There seems to be a common misconception among people that they would be expected to stop everything all at once. Some people come for therapy with a feeling of hopelessness and claim that they have tried to stop their compulsions themselves but have not succeeded. But progress in ERP does not mean stopping everything at once. It means a systematic reduction in compulsions, through a process of learning.
Think of a small child who goes into the first grade. If he is shown a book of advanced mathematics, he is going to panic. He may begin to believe that he cannot handle it, and he would be right. He would not be able to handle such advanced concepts. But he is not even expected to handle that at his age. He is expected to understand basic addition. As he grows, he would be taught to handle more complex concepts and then eventually he may graduate to advanced concepts.
In a similar way, when you start doing ERP, you are in the first grade, metaphorically speaking. You need to only handle those obsessions and resist those compulsions that are the easiest. The time for handling bigger ones will come later. If you try to handle everything together, you will fail.
Not you may. You will.
If you don’t even try because you think that it will be too much, you may be giving up because you expect the first grader in you to be able to handle advanced mathematics. This is bound to seem like an impossible task.
So, first things first, you need to truly understand that the recovery process will be slow and will need lots of practice in strengthening fundamentals. Progress in Harm OCD can be measured in a number of different ways that I want to talk about.
- Compulsions may be reduced in duration. If you are engaged in episodes of rumination, and your typical rumination episode lasts for one hour, reducing that to fifty minutes is progress.
- Compulsions may be reduced in frequency. If you are engaged in a compulsion of praying five times to make the harm thoughts go away, progress would mean bringing the praying down from five times to four times.
- Compulsions may be reduced by creating a gap between the obsession and compulsion or between two instances of compulsions. If you are engaged in the compulsion of reassurance seeking from your family about whether you are a good person, you may wait for ten minutes between the trigger and the reassurance seeking, or between two instances of reassurance seeking. Doing even so much, is progress.
Often, sadly small progress is dismissed as zero-progress. People may think that you are not putting in enough effort. This may deter you because you know how much effort you are putting in to bring about small changes. You may need to learn to pat yourself on the back for the effort made. And you may need to build on the success you have experienced, no matter how small.
Another concern people have is that it would take a very long time to recover if progress is so slow. Well, yes. It may, and it probably will. But the alternative is to continue to struggle for life. Besides, as you get better at managing your compulsions, progress is much faster. You will be able to handle more as you progress in your recovery journey. So, while all this may seem overwhelming and never ending when you start, it really won’t be. You need to just push your way through the first few weeks or months of excruciating work before it starts seeming simple and doable.
Yet another expectation from ERP people with Harm OCD may have, is gaining certainty about their goodness. But even people who do not have Harm OCD can never be (or remain) certain about how good they are. So, ERP will not result in bringing about the certainty you seek. It can make you look at your imperfection more adaptively, though, so that you can live a happy life. That is the simple goal that you need to set for yourself. Just that!