Finding the Right OCD Therapist

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Finding a good therapist to treat OCD can be a difficult task. Although there are many therapists out there, not every mental health professional is knowledgeable about, or well trained in, treating OCD. Depending on your geographical location, it may be difficult to find even one qualified therapist in your area! There are also other factors to consider, such as whether the person is a good fit interpersonally or financially.

To find the right therapist, it is necessary to spend time researching your options. Below are suggestions for what to look for, where to look, and how to find someone that meets your needs.

The most effective psychological treatment for OCD is Exposure and Response Prevention (ERP), a specific type of Cognitive Behavioral Therapy (CBT). ERP involves gradually being exposed to the thoughts, situations, objects, impulses, and images that cause anxiety, disgust, or distress, and preventing the compulsive behaviors that temporarily reduces the distress. Through repeated exposure and ritual prevention, anxiety will decline naturally, and over time, obsessions and compulsions will become less frequent and less intense. ERP has been found to work well for 80% of patients

Where to Look

There are several ways to find a provider who specializes in ERP in your area:

  • The International OCD Foundation (IOCDF.org) provides a directory that enables you to search for therapists, treatment programs, support groups, and organizations specializing in OCD in your area.
      • Many major universities and hospitals with clinical psychology departments have clinics that offer low-cost therapy services to the public by doctorate-level psychology students. Some of these clinics have specialized anxiety programs that provide ERP. Typically, the student therapists are well trained and closely supervised by licensed clinical psychologists who specialize in anxiety disorders.
      • Your general doctor or your psychiatrist may be able to refer you to a therapist. If you are looking for treatment for your child, the school’s guidance counselor or child study team may be able to offer referrals.
      • You can call your insurance company and ask for a list of providers in your area. These providers may not necessary specialize in OCD, therefore it may be more effective to find local OCD therapists using the above means, then finding out if they are in network.

         

        Questions to Ask

        Think of the process of choosing a therapist as similar to hiring a nanny to take care of your kids. You want to find someone who you can trust, so it’s important to interview your candidates. Asking questions during an initial phone call, in an email, or during an initial in-person intake is appropriate and encouraged. Here are some questions to consider asking:

        • What kind of treatment do you use to treat OCD?
          • Look for therapists who say they use Exposure and Response Prevention (ERP). Be cautious of those who say they use Cognitive Behavioral Therapy (CBT), without being more specific. Therapist can be knowledgeable about CBT and have experience with anxiety disorders without having experience with OCD. There are many nuances of OCD that requires a specific skill set somewhat different from the treatment of other anxiety disorders.
        • What is your training and experience in treating OCD?
          • Look for therapists who have had formal training in graduate school and/or supervision from an expert in the field during an externship, internship, or fellowship. Also look for providers who attended specialized workshops by reputable organizations such as IOCDF or major university clinics. Though there is no magic number, is important that the therapist has solid experience treating patients with OCD, or at least is closely supervised by a licensed psychologist who specializes in OCD.
        •  What does treatment look like?
          • Many patients say they have done CBT or ERP and it did not work, though when questioned, it is clear they did not get legitimate ERP treatment.  The therapist should describe creating a hierarchy of feared stimuli, gradually facing these fears through exposure, and refraining from compulsions. They should describe practicing the exposures in session and assigning exposures for you to practice at home.
        • What are your credentials?
          • Learning about a therapist’s educational background may inform your decision. Therapists can have a bachelor’s degree (4 years of undergraduate school), a master’s degree (typically 2 years of graduate school), or a doctorate degree (typically 5 years of graduate school, 1 year of internship, and 1 year of post-doctoral fellowship). Their degree may have been in clinical psychology, counseling psychology, school psychology, or social work, which can change the way they view psychological difficulties and treatment.
        • How long does treatment take?
          •  Although this can vary greatly, when there are no barriers to treatment, symptoms can improve significantly by 16-20 sessions. Be leery of answers that are much longer than this.
        • How effective is treatment?
          • Research shows most people experience a 60-80% reduction in symptoms with successful treatment. There is no cure to OCD, and treatment cannot be guaranteed to work, so be cautious if a provider makes these claims.
        • What is your fee? Do you take my insurance?
          • The answers to these questions may be important factors in your decision. Unfortunately, you will find that most providers that specialize in OCD do not take insurance. However, many insurance companies have out-of-network benefits, which means they will reimburse some of the money you spend on a provider that is out of network.

        What Else to Look For

        When searching for a provider and even as you go through treatment, there are other important factors to consider. Beyond the training in OCD diagnosis and treatment, the provider must also be a good fit for you. It does not matter how good a therapist is in treating OCD, if you are unable to “click” with that person, treatment likely will not be effective. Research has shown that a strong therapeutic alliance is crucial for change to take place in therapy. Look for a therapist who:

        • Makes you feel safe and comfortable.
        • Listens to you and makes you feel heard.
        • Is responsive and empathetic.
        • Does not appear defensive or angry at your request for information.
        • Makes you feel like you can open up to them.
        • You feel comfortable saying no to.
        • Is reasonably available for you.

        Finally, in addition to relationship factors, also consider the effectiveness of your ERP treatment. Good OCD therapists:

        • Collaboratively create hierarchy items.
        • Collaboratively choose exposures and agree on specifics. A therapist should not force you to complete an exposure.
        • Individually tailors treatment for you. Even standardized treatment is not a one size fits all.
        • Do not provide reassurance that will temporarily reduce anxiety and interfere with natural habituation and learning.
        • Identifies covert rituals that get in the way of progress, such as mentally reassuring yourself, mentally undoing/neutralizing the exposure, distracting, or counting silently.
        • Get at the core fear. Choose exposures at the top of the hierarchy that go “above and beyond” to fully target core fear, without being truly unsafe, harmful, or outside of what is accepted in your culture or religion.
        • Help you grow into the role of becoming your own therapist.

        As you go through treatment, if you find that you are having problems in your relationship with your therapist or with the treatment, bring up your concerns. A good therapist will be glad you did and will work with you to address them. If you find your therapist is not working for you, it is okay to end treatment and find someone else. Finding a good OCD therapist may appear daunting, but with enough motivation and work, you can find treatment that works for you. Good luck in your search!

        References:

        Ardito, R. B., & Rabellino, D. (2011). Therapeutic Alliance and Outcome of Psychotherapy: Historical Excursus, Measurements, and Prospects for Research. Frontiers in Psychology, 2, 270. doi:10.3389/fpsyg.2011.00270

        Foa, E. B. (2010). Cognitive behavioral therapy of obsessive-compulsive disorder. Dialogues in Clinical Neuroscience, 12(2), 199–207.

        http://iocdf.org/about-ocd/treatment/how-to-find-the-right-therapist/

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