Treating OCD Without Reinforcing It: A Practical Guide for Therapists
Ever had a client casually mention they’re afraid of stabbing their partner or harming a child—and you immediately wonder if you need to file a report?
If you’re not trained in Obsessive-Compulsive Disorder (OCD), those moments can be panic-inducing. But for Beth Brawley, LPC, an expert in evidence-based treatment for OCD, these scenarios are far more common (and less dangerous) than they seem. In this episode of Not Boring CEs, we dig deep into the clinical nuances of OCD, from subtypes and intrusive thoughts to treatment and therapist pitfalls—so you can better serve clients and avoid unintended harm.
Whether you’re brushing up on your skills or considering specializing, this conversation is a must for anyone seeking quality CEs for therapists or continuing education for counselors.
What OCD Actually Is—and Isn’t
OCD isn’t just hand-washing or checking if the stove is off. It’s a cycle of intrusive, unwanted thoughts (obsessions) and behaviors meant to neutralize those thoughts (compulsions). Beth explains it like this:
- Obsessions = Ego-dystonic thoughts, images, or urges that feel scary, wrong, or repulsive.
- Compulsions = Rituals or safety behaviors designed to reduce distress, which provide short-term relief but reinforce the obsession long-term.
So if your client avoids driving because they worry they’ll run someone over, or refuses to be alone with their child out of fear of harming them—those might be OCD symptoms, not signs of actual intent.
Common OCD Subtypes (a.k.a. the 31 Flavors)
Think of OCD like Baskin-Robbins: it all stems from the same base, but presents in different “flavors.” Beth outlined several subtypes, including:
- Contamination OCD – Fear of germs, illness, or general “grossness”
- Harm OCD – Fears of hurting oneself or others
- Scrupulosity – Religious or moral fear of doing something “wrong”
- Sexual Orientation OCD – Obsessive doubt about one’s sexual identity
- Pedophilia OCD (POCD) – Fear of harming or being attracted to children
Each subtype uses the same treatment—Exposure and Response Prevention (ERP)—but may require some creative tailoring.
Exposure and Response Prevention (ERP): The Gold Standard
ERP is the go-to evidence-based treatment for OCD. It’s like CBT’s nerdy, hyper-focused cousin. Here’s how it works:
- Exposure – Intentionally triggering anxiety by facing feared situations or thoughts.
- Response Prevention – Resisting the urge to do the compulsion that would normally follow.
Over time, the brain learns: “This is scary, but I can handle it.” And that changes everything.
Beth emphasizes that ERP isn’t about making clients feel worse—it’s about showing them they can survive and thrive through discomfort. It’s empowerment through tolerable risk.
What ERP Looks Like in Real Life
Therapy gets real when a parent with POCD is afraid to change their baby’s diaper. Beth doesn’t ask them to prove they won’t harm their child. Instead, she gently helps them stop avoiding those moments. She might have them:
- Rock the baby to sleep
- Change the diaper without their partner watching
- Refrain from self-monitoring arousal cues
It’s always in line with the client’s values—never gratuitous, never unsafe.
Pitfalls for Non-Specialists to Avoid
If you’re not ERP-trained, Beth urges you to steer clear of these common landmines:
- Reassurance Giving – Telling clients “you’d never do that” may feel kind but feeds the OCD cycle.
- Logic Wars – Trying to “reason” someone out of OCD rarely works—and can backfire.
- Therapy as a Compulsion – Be careful if therapy becomes their main source of anxiety relief.
The solution? Education and supervision. This isn’t a learn-it-in-a-weekend kind of skillset, but this blog—and the full Not Boring CEs episode—can be your first step.
What About Kids? Or Postpartum Clients?
Good news: ERP works for kids, too. Beth just adapts the language, gets creative with exposure tasks, and adds a dash of playfulness.
She also talks about perinatal OCD, which can show up in both birthing and non-birthing parents. The key to differential diagnosis? Ego-dystonic thoughts. If it’s causing distress, it’s worth exploring—whether it’s OCD, postpartum anxiety, or both.
Referrals, Training & Taking It Further
So when do you refer out?
- When the OCD is central to the client’s distress, and you’re not ERP-trained
- When you know your own limitations (i.e., certain subtypes make you too uncomfortable)
- When the client needs a multi-pronged treatment approach
That said, many generalists do great work in collaboration with an OCD specialist. As Beth says, you don’t have to know it all—you just have to know what you don’t know.
Final Thoughts: OCD Clients Aren’t Fragile—They’re Brave
There’s a myth that ERP is harsh or even cruel. Beth flips that narrative on its head. Facing your deepest fears on purpose? That’s not fragility. That’s courage.
Therapists, if you’re looking for an online education course that challenges you to grow while giving you practical, evidence-based tools—this is it.
Ready to Learn More?
🎧 Check out the full conversation with Beth Brawley on Not Boring CEs.
🧠 Get all your CEs for therapists in one place—without dying of boredom.
🎓 Explore accessible, engaging continuing education for counselors and mental health professionals who want real clinical growth.
👉 Start your Not Boring journey now at NotBoringCEs.com
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