Finding a Good Therapist for OCD In US and Canada

The International OCD Foundation(IOCDF)has an an OCD Treatment Provider List for the United States and Canada. There is a dearth of qualified Exposure and Response Prevention(ERP)/Cognitive Behavioral therapists, and it can be frustrating to find effective therapy, but this is the place to start.

What to look for:

• Behavior Therapy Training Institute(BTTI) faculty
  
• Graduates of BTTI
• If they are a graduate of BTTI and have a website, check to see if they mention ERP at all. Some take the training, but their sites show no trace of it.
  
• Specific mention of ERP in their listing
  
• Cognitive Behavorial Therapy(CBT) in combination with ERP
  

Keep in mind that this list is made up of therapists who requested to be on it, and there is a disclaimer that the IOCDF does not screen or research any of the therapists, but I do think it increases your odds of finding someone who is well versed in current treatment.

Related Link:
Tips on Finding a Therapist from Austin OCD Center
Finding a CBT Therapist

Introducing my ERP Therapist

He's going to show up quite often in this blog, so I'm going to call him "Leonard, " and introduce him as my wise, sharply observant Exposure and Response Prevention therapist. To go with the metaphor of an owl, Leonard has spent enough years treating people with OCD, that he can hone in on a rodent-like obsession scurrying through the fields and snap it right up. He likes to tell me he's helping me become my own therapist, and encouraging to trust my own thinking--which the OCD vehemently opposes!

His ability to hunt the feared consequence of any given obsession, and uncannily predict the kinds of protests the OCD will make to any given challenge, is truly invaluable. He doesn't get mired in the mud of obsessional thinking. He's not a mind-reader; he's just had 7 or 8 years with the bulk of his clients having OCD.

This is the difference between him and my previous therapist, who though she helped me with everything but the OCD, thought my continuous websearching at work was because I was bored. Yeah, I'm bored at work, but I was also avoiding doing even the most basic of tasks because I might not do them perfectly. OCD tends to form around a grain of truth, and a therapist who doesn't understand ERP therapy, or the ways of OCD, will get sidetracked pretty quickly.

It's hard to imagine I didn't drive for 12 years

I learned to drive at 15. I had the spectre of perfectionism looming over my lessons, where I assumed that I should be able to just learn without trial and error, and that something was seriously wrong with me because I did indeed make errors, like changing lanes without putting on my signal. My instructor was patient, and even gave a particularly riled up driver the finger when I was struggling along. I started a list of all the driving mistakes I made, and felt overwhelmed with all I had to fix. I kept driving through college, maneuvering a Chevette, which had absolutely no oomph after 35 mph. Then on to driving a van as part of my workstudy.

But when my husband and I got married during graduate school, his car was a stick shift, and I had learned on an automatic. I only had one experience with a manual transmission, and that was the day I got my driver's license and my father took me out in his tiny Honda, and expected me to know how to operate the clutch. It was the longest block of my life. I started by rolling backward and ended with much lurching, and felt entirely responsible for my deficiency, rather than realizing my father was expecting me to learn by magic.

My husband took me to a parking lot with the stick shift car, and I was sufficiently scared of making any mistakes that I didn't ask for another lesson. In the meantime, my husband was more than glad to drive me anywhere I wanted to go. He'd wait for me, find a place to sit or walk. When we got a new car 5 years later, I asked that it be an automatic transmission so I could drive if I needed to. But after one nerve wracking trek down to the grocery store, with every muscle tense, and my hands clamped on the steering wheel, I shied away from driving again.

Later, my husband told me that he was so willing because he was afraid that if I had an accident while driving, that it would send me over the edge with my anxiety. For 12 years we did everything together, "joined at the hip". Anxiety can tell you something important, an actual threat that needs to be heeded, but parasitic anxiety lives only to perpetuate itself. Much of my perfectionism was a child's way of dealing with the world--"If I am perfect, then I will be loved. Don't ever make a mistake." And the OCD latched onto this, amplifying the fear. I couldn't imagine myself driving, and therefore, until I could be certain I could drive, I avoided it.

Learning to Live with Uncertainty

My ERP therapist is fond of saying, "The goal of treatment of OCD is to learn to live with uncertainty." The selective filters of OCD are insidious in their stealthiness. I used to feel angry and frustrated when listening to my therapist describe all the ways in which I do tolerate uncertainty, except of course in my OCD hot spots.

My first impulse was to say, "So what?" Yeah, I drive without worrying that every odd clank I hear means that I hit a pedestrian. Yeah, I work at a hospital, and often ride elevators with patients and family and doctors come in and out of my office all day, and even though I run through all sorts of scenarios of contamination in my mind, they pass through. Sometimes I do obsess that I'll start obsessing about these things. . .

