Finding the right therapist who is well-versed in treating OCD can be a challenge. Some describe it as finding a needle in a haystack. When I see clients for their intake, I often hear a familiar story: "I've seen several therapists before, and while they have all been sweet, I feel like I keep spending money, without finding much relief." The truth is, not every therapist is trained in OCD. This results in the use of inappropriate techniques and treatment methods that only prolong your recovery journey.
Below you will find some key questions to ask when interviewing a potential therapist. While you may feel you are putting someone through an inquisition, these questions are essential in finding appropriate treatment. Speaking as a provider myself, I enjoy when clients ask questions about my experience and treatment methods. It shows that the client is invested in his/her treatment, has done their research, and wants to ensure a good fit.
1.) What strategies do you use to treat OCD?
If the provider does not mention Exposure and Response Prevention (ERP), I would be extremely cautious. ERP is the gold standard treatment for OCD, along with other Cognitive-Behavioral Therapy interventions. If they do not bring up ERP, feel free to ask them about it. A seasoned therapist who uses ERP on a regular basis will be able to speak fluently and confidently about it. If, on the other hand, they struggle to describe what it involves, or instead suggest talk therapy to perhaps get to the root of your OCD, I would seek therapy elsewhere. While some therapists may say they use Cognitive-Behavioral Therapy (CBT), it is essential that CBT techniques are tailored to the treatment of OCD, or treatment will not be effective. Not every therapist is familiar with how to do this, which leads to question #2.
2.) What advanced training do you have in the treatment of OCD?
Graduate level coursework alone does not provide the in-depth level of training to successfully treat individuals with OCD, especially those with moderate to severe symptoms. Perhaps ask your potential provider if they are familiar with any experts in the field, and if they've read any of their books/papers. This provides additional information for you, as the consumer, to know how much knowledge, training, and interest your provider has in OCD. Those who are well-versed in the field will be able to mention one or two names without much hesitation, and discuss post-graduate level training they have attended.
3.) What percent of your practice is working with those experiencing OCD?
Some providers may only see one or two cases a year, while others dedicate a large majority of their practice - even their whole practice - specifically treating individuals like you. While the exact percentage is not so important, you may find a great deal of comfort knowing your therapist has a strong interest in treating OCD, and does so on a regular basis. Think about seeking out a specialist to treat a heart condition. Who would you feel more comfortable seeing a.) someone who has treated only two cases, or b.) someone who treats your same condition on a daily/weekly basis?
4.) Do you have experience treating Pure-O? What treatment strategies do you use?
Some individuals experience what is called Pure-O, meaning their obsessions are accompanied by covert rituals (ones that take place in the mind, and can therefore not be observed), rather than overt, physical ones. Some providers may say that obsessions without any physical rituals are nearly impossible to treat, and therefore encourage the use of anxiety medication alone, or incorporate coping skills such as snapping a rubber band when an intrusive thought shows up, or visualizing a stop sign to encourage thought stopping. Unforuntately, these suggestions do not work. Pure-O can absolutely be treated using ERP techniques, and you can surely find relief.
5.) What are your thoughts on the use of medication in treating OCD?
Medication is certainly not a cure-all for OCD symptoms, so it is important for your provider not to see it that way. However, medication, used together with ERP/CBT techniques, is an incredibly helpful treatment combination. If your provider is against the use of medication, I would also be extremely cautious. While you may be able to cope without it, it would be wise for your provider to encourage a medication consult if you are not benefiting from ERP sessions alone. Not encouraging medication at that point would be a large disservice.
6.) What are your thoughts on Homework between sessions?
If a therapist feels homework is an optional component of therapy, or does not believe strongly in collaboratively assigning it, this is a big red flag. Only focusing on treatment once a week in an office setting will not help you reap the benefits you are looking for. Skills, exposure exercises, and acquired information must be reinforced on a daily basis. A therapist who does not assign homework is also not truly practicing CBT, as homework is an essential component of proper CBT treatment. While all homework assignments are individualized, it may be helpful to ask a therapist for a general sample of homework assignments used with previous clients. Proper homework consists of actively practicing skills/exposures on a daily basis, keeping track of specific items throughout the week, reading supplemental materials, reviewing therapy notes, etc...
7.) Do you offer sessions outside the office setting, if needed?
Many individuals with OCD can greatly benefit from ERP sessions in their own home environment, or in the "real-world" setting (restaurants, crowded places, parks, etc...) ERP can be a challenging treatment to engage in all on your own, especially in the beginning stages, so the support of your therapist during exposures can be a helpful component of your treatment. However, if a provider does not offer these services, it is certainly not a red flag. Treatment outside the office setting is simply a bonus. A lot of good work and progress can be done right in the office setting, with homework assignments geared towards transferring those skills into your home and "real world" environments.
8.) Do you accept insurance?
The truth is, it is very difficult to find a skilled provider in the field who accepts insurance. However, many providers are open to submitting sessions through your out-of-network benefits, so that you may be reimbursed a percentage of the session cost. In fact, some providers, including myself, are even willing to submit all paperwork on your behalf, so that's one less item on your plate to juggle. Others may offer a sliding scale fee, while some may have set fees that are more affordable than others. Insurance or not, treatment for OCD will be an expense. However, it is also important to see your treatment as an investment in yourself, and your future..
Finding the right therapist who treats OCD does require research. It requires asking necessary and appropriate questions to find out if their treatment approach and experience is what will best help you succeed. While it may take time to hit the therapist jackpot, know that once a good match is found, much progress and symptom relief is possible. If you need help looking for a provider in your area, the International OCD Foundation is a great resource to help get you started.
----------------------------------------------------------------------------------------------------------------
DISCLAIMER: The blog posts shared on www.StacySmithCounseling.com contain the opinions of Stacy Smith, MS, LPC, and do not reflect the opinions of any organizations or affiliates. While Stacy is a licensed mental health professional, all blog posts on her site are for informational purposes only, and are never a substitute for professional advice catered to your individual needs. Stacy Smith is not liable for any diagnosis, treatment plans, or decisions made based on the information presented on this website. Furthermore, commenting on posts does not mean a treatment relationship has been established with Stacy Smith.