Podcast Summary: The OCD Stories – Sheva Rajaee: Relationship OCD Couples Therapy (#492)

Podcast: The OCD Stories
Host: Stuart Ralph
Guest: Sheva Rajaee, LMFT – Founder/Director, Center for Anxiety and OCD
Episode: #492
Date: June 29, 2025

Episode Overview

In this episode, Stuart Ralph welcomes back Sheva Rajaee to discuss her center’s innovative treatment protocol for couples facing Relationship OCD (ROCD). Beyond individual symptom management, Sheva’s approach incorporates both partners, focusing on healing the “system” of the relationship. The conversation covers ROCD dynamics, attachment theory, novel therapeutic interventions, partner empowerment, boundaries, sex/intimacy, and building resilience within couples.

Key Discussion Points and Insights

1. Why a Couples Protocol for ROCD?

• Background: Many individuals with ROCD seek therapy, but their partners often struggle to find support. Typical OCD treatment overlooks the relationship's systemic impact.
• Sheva’s Motivation: After failing to find referrals for OCD-informed couples therapy, Sheva and her team developed their own protocol for couples, rooted in recurring themes from individual and ad hoc couple sessions.
  • Quote: "Always we're talking about the impact on the system, on the partner... And after kind of striking out, quite frankly, we decided to develop a protocol ourselves..." – Sheva ([05:54])

2. Attachment Styles and Relationship Dynamics

• ROCD Amplifies Attachments: Existing partner dynamics—like avoidant or anxious attachment—become intensified in ROCD contexts, leading to “amplified” conflict and distress ([08:01]).
• Healing Through Relationship: Drawing on attachment theory, Sheva notes partners with secure attachment can offer “earned security,” fostering healing for the person with ROCD.
  • Quote: "We heal these attachment insecurities by being in relationships... but we must heal in the context of a secure relationship." ([09:30])

3. Integrating Couples Therapy with ERP (Exposure and Response Prevention)

• The protocol blends traditional OCD interventions (like ERP) with elements from Emotion-Focused Therapy (EFT), creating space for deep, emotionally attuned conversations between partners.
  • Quote: "How can we bring what we know about ROCD and how it uniquely affects this couple, into that kind of framework of having a healing, emotionally attuned couples conversation?" – Sheva ([10:45])

4. Recognition of Underlying Issues vs. Only Symptom Reduction

• Beyond Intrusions: Focusing only on reducing compulsions may miss deeper attachment wounds fueling ROCD; true healing requires addressing these “fuels for relapse” ([12:31]).
  • Quote: "If ROCD is... heavily triggered to people's wounding attachment styles, whatever, then just focusing on the symptom reduction, we're also missing this big piece..." – Stuart ([11:48])

5. Overview of the Couples Protocol

Key Components

• Psychoeducation for Partners:
  • Explanation of the reassurance/compulsion cycle.
  • Teaching partners to avoid unhelpful reassurance and “accommodations” while remaining supportive.
  • Quote: "We're going to be really working with that partner on... how can we respond in a way that is not reassuring but is still supportive?" – Sheva ([16:01])
• Empowerment and Boundaries:
  • Encouraging partners to set healthy boundaries to prevent “walking on eggshells.”
  • Partners are empowered to protect their emotional wellbeing and are educated it’s healthy (not punitive) for recovery.
  • Quote: "We need that partner to understand that boundary setting is really healthy for the relationship, but also for the individual's recovery." ([21:50])
• Targeting Impactful Behavioral Knots:
  • Like the SPACE model for children, ask partners: What behaviors/accommodations cause you the most distress?
  • Jointly target 3-4 key areas for change over 10–15 sessions.
  • Quote: "We're going to talk to the partner and figure out what is the most distressing behaviors or accommodations for you..." ([27:31])
• Concurrent Individual Therapy:
  • The person with ROCD (the “primary”) should have recent or concurrent individual OCD therapy with another clinician to maintain privacy and efficacy.

