One Hell of a First Exposure and Response Therapy Session for OCD

I breathe deep and shake out my shoulders, letting my breath loosen the knots in my stomach. I’ve met enough therapists in my mental health journey that the initial sessions don’t phase me much anymore. Today is different, though, at least in part because I’ve never met a therapist online. My nerves start to settle as we work through the get-to-know-you questions, and — he blindsides me. He reaches off-screen and grabs a knife, holding it casually in front of the screen like it’s no big deal. It’s a letter opener, he tells me. Somewhere in the logical minority of my mind, I know that letter openers aren’t all that sharp. Still, the one glinting at me through the screen is shaped like a sword, and I feel my composure start to crack. After a brief discussion of how the on-screen blade is making me feel, my new therapist — remember, I have never met this man before in my life — swivels the point of the blade toward his throat and rests it against his skin, right over where his jugular vein must be. My palms are drenched. My heart is racing. My stomach could outweigh the sun. Despite my growing desire to slam my laptop shut and never see this person ever again, I sit still and finish the session, trying my best to stay present as my new therapist removes the letter opener from the screen and talks me through the experience.

Just like that, I complete my first session of exposure and response prevention (ERP) therapy.

Despite ERP’s status as the “gold standard” of treatment for obsessive-compulsive disorder (OCD), many people haven’t heard of it. I certainly hadn’t, at least not before I discovered I needed it. Exposure and response prevention is the practice of triggering an obsessive thought and sitting with the discomfort it causes, rather than performing a compulsion to temporarily make you feel better. For someone with a contamination obsession, this might look like touching an “unclean” surface and not washing their hands after. It’s a message to the brain that the threat is not nearly as dire as it feels, which helps lessen the intensity of the obsessive thoughts.

Before my foray into the world of ERP, I never would have even recognized my thought patterns as obsessive-compulsive. Sure, I’ve always felt a sort of resonance with other peoples’ OCD stories, but I am the messiest person I know, and I use the five second rule pretty liberally. It just seemed out of the realm of possibility that I might have the same disorder as someone obsessed with cleanliness and order. As it turns out, obsessive thoughts can be about anything (in my case, fear of causing harm to myself and/or other people). Compulsions can be mental, like, say, replaying a tragic news story over and over in your head to make sure you would never do something so violent. They can also be avoidance-based, like, for example, hiding all the knives in the house to make sure you don’t just snap and stab someone you love.

All of this is why, even though every cell in my body was screaming at me to get out of my first exposure and response prevention therapy session, I made the choice to stay. Over the past few years, I’ve felt myself curling up tighter and tighter in a desperate attempt to keep myself safe from the world, and the world safe from me. Diving into a world of treatment that is ostensibly terrifying was hard, but it’s better than losing myself to the constant cycle of horror in my head. It’s an act of love to commit to opening myself up again. So the next time my therapist pulls out a knife and brandishes it for me to see, I will let the thoughts happen. I will sit with the panic inside my chest and remind myself that this is all worth it. I’m doing this for me. I’m doing this out of love.