When learning about ERP for OCD in the “classroom setting,” the treatment can seem deceptively simple. However, the nuance and technical details of delivering high-quality ERP to a specific patient becomes far more complicated “in the therapy room,” leading many therapists to deviate from the prescribed protocol. For many ERP therapists, these alterations to standardized ERP practice can feel like mistakes or poor decisions, leading therapists to avoid discussing them in supervision or consultation. In many cases, therapists pivot away from ERP because of their own discomfort or intolerance of the discomfort of their patients. Yet, at the same time, therapists clinging too tightly to manuals, modules, and protocols may miss important treatment opportunities or patient-specific adjustments that could increase treatment response. These opportunities could reveal treatment needs that extend beyond OCD and/or they could help to access much-needed motivation for targeting core fears with ERP. This talk has two broad aims: 1. To bring the common practice of deviating from prescribed ERP protocol out of the shadows, addressing therapist’s reluctance to admit or discuss their own deviations and 2. To explore the common causes and outcomes of such deviations. Specifically, the workshop will address both therapist and patient factors that lead to deviations during a course of ERP, including examples of helpful and unhelpful deviations.
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