9 Things I Tell My Patients in Their First Session of OCD Treatment | Ep. 487

In this episode, I’m sharing the nine core things I teach every OCD client in their very first therapy session to help them better understand recovery, build confidence in ERP, and begin responding differently to intrusive thoughts.

• Why starting OCD treatment is one of the bravest things you can do, even if you feel scared or uncertain
• The research-backed treatments I use for OCD, including ERP, mindfulness, ACT, and self-compassion
• Why OCD therapy is not just “talk therapy” and what actually creates lasting change
• The life-changing mindset shift that helped my clients stop treating intrusive thoughts as dangerous
• Why you cannot control your thoughts and feelings, but you can learn to control your response
• How to approach OCD recovery with realistic expectations, self-compassion, and the willingness to do hard things

The 9 Things I Tell Every OCD Client in Their First Therapy Session 

Starting OCD treatment can feel terrifying. You may be overwhelmed, doubtful, emotionally exhausted, or unsure if recovery is even possible for you. But there are nine specific things I tell every OCD client in their very first session that help lay the foundation for real, evidence-based recovery.

These are not just encouraging phrases or motivational quotes. These are the exact concepts that become the backbone of treatment moving forward.

Whether you’re working with a therapist, taking an online course like Your OCD Toolkit, or beginning your recovery journey on your own, these are the mindset shifts and principles I want you to hold onto from day one.

Let’s walk through them together.

1. You Are Incredibly Brave for Starting Treatment

The very first thing I want you to know is this: seeking help for OCD is brave.

Learning that you may have OCD, reaching out for support, signing up for therapy, or even listening to a podcast like this takes courage. OCD is a condition that thrives on fear, shame, uncertainty, and self-doubt. So the fact that you are here, willing to face it, matters deeply.

You may not feel ready. You may feel anxious, hesitant, or overwhelmed. That’s okay.

You do not have to feel fearless to begin recovery.

You simply have to be willing to take one small step forward.

I celebrate every single person who says:

• “I want things to change.”
• “I don’t want OCD running my life anymore.”
• “I’m ready to respond differently to my intrusive thoughts.”

That willingness is powerful.

2. OCD Treatment Actually Works

One of the most important things I tell my clients is that OCD is highly treatable.

We have decades of research showing that Exposure and Response Prevention (ERP), a specialized form of Cognitive Behavioral Therapy (CBT), is the gold standard treatment for OCD.

ERP helps you learn how to:

• Face uncertainty
• Tolerate anxiety
• Resist compulsions
• Respond differently to intrusive thoughts

And the research behind it is incredibly strong.

But what’s even more exciting is that modern OCD treatment has evolved beyond just ERP alone. We now know that combining ERP with additional evidence-based approaches can significantly improve outcomes.

The Power of Combining Treatment Approaches

In my work with clients, I often integrate several evidence-based tools together.

Mindfulness

Mindfulness helps create space between you and your intrusive thoughts. Instead of getting tangled up in every obsession, you learn how to observe thoughts without automatically reacting to them.

Mindfulness teaches:

• Awareness without panic
• Observation without judgment
• Presence without compulsions

Acceptance and Commitment Therapy (ACT)

ACT helps clients stop fighting their internal experiences and start building a meaningful life alongside discomfort.

Instead of asking:
“What if I never feel anxiety again?”

We begin asking:
“How can I move toward what matters even while anxiety is present?”

ACT helps you:

• Build psychological flexibility
• Respond differently to obsessions
• Reconnect with your values
• Stop organizing your life around fear

Self-Compassion

Self-compassion is another critical part of recovery.

So many people with OCD are incredibly hard on themselves. They judge themselves for their thoughts, emotions, or setbacks. But research shows that self-compassion actually improves emotional resilience and increases our ability to tolerate discomfort.

Self-compassion helps you:

• Reduce shame
• Increase emotional tolerance
• Recover more quickly from setbacks
• Stay engaged in treatment

You do not have to bully yourself into healing.

3. OCD Therapy Is Not Talk Therapy

This is something many people are surprised to hear.

OCD treatment is not simply sitting in a room talking about your fears for 50 minutes each week.

ERP is active treatment.

It involves:

• Exercises
• Homework
• Exposure practices
• Skill-building
• Response prevention
• Problem-solving
• Daily behavioral changes

You are not just analyzing your fears. You are learning how to change your relationship with them.

In fact, excessive talking, reassurance-seeking, rumination, and overanalyzing can actually strengthen OCD.

That’s why effective OCD treatment focuses heavily on action.

Recovery happens through practice.

