As a therapist, working with clients who have taboo subtypes of OCD can feel intimidating or even uncomfortable. POCD is no exception to this. POCD involves intrusive and unwanted thoughts, images, and/or urges around children that are sexual in nature. Taboo subtypes of OCD tend to be less talked about and less known by professionals, and this can lead to further stigma, guilt and shame around POCD.

The truth is that clients who struggle with POCD desperately need our help, and avoiding this subtype only perpetuates shame and suffering. Let’s break down what POCD is, how to recognize it, and some tips for managing your own discomfort as a therapist.

What is Pedophilic OCD?

Pedophilic OCD is a subtype of OCD in which individuals experience intrusive, unwanted thoughts, urges or images related to sexual contact with children. It’s crucial to emphasize that these thoughts are completely unwanted. The obsessions cause intense distress, fear, and disgust in the person experiencing them. The individual with POCD is not a danger to children, nor do they have any desire to act on these thoughts. That last part is extremely important to emphasize!

In fact, people with POCD often go to great lengths to avoid any situation that might trigger these thoughts. They may avoid being around children entirely, feel intense distress when around their own children and avoid tasks like changing diapers, and may even question their morality or identity.

The hallmark of POCD, as with other subtypes of OCD, is that the thoughts are ego-dystonic, meaning they don’t align with the person’s values, desires, morals or character, which makes them even more distressing.

Recognizing POCD in Clients

Clients with POCD may not come right out and say, “I’m having intrusive sexual thoughts about children.” The shame and fear of judgment are often so overwhelming that they’ll either avoid the topic or hint at their distress in vague ways. Here are some signs to look out for:

• Extreme avoidance of children or places where children may be present.
• Excessive rumination on whether they’re a “bad person” or secretly harbor inappropriate desires.
• Compulsive behaviors such as mentally reviewing interactions, seeking reassurance, or avoiding media content that involves children.
• Overwhelming guilt or disgust with themselves, paired with frequent confessions or a need for reassurance from loved ones.
• Hypervigilance in monitoring their thoughts or feelings when around children.
• Body scanning to make sure they didn’t have a groinal response to children

Often, clients with POCD are terrified of being judged by their therapist and/or have worries that their therapist will report them to child services. They may have delayed seeking help because they fear that their therapist will misunderstand their distress or, worse, assume they pose a risk to others. Creating a safe, non-judgmental space is key to helping these clients open up about their experiences.

Overcoming Therapist Discomfort

As a therapist, you may feel discomfort when working with taboo themes like POCD, especially if it’s your first time. You might worry about how to respond, feel unsettled by the content, or even fear misinterpreting your client’s thoughts. Here are some ways to navigate your own discomfort:

1. Understand the Nature of Intrusive Thoughts

It’s essential to remind yourself of the fundamental nature of OCD. The thoughts themselves are not reflective of who the person is or what they would do in reality. Educating yourself on POCD can help demystify it and reduce the fear surrounding this subtype. IOCDF has great resources on OCD and different subtypes. You can learn more about POCD here.

2. Challenge Your Own Biases

As humans, we carry implicit biases, and taboo content like POCD can stir up our own feelings of discomfort, even if we don’t want them to. Take the time to reflect on any discomfort or biases you might have and recognize that this doesn’t mean you’re ill-equipped to help. It simply means you’re human. If you find certain aspects triggering, seek consultation or supervision to process your feelings in a healthy, supportive space. Separating OCD from the person can help with this process. 

3. Create a Safe, Non-Judgmental Space

Your clients are already battling enormous shame. One of the best things you can do is model that you’re not shocked by what they’re sharing and that their thoughts don’t make them a bad person. Normalize the experience of intrusive thoughts, and explain how OCD latches onto what a person fears most. Creating a safe, judgment-free environment is crucial for clients with POCD to feel comfortable opening up.

4. Use Evidence-Based Treatment

Exposure and Response Prevention (ERP) is the gold standard for treating OCD, including POCD. As with other OCD subtypes, ERP for POCD involves exposing clients to their fears without engaging in compulsive behaviors like reassurance-seeking or avoidance. It’s important to explain the treatment process clearly so that clients know their therapy will focus on managing the anxiety caused by the thoughts, not the content of the thoughts themselves. The content isn’t the problem, it’s the reaction to the content that reinforces the OCD cycle.

Incorporating values-based exposures and ACT principles can also be highly beneficial, helping clients anchor to what they care about rather than getting swept away by the noise of their OCD.

5. Recognize When to Seek Support

If you find yourself struggling with discomfort or doubt in working with clients with POCD, it’s important to know when to seek support. Consultation with colleagues who have experience with OCD, can be invaluable. Supervision can provide a space to process your reactions and get guidance on how to provide effective ERP treatment.

Final Thoughts

Approaching treating POCD with the right understanding and framework, can help clients find relief and healing. Remember, the thoughts your clients are experiencing do not reflect who they are, and by providing a non-judgmental, compassionate space, you can be an essential part of their recovery journey.

Therapy for POCD requires a blend of evidence-based strategies like ERP, ACT and a lot of compassion, for both your client and yourself. Don’t shy away from these tough cases. Embrace the challenge, knowing that you are offering much-needed help to people who have been carrying their fears and shame alone for far too long. You are a difference maker who is providing life-changing and rewarding care.