Alice* hunched on the couch in my office, a curtain of dark hair falling over her downcast face. Her legs bounced as she asked me to repeat my confidentiality policy again. When I began, she interrupted me.
“So, if I’ve only had thoughts about doing something, you don’t have to tell anyone, right?” She peered through her hair at me. “I would never hurt my daughter,” she continued, her voice thick with tears. I passed the tissues to her and explained that I know unwanted harm thoughts can happen within the context of OCD. She sighed audibly, appearing to relax into the cushions a bit.
Alice was right to be worried. Her last therapist, Dr. Thomas*, upon hearing of her classic harm OCD symptoms, encouraged Alice to move out of her home and in with her parents. He then informed Alice’s spouse that she was a possible danger to her infant daughter, cautioning him to supervise her time with her baby. Finally, for weeks, Dr. Thomas taught Alice anger management techniques to resolve what he felt were her feelings of rage and jealousy toward her baby. Alice felt shame burning her cheeks as she tried week after week to explain that she didn’t really want to harm her child. But, she thought, what if he’s right, and I am the monster I fear being? Better to learn to control my anger just in case.
Thankfully, Alice came across a post on Reddit about intrusive thoughts and learned that she might have OCD. She refocused on finding a specialist, moved back in with her family, and began receiving the specialty care she needed.
While Alice’s story is a striking example of misdiagnosis and unethical treatment, many other clients come to the Nashville OCD & Anxiety Treatment Center with less extreme versions of mishandled mental health care. These almost always occur at the hands of therapists with good intentions who lack the training to accurately diagnose or treat OCD. These clinicians may have even taken a training or two in an OCD-specific modality and feel energized to work with this community.
However, OC symptoms can be complex, confusing, and malleable. So, it’s important that therapists’ training and experience be extensive. This means having taken multiple targeted workshops, immersing oneself in the scientific literature of the field, and ideally working alongside other professionals who also work with OCD. Finding a provider who has worked with OCD in multiple settings (such as residential treatment and regular outpatient services) may be helpful too. Additionally, OCD is one of those conditions for which so-called talk therapy is not only unlikely to help but may also worsen symptoms. So it’s important to be selective about therapists.
If you are seeking support for OCD, here are some questions to consider when seeking a provider. This list may also be helpful for therapists who want to specialize in OCD treatment and aren’t sure where to start. The purpose of this list is to ensure that everyone with OCD has a chance at finding effective, ethical, and compassionate help.
- Make sure the therapist uses evidence-based treatment for OCD.
This document from the International OCD Foundation has a list of the first-line treatment (Exposure and Response Prevention or ERP), adjunctive treatments (Acceptance and Commitment Therapy, cognitive therapy, DBT, mindfulness-based therapy), and second-line treatments (Inference-Based CBT, metacognitive treatment) for helping people with OCD. All these treatments fall under the umbrella of cognitive-behavioral therapy (or CBT).
Be wary of therapists who say that they treat OCD but only list other modalities such as IFS, EMDR, hypnosis, or brainspotting on their website. Also, be cautious about working with those who only use one of these modalities - especially if it isn’t the first-line treatment, ERP. At most specialty clinics, therapists will have training in a variety of modalities to approach therapy with both scientific evidence and your personal needs in mind. On the other hand, if someone has more than five or so modalities or specialties listed on their website, this is another red flag – no one can truly be an expert in everything!
- Check in about how much training the therapist has had.
Maybe your therapist has listed at least one of the treatments above on their website. Awesome! Now it’s important to know how much training they’ve had in the topic. Thankfully, there are more trainings available now than ever before, and therapists who want to specialize in this population have a wealth of options to choose from. However, taking a single workshop in one technique is insufficient to become proficient in working with OCD, even if the therapist has lived experience with it. I have personally worked with OCD for almost 20 years, and I’m still learning new ways to engage clients and infuse therapy with new techniques.
As a possible client, you can ask therapists about how many hours of training they’ve had and from what kinds of institutions. You can also ask whether they receive supervision (what therapists get before they are independently licensed) or consultation (what therapists get after licensure) with an OCD specialist. Ongoing consultation is a part of our clinic’s structure and helps to ensure that even licensed therapists continue to refine their skills.
- Ask about their clinical experience with people with OCD.
There’s a big difference between learning about OCD treatment and having hands-on experience with clients who have OCD. You can ask therapists about how many people they’ve worked with or if they’ve worked with people who are like you in age, background, or other demographics. Although it’s tempting to ask for therapists who specialize in your OCD subtype (e.g., relationship OCD, contamination, etc.), this may not be necessary. That is, OCD tends to follow the same pattern regardless of the symptom content. So, trying to find someone who has treated the exact same symptoms as yours may not be helpful and may hinder your search for an appropriate fit.
But every therapist has to start somewhere, and you may opt to work with a therapist who hasn’t yet had much experience with OCD. Maybe they are a student offering a low fee or someone who is re-specializing in OCD work. If this is the case, again ensure that they are getting adequate supervision or consultation from someone who does have that experience.
- Be cautious about therapists who over-promise.
If you have OCD, you know that it can be a painful, complicated, and impactful condition. If it were easy to stop doing compulsions, no one would have symptoms in the first place. But people with OCD often struggle for years before getting an accurate diagnosis or receiving proper treatment. Unfortunately, some therapists may take advantage of the anguish that accompanies OCD and promise potential clients that they can alleviate their symptoms within a few sessions or that they can experience symptom remission without significant effort. Others may say that they have modified existing protocols to make therapy less stressful or more effective for certain groups of people. If they don’t have research findings to back this up, don’t trust it. The rule of thumb is: if it sounds too good to be true, it very well may be.
- Find out how involved the therapist is in the OCD community.
While this isn’t necessary, it’s a good sign if your therapist or others they work with are involved in the greater treatment community. Is this therapist a member of the International OCD Foundation? Do they regularly attend conferences devoted to OCD research and treatment? Have they published articles, written books, or spoken on topics surrounding OCD and its treatment? And if they haven’t, have they been supervised by someone who has? Again, none of these are necessary for ensuring that your therapist is an appropriate fit. However, they may be the cherry on top in your search for a competent and effective therapist.
Living a meaningful life is possible when you have OCD. And finding a therapist who truly understands your experience and the best treatment methods can help you move toward that life. You owe it to yourself to find a provider who understands OCD and sees you as a holistic, complex person. We wish you the best in your search for that right fit!
* Names have been changed to protect patient privacy
