in our crazy world, they are the minority. The “evil therapist” myth, however, is so pervasive that it represents a significant roadblock to recovery.
I’m sure you’ll remember how the Bible speaks about the Holy Spirit as a “Helper.” The Greek word that Jesus uses to describe the Spirit is parakletos, literally “one who comes alongside.” As a follower of Christ, you can be sure that the Holy Spirit is in you and with you. But you can also look around you to see evidences of the Spirit’s work to “come alongside you” in the presence of others.
- Does your mother come alongside you with a bowl of chicken soup when you’re sick?
- Does a colleague come alongside you to help you figure out a tough work assignment?
- Does your therapist come alongside you to guide you to better mental health?
God’s providence in our lives is not like Disney magic. There is no fairy dust and no magic wand. He generally works through normal people and events to give support and answers to prayer. Sometimes God comforts us with warm, tingly feelings — but not always, and often our tingly feelings can be misleading, anyways.
God may be seeking to guide and help you through your therapist, but your vision of the “evil therapist” could be keeping you from receiving the blessings of Providence. Here are 4 reasons to let go of your trepidation about therapists.
1. Your therapist doesn’t want to compromise your personal ethics.
Every therapist has his or her own set of beliefs and values. He may be Jewish, Catholic, or Pentecostal. He may be democratic or republican or fed up with both. But when he comes into the therapy session, he does his best to leave his personal beliefs at the door.
His goal is to help you become the best version of yourself. He isn’t interested in making you a reflection of himself.
And did you know that when therapists are studying in college, their professors teach them all kinds of things that will help them avoid ethical compromises? It’s actually a pretty big deal, especially in something as messy as scrupulosity.
If you’re working with a therapist who understands OCD, he’s probably well aware of the ethical landmines involved in treatment. Remember that old game, “Operation?” You had to carefully insert the metallic surgical tool without touching the “body,” which would cause a loud buzz. Your therapist is playing “Operation” when he tries to extricate the disorder — scrupulosity — without touching your personal ethics.
But with that said, it’s important to remember that your therapist is an expert in mental health, not religion and ethics. It’s impossible for him to become well-versed in the belief systems of every person who walks through his door.
As somebody with scrupulosity, it’s possible that 30% or 50% or 80% of your religious thoughts and behaviors are unnecessary maladaptations of your relationship with God. You’ll be tempted to feel that every single obsession and compulsion are valid, but your therapist will try to gently show you otherwise.
In the process, it’s entirely possible that he may touch his surgical tool on something that is valid to you and your entire faith community.
This doesn’t make him an evil therapist. It simply means that he has professional limitations, just like anybody else. So be willing to speak up, be grateful for the area of expertise that he has, and be realistic about the areas that aren’t his speciality.
2. Your therapist cannot force you to do exposures.
Like the evil therapist in the movie I started watching, some people are afraid their therapist will do a forced exposure. They fear being pushed too fast into things that are too scary.
It’s vital to remember that if you are voluntarily going to your therapist’s office, the entire process of what happens there is completely based on your cooperation. It isn’t like Hollywood depicts mental health, with straightjackets, padded rooms, and leather wrist restraints. You are there of your own free will, and your therapist cannot force you to do anything.
She may probe. She may suggest. She may strongly recommend.
But she won’t use force.
(Unless, of course, you have the bad luck to be in a very small minority of people who get abusive therapists. This woman’s therapist used the power dynamics of the clinical relationship to sexually abuse her during their weekly sessions. If you are ever in a situation where you are being forced, pressured, or manipulated into something against your will, seek help immediately.)
Most therapists work to gain your trust before guiding you through difficult interventions, because they know therapy will never work unless it’s you in the driver’s seat making the decisions. Yes, toxic and abusive situations may happen in clinical settings, but statistically you are about as likely to be abused by your therapist (4.4%) as you are by your religious leader (4%), which is still less likely than being abused by a teacher or sports coach (5-7%).
So drop your defenses. Tell your therapist what makes you feel uncomfortable about exposure therapy. Know that you’re ultimately the gatekeeper for whether the exposures happen or not. Let that feeling of empowerment give you the confidence to start with a nibble instead of feeling like saying “yes” means you’ll get the whole waterfall at once.
3. Your therapist can’t help you unless you trust him.
Your therapist knows how to help you.
But he has to blindfold you and guide you over a rickety rope bridge and through a jungle full of wild animals. Then you’ve got to cross the slippery stepping stones of a piranha-infested river and creep past a village of cannibals before reaching safety.
That’s literally how therapy for OCD can feel.
Do you trust your therapist?
Sure, it doesn’t feel good in the moment. In fact, when you start working through your obsessions and compulsions, your anxiety levels may actually go up. But if there’s any truth to the old adage, “the darkest hour is just before dawn,” you’re heading in the right direction.
