Do you have OCD? Do you know someone with OCD?
Unfortunately, finding help isn't as easy as it might seem. You can't just go down to any mental health professional and get good therapy-- that's because OCD is a complex problem, and not all doctors (psychologists, psychiatrists, social workers, therapists, etc.) are well-trained to understand and treat it. The best treatment for OCD includes the techniques of exposure and response prevention (ERP), which are part of cognitive-behavioral therapy (CBT). Medications can also be helpful--particularly the serotonin reuptake inhibitors (SSRIs such as Paxil and Prozac). But these medicines do not have the long-term effectiveness that ERP has. They can also produce side effects. Anyway, to find a trained theapist who really knows how to help you with ERP, you will have to do some legwork. Here's what I recommend...
Finding a Qualified OCD Therapist
Most likely, you'll have to look around a little before you find a qualified OCD therapist. While we know that ERP usually works for OCD, not all therapists are familiar with, or well trained to use, these techniques. One of the best ways to find good therapists in your area is by asking the leaders or members of local OCD support groups. The International OCD Foundation (IOCDF) website (www.ocfoundation.org) provides a list of these groups, and even if the nearest one is some distance from you, they may know of good therapists in your area. Three organizations can also provide you with a list of professionals in your region who have indicated that they treat OCD: The IOCDF, the Association for Behavioral and Cognitive Therapies (www.abct.org), and the Anxiety Disorders Association of America (www.adaa.org).
You might also be able to get referral lists from your state, provincial, or region's mental health, psychological, and psychiatric associations. And if you happen to live near a major university that has a training program in psychology, or a medical school with a psychiatry department, you could call and find out if they have a clinic that offers treatment from their therapists-in-training. And don't be too concerned about working with a student therapist-especially one with experience using CBT for anxiety and OCD: he or she will be closely supervised (and working hard to impress the supervisor!). Not only is the quality of their therapy often very good, such clinics often provide services at low cost.
If you still can't find anyone with related expertise, check out the organizations and websites listed in the Resources at the back of this book. Many of these provide information on OCD and/or help you find a cognitive-behavioral therapist or psychiatrist.
Checking on Qualifications
Whether or not you locate a therapist through these outlets, before agreeing to start treatment with a particular clinician, make sure he or she is licensed to practice in your state or province. Then, ask the practitioner to describe his or her qualifications and treatment approach to you (email or call them on the phone rather than paying for an initial session to get this information). Here are some questions to ask a potential treatment provider and the answers you should be looking for. Don't be afraid to ask these kinds of questions-it's important that you stand up for yourself to make sure you're getting the treatment you need.
1. What kind of treatment approach do you use for OCD? (Answer: Behavioral or cognitive behavioral. If they say anything such as "gestalt,""psychodynamic," "eclectic," "psychoanalytic," "humanistic," "Rogerian," or "Jungian," this is not the person you're looking for!)
2. Can you tell me what CBT involves? What would the therapy be like? (Answer: The description should include facing your feared situations and thoughts [exposure] and refraining from rituals [response prevention]. If the therapist mentions "biofeedback," "hypnosis," "relaxation," or "thought stopping," you're not in the right place. Snapping a rubber band on your arm doesn't reduce OCD; it only leads to a sore arm.)
3. What formal training have you had in treating OCD using CBT? (Answer: You want a treatment provider with formal training. This means being trained in CBT in graduate school, through one-on-one training and supervision from an expert, or by attending multiple seminars or workshops. Simply reading (even a lot of reading) about CBT, or attending a few workshops or lectures, is not enough. Take it from me: you can't learn to do good CBT in a few hours. It takes months [if not years] of training.)
4. About how many people with OCD have you worked with using CBT? (Answer: At least 5 to 10 before you.)
5. What kinds of results do you get with CBT? (Answer: Research shows that most people benefit with at least a 50% reduction in their symptoms. The treatment provider should sound confident that he or she knows how to use CBT to get good results.)
6. How long will it take me to start feeling better with CBT? How long does treatment usually last (how many sessions, weeks, or months will it take)? (Answer: Most CBT programs work within about 20 sessions. If the provider's answer is much longer than this, it might mean he or she is using other strategies besides CBT.)
7. Will we do exposure therapy together during the treatment sessions, or will I do it for homework? (Answer: Look for a therapist who will help you do exposure practice in the session and also assign you more practices to conduct between sessions.)
8. Are you able to leave your office to help me do exposure therapy? (Answer: Yes.)
9. Do you use imaginal exposure along with situational exposure? (Answer: Yes.)
10. Is it OK if I bring in some self-help materials I've been using so you can see where I'm at with working on this problem? (Answer: Yes.)
It's possible that you won't find a therapist who gets a "perfect score" on these questions; but answering most of them correctly is often a good sign. You should be skeptical if a potential clinician offers you a treatment you've never heard of before, such as "Thought Field Therapy" or "Rebirthing." Also, be leery of anyone who seems overly confident, claims to be able to cure you, or guarantees the treatment (anything that sounds too good to be true probably is). Finally, if the clinician can't tell you how long treatment might be expected to last, you should look for someone else.
Some therapists are knowledgeable about CBT in general, but not necessarily experienced with OCD. If this is the case, ask whether the practitioner has used CBT when working with people who have problems with phobias, social anxiety, or panic attacks. The treatment of these problems is similar to CBT for OCD. You can therefore be reasonably comfortable that this person will have a basic knowledge of what's necessary to help you with OCD. Perhaps you might suggest using a self-help workbook, such as my book Getting Over OCD, to tailor the treatment to your specific types of obsessions and rituals.
If you're thinking about using medication to help with your OCD symptoms, try to find a psychiatrist (with an M.D. degree) who is experienced with drug treatments for OCD. If you can't locate an OCD expert, try to find someone who is familiar with treating anxiety disorders in general. Very often, the medication treatments for OCD are the same as those for other anxiety problems.
© 2010 Jonathan Abramowitz. All Rights Reserved