Melissa Fasteau, PsyD, Jennifer Sy, PhD, Chad Brandt, PhD, and Keith Klein, MA Present at the 2019 ADAA Conference

ADAA 2019 Conference – March 28-31, 2019  Sheraton Grand Chicago, Chicago, IL

Pray the Gay to Stay: Treating Diverse Themes of OCD

Saturday, March 30: 5:45 PM  – 6:45 PM
Meeting Room Level 2
Room: Huron
Patients with Obsessive Compulsive Disorder (OCD) experience intrusive thoughts that challenge societal norms and values, including sexual, racial, religious, and other identity-related intrusions. Much of the time, patients experience these thoughts as ego dystonic, resulting in elevated distress and impairment (Sketetee & Barlow, 2002). This roundtable will describe examples of diverse obsessional themes and the effect of such themes on conceptualization and treatment of OCD. For example, some client’s report uncertainty about whether or not their sexual-themed intrusive thoughts about someone of the same sex reflect their sexual orientation (referred to at times as homosexual OCD [HOCD]; Williams et al., 2015). In such cases, disentangling personal values and identities from intrusive thoughts has important implications for implementing multiculturally sensitive interventions. For instance, some patients with HOCD experience ego dystonic fears, at times the fear they may become contaminated or unwillingly transformed into a member of the feared population. Case examples will be used to illustrate effective ways to treat obsessional themes of OCD, therapist challenges, and creative exposures for diverse intrusive thoughts. Specifically, intrusive thoughts to address include religious beliefs and practices, race and ethnicity, disabilities and other diagnoses, personality features, and HOCD. The panel will discuss potential impacts on assessment, case conceptualization, and treatment of OCD within the ERP model with an emphasis on the working alliance and multicultural awareness. Ethics of creating exposures within obsessional themes will be explored. Given the challenges for a therapist to address these themes in a sensitive manner, the panel will discuss managing therapist reactions, the cultural context, and decision points for referrals. These instances will be discussed related to racial and disability fears.

Learning Objectives

1. Demonstrate assessment and differential diagnosis of OCD and diverse obsessional themes.

2. Identify steps to strengthen the working alliance when ego dystonic fears occur.

3. Recognize ethical implications of creating exposures related to diverse themes of OCD.

Audience Level





Diversity – Yes


60 minutes


Obsessive Compulsive Disorder

Treatment Approach

Exposure Therapy



Sheraton Grand Chicago
301 E North Water St
Chicago, IL 60611
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