What’s the best therapy for retroactive jealousy OCD?

As a therapist who works with this frustrating issue, my money is on Exposure and Response Prevention therapy (ERP).

But ERP has to be done right. Retroactive jealousy has some specific features that we have to be aware of.

Otherwise, it’s wasted effort and we give up and feel even more stuck with intrusive thoughts about our partner’s past. Ouch.

So here’s a quick rundown of ERP mistakes – particularly when working with RJ. I share this as a therapist who’s made the mistakes. Full disclosure: I still fall into one of these traps quite regularly.

So whether you’re having therapy, or considering it or looking at the ERP self-help route, these are my hard-earned insights into when ERP might be going a bit wrong.

Getting sucked into the all-too-interesting content

A real threat to effective ERP – and as much for the therapist as the client – is getting sucked into the content. People struggling with RJ naturally want to air all their thoughts, and often the whole backstory of their partner’s sexual past.

And there’s inevitably a lot of content: the exes, the arguments, the things the partner may have said or done that haven’t helped. It’s all interesting content – too interesting sometimes.

There’s a perception that that’s what therapy is. You come in, you talk about all the things that have been bothering you. That’s how talk therapy is portrayed, I get it.

So for effective ERP, we need to keep things on track. We need to get a good understanding of the triggers, thoughts, and compulsions. We want to see the thinking process at work.

But there’s a tipping point: tipping over into rumination and speculation.

For example, the client might say “I hate feeling like my partner has lied to me about how many people they’ve slept with.”

Useful to know, and I’ll ask the client how they’ve been dealing with this feeling. “Oh it makes me want to ask them again… tell me honestly this time. I keep going through all their exes that I know about and I add them up in my mind, and I’ve looked through their Facebook photos to see if there are others…“.

Bingo. There’s a bunch of compulsions we can work on. This is really useful to know.

Then the client is on a roll and says “because when we first got together she said 8 and I didn’t really like that but I thought OK, at least that’s not as many as me… but then another time I asked her and she said about 12, and I was like what? You said 8 before and she said well do you mean slept with or just been with..? And I knew she was backtracking and….“

Respectfully, OK. Now we’re ruminating.

It might feel like useful detail but it’s not. It’s talking rumination. And if I don’t spot that, and sometimes I don’t, I’m joining in and using up time for actually doing ERP.

Missing the core fears

We need to identify and expose to the underlying fears and doubts.

For example, I’ll say to that same client “so your partner downplayed how many people they’d slept with… and they might do it again. This might sound like a stupid question, but what’s the problem with that?“

“Well, if they lie to me about that, what else might they be lying about? How can I trust them? Even if it’s all in the past, what if their body count is higher and I find out there were more? I’m going to feel even more like I’ve been taken for a ride… all their friends and exes knowing more about the past than me…“.

OK so we have some fears about being hurt in the future, and the prospect that we could always find out more and what that might do to us. And that we’re being taken for a ride and other people know it – a status related fear. I’d clarify that and we’d do some exposure work around those fears.

And we’ve already had a mention of “at least they’ve slept with fewer people than me“. Often there’s a bit of FOMO going on. ‘I need to feel like I’m ahead’, which feeds into RJ struggles.

So there’s more to all this than ‘not liking my partner’s sexual past’.

Again, we want to gather this information without getting sucked in. And make sure we set up exposures that can specifically tackle these uncertainties. Imaginal exposures are good for this. This is essential for ERP to get results.

Not addressing mental compulsions

Obsessive compulsions come in two forms. There are the things we do or say when the thoughts are chewing us over. With RJ, it’s the questions, digging, snooping, researching, avoiding, leaving. All the things we do to try to fix it and get some relief.

And often, by the time people with RJ come and talk to me, they’ve already stopped doing a lot of these things. They’ve had to. Their partner issued an ultimatum or they realised how hurtful this stuff is.

That’s positive. We’ve got to stop doing these things.

The other type of compulsion is internal. It’s the endless thinking. Ruminating for hours on end. The mental arm wrestling of ‘my partner did that’ – ‘but it’s in the past’ – ‘but I need to know’ etc.

It goes on and on. Trying to figure it all out, to get to the bottom of it and feel better.