4. There Is No Such Thing as a “Bad” Thought

This may be the most important concept of all.

At the center of OCD recovery is this truth:

There are no bad thoughts.

Not bad images.
Not bad sensations.
Not bad urges.
Not bad feelings.

Thoughts are simply thoughts.

Many people with OCD experience deeply disturbing intrusive thoughts that feel completely opposite to their values. And understandably, they begin asking:
“What does it mean that I had this thought?”
“Why would my brain produce something so awful?”
“Does this say something about me?”

But in OCD treatment, we stop assigning moral meaning to thoughts.

We stop labeling thoughts as dangerous, unacceptable, or significant.

Because the moment we label a thought as “bad,” OCD grabs onto it and demands certainty.

Recovery begins when we learn to allow thoughts to exist without treating them like emergencies.

5. You Cannot Control Your Thoughts ,  But You Can Control Your Response

This is another major turning point in OCD recovery.

You cannot fully control:

• Intrusive thoughts
• Emotions
• Physical sensations
• Mental images
• Urges

Trying to force thoughts away usually makes them louder.

Trying to suppress anxiety often intensifies it.

Trying to guarantee certainty fuels the OCD cycle even more.

But while you cannot control what shows up in your mind, you can learn to control how you respond.

That is where your power lives.

Recovery is not about eliminating thoughts.
Recovery is about changing your response to them.

Instead of:

• Arguing with thoughts
• Analyzing thoughts
• Neutralizing thoughts
• Avoiding thoughts

…you learn to practice willingness, non-engagement, and response prevention.

That shift changes everything.

6. ERP Should Never Be Cruel or Unsafe

I know ERP sometimes gets misunderstood online, and unfortunately, not every therapist practices ERP ethically.

So I want to say this very clearly:

I will never ask a client to do something unethical, harmful, or against their values.

Good ERP is collaborative.

Yes, you will face fears.
Yes, anxiety will rise sometimes.
Yes, treatment can feel uncomfortable.

But ERP should always be:

• Respectful
• Gradual
• Compassionate
• Intentional
• Collaborative

We are not trying to traumatize you.
We are helping you build confidence in your ability to tolerate discomfort.

The goal is not to force suffering.
The goal is freedom.

7. Recovery Is Not Linear

One of the biggest mistakes people make is expecting recovery to look perfect.

It won’t.

There will be:

• Wins
• Setbacks
• Good days
• Difficult days
• Progress
• Moments where OCD feels louder again

That is normal.

OCD recovery often looks like:

• Two steps forward, one step back
• Huge breakthroughs followed by difficult moments
• Learning, adjusting, and trying again

Setbacks do not erase progress.

They are part of progress.

I want my clients to let go of perfectionism in treatment. We are not aiming for perfect recovery. We are aiming for consistent, compassionate practice over time.

8. Recovery Must Become a Priority

ERP works best when you actively practice it every day.

That means recovery has to move higher on your priority list, at least for a season.

This doesn’t mean abandoning your family or responsibilities. It means intentionally creating space for healing.

You may need:

• Extra support from loved ones
• Accountability
• Community
• Scheduled practice time
• Daily reminders of your goals

You cannot recover from OCD by thinking about recovery once a week.

Recovery requires repetition.
Consistency matters.

The beautiful thing is that the work compounds over time.

9. You Can Do Hard Things

This is the final thing I tell every client:

You are capable of doing hard things.

Even if you don’t believe it yet.

Even if OCD is screaming otherwise.

I have watched countless clients face fears they once believed were impossible to tolerate. I have seen people reclaim their lives after years of feeling trapped by obsessions and compulsions.

You may not feel capable today.
But that does not mean you won’t become capable tomorrow.

Recovery is built through willingness, practice, courage, and support.

And if you cannot believe in yourself right now, you can borrow my belief in you until your own grows stronger.

Final Thoughts

If you are beginning OCD treatment, I want you to remember this:

Recovery is possible.

Not because you’ll become fearless.
Not because you’ll eliminate uncertainty.
Not because you’ll never have intrusive thoughts again.

Recovery becomes possible when you learn how to respond differently.

That is the work.

And while it can be difficult, it can also be deeply empowering.

You do not have to do this perfectly.
You do not have to do this alone.
And you absolutely do not have to let OCD define your future.

You can do hard things.

