Obsessive-compulsive disorder, OCD, affects approximately 1.2% of the U.S. population at any given time, with similar rates around the world. Individuals who live with OCD are often greatly impacted by their symptoms, and can see disruptions in various areas of their lives. Keep reading to learn 50 OCD discussion questions to ask clients in therapy.

Repeated, and uncontrollable thoughts (obsessions) and engaging in repeated behaviors (compulsions) are the hallmark symptoms associated with OCD. Individuals may be living with obsessions or compulsions, or possibly with both.

Those who experience obsessions may have thoughts, urges, or mental images that they are unable to control, and that tend to cause a great deal of anxiety. Common obsessions among individuals living with OCD include:

The fear of germs or contamination

The fear of losing, forgetting, or misplacing items

The fear of losing control of their own behaviors

Having aggressive thoughts towards themselves

Experiencing unwanted, forbidden, or taboo thoughts about sex, religion, or harm

Experiencing an intense desire for things to be in perfect order, or symmetrical

Compulsions may occur as a result of an obsession. Individuals experience a strong urge to engage in repetitive behaviors, and oftentimes feel unable to control the urges and their followed behaviors. Common compulsions among those who are living with OCD include:

Washing their hands excessively

Arranging items in a particular way

Repeatedly checking things (that the doors are locked, the stove top is off, hair curler is unplugged)

Compulsive counting

Repeating words or phrases silently

Individuals who are living with obsessive-compulsive disorder may find themselves spending an hour or more a day engaging in or experiencing their obsessions or compulsions. Obsessions and compulsions are not enjoyable activities, and engaging in compulsions can bring temporary relief from the anxiety symptoms that they are experiencing. Individuals who are living with OCD may find that their symptoms vary in intensity, and worsen during periods of high stress. They may also notice a shift in the focus of their obsessions and compulsions over time.

Individuals who are living with OCD can experience co-occurring disorders. Tic disorders can include repetitive movements or sounds. Comorbid conditions that can occur include anxiety, mood disorders, ADHD, and substance use disorders.

Treatment for obsessive-compulsive disorder often includes a comprehensive approach that utilizes psychotherapy and psychotropic medications. Common treatment modalities used include cognitive-behavioral therapy (CBT), and exposure and response prevention therapy (ERP). The FDA has approved the use of repetitive transcranial magnetic stimulation (rTMS) in conjunction with psychotherapy and psychotropic medications for those who are living with severe symptoms and have not been able to find improvement from other treatment options. 

Getting Ready for Your First Therapy Session with a New Client with OCD

Preparing for your first session with a client who is experiencing OCD symptoms may resemble your routine for other clients. If this is a new client, it can be helpful to spend a few moments reviewing documentation or referral information that you have received already. This can also include any questionnaires or screeners that they have completed before your session. You may find that reviewing the paperwork you will be completing helps you outline a rigid  flow for your session.

If you’re meeting with a client who has already completed an intake assessment, reviewing the paperwork can provide you with insight into their presenting concerns, the severity of their symptoms, and their goals from counseling. This can help you develop a rough plan for your session.

If you find that you work well with worksheets in your sessions, TherapyByPro offers a range of worksheets that can be used with clients who are living with OCD and common co-occurring disorders. Examples of popular OCD worksheets include:

ERP Therapy Worksheet Bundle

OCD Worksheet Bundle

Mindfulness Worksheet Bundle

Lastly, we encourage you to take time to check in on yourself. Taking time throughout our day to ensure that our needs are being met allows us to provide optimal care for our clients. 

OCD Discussion Questions to Ask Clients in Therapy

OCD questions can be used as a tool to explore your client’s symptoms, as well as the progress that they are making throughout their counseling session. Continue reading for our list of 50 OCD discussion questions!

Can you tell me about any fears or thoughts that occupy your mind?

How would you describe the impact that your thoughts have on you throughout your day?

Have you learned of any triggers for these fears or thoughts?

Have you tried to use any coping skills or made behavioral changes in an attempt to reduce the frequency or intensity of these fears and/or thoughts?