And to make it to safety, you’ve got to trust your therapist.
Trust can be one of the biggest keys to unlocking your recovery. After all, you’ve been spinning your wheels in the same old mud pit, not going anywhere, doing what feels comfortable. You already know what doesn’t work. Just because the way out of your mud pit is a bit of a tough climb doesn’t mean it’s bad.
In the Bible, God frequently asked people to trust Him even when the way was very dark. It is no virtue to only trust in times of balmy weather.
You’ve prayed and asked for God’s help to get over your scrupulosity. He’s answered by giving you an appointment with a therapist who knows how to treat OCD. Trust in the process of God’s Providence by trusting your therapist.
It doesn’t mean you have to uncritically swallow everything he says. But give him a chance.
4. Your therapist is doing her best to help you.
At times it may feel like your therapist is your enemy. She brings up all kinds of anxiety-inducing topics and asks you to do hard things. You are almost convinced that she is truly an evil therapist.
But most people who work in mental health are really, honestly on your side.
Again, not everybody is. I always leave a bit of gray area for exceptions. I’ve been fortunate to have overwhelmingly positive mental health experts who came alongside in my times of need. I’ll never forget the inpatient program I attended for my depression. One day during the afternoon group lecture, the doctor was so touched that he started crying with us.
It’s not easy for therapists and doctors to be emotionally invested in the people they try to help. But many mental health providers wake up every day because it’s their passion to help people like me and you.
They’re on your side. They are excited for your progress. They feel good about themselves when they see you improving.
The myth of the evil therapist is just that: a myth. Toxic therapists are a minority, the healthcare system’s dust bunnies under the bed. If you believe that your therapist is on your side, you’ll be able to trust her. Then you’ll be able to let her guide you through the necessary interventions. Then you’ll be open enough to co-navigate the post-scrupulous reconstruction of your moral and spiritual life.
Believing in and trusting your therapist is where it all begins.
So next time you have an appointment, give your therapist some appreciation. Let her know you’re committed to the process of getting better, and you’re grateful that she’s willing to come alongside you. Start to conceptualize of her as your cheerleader, not some dark-dungeoned torture overseer. She’s on your side!
One of the biggest ways we self-sabotage in the treatment of scrupulosity is to set ourselves at odds with our therapists. This doesn’t have to happen.
I’m not a therapist; I’m a spiritual coach. Fairly often, my clients tell me they don’t like their therapist, they don’t feel comfortable doing ERP, and they feel like therapy makes them compromise their faith.
I understand that there are some challenges with treating scrupulosity because it involves faith and mental health. But let’s not throw the baby out with the bathwater. Your therapist is there to help you. He may not get it perfect every time, but who does?
Don’t sabotage your recovery by dropping out of therapy. Stick with it. Trust God by trusting the process, and you’ll make it to safety.
What about you — what’s been your experience in therapy? Did you ever drop out because you felt like it was too hard? Would you be willing to try again?
Best wishes on the journey!
Personally in my ocd journey I've had ocd therapists who made me much worse. What I found thru a psychologist who herself has ocd is that my particular Harm OCD was made much worse during ERP because the previous therapists without knowing it had me trying to habituate to my ruminations as all I was doing during erp was ruminating and my ocd got more severe. They literally had me doing my compulsions . My present therapist works on my ocd by showing the patient how to stop Ruminating.
I think traditional erp can work on ocd where the compulsions are more physical but at least for me with so much pure o this
Response prevention and teaching me how
to not engage with the thoughts works much better.
Also I must say I was at a famous ocd clinic previously where some interns there seemed uninterested.
A therapist who has and understands ocd can definitely be more intuitive and empathetic , especially for someone like me who got very severe.
Watch out for those therapists who went to a three day seminar on how to treat ocd.
I'm not saying traditional erp is bad but response prevention worked better than habituation my case.
Best comment ever. 🙂 Thanks, Timothy! I totally understand your points and I think they are all valid!
I consider therapists to be evil -they take your money and do nothing. When you question them, they gaslight you. The client is a consumer and therapists are selling snake oil.
Sam, truer words were never spoken. Jaime’s contention that the majority of therapists are trustworthy, competent, and experienced is her opinion presented as a fact. She means well but she cannot present proof.
With scrupulosity, the probability of therapy like ERP resulting in further trauma and harm to someone already suffering terrible anguish and fear is huge. This is my opinion and no, I cannot present proof.
However, I fail to see how ERP can work when the fear is that the symptoms of scrupulosity will lead to eternal damnation. Hell is not an immediate result, so seeing that an intrusive thought or a failure to confess a sin or forgetting to pray in the proper form, etc doesn’t result in you finding yourself in Hell is not going to provide any reassurance. On the contrary, I would merely feel I had just made my worst fear even more likely to come true.