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Transcription: 9 Things I tell my patients in their first session of OCD treatment

There are nine specific things I tell my OCD clients in the very first session, and these are not fluffy things. These are specific concepts that will continue to be the backbone of OCD treatment. So today, I’m gonna take you through the actual step-by-step process that I take my clients through on their very first session. I’m gonna teach you the specific nine things so you can get to work, whether you’re with a therapist, on your own, or whether you’re one of my students taking your OCD toolkit and you’re doing this step by step through the program we have at CBT School. My goal here is to make you confident, to make you get really clear on the mindset shifts you’re gonna need to make, and so you can get going and feel like you’re ready to move forward. So get your notepad out, get your pens, get a cup of tea, and let’s do this together. First thing I’m gonna tell my OCD client is that you are so freaking brave for doing this treatment. Learning you have OCD and signing up for therapy is the coolest, bravest, most courageous thing you could do. I just wanna celebrate you for being here today and being ready to go Now you mightn’t feel ready. You might feel a little like, “Oh my gosh,” and a little bit scared. That’s okay. But it’s just so brave that you raised your hand and you said, “Hey, I wanna change some things. I wanna have a different response to my intrusive thoughts. I wanna overcome this condition that’s taking and taking and taking from my life.” So let’s take a moment to really just celebrate the fact that you are here. Even if you’re listening to this today and you’re not even quite sure you’re ready to get going, I still think it’s so brave that you’re willing to inquire and take this first step. So thank you for being here. I know how valuable your time is. Okay. The second thing I’m going to tell you is that the research backs OCD treatment. This treatment works. We have a lot of research, thousands of studies, that show that exposure and response prevention, which is a type of cognitive behavioral therapy, is the most successful treatment for OCD. And you guys, it works. ERP is not just something that helps for OCD, it helps with health anxiety, body dysmorphic disorder, social anxiety, panic disorder. It helps in so many ways. It helps you to learn how to have fear, to have anxiety, and show up anyway. Now, the additional cool thing is, is that we don’t just use ERP anymore. We don’t just rely on exposure and response prevention and cognitive behavioral therapy. What we do is we’ve now learned that if we can add on some of these amazing additional modalities, we can actually squeeze the benefits out of them. I always imagine, like, you’ve got a cloth and it’s got water in it, and you’re squeezing out all of the goodness. Maybe it’s like a lemon that you squeeze and you get all that delicious lemon juice out of. So we’re going to start with the foundation of exposure and response prevention, but then we’re gonna add concepts like mindfulness training. Mindfulness training is so important and so helpful to folks when they are in distress, when they are feeling anxious, when they’re having intrusive thoughts. It allows us to have some distance from those uncomfortable obsessions and intrusive thoughts and feelings and sensations. So mindfulness is going to be an additional component. We also know that by including acceptance and commitment therapy, we get even more benefit. Acceptance and commitment therapy are sort of allowing us to have an extension of those mindfulness skills, allow us to be able to observe our thoughts from a non-judgmental perspective, to also then engage in other behaviors that line up with our values, and also have a different response to the obsession that we experience. Now, we’ve also got evidence that by adding on self-compassion, we also reduce our anxiety and increase our window of tolerance for uncomfortable emotions. So by practicing this additional self-compassion component, which we talk about here on your Anxiety Toolkit all the time, that also will have an elev- Get it effect when you’re using it with exposure and response prevention. So big point here, the thing I want you to take away is you can trust in these treatment programs. You can trust in these treatment modalities. Thank goodness, compared to some of the other conditions that don’t have a science-based treatment yet, we are so lucky that we have this treatment with tons of research and tons and thousands of people who have done the same treatment. Let’s move on to number three. The third thing you need to know is that OCD therapy is not talk therapy. You will not just come in and talk about your fear and then leave 50 minutes later. I won’t be asking you, “How do you feel about that?” And then leaving you to just try and figure it out on your own. Exposure and response prevention, cognitive behavioral therapy, is a very proactive treatment modality. It requires you to do worksheets. It requires you to do homework. It gives you exercises for you to practice. It helps you troubleshoot struggles that you’re having and come up with new, more effective, helpful ways to respond. So again, that’s not a bad thing. That’s a good thing. We’re not here in OCD therapy just to talk it over and leave it, and that… In fact, that will make your OCD worse. Talking about it and getting reassurance and ruminating about it will make your OCD worse. And so if you’re in talk therapy and you’re not doing any exposures, and you’re not practicing response prevention, and you’re not doing homework, that’s a very, very sure way to know that you’re probably not going to make a ton of progress. The beauty of exposure and response prevention is it’s active. It’s engaging. You’re practicing. You’re strengthening new skills instead of just doing