Distinguishing Validation from Reassurance in ERP for OCD

by Foluso Solarin, PhD

Introduction

Exposure Response Prevention (ERP) Therapy for is the gold standard, non-medical treatment for OCD.  One of the ways this treatment differs from traditional talk therapy is that therapists typically do not reassure their clients.  Instead, clients are taught to work through their doubt, fears, and triggers in a systematic way, replacing OCD rituals with more adaptive coping techniques.   Because reassurance interferes with the reduction of OCD behavior, clinicians eliminate this from their therapeutic interactions with clients.    This style be challenging for clinicians new to ERP as well as to clients, who are likely used to a different type of therapy dynamic where reassurance occurs in response to distress. 

What is Reassurance? 

Reassurance occurs when someone attempts to calm, neutralize, or reduce someone else’s anxiety.  People with OCD often attempt to reassure themselves and seek reassurance from others that what they fear has not or will not occur.  Reassurance-seeking is a normal coping mechanism in response to distressing emotional states such as depression and anxiety.  However, no amount of reassurance will ever be enough when you have OCD.  OCD demands absolute certainty, and while it is tempting to seek reassurance, it will ultimately backfire.  While reassurance temporarily quell doubt and uncertainty, the “what ifs” always come back with a vengeance. The goalpost of relief-providing certainty is always being moved by OCD.  The amount and type of reassurance that worked before becomes less satisfying and calming over time.   

Examples of Reassurance 

Individuals with OCD often try to reassure themselves or have others reassure them.  Reassurance can pertain to whether a feared outcome occurred, the probability of the outcome occurring, or their ability to cope of if the feared outcome did occur. These are just some of the ways people engage in reassurance, but the goal of reassurance is to determine “is everything alright, will everything be ok?”  We all ask for reassurance from time to time. However, with OCD, the reassurance is repeated and unsatisfying to the one seeking the reassurance.  Reassurance can also drain and irritate the others who are being asked to provide the reassurance, especially if it is asked for often.

Here are some examples of reassurance

1. Repeatedly asking someone what was said or heard during a conversation, 
2. Mentally reviewing and rehearsing what you said or did during a situation
3. Asking someone’s opinion of you or how you come across to others
4. Rehearsing in your mind different ways an uncomfortable or distressing situation can turn out 
5. Asking someone to come with you so you are not alone in a triggering situation

Reassurance can also occur in a therapy setting.  This can look like:

1. A client asking a therapist if they truly believe their account of a situation
2. A client asking a therapist to reassure them about their sexual orientation
3. A therapist telling a client that their feared outcome will not come true
4. A therapist providing reassurance during an ERP exercise during session when a client becomes upset (i.e,, “just touch the doorknob, I am sure there aren’t that many germs.”
5. A therapist telling a client to “relax, it will all be ok” when they become anxious during an ERP exercise

Reassurance is never enough.  It can be challenging for a client to be in distress and not receive relief from their therapist in an overwhelming distressing moment.  Also, it can be very upsetting for a therapist to see a client seeking reassurance and withhold it. However, this is not a sign of being mean-spirited or clinically incompetent.  

Clients who receive traditional forms of talk therapy that are not ERP will often state that at first, the therapist’s reassurance helped them temporarily feel better.  Over time, however the reassurance was unhelpful, and actually increased the client’s anxiety because they realized that no amount of reassurance would ever be enough. They would need to learn to face their fears and tolerate the discomfort and uncertainty that accompanies OCD symptomatology, 

A therapist withholding reassurance, however, does not mean a therapist is depriving their client of empathy or general support.  A therapist can be supportive and empowering by providing validation instead of reassurance

What is Validation?
What does validation look like? In simple terms, validation communicates, “I see you, I hear you.”  Validation is not only communicated in words, but in actions.  Validation is part of forming a therapeutic alliance, which research shows is a strong predictor of client success.¹

For people of color and individuals in minoritized populations, validation is especially important. A therapist who is culturally competent should take an active role in understanding their client’s cultural worldview and perspective, even if they are from a different racial background.  A client cannot feel safe and vulnerable with a therapist if they don’t believe that the therapists is willing or able to validate their experience, and everyone’s experience is impacted by their culture and their race.  

When it comes to dealing with OCD symptoms, validation is a powerful tool that can be used in therapy.  A therapist can validate how debilitating OCD symptoms can be and how they have witnessed the client’s strength in persevering through therapy and their battle against OCD.  

Examples of Validation

Here are some other examples of validating statements or behaviors from a therapist

1. Leaning in making eye contact, and other non-verbal communication showing their presence
2. Echoing the client’s statements about how challenging an experience of discrimination was and seeking to learn more about it (instead of dismissing it)
3. Asking questions about a client’s racial and cultural identity
4. Identifying strengths about the client that the therapist notices
5. Reflecting statements that the client makes about how frustrated they are with OCD taking over their lives
6. Reflecting empowering statements that the client has made back to them
7. Taking an active role in learning more about the client, instead of expecting the client to teach them everything.

A therapist who validates will make encouraging statements, such as “You’ve got the guts to stick through this,” instead of “Everything will turn out all right in the end.”

REFERENCES

1. Ardito RB, Rabellino D. Therapeutic alliance and outcome of psychotherapy: historical excursus, measurements, and prospects for research. Frontiers in Psychology. 2011 Oct 18;2:270. 

At ERP Kaleidoscope, we have a wide array of clients who will provide validation instead of reassurance.  You will get the validation you need to feel seen and heard, and build that strong therapeutic alliance, while leaving out the reassurance that makes OCD symptoms worse.  Book your appointment today! 

Foluso Solarin, Ph.D. is a licensed psychologist  and owner of Skillset Counseling, LLC a private practice that focuses on the treatment of OCD, Spiritual Abuse, and Cultural Abuse..  The website for the practice is https://skillsetcounseling.com