By Lindsay Hinojosa MA, LPC Supervisor
From the beginning of time, therapists have had a propensity to fix. We love helping people heal, grow, change, recover, and overcome whatever obstacles keep them stuck in painful psychological ruts. Good clinicians, in my opinion, also push themselves to learn new modalities so they can offer clients a wider range of tools to reach their treatment goals.
But there is one particular therapy that tends to send even seasoned clinicians running for the hills: exposure therapy.
Prolonged Exposure (PE) is one of the best-known forms, studied extensively in the VA system with remarkable success. Interoceptive Exposure (IE) helps people with panic disorder face feared physiological sensations. And my personal favorite, Exposure & Response Prevention (ERP), gives clients a ladder out of the hell that is OCD. There are gentler forms, too, like Systematic Desensitization (SD), which gradually introduces feared stimuli rather than diving in headfirst. I fell in love with all of them for a reason: they are exceptionally effective and, for motivated clients, often exceptionally fast.
It all sounds amazing, right?
Until the new trainee realizes something horrifying:
Exposure therapy requires clients to be very, very, very uncomfortable — and we have to let them. On purpose.
Cue the gasp.
Isn’t this unethical? Cruel? Completely counter to everything we’ve been trained to do? Aren’t we supposed to help clients alleviate anxiety, not sit in it?
No. In my view, when done with tact, unconditional positive regard, and compassionate encouragement, exposure therapy can be one of the kindest gifts we ever give a client.
Consider this: on average, a person with OCD goes 17 years before receiving the correct diagnosis and appropriate treatment. Seventeen years of psychological torment. Many of them did go to therapy — often to multiple skilled clinicians who simply weren’t trained to recognize OCD (a major issue in our field, but that’s for another blog post). So they received the modalities those therapists knew best:
CBT: “Challenge the thought and the anxiety will decrease!”
CPT: “Explore the core belief and the nervous system will regulate!”
DBT: “Use skills to calm your mind and body!”
These approaches are wonderful and genuinely life-changing for many people. The therapists using them are not incompetent or ill-intentioned. But for clients with OCD, phobias, PTSD, panic disorder, hoarding, GAD, body dysmorphia, eating disorders, and related conditions, these therapies often provide only temporary relief. In some cases, they unintentionally reinforce avoidance — which prolongs suffering.
You should have seen the faces of clinicians in my first ERP training when the instructor announced that we should not provide reassurance to OCD clients when they ask for it. Their shock was palpable. And I get it. When I started doing exposure work, I was terrified I was harming my clients. It is brutal to watch someone cry because you intentionally asked them to face the very thing they’ve avoided for years.
But then you witness the first win.
A client comes back and says:
“It really sucked, but I did the exposure every day. And by the end of the week, it felt just a tiny bit easier. Will it keep getting better if I keep doing this?”
YES. Yes, it will. And the energy in the room shifts — for them and for you.
So to my fellow therapists, I offer this question:
What is kinder: allowing clients to avoid anxiety indefinitely, or helping them discover how strong, capable, and brave they truly are by facing it — and finally experiencing lasting freedom?
Brené Brown reminds us, “We cannot selectively numb emotions.” Life itself is one big exposure. If we are going to enjoy it, we must also tolerate discomfort. We will have hard conversations. We will endure breakups. We will lose jobs. People we love will die. We’re meant to feel the anxiety, just as we’re meant to feel joy, sadness, anger, and love.
Avoidance numbs anxiety temporarily — but it also numbs everything else.
Choose discomfort.