what OCD tells you to do, compulsions, rumination, avoidance, all those types of things. So it’s not talk therapy, and that is, in fact, why it works. Now, as you know, I have a private practice. I have six amazing therapists in Calabasas, California. However, we do not take insurance. Now, if you are looking for insurance-covered OCD or BFRB treatment, I wanna let you know about NOCD. NOCD provides face-to-face live video sessions with specialized licensed OCD therapists. Now, their therapists use exposure and response prevention. We know this is the gold standard for OCD, so you can be absolutely confirmed that you’re in the right place there, and they have a clinically proven app that helps you stay connected to your therapist and others who have OCD between sessions, so you’ll always feel supported. Now, the cool thing is NOCD is available in all 50 US states and even internationally, and they accept most insurance plans, making it affordable and accessible. We love that. Now, if you think you might have OCD or you’re struggling to manage your symptoms, you can book a free call. Just click the link in the show notes at nocd.com. I am honored to partner with NOCD. I want to remind you that recovery is possible. Please do not forget that. Now, big hugs, and let’s get back to the show Number four, and probably one of the most important, is this key point, and if you take one thing away from today, this needs to be it. There is no such thing as a bad thought. There is no such thing as a bad feeling. There’s no such thing as a bad image or sensation or urge. That is the core principle that we will be f- building a foundation on. So I’m here to say I know you probably had some pretty scary thoughts, some intrusive thoughts that don’t line up with your values, that scare the pants off you, and you’re left thinking, “Why? Why on earth would I ever have this repulsive thought?” We are going to have a new approach starting today, which are there are no bad thoughts. There is not a bad thought. There is not a good thought. Thoughts are just thoughts. We do not sign, assign them meaning. We do not, uh, give them an inherent, like, you know, you’re a good person for having this thought and you’re a bad person for having that thought. No, it doesn’t matter how graphic and heinous your thought is, that does not make it a bad thought. All thoughts are created equal. We are not assigning value to them. Thoughts are simply thoughts. Same goes for feelings, okay? Once we identify and acknowledge that, then we can start to change how we respond to them. So the fifth thing I’m going to teach my clients is that you cannot control your thoughts. You can- cannot control your feelings. You cannot control your sensations. These are totally out of your control. Again, you’ve probably been told by many different therapists and mental health gurus and folks on the internet that if you just pick positive thinking, everything’s going to be okay, and I’m a big fan of positive thinking. But when it comes to OCD, it doesn’t check out. It doesn’t help. You can’t control your intrusive thoughts. We have images of the brain. We understand that for folks with OCD, the brakes of their brain is very weak. Now, that’s not physiologically true, but think of it like that as a metaphor. The brakes are in your brain. That pumps brakes on thoughts is very weak. It doesn’t pump the brakes on them. You just keep having them and having… No matter how hard you try to stop them, you keep having them. You won’t be able to control the thoughts that you have, nor will you be able to control the feelings and sensations you have, but you can control how you respond. That is the foundation of the work that we do when it comes to OCD treatment and OCD therapy. You can’t control your thoughts, but you can control how you respond. Similar to the point we just made, we’re not going to respond to thoughts by treating them as good or bad. We’re going to learn to respond to them as if they are neutral, which is factually what they are. So we really need to get to this point. It’s a hard one. It takes people a lot of time and practice, but that is the main format in which we are… That’s the North Star. That’s where we’re heading. We’re heading here on building a lifestyle and a habit of responding effectively in a helpful way to the intrusive thoughts that we have. Okay, so now let’s talk about number six. Now, here’s the thing where I get really close and I say, “Lean in, let’s talk about this.” Now, I know that ERP sometimes gets a bad rap, and you may have had therapists who did not do ERP ethically. That does happen in every modality of therapy, but here is what I want you to know. So one thing I tell all of my clients is, as a clinician, I will never have you do something you don’t want to do. I will never have you do something that goes against your values. I would never have you do something I myself would not be willing to do. Now, there is some nuance to this, which is, of course you don’t want to do the scary thing. Of course. You don’t want to do the thing that may give you a panic attack. You don’t want to do the thing that may increase your thoughts. But as we’ve already learned in previous steps, we have to change and have a new response. So yes, I understand no one wants to face their fear, but the people who come to see me, and you as someone who is a student of mine, you obviously want something to change. And so in the case of this, we are going to acknowledge that you mightn’t want to face your fear, but you want to get better, and therefore you’re willing to do the scary, hard thing, to face the thing that creates anxiety, because the more we can practice facing our fear, the less control fear has over us. The more we’re willing to have scary thoughts that we have in the past maybe told ourselves we weren’t allowed to have, the less scary those thoughts become, or the more you realize that you can