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Hi, I'm Tracy Ibrahim and I'm here to talk to you today about why therapy might not be working. I first want to say it is very normal to feel like, gosh, I have been doing therapy for a while and I've not really seen the results that I was expecting. And that's okay, that's very normal. It's very, it's varied as to why this might be happening. I know I've been in that position. When I was first diagnosed incorrectly as a 10 year old child, I had OCD and they didn't recognize that and I was misdiagnosed. So. So the treatment that I was receiving, both with medications and therapy wasn't the right treatment. So a lot of times what happens is you have a condition and the person that you're going to for treatment or the people turns out that they don't know what your actual condition is, they might think it's something else. They might have misdiagnosed you and are providing the wrong treatments. Sometimes it's that there's a combination of things that are needed. Maybe it's a combination of different medications or different type of therapy and maybe they do know exactly what you have. But it's the therapy approach that's not quite working out. I'll give you some examples. Unfortunately, a lot of people are not properly trained in assessing, recognizing and treating ocd. It's a huge problem. It happens across all professions in terms of therapists, psychiatrists, nurse practitioners, psychiatric nurse practitioners, all the people that are supposed to be out there treating people and knowing what it is to look for and what to do about it. I am one of those people. Even in my own training as a therapist, we learned just a tiny bit about O, C, D. And it was really a lot more about the basics that everybody knows about, oh, I wash my hands too much, I check too much. But they never did train us about all of the other ways that OCD can show up, like taboo themes, harm themes, sexual themes. And we only really learned about physical compulsions. We didn't learn about mental compulsions. We didn't learn about intrusive feelings and intrusive urges and all of those kinds of things. So when I first started doing therapy for people, I didn't know what I was doing either, even though I thought I knew. So it's not necessarily that anyone's trying to do harm, but maybe they were trained improperly. So I went out and I learned the most gold standard, most researched and evidence supported treatment for ocd, which is ERP or exposure response prevention therapy. Now I do want to talk a little bit about what if you're in the right therapy, but you feel like it's not working because that can also happen a lot. And I think this is really important to examine because I've heard from a lot of people, oh my gosh, I'm doing therapy, it's not working for me. Why am I not feeling better? Why has my OCD not just gone away? And what I always share with my clients or my members that know CDC is that therapy does not do the work for you. Therapy is the place where you go to learn tools. This is where you go to learn more about your disorder, how it shows up, how your compulsions are feeding the ocd, making it louder and worse. And therapy should be really a place where you're stopping and to learn tools. So I think of therapy more like a training ground, if you will. So I always describe it as you come into therapy sessions and if you really think about this, this is one hour of therapy in a 24 hour day, seven days a week. So even if you're going to two hours of therapy a week, you're talking about 24 hours a day, seven days a week when you're not in therapy. And what you're doing in those times is the most critical. So coming into therapy is a place to learn to fill your toolbox with lots of different therapy tools such as non engagement responses, learning about response prevention messages. These are things that we use in exposure response prevention to help you manage through the discomfort of being triggered with OCD and not compulsing. So the most important factor in whether or not therapy quote unquote works for people is what you do outside of therapy. A lot of people feel like they are going to come into therapy and their therapist has some sort of magical words or something that they say, hey, just do this thing and everything's going to get better. And then you leave and you feel great and you don't have OCD distress anymore. And that's just not how it works. We fill your toolbox with tools and you go out and when you're not in therapy, we need you to use those tools. We need you to put those into practice in your day to day life. So when we are talking about ERP and doing your homework or your therapy homework, I like to think of it instead of like doing a homework assignment, a therapy homework assignment, or you know, just doing something a couple of days a week. I've kept my own OCD manageable for the last 20 years building ERP into my daily lifestyle. So if there's something that I find triggering to my ocd, I go toward it in terms of I don't avoid, I don't try not to engage with things that trigger that I do, I do the things that I need to do in my day to day life and I allow my values, my personal values to guide what it is that I'm doing as opposed to letting OCD fears guide what it is I'm doing. And that in itself can be why therapy might not be working for you if you're only doing a little bit of work outside of your sessions. So I'll just give you a contamination OCD example. You know, sometimes my O C D will, it flares up quite a bit, but it'll flare up and it'll be like, oh gosh, you can't touch anything in the bathroom. There's poop, germs. And so I just will go into the bathroom and I'll touch whatever I need to touch to go to the bathroom, do all the things. I don't avoid it, I don't do any extra sanitizing of my hands or the things in my bathroom. And that's just a built in experience, exposure in day to day life. I'm not avoiding it. When I used to be compulsive, I used to, you know, put my hand in my shirt to open the door to come out of the bathroom. I wouldn't touch the handles on the sink, I didn't touch the flusher with my hand on the toilet, I used to flush it with my foot. And so I've stopped doing those things. And I go through a bathroom even though it feels triggering touching the things that I need to touch, doing a normal hand wash and walking out. The same goes for my more taboo themes such as my harm theme. You know, if I was listening to my ocd, I would be avoiding sharp objects and knives and not going near loved ones that I fear in my, my OCD tells me I'm going to harm them. And so instead what I do when it's telling me something like that, I build the ERP into my lifestyle. So I'll be in the kitchen, I'll get intrusive thoughts, oh, maybe you know, I'm going to stab my, my daughter or something along those lines. And I won't avoid, I'll go ahead and get a knife, I'll be cutting my veggies, my daughter will be next me helping me prepare a salad. And that's really the work that needs to be done outside of your sessions in order for you to get well. If you feel like you might be experiencing some O C D symptoms or you might be struggling and might be in the wrong type of therapy, head on over to nocd.com where we can help you get assessed for proper diagnosis and get you connected with one of our wonderful therapists who can help you along your recovery journey. I would also like to mention that we will be able to talk more about the in between session support that we offer, including through our community app and also through our community support groups. So if you have any questions about this or anything that is OCD related that I've talked about today, drop your comments below. I'm out. Have a great day. Bye.