Are there any behaviors or rituals that you do to reduce your distress?

How much time would you estimate that you spend engaging in your compulsive behaviors?

Are there any compulsive behaviors that you find more distressing or upsetting compared to others?

Can you describe the impact that your OCD and related challenges have had on your relationships?

How has your OCD impacted your work or school performance?

Can you tell me about any activities that you don’t do to avoid experiencing your symptoms?

How do you feel about your obsessive thoughts? Do they make sense to you?

Do you feel as though your obsessive thoughts may be irrational?

Have you picked up on any patterns with your OCD? Any common triggers, or challenging times during your day?

Can you think of a time when you were able to resist engaging in compulsive behaviors? Can you tell me about this experience?

Have you received any feedback from friends or family about your OCD or your overall mental wellness?

Can you tell me about any fears that are incorporated into your obsessive thoughts?

How do you feel that these fears impact your thoughts?

Have you noticed any environments where your symptoms are more present?

Can you think of any environments where you are less likely to experience your symptoms?

How much time could you spend in your safe place?

Can you tell me about any coping skills that have been helpful for you?

What has not helped you cope with your symptoms?

Can you think of any goals that you would like to work towards in counseling?

What changes will you notice in your symptoms when you are making progress?

Can you tell me about a goal you have for your mental health? Try to be as specific as possible.

Are there any aspects of your mental health that you feel as though you have already made progress in?

Can you tell me how you were able to accomplish those changes?

Can you tell me about the healthy support you have in your life?

Who can you turn to when you are having a hard time?

How comfortable are you talking about your mental health experiences and challenges with the people who are close to you?

Can you tell me how your family and friends respond to your mental health challenges?

Do you have any hesitations about engaging in therapy?

What questions do you have for me about the therapeutic process?

Are there any concerns that you have about participating in counseling?

Can you tell me about any previous mental health treatment experiences? Were these positive experiences for you?

Did you feel as though you made progress while in treatment before?

What did you find helpful from your previous counseling experience?

What was unhelpful for you during your previous treatment episodes?

How do you feel that your symptoms have impacted your self-esteem?

How would you describe your mood throughout the day?

Have you noticed any negative thoughts, opinions, or perceptions you have of yourself because of your OCD symptoms?

Has there been a time when you thought about, planned, or attempted to kill yourself?

Can you tell me about how comfortable you are with uncertainty? This could include not planning your day out, or allowing someone else to take the lead in your activities.

Has there been a time when your OCD symptoms impacted your sleep?

Can you tell me about your sleeping patterns?

Do you feel as though your OCD symptoms interfere with the structure of your day? This could include being late to work or other activities and being unable to be fully present in your environment.

Can you tell me about your strengths that have helped you, that we could work to apply to your OCD symptoms?

What is your understanding of mindfulness and meditation practices?

Would you be willing to learn about mindfulness and meditation?

Can you think of any ways that mindfulness could help you with your current mental health symptoms?

Final Thoughts on OCD Questions to Ask Clients

Thank you for taking the time to read our OCD discussion questions! Clients who are living with OCD may find that their life and routine is significantly impacted by their symptoms, which can cause them great stress. They may be unable to focus on their work or schooling as they would like to, and may struggle to maintain healthy relationships. Your compassion and expertise are key to helping those living with OCD find strength and healing. 

If you would like to learn more about obsessive-compulsive disorder, or effective treatment approaches for OCD, we encourage you to utilize training and continuing education opportunities within your respective field.

TherapyByPro is an online mental health directory that connects mental health pros with clients in need. If you’re a mental health professional, you can Join our community and add your practice listing here. We have assessments, practice forms, and worksheet templates mental health professionals can use to streamline their practice. View all of our mental health forms, worksheet, and assessments here.

Resources:

Brock H, Hany M. Obsessive-Compulsive Disorder. [Updated 2023 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553162/#

“Obsessive-Compulsive Disorder.” National Institute of Mental Health. Accessed January 25, 2024. https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd. 

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