The mental compulsions are often the bigger part of retroactive jealousy. And because a lot of the ‘doing’ compulsions have stopped, we’re bottling it all up inside now and hamster-wheeling on it even more.

So a big part of exposure therapy is realising how to stop doing that. And that’s not by trying to think positive or replace the thoughts. It’s getting better at rolling with the thoughts and learning how to let them pass along by themselves.

To stop swatting the fly and let it buzz off by itself. Counter-intuitive, I know. It can feel impossible at first. But we can do it, when we make it one of the priorities of ERP therapy.

When your partner isn’t on board

Any kind of obsessive-compulsive issue makes life difficult. It sucks up our time, it’s exhausting. But some OC struggles chip away at our lives more than others.

Retroactive jealousy chips away at our relationship and our partner’s quality of life in really destructive ways. Often we feel immense guilt about that.

All the questions and dredging up our partner’s past and avoiding and mood swings. A lot of relationships don’t survive. So there’s panic and pressure to get this RJ resolved somehow, ASAP.

ERP therapy works but it’s a process. We need to be doing it and we need to give it time. Can the relationship and our partner hang in there? Or do we need to think about damage limitation right away?

This is where involving the partner in therapy is key. With any form of OCD, we identify where loved ones might be accommodating the rituals. Same for RJ, but the partner is also being accused, guilt-tripped, shamed or emotionally abused sometimes.

It’s on the person with RJ to stop all this, of course. But there are interim things we can do to support the partner too. And to lower the tension and aggravation during the process.

If we neglect this, ERP may well fail. Either because the friction and upset at home is just too much for doing effective exposures, or the relationship ends before we make any real progress.

And then the client loses any motivation to work on their RJ. Or they feel the instant relief of ‘well I’m single now but at least all these thoughts have gone away’ and it just lies in wait for their next relationship.

We need to support and involve the partner. Maybe bring them into a couple of sessions. ERP and exposure work requires both partners to take a leap of faith sometimes.

Confusing RJ with other issues

People experiencing depression tend to shut down and retreat from others, including their partners and loved ones. And they find reasons for doing so. A lot of rumination and focusing on past pain goes on with depression.

Generalised anxiety too: a lot of worrying and ‘what if’ thinking. Anxiety about having anxiety. There might not be obvious compulsions but it can certainly encroach on the relationship.

Narcissism might be in the mix. The judgement of a partner’s past along with a feeling that my body count should be higher. This kind of ‘feeling superior yet also inadequate’ can suggest traits of narcissism. Plus the lack of empathy that has us accusing and questioning all the time.

Sexual issues too: performance anxiety, sexual dysfunctions. This can underlie feelings of inadequacy, comparing ourselves to our partner’s exes. ‘I’ll never be as good, it’s only a matter of time…’

I’d say that 9 times out of 10, when someone is obsessing over their partner’s past and doing these behaviours – especially when they’ve noticed this tendency in previous relationships, and maybe obsessive ‘needing things to feel right’ in other areas of their lives – we’re talking RJ OCD.

But these other issues might be in the mix. When planning ERP exposures, we should be mindful of this.

Do we need to address feelings of depression first? Otherwise exposure could be too much of an ask. Or do feelings of sexual inadequacy or narcissism play into the underlying fears of RJ, and do we need to make sure we’re addressing them in exposure?

All valid considerations that can make for better outcomes.

More ERP pitfalls

There are other ways that exposure response prevention can go wrong or not have the desired therapeutic effect:

• We need to start with doable exposures and work up to things that feel too challenging or scary right now. An experienced therapist knows when to push it and has the confidence to do that. To help the client think the unthinkable sometimes.
• Exposures need to be regular and consistent. And without softeners or escape hatches. Give RJ an inch and it’ll take a mile.
• We need to be supportive and positive but not give reassurance. It’s about being able to tolerate uncertainty and let these thoughts about our partner’s past matter less.

So if you’re struggling with RJ and considering ERP, I hope this gives you some useful pointers.

Or if you’re doing ERP and it’s not delivering, maybe there’s some explanation here. A different therapist or guide might make the difference.

Exposure to the thoughts and feelings of RJ is hard work. It’s not fun and it can be a slow process. But once we start to feel the benefits, once we get it – it’s absolutely worthwhile.