Treating Racism OCD as a BIPOC Clinician

by Bianca Simmons. LPC

Many people still hold the assumption that having an Obsessive Compulsive Disorder (OCD) diagnosis means being a “neatfreak” or a “germaphobe”. While cleanliness and germs are definitely something that OCD can latch onto, the disorder may also become hyper fixated on other things, including harming others or yourself, being attracted to others you are not interested in, or even your religion. What we often see in treatment is that OCD tends to latch onto what is most important to someone at any given time. For some individuals, justice is an important life value and is unfortunately not off limits when it comes to OCD. Seeing activism through different social media outlets, especially as a result of injustice toward the BIPOC communities, could potentially be a trigger for someone with this type of OCD.   

What is Racism OCD? 

People struggling with this theme of OCD most often have intrusive fears of doing or saying something extremely offensive, appearing to be prejudiced or a racist. OCD may plant seeds of doubt about whether the person could be capable of even shouting derogatory expletives. The individual with OCD then attempts to reduce the anxiety felt from these fears by avoiding everyone that has any noticeable difference from them. Other individuals with this theme of OCD may have a more specific fear, such as applying negative stereotypes to their in-laws, resulting in them researching on the internet for hours for various information (i.e. information about their in-laws culture, what not to say to people from that culture, and as many testimonials of prejudice experiences towards people of that culture so they will not make a mistake when around them) as well as constantly asking their partner for reassurance on the information they found.  

How Racism OCD is Treated

Racism OCD is treated the same way any other subtype of OCD is treated: using Exposure and Response Prevention (ERP) therapy. Whether you’re  a clinician of color or not, it is important to be mindful of how we utilize ERP in this specific situation. When empowering our clients to use Exposure and Response Prevention, as with other harm oriented OCD subtypes, maintaining our ethical standards of doing no harm is vital. As a clinician of color, that means that YOU are valued and are not required to experience harm in order to be able to support clients with their treatment goals. When creating exposures with a client whose core fear is calling someone a racial slur in public, under NO circumstances would you need to be subjected to being called a racial slur, though this is sometimes a request made by non-clinicians of color who are in the early stages of learning about cultural sensitivity and how to be culturally competent even with their colleagues. Additionally, exposures should not involve calling strangers a racial slur whether inside or outside of session as this could create safety concerns for your clients. Some helpful alternatives for this theme may include:

1. Recommending clients focus on enjoying their time while practicing defusion when these fears are triggered when spending time with loved ones. This allows clients to live according to their value of socializing and being present when with others. 
2. Encourage clients to  sit in with the uncertainty of not knowing the thoughts of strangers when their fears are centered around whether people assume they are racist.
3. Teach clients to practice acceptance around having this theme, though unwanted. Clients can also be taught how to tolerate the physical sensations as well as emotions that may arise along with these thoughts. 

4. Watch videos or read articles of the public figures that your client deems as racist. Identifying specific taboo quotes by these public figures may be useful to read or listen to. Remember, it is important that when clients are engaged in this type of in-vivo exposure, that they are also taught to refrain from performing compulsions or ruminating. 

Naturally, there are many other culturally sensitive exposures that can be utilized, however, we wanted to provide a few recommendations as this can sometimes be unchartered territory for clinicians who have never experienced this theme of OCD. 

Potential BIPOC Emotional Experience 

While working to formulate a solid ERP plan with a client experiencing racist obsessions, there might be a few thoughts that cause big emotions for you as the provider. This is completely understandable and your feelings are valid. Clinicians of color may feel hurt or be triggered from their own past racial trauma experiences and this shouldn’t be ignored. Processing these emotions can be complex because of already living in a world where you need to navigate situations such as racism, microaggressions and other acts of discrimination.

How to Take Care of Yourself – BIPOC Clinician Edition

Sometimes it can be hard as clinicians to remember that we can’t help others if we do not first help ourselves. In order to help others see the magic of their own kaleidoscopes, we need to work to ensure we are healthy first. Below are a few recommendations for supporting yourself when working on racist obsessions with your clients:

• Remind yourself these thoughts are unwanted for the client as with all OCD thoughts. 
• Remember that these thoughts more than likely developed in the first place, because of your client’s values. 
• Acknowledge how you feel and don’t be embarrassed or ashamed about any emotions that may manifest as a result of your our racial trauma history.
• Maintain awareness of any countertransference and engage in consultation with BIPOC providers that understand you.
• Boost the self care activities on days you have a therapy session with clients struggling with racist obsessions.
• Participate in your own therapy to process these experiences

Clinicians within the ERP Kaleidoscope (ERP-K) network understand best how working with racist obsessions can be extremely difficult, even with awareness of how OCD functions. ERP-K provides a safe community for BIPOC clinicians to process the difficult emotions through our BIPOC peer consultation groups and through our support groups. We also invite you to sign up for our wellness classes in service of practicing self care. Healing is needed for you too. Without our own healing, it can be difficult to proceed with the intense work that may come from navigating this particular theme. You no longer have to stumble through these experiences alone or in settings with individuals that may not truly understand.