Catholic and OCD

Effective treatment for OCD is available. This can include medication, therapy, or both. 

The “gold standard” therapy for OCD is called “Exposure Response Prevention” (ERP). A subset of Cognitive Behavioral Therapy (CBT), ERP is an application of Exposure Therapy that is specifically tailored to OCD.

Exposure Therapy has been used to good effect with anxiety and phobias for many years. Exposure Response Prevention adds one additional step, necessitated by the unique role of compulsions in OCD: “Response Prevention.”

The basic idea is that in order to rewire the faulty brain connections that make us irrationally afraid that obsession A will lead to feared outcome B if we don’t do compulsion C, we have to intentionally expose ourselves to obsession A, without letting ourselves engage in compulsion C. Eventually, our brain will learn that obsession A does not result in feared outcome B, and our anxiety surrounding obsession A will die down.

This process is highly structured, tailored to the specific obsessions and compulsions of the OCD sufferer, and deliberately graduated from lower fears to higher fears. Many supplemental strategies taken from other types of therapy can help the OCD sufferer learn to cope with these exposures in a healthier way. ERP requires work and commitment, but it is achievable and effective. (To learn more about ERP, look up “ERP for OCD: a Brief Primer,” a Psychology Today article from January 2019.)

However, not every therapist is trained in ERP. Just as we wouldn’t expect every therapist to specialize in trauma therapy, we cannot assume that every therapist specializes in OCD. In light of this fact, if you suspect you have OCD, it is important to look for a therapist who does.

Many therapists with an OCD specialization also work with the whole spectrum of anxiety disorders. As a general rule, they should know how to utilize ERP, as well as a variety of supplemental therapies that can also support the process of OCD healing.

One danger to keep in mind is that therapists who are unfamiliar with OCD are vulnerable to being turned into a compulsion. Remember how many subtypes of OCD include compulsions to seek external reassurance? Well, traditional psychotherapy can provide a perfect opportunity for compulsive reassurance seeking, if the therapist and client are not careful to avoid this. That is one reason why it is important to find a therapist with experience treating OCD.

Many OCD Catholics also wonder if it is imperative to find a Catholic OCD specialist, thereby adding another layer of complexity to the search. Since my own experience of OCD therapy was deeply enhanced by my therapist’s understanding of Catholic principles, I do believe that Catholic OCD therapy is ideal if available. However, if it is not available, I think it is better to seek help from a trained OCD specialist than to continue to suffer without help. 

One strategy that can be used to compensate for the lack of a Catholic OCD specialist is to divide the responsibility for technical therapy apart from the responsibility for spiritual direction. In this case one would rely on the combined efforts of a trained OCD therapist and a Catholic spiritual director, who would each operate in their own domain, but would be aware of and cooperative with each other. The Catholic church has always recommended that scrupulous Catholics, in particular, find and obey one good confessor. Ideally, this person can work together with a therapist to fully support a Catholic suffering from OCD.

A good therapist is trained to respect each client’s religious beliefs. This principle should govern OCD therapy, as much as it governs every other kind of therapy. The tricky part is that OCD sometimes latches onto matters of faith directly, as in the subtype of scrupulosity. A non-Catholic therapist could potentially struggle to sort out the teachings of a faith that is not her own from the unhealthy thought patterns of OCD, although many of them have sufficient experience that this is not a problem.

The therapist should be able to work with the client to develop an exposure hierarchy that triggers the client’s anxiety, without violating his beliefs. In his book, “The Doubting Disease,” expert Joseph Ciarrocchi suggests that if the client is in doubt about the morality of an exposure, the client should ask his spiritual director to approve it or suggest an appropriate modification. I would add that it is important in this case to abide obediently by the spiritual director’s judgment, not permitting oneself to descend into OCD over-analysis or seeking second and third opinions.

The main point here is that targeted, effective treatment for OCD is available. You don’t have to suffer without support, laboring in miserable servitude to fear and anxiety. If you have been on the fence about seeking OCD therapy, I encourage you to make a start today.

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I will list a few resources to get you started, but I would also suggest that you search “Catholic OCD therapy,” “Catholic scrupulosity therapy,” and similar combinations to find local therapists who might meet your needs better than the general recommendations I can find online.

*As always, please remember that I am not a therapist, a professional, or a priest. I am not qualified to directly endorse therapists or spiritual directors, and could not vet all of these providers even if I wanted to. These are simply resources to spark your own research.

• The International OCD Foundation offers a database of OCD providers here. Please note that it is not a faith based organization.

• NOCD is an organization that provides OCD therapy online. It is not faith-based.

• Holy Family Counseling is a Catholic organization that provides teletherapy. It does not restrict itself to OCD therapy, but at least some of the counselors have experience with it.

* One of my long-term goals for this website is to be able to provide a database of Catholic providers with expertise in OCD treatment. I am not at that point yet, but if you are a licensed Catholic therapist/counselor/psychologist who specializes in treating OCD, please reach out to me so that we can start to build that resource.