My next impulse was to want him to shut up. I don't want to think about other things I could obsess about. Ironically, the first time he told me that I tolerate the uncertainty of getting in the car and driving to work, risking death and destruction, I then backed my car out of the therapy center parking lot directly into a car parked in front of the neighboring garage. The car was there for smoothing out a dent in the roof from a golf ball, and I put a much larger dent in the side of the door. But I dealt with it. It sucked. I put $400 dollars on my credit card to pay for the necessary parts. It was a very expensive therapy session. But I still don't obsess about driving.(Though this wasn't always the case.)

But if it's a body symptom that I notice, a spot, an asymmetry, a miniscule white area, a twinge, a bump, then my OCD is all over it. I want certainty about what it means, right now. I want to know the future, how it will all turn out. I crave doing tons of research trying to figure out what it means. I keep checking the area, prodding it, touching it, comparing both sides, using a flashlight, a magnifying mirror. I want to know what it is, definitively and for all time. This isn't something humans get. I can usually diagnose myself with great accuracy, but it doesn't stick. If it were someone else, I would assume it was benign--a mole, a normal variation. And I would go to doctors frequently for reassurance, but relief would only last a second, because what if they missed something?

And yes, sometimes doctors do miss something. That's a part of the pain of living. I hate that. But putting my life on hold to figure out symptoms, to ward them off, figure them out, analyze and classify them is even more painful.

OCD the Perpetual

I'm back at the computer, same scenario, fairly random websearching when there are other things I want to be doing. I still get surprised when this happens. My ERP therapist says it's OCD's job to perpetuate itself, that it will show up.

I may need to write a script for this, because OCD is getting free reign, and I still fall for its promises that if I just look at one more email, one more link, one more site, then it will leave me alone and I will *feel* ready to get up and do something else.

Any phrase beginning with "Just one more" can't be trusted.

One more sentence.
One more minute.
One more time.
One more page.
One more word.

OCD Toolbox: Listening to Scripts/Imaginal Exposure

My husband had this habit, when records were still current, to play one side over and over, the arm continually lifting up and going back to the beginning. This drove me crazy, but it's the same principle that helped me to deal with my indecision. Jon Grayson discusses this in his book, and once I started writing and recording and listening to scripts as both exposures and support for doing exposures, I was able to give the healthy part of myself more airtime. OCD usually has a monopoly on all channels, and has worn deep paths into my brain, but scripts gave me some alternatives.

Traditionally, tapes were made on the itty bitty cassettes in answering machines that can loop over and over. I used QuickVoice recording software, which is very inexpensive, and fairly straightforward to use, which enabled me to record my scripts sitting at my computer with no additional microphone or device needed.

I then listened to the script continuously on my iPod Nano. I have about 50 scripts that I wrote and recorded. In the case of decision making, when I went grocery shopping, I would listen to a script I wrote about it never being possible to make a "perfect" decision and that OCD will change the criteria of "perfect" the minute I start to reach for an item, and that my life was waiting.

The key was finding what gave me the most unease about an OCD fear, and directly addressing that in the script, putting it out there, rather than running from it. Yeah, I might choose the "wrong" item and feel my face go hot, and a panicky ache in my chest. I might really screw up, and be haunted by regret about my poor decisions and never have any peace from the obsessing about obsessing.

For about a year, I took the shopping script with me almost everywhere I bought things, and listening to it continuously, logging many hours, and gradually, in combination with flipping a coin when I really felt stuck, I freed up a lot of time in my life instead of circling the aisles of the grocery store, looking at every item, reading every label, picking stuff up and putting it down, over and over.

Related Posts:
OCD Toolbox: Flipping a Coin

OCD Flashback #2: Verbatims

I was 19, and had my first boyfriend. We would have long conversations on the phone, and then after I hung up, I'd work on reconstructing the conversation in its entirety. I filled scraps of paper with keywords. If I could not remember the order in which something was said, or what brought up a particular subject, I would sit there, frozen, going over it, hoping to jar the elusive chronology loose, dredge up the missing details. If I could not remember every line, I would feel a tightening in my chest, a vertigo of fear and anxiety.

The thought of losing even the smallest scrap of conversation drove me to document everything. I was hugely frustrated when I discovered the keywords were not enough to remind me what they were about. I knew this need to reconstruct was not normal. It ate up a lot of time and mental space. I half-heartedly wrote that if I wanted to be a therapist, at least I would be very good at writing verbatims of case sessions.

I was all alone in my fears. I couldn't tell anyone what I was doing. They would think I was loopy. I was living in a new country. I was homesick. My father had left. I really never expected anyone to love me. I was afraid of losing this boyfriend. OCD latched onto this with a vengeance--Just write it all down. Capture it. Preserve your relationship by hoarding every word.

Related Post:
OCD Flashback #1