have those thoughts and that you don’t have to respond to them. You don’t have to treat them like they’re all important and dangerous and things to avoid. And so in this concept, I want you to really understand, I would not make anybody do anything they don’t wanna do. But every day we’re going to encourage you to challenge yourself by facing your fear. That in steps that feel reasonable to you, that feel respectful to you, that feel ethical to you, that feel, like, tolerable to you, we’re gonna have a lot of conversations about that as we go. Okay, number seven. The seventh thing I tell my patients in their first session of OCD therapy is that recovery is not linear. This is not gonna be pretty, and what I mean by that is it’s going to be two steps forward, one step back. Five steps forward, one step back. 20 steps forward, 10 steps back. Or, you know, that’s gonna be the normal part of this treatment. Now, I know that’s disappointing. I know you want this to be a beautiful arc that just takes you sweeping up to the top of the hill where you can put your hands above your head and be like, “I’m the king of the world,” and I want that for you, too. But we are playing with a very tricky condition. OCD is tricky. It’s clever, it’s sneaky, and it will sometimes trick you. And the reason I’m saying this isn’t to make you feel bad or to make you feel hopeless or to sort of bring you down, it’s to actually help you set realistic expectations that you don’t have to get this perfect the first time. You’re not gonna win them all. You will have days where you’re not coping as well and OCD takes you down, and we’re going to actually acknowledge that as a normal part of OCD treatment, a normal part of OCD therapy, that we do not expect perfect A grade treatment here. We’re looking for a human, ethical, respectful treatment that gives you permission to have good days, have not so good days, win lots of things. You will have some losses, and that is okay. We’re gonna be as compassionate and kind to yourself as we can as you work your way up that big mountain. Now we’re gonna move on to number eight. The eighth thing I tell my clients is you- Have to make this your number one priority. And I know you’re probably thinking, “Kimberly, I have children. I have a husband. I have a job. I need to pay the bills.” Yes, all of those are your priority, but we need to put this at the front just for a while. It doesn’t mean it’s black and white, you give up taking care of your kids. You can do more than one thing at a time, but this has to be way up there at the top. You will need to set aside time every single day to explore and look at the skills and important concepts that you need to remember so that you can be practicing response prevention throughout the day. This has to be the priority. I love talking with my patients and my students about ways we can make this the priority. Can you ask your neighbor to drop off your children? Can you ask your partner to help you with meals? Can you invite family or church or community in some way to support you? Can you join a support group to help you as you face your really hard things? Is there a friend who you can rely on to text when you’re about to do that hard thing, and they can send you the clapping emoji? We have to make it a priority, and you have to be willing to ask for help. This is not easy. This is not something you’re just like, “Oh, yeah, I’ll do it for one hour a week and it should be fine.” No, this requires you to show up every day. And when you do, I promise you, I promise you, you will not regret it. Which brings me to my last thing. The ninth thing I tell my patients in the very first day of OCD therapy is a beautiful day to do hard things, that you can do hard things. I do not question this for a second. And if you don’t believe me, borrow my belief in you. You can do hard things. I see clients every single day here in my office learn to do the thing they thought was intolerable, absolutely unimaginable, they are able to do that. It is the most empowering thing on the planet. And while you can’t do it right now, I want you to recognize that just because you can’t do it right now does not mean you won’t be able to do it in the future, ’cause you absolutely will. OCD is a treatable condition. OCD, we have a ton of research to know that if we have the skills, you have a plan, you know what you’re doing, and you’re willing to be uncomfortable and willing to put in the work, the outcomes are really, really positive. And so again, if you’re with therapy and you’re in a th- with a therapist, remind yourself of these points. Write them on a sticky note. If you’re a student taking your OCD Toolkit, which is our online course for those who don’t have access to a therapist, you’ll need to remember these every single day, and I’m reminding you of these things throughout the course, the whole way through. You’ll hear me reinforcing these concepts over and over and over again because when I’m with my clients, I’m reminding them of them all the time as well. Not in a reassurance compulsive way, but as a encouragement, as a cheerleader, as someone who believes in them more than anyone believes in them, and that’s what this is all about. We can’t do this alone. We have to do it in community, ’cause that’s how we grow, and I really want to leave you here today with this is something possible for you. Please don’t let OCD bully you into believing that you can’t get better, because you can. Thank you so much for being here. Those are the nine things I tell my clients on the first session of OCD treatment. I hope you found it very helpful. Thank you so much for being here with me today. It is an absolute pleasure, and I look forward to seeing you next week at Your Anxiety Toolkit. Please note that this podcast or any other resources from cbtschool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day and thank you for supporting cbtschool.com.