Wednesday, July 13, 2011

OCD A to Z: T is For Therapy

The International OCD Foundation has a useful checklist of questions to ask of potential therapists for OCD, as well as a database of OCD therapists. This is where I refer people who ask about finding a good therapist for their OCD. There is evidence that Exposure and Response Prevention Therapy works for Obsessive Compulsive Disorder, and yet very few therapists who are actually trained to do it or who have even heard of it.

It's a bizarre thing that OCD symptoms in all their permutations sound incredibly familiar to me, but to therapists who are unfamiliar with OCD, they don't see the patterns, and are baffled, frustrated, or assume there are deeper issues that must be dealt with first and the symptoms will then go away. I have had several excellent therapists who cared deeply about me, and wanted only the best for me, and did indeed help me dramatically with other areas of my life, but who didn't know how to treat OCD or didn't even recognize that I had OCD.

There are some areas of the US with no trained ERP therapists, and this sucks, but I encourage you to persist in searching out help, whether by support groups, or therapists who work with Skype, or the telephone.

Tips for Interviewing Therapists: What Should I Ask?

The following checklist can help guide your search for the right therapist. The answers to most of these questions are available on the individual listings in our Treatment Provider search engine, but it never hurts to ask a therapist yourself:

"What techniques do you use to treat OCD?"

If the therapist is vague, or does not mention cognitive behavior therapy (CBT) or Exposure and Response Prevention (ERP), use caution.

"Do you use Exposure and Response Prevention to treat OCD?"
Be cautious of therapists who say they use CBT, but won't be more specific.

"What is your training and background in treating OCD?"

If they say they went to a CBT psychology graduate program or did a post-doctoral fellowship in CBT, it is a good sign. Another positive is if a therapist says they are a member of the International OCD Foundation (IOCDF) or the Association of Behavioral and Cognitive Therapists (ABCT). Also, look for therapists who say they have attended specialized workshops or trainings offered by the IOCDF, like our Behavior Therapy Training Institute (BTTI) or Annual Conference.
"How much of your practice currently involves anxiety disorders?"

"Do you feel that you have been effective in your treatment of OCD?"

"What is your attitude towards medicine in the treatment of OCD?"

If they are negative about medicine, this is a bad sign. Medicine is an effective treatment for OCD.

"Are you willing to leave your office if needed to do behavior therapy?"

It is sometimes necessary to go out of the office to do effective ERP.
This has been adapted from: "How to Choose a Behavior Therapist" by Michael Jenike, M.D.


  1. Great post, thanks for the tips!!!

  2. I had better luck with clinical social workers than psychologists or psychiatrists. My therapist is a CSW and he has quite a bit of experience with ERP. He's more down to earth and approachable than many of the psychs I've met.

  3. Lolly--glad it was helpful!

    Greg--Yes! My therapist is a LCSW, with lots of ERP experience, and he rocks.

  4. Karin Said:

    When i went to the mental health clinic in my city they assigned me to a social worker. After about a year she went on a leave of absense and i got reassigned (temporarily, i thot) to the Occupational therapist. This OT is now leaving and i basically had to tell her that i was not interested in just being reassigned to the new OT unless he has lots of experience with ocd. I pretty much had to beg to get her to go back to the group session and get me a competant therapist (why can't i go back to the original one. We had a good relationship???) not just anyone with lots of open spots.

    Greg, i feel better now that you say social workers are good ocd therapists. I guess i am learning to be a better advocate for myself. Lucky me.

  5. Karin--Self-advocacy was really hard for me, but it paid off. I had a therapist who really helped me with my depression. She was a good therapist. I felt guilty looking for an OCD specialist, but I finally realized that my OCD wasn't getting better, and I had to take the lead. My ERP therapist said that Licensed Clinical Social Workers are trained to put the client first, and that has served him well, as well as me!