By Dr. Fugen Neziroglu, PhD, Cofounder of Bio-Behavioral Institute in Great Neck, NY
When looking for an OCD therapist, make sure that your potential therapist has training in Cognitive Behavioral Therapy (CBT) and specifically Exposure and Response Prevention.
If you ask therapists, "Do you do CBT?" most will likely respond "yes" because they might have learned a technique or two. Unfortunately, if the therapist’s therapeutic orientation is not CBT, they will only know how to implement a few strategies; they may not be proficient in determining when, at what pace, and what strategies to use these techniques and for which symptoms. They may even claim to know Exposure and Response Prevention treatment but only use it here and there.
Here are indications that the therapist you've selected is qualified to treat OCD.
The therapist conducts a thorough intake assessment
A well-trained OCD therapist first conducts a thorough background intake and assessment of all your symptoms.
- YBOCS self-rating scale: They may administer a self-rating scale called the YBOCS, designed to assess the severity and type of symptoms in patients with OCD.
- Treatment outcome predictors: They may assess some treatment outcome predictors such as depression, anxiety, shame, disgust, overvalued ideation, and trauma.
- Comorbid disorders: They will also look at comorbid disorders and decide what needs to be treated first.
The therapist uses evidence-based treatments for OCD
There are well established evidence based treatments for the OCD Spectrum Disorders. Exposure and response prevention (ERP), the primary treatment choice, refers to exposing someone to their fears and preventing them from engaging in their compulsions. This is done by creating an anxiety hierarchy of situations that provoke distress and gradually putting the person in those situations at a rate that they are able to tolerate.
The therapist designs and implements treatments unique to your obsessions
A good therapist needs to be able to take any symptom and create various situations to expose you to. They will work with you, including going outside of the office, going where the problem is, or coming to your home.
We often think of hand washing and double-checking as symptoms of OCD, but it takes on many forms. You may have emotional contamination which means you avoid everything that someone you dislike or angry at touches. You may have thoughts of being gay, a pedophile, an ax murderer, a person possessed by the devil, or you may be counting or repeating activities all day.
Sometimes developing a treatment plan takes a lot of creativity, especially when you have a pure obsession and you need to create the situation in real life. Let’s take the need for ordering and arranging, meaning you get anxious if your belongings are moved. It may prevent you from letting others enter your room, or you may have to check to make sure everything is in its “proper” place every night. The therapist would come to your home and gradually start moving things around and have you tolerate the discomfort. They may instruct family members to do the same with your permission. You learn over time to not be bothered by your compulsions.
Another example may be the fear of hurting someone with a sharp object or running someone over while driving. The therapist would have you sit next to someone with a knife and have you think of stabbing the person, or go out driving and not check if you ran someone over. Individuals with OCD do not act out their fears and are able to realize this in these exposure treatments.
Discussing the obsession or compulsion rationally and logically does not work. It may help the person reduce their anxiety for a little while but not in the long run. Good therapists help you through active therapy, skill building, and exposure work both in and out of the therapy room so that you are equipped with the tools to address any future obsessions.