When you first come in to see a therapist for help with anxiety or OCD, you want to feel assured that the therapy is actually going to work. You understandably want to know that you will not be wasting your precious time and money on something ineffective. You are in a great deal of distress, and you want to feel confident that therapy will help you feel better.
In this post, I explain what you can do as a client to maximize your chances of success by discussing the six things that successful clients do to make therapy work for them. These characteristics of successful clients are quite common and not at all rare. In fact, the vast majority of my clients do all of these things and, consequently, get better.
In giving this advice, I make an important assumption: that you have found a good therapist who is going to do the right kind of therapy for your issue (for anxiety/OCD, this is almost always Exposure Therapy).
Here is a great article on how to find the right therapist for you: https://iocdf.org/about-ocd/treatment/how-to-find-the-right-therapist/.
In addition to the excellent advice in that article, I would recommend that every client ask potential therapists this question: “Will you give me clear, very specific advice about exactly what I should do to get better?” The answer should be an unqualified yes.
So, what do clients who have success with therapy for anxiety and OCD typically do that leads to an effective treatment? Here are 6 key things:
1. Successful clients choose to trust their therapist
Although you can do your best to select a therapist who is a good fit and seems competent, there is never a 100% guarantee that your therapist is good at their job and is giving you the right advice. So, naturally, you may wonder whether the advice your therapist is giving you is really going to work or not.
Look at it this way: if you choose not to trust your therapist and follow his or her advice, then there is absolutely zero chance that therapy will work for you. If you don’t trust them, it has no chance even if they are the best therapist in the world.
Instead, if you choose to follow your therapist’s advice, there are two possible outcomes: one, that the advice is wrong and will not work for you; or two, that it is right and will work. Therefore, there is nothing to lose by trusting your therapist. The alternative guarantees that therapy won’t work. Trusting them at least gives it a chance. And, if it turns out you have indeed chosen a therapist who does know what they’re doing, the chance of success by trusting them is very high.
2. Successful clients are willing to tolerate short-term discomfort
As I’ve discussed in prior posts, anxiety is maintained by avoidance. When you avoid something that makes you anxious in the short-term, your anxiety gets worse in the long-term. Why? Because avoidance prevents your brain from learning that whatever is triggering your anxiety is not actually dangerous.
For Exposure Therapy to be effective, clients have to be willing to do whatever it is that makes them anxious. And they have to do those things enough times so that their brains get used to the situations and decide they’re not dangerous. Only then will the anxiety stop.
Confronting your anxiety triggers always involves some amount of discomfort. Successful clients are willing to experience this discomfort in the short-term because they know that it is the only way for their anxiety to get better in the long-term. It may be painful, but it’s pain with a purpose.
3. Successful clients are willing to do things that feel counterintuitive or even illogical
The advice you get from a good anxiety therapist may not always make complete sense. In fact, it may go completely against every instinct in your body. While your therapist should do their best to explain their rationale, sometimes therapy requires that you make a leap of faith and try things even when they don’t seem right. After all, your instincts about this issue have led you here, so they can’t be entirely right. Your therapist’s advice may seem illogical at times, but successful clients go with it anyway.
4. Successful clients accept that they will have to make sacrifices and take risks to get better
Overcoming anxiety requires an investment of time, energy, and effort. It also requires giving up on coping mechanisms you’ve used for years, such as avoiding certain situations or seeking reassurance from loved ones.
It also requires doing things that your brain tells you are risky. For example, take a client who has obsessive thoughts about hurting other people. She won’t cook anymore because she doesn’t want to be around knives — she fears losing control and hurting her family. In therapy, this client will have to risk being around knives to get better even though her brain tells her doing so is too risky and too dangerous.
Anxious behavior is all about avoiding risk at all costs. Therefore, effective treatment of anxiety requires taking those risks so your brain can learn from the experience that nothing bad actually happens.
5. Successful clients view therapy as a place to learn and practice what they themselves need to do rather than as a procedure that is performed on them
In Exposure Therapy, the therapist’s role is not that of a surgeon. It’s not the therapist’s job to perform a procedure on you. It’s not their job to make you better or to fix you. It’s their job to show YOU how to make yourself better. This means doing therapy “homework” by practicing what you learn in therapy on your own.
The therapist’s role is more like that of a football coach: they can teach you what plays to run, train you in the skills necessary to run those plays, and practice running the plays with you. But they cannot go out on the field and play for you. You have to do that yourself. The real work doesn’t happen during therapy sessions, it happens when you take what you learned during your sessions and go use it on your own between sessions.
While your therapist should tell you very specifically and clearly exactly what you need to do to get better and practice it with you during sessions, you are the one who actually makes yourself better.
6. Successful clients eventually do everything their therapist asks them to do
I’ve saved the most critical thing for last. This is, by far, the most important factor in whether anxiety therapy is successful (again, assuming that the therapist knows what he or she is doing). After all, if your therapist is going to give you specific advice for exactly what to do to make your problem better, how can it possibly work if you don’t follow the advice?
Think about it like what happens when you are sick and you go to your family doctor. Let’s say the doctor tells you that you will get better if you take some pills she prescribes for you. If you don’t take the pills, you shouldn’t expect to get better, right? Or if you take the pills differently than how the doctor directed — less frequently or in a different dose — you also shouldn’t expect to get better.
Anxiety therapy works the same way. Instead of pills, the medicine being prescribed by an anxiety therapist is a set of behaviors for you to do. If you don’t do the behaviors, or do only some of them and only some of the time, you should not expect to get better.
In my experience, the biggest factor determining whether therapy is successful or not is whether the client actually follows my advice on their own between sessions. The clients who do this consistently (which most clients do) are pretty much always successful. The clients who don’t are much less likely to succeed.
So, those are the 6 things that I think are most essential for clients with anxiety and OCD to do to ensure that their therapy succeeds. I’m confident that if you do these things, you will meet your goals in therapy and greatly reduce or even eliminate your anxiety and OCD symptoms.
Interested in learning some of the most common and most effective strategies I teach my clients for dealing with anxiety and worry? Check out my self-help video series, How to Stop Overanalyzing, with over 3 hours of content covering the skills I teach to almost all of my clients in the first 5 therapy sessions.