I am a person whose scrupulosity is characterized y obsessions without accompanying compulsions to relieve them. Another reason why ERP is out of the question.
Thank you for expressing your opinion. It might save many people from placing trust in a profession that has the potential to do great harm.
Sorry, the 5th line was meant to say "*not* quite sure where they're headed". I presume u caught the error but just thought I'd make sure:)
I think it’s totally healthy and a good idea to bring this up. I’m NOT a therapist myself, but just from a common sense perspective what I’d be looking for in a therapist who can help me with my OCD is going to be a focus on defining and recognizing my obsessions/compulsions. I’d expect them to explain ERP and take steps towards guiding me through that. They might detour into other aspects like CBT or DBT if I have some cognitive distortions holding me back or if I am severely deregulated and nonfunctional in everyday life kinds of things. But ERP would probably be something they would view as the main entree.
A therapist who is meandering through the meadows of family relationships for a really long time might not be your best bet for dealing with OCD. As far as I’ve read till now, trauma or adverse childhood experiences do not “cause” OCD. I would feel like you; maybe we are “barking up the wrong tree.” You may wish to ask your therapist quite plainly if she/he has had experience in ERP therapy and how capable they feel in guiding someone through that. You might also want to ask if they can share any examples of how they have administered ERP in the past and what the results were. If you get a blank look, I’d suggest looking for a different therapist. Not that your current therapist is bad, but everyone has specializations, and you need something very specific.
Hope this helps,
OK, thanks Jaimie. My therapists website says she's a Christian and that she uses CBT to treat OCD. I'm not sure if ERP comes under the definition of CBT or whether they're separate?. The only thing the therapist has said so far when I mentioned curing the OCD is that I should try writing things down.
Again, I’m not a medical person, so any mental health specialists who happen to be reading this, feel free to correct me–I do believe that Cognitive Behavioral Therapy (CBT) is a large umbrella term used to describe a number of different types of therapies designed to get the patient to use his or her will and thoughts to modulate the effects of the anxiety (as opposed to using medication or electrical brain stimulation to get the anxiety to go away). CBT can technically include DBT, ACT, ERP, REBT, MBSR, etc (sounds like alphabet soup). But CBT can ALSO be used as a standalone term for a more general type of therapy which focuses on analyzing the thoughts as they come, looking for distortions, and attempting to correct these problematic thought patterns. This can be very triggering for someone with OCD, since we tend to overthink things anyways, and want to “get it right,” which is hard to do perfectly with thoughts.
I wonder if your therapist is using CBT as a specific term or as an umbrella term. If she’s using it as an umbrella term, maybe she’ll get to ERP eventually. Remember it’s always ok in the patient-therapist relationship to say what you’re thinking and ask questions. You’re not rude for doing so.
As for writing things down, this is probably a terrible idea. It sounds like a new compulsion waiting to happen. I’ve worked with a number of clients who write things down compulsively. It’s like ruminating, except on paper. Not sure what her idea is with that one.
OK thanks for that reply. Maybe I'll give it one more try with my current therapist just see if it's heading anywhere. If not, maybe I'll try booking a session with yourself (although I know you said you're not a therapist) since you seem to have a very good grasp on the bible and, from what I can tell, have read widely on scrupulosity thing
Sounds good to give it another try, and maybe ask your therapist more pointedly about her strategy.
I am not taking appointments until April because I am finishing my doctoral dissertation so I can graduate this May. Have you already checked out the International OCD Foundation’s database of OCD specialists? I pulled this up for you to see what’s available in the UK. Looks like you might have some good options. If they’re listed with the IOCDF, they probably are a bit more specialized in OCD than the average therapist. Check this link and see if anything stands out to you: https://iocdf.org/find-help/?_provider_proximity=55.378051%2C-3.435973%2C700%2CUnited%2520Kingdom
Hi Jamie, I've just recently started therapy for my scrupulosity and had four sessions so far in the UK. It's not so much I fear my therapist is evil – it's more that I'm quite sure where they're headed, since every conversation so far has centered on asking me about my relationships with family and friends and I'm thinking 'This is fine and all but when's the actual treatment starting to help me cure the issue?'. I kinda wondering if this style of treatment is normal for my issue or whether I may have chose the wrong therapist?. I didn't want to be rude to the therapist but I'm thinking of maybe bringing it up next session since I'm worried we're just going to continue to go over the same ground. Or maybe I'm missing something and the therapist is actually building to something? It just seems a little slow. James
Yeah I checked that site before but it keeps saying 'no results' found when I put in my location and "ocd" . One of the sites I checked before was psychologytoday.com. There is one guy on there who is near me that says he specialises in scrupulosity but he only does zoom so that's why I chose to go with the other therapist – maybe I'll give him a second look