You’re Doing It Right : ERP and the Myth of Feeling Better

As a therapist I hear a whole lot of stereotyped perspectives of what I do professionally. The whole…

“Are you analyzing me?”

No I’m not, I’m trying to eat lunch. Or the…

“Do you just make everyone talk about their family?”

Also no, I don’t make anyone talk about anything they do not want to - but you all know talking about your family eventually breaches the surface. 

But the one that I think does the most harm is that

the job of therapy is to make someone feel better. 

Now don’t get me wrong, feeling better is a very common result that comes from working on something and acquiring a level of mastery or confidence over it. However, as a therapist, namely as an ERP therapist, I have a deep appreciation for how important it is to help people have a deeper relationship with their struggle, discomfort, and fear. A more confident relationship with fear and uncertainty doesn’t just make a person feel better - it makes them believe in themselves in the coolest way possible. 

Despite this being some of the shtick I provide my clients at the start of care, the “hey this is going to be tough before it's easier,” I’d say the majority find themselves really concerned over the fact that when they start learning how to sit with discomfort… they must actually sit with discomfort. I am not immune to that feeling either! Both in my own journey of learning to sit with discomfort and in my journey of witnessing others do so, I have to make the conscious choice over and over to let the wave of discomfort be there and not ‘fix’ it. 

Do the hard work by taking small leaps.

So how do we do this? If you’re new to ERP (Exposure and Response Prevention Therapy) here’s a very short version to that answer. Ever jumped in a really cold pool? Remember how uncomfortable it was at the start. Maybe you contemplated jumping out when your breath picks up, your body sending all the alerts to be done with this thing. Yet you keep swimming because you know that if you ride out that wave of discomfort, the peak will eventually come and then you will… get used to it. All of a sudden the frigid pool becomes tolerable, maybe even enjoyable. 

This is a common analogy most of us in the ERP community use when teaching clients how exposures might feel. I think most people walk away feeling like they theoretically get it. And then they get into the metaphorical cold pool. They start using the skills we teach them to stay in the pool and keep swimming and when instant relief is no longer what we’re choosing, we have officially entered the working part of the exposure model. Without it, we don’t get that mastery and confidence that makes us believe in ourselves.

I want to underline that if an ERP therapist is guiding their client effectively, the level of challenge and discomfort they’re learning to sit with in the early days of their work should be manageable and chosen collaboratively. Whether our fear and discomfort is a 3/10 or an 8/10 - discomfort is discomfort and it doesn’t feel great. That is one of the many reasons why our fear brain tries to resist it. It is in this stage of learning where we become more aware of our own resistance to discomfort that is actually manageable - and this is some of the most spiritual work we do in ERP. This is where reckoning and grief may start to show up in the work. As we start to realize that if we want to overcome the exhaustive nature of fear cycles and compulsions, we no longer will choose a short lived immediate gratification. Rather we learn to sit with ourselves in a compassionate manner through the discomfort learning just how capable we are to allow it to exist and then fade.

In these moments I often hear clients go, “Wait I’m doing this wrong, I’m still feeling uncomfortable.” I see disappointment cross their faces, as if they had failed the one and only opportunity they had to overcome this thing. And that's when I say, “Remember the pool? Just keep swimming. Coach yourself with compassion. Disengage from the negative narrations of fear and self-criticism. Give yourself a chance to ride the wave. This discomfort is your body telling you that you’re experiencing something, not failing it.” 

As I watch these brave and warrior-hearted individuals go at it again, again, and yet again, there is that tiny magnificent moment where it clicks. 

“I don’t have to fear the discomfort, I do not have to do anything to fix or change it, I am both strong and soft enough to let it come and pass.”

I invite you to keep on swimming, not ferociously for survival, just enough to keep the momentum going, regardless of whether you’re doing ERP work in your therapy or you’re simply a person learning how to do something hard, challenging, and uncomfortable. Notice how good confidence feels in the weight of doing something hard. What you learn about yourself might astonish you.