49 OCD Discussion Questions to Ask a Client in Counseling

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 49 OCD discussion questions to ask clients in counseling.

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.

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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, TherapyPatron 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:

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 Counseling

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!

  1. Can you tell me about any coping skills that have been helpful for you?
  2. What has not helped you cope with your symptoms?
  3. How do you feel that your symptoms have impacted your self-esteem?
  4. How would you describe your mood throughout the day?
  5. How has your OCD impacted your work or school performance?
  6. What is your understanding of mindfulness and meditation practices?
  7. Would you be willing to learn about mindfulness and meditation?
  8. Can you think of any ways that mindfulness could help you with your current mental health symptoms?
  9. Have you received any feedback from friends or family about your OCD or your overall mental wellness?
  10. Can you describe the impact that your OCD and related challenges have had on your relationships?
  11. 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.
  12. Can you tell me about your strengths that have helped you, that we could work to apply to your OCD symptoms?
  13. Can you tell me about any activities that you don’t do to avoid experiencing your symptoms?
  14. Have you noticed any environments where your symptoms are more present?
  15. What did you find helpful from your previous counseling experience?
  16. What was unhelpful for you during your previous treatment episodes?
  17. What questions do you have for me about the therapeutic process?
  18. Are there any concerns that you have about participating in counseling?
  19. Can you think of any environments where you are less likely to experience your symptoms?
  20. Can you think of any goals that you would like to work towards in counseling?
  21. Can you tell me about any previous mental health treatment experiences? Were these positive experiences for you?
  22. Did you feel as though you made progress while in treatment before?
  23. What changes will you notice in your symptoms when you are making progress?
  24. How much time could you spend in your safe place?
  25. Can you tell me about any fears that are incorporated into your obsessive thoughts?
  26. How do you feel that these fears impact your thoughts?
  27. Can you tell me how your family and friends respond to your mental health challenges?
  28. Do you have any hesitations about engaging in therapy?
  29. Who can you turn to when you are having a hard time?
  30. Have you noticed any negative thoughts, opinions, or perceptions you have of yourself because of your OCD symptoms?
  31. Has there been a time when you thought about, planned, or attempted to kill yourself?
  32. 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.
  33. How comfortable are you talking about your mental health experiences and challenges with the people who are close to you?
  34. Do you feel as though your obsessive thoughts may be irrational?
  35. How do you feel about your obsessive thoughts? Do they make sense to you?
  36. Have you picked up on any patterns with your OCD?
  37. Has there been a time when your OCD symptoms impacted your sleep?
  38. Can you tell me about your sleeping patterns?
  39. Any common triggers, or challenging times during your day?
  40. Can you tell me about a goal you have for your mental health? Try to be as specific as possible.
  41. Are there any aspects of your mental health that you feel as though you have already made progress in?
  42. Can you think of a time when you were able to resist engaging in compulsive behaviors? Can you tell me about this experience?
  43. How much time would you estimate that you spend engaging in your compulsive behaviors?
  44. Are there any compulsive behaviors that you find more distressing or upsetting compared to others?
  45. Are there any behaviors or rituals that you do to reduce your distress?
  46. Can you tell me about the healthy support you have in your life?
  47. 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?
  48. Have you learned of any triggers for these fears or thoughts? How would you describe the impact that your thoughts have on you throughout your day?
  49. Can you tell me about any fears or thoughts that occupy your mind?

Final Thoughts on OCD Discussion 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.

TherapyPatron.com helps mental health professionals better serve their clients. Our (editable, fillable, printable PDF) therapy worksheets can help you streamline your practice, effectively deliver different types of therapy, and support your clients be the best version of themselves.

  • Sale! Exposure and Response Prevention (ERP) Therapy Worksheet Bundle
  • Sale! OCD Worksheets Bundle PDF Templates

Resources:

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

Kayla is a Mental Health Counselor who earned her degree from Niagara University in Lewiston, New York. She has provided psychotherapy in a residential treatment program and an outpatient addiction treatment facility in New York as well as an inpatient addiction rehab in Ontario, Canada. She has experience working with individuals living with a variety of mental health concerns including depression, anxiety, bipolar disorder, borderline personality disorder, and trauma.

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