6. Addressing Guilt, Shame, and Repair

• Shame/Guilt in Recovery: Many people with ROCD experience immense guilt—sometimes only once their symptoms subside.
  • Witnessed Vulnerability: The protocol includes space for the partner to witness this vulnerability, facilitating emotional healing and “repair” within the relationship.
  • Quote: "Having the partner witness the primary experiencing and being in that vulnerability of, wow, this is where I feel I messed up, can be so incredibly healing..." – Sheva ([31:22])
• Rupture and Repair: Normalizing the cycle of rupture (conflict) and repair as inherent to all relationships.
  • Quote: "All relationships are a cycle of rupture and repair... and to trust that your relationship can not only tolerate rupture and repair, but that every repair leads us to more... understanding." – Sheva ([47:21])

7. Sex and Intimacy in ROCD Recovery

• Impact on Intimacy: ROCD frequently disrupts sexual connection and desire.
• Values-Based Sex: Introducing the concept that couples can choose sexual intimacy based on shared values and mutual goals, not just spontaneous desire.
  • Quote: "You can engage intimately with your partner, not because you feel it in that moment... but for values-based reasons." – Sheva ([38:15])
• ERP for Intimacy: Using exposure principles to gently rebuild sexual closeness—sometimes inspired by sensate focus therapy (gradual, non-sexual touch).
  • Quote: "Absolutely, we certainly can and do essentially erp... for sexual initiation and closeness." – Sheva ([40:55])

Notable Quotes and Memorable Moments

• On the Need for Integrative Care:
  “The holistic work of treating ROCD effectively... requires attention to other matters. Oftentimes, there is an attachment insecurity, there’s a trauma background... looking at the effects on the partnership.” – Sheva ([05:42])

• On Partner Empowerment:
  “Helping the partner understand... they have the right to protect themselves from, quite frankly, sometimes abusive behavior.” – Sheva ([21:50])

• On Sex and Connection:
  “Sex is one of those things that the more you know someone, the harder it gets... now you are so, the stakes are so high... if they were to reject you, it feels like such an ender.” – Sheva ([44:00])

• On Hope and Progress in OCD Treatment:
  “I think, as a community, we’re getting better at working with OCD because we’re being less rigid about what it means to recover.” – Sheva ([45:59])

Timestamps for Important Segments

• [03:54] — Why a couples protocol was developed
• [05:42] — ROCD and the importance of treating the system
• [09:30] — Attachment theory and the opportunity for healing
• [10:45] — Integrating emotion-focused couples therapy with ERP
• [16:01] — Psychoeducation for partners on accommodation
• [21:50] — Empowerment and boundary-setting for partners
• [27:31] — Targeting the most impactful behaviors ("target knots")
• [31:22] — Addressing shame, guilt, and relationship repair
• [38:15] — Sex and intimacy, values-based intimacy
• [40:55] — ERP for sex/sexual avoidance
• [44:00] — High emotional stakes in long-term sexual relationships
• [47:21] — Billboard quote: Relationships are cycles of rupture and repair

Additional Resources from the Episode

• Sheva’s 10-session protocol for couples; available at her center in California.
• Relationship OCD Masterclass: Online resource incorporating many “heavy-hitter” concepts from her couples work, available for individuals unable to attend in person.

Conclusion: A Message of Hope

Sheva closes with optimism, emphasizing that evolving approaches—blending ERP, attachment work, and emotionally attuned couples work—are allowing the OCD clinical community to better serve couples and individuals. The protocol normalizes struggle, celebrates vulnerability, and focuses on practical tools for lasting relationship repair and growth.

For more:

• Visit Sheva Rajaee’s Center for Anxiety and OCD
• Find the Relationship OCD Masterclass online
• See show notes or episode links for further resources

Disclaimer: This summary is not a replacement for professional therapy. Please seek guidance from a licensed mental health professional for treatment.