How To Choose the Best OCD Therapist For You
So you’ve been diagnosed with OCD. What now? Looking for the right OCD therapist can be a confusing and overwhelming process. This is the person who should help you recover from OCD and start living a life that’s free from the torturous obsessions and compulsion cycle that you’re living with now – it’s understandable that you want to be thoughtful about who you choose to work with.
Not Any Therapist Will Do for OCD
You might think that as long as you like your therapist, and they’re a licensed professional, then it doesn’t really matter too much what exactly their background is or what therapeutic modalities they use. Not true; although of course having a good relationship and a license to practice are important (we’ll talk more about this later), not just any therapist will do when it comes to OCD.
OCD is such a misunderstood condition, even within the mental health community. People with OCD can suffer for a painfully long time before they finally receive an accurate diagnosis and start getting the treatment they need. The media’s portrayal of OCD probably has a lot to do with that; even mental health professionals imagine OCD to look like contamination or “just right” obsessions with compulsions that are visible and obvious to anyone watching. Of course, those of us who actually have OCD know that that’s not always the case.
We’ll go into more detail about what to look for and what to avoid when looking for an OCD therapist, but a major thing to keep in mind is that traditional talk therapy, especially if it’s based in psychodynamic theories, is ineffective when it comes to OCD – and it can even make things worse. Imagine this: you talk to a therapist about your HOCD obsessions, only to be told that you’re suppressing your true identity as an LGBTQ person because of some childhood trauma. It’s not hard to see how counterproductive and damaging that would be.
That’s why it’s so crucial to find an experienced, knowledgeable therapist if you have OCD; if you aren’t careful, you could go for years without getting the right diagnosis or treatment – which means you’ll suffer needlessly when you could have been recovering from the painful symptoms of OCD with the right therapist. Trust us: it’s worth your while to follow this guide and make sure that you find the right OCD therapist who’s actually going to help you.
Look For ERP: The Gold Standard in OCD Treatment
The number one thing to keep in mind when you’re looking for an OCD therapist is this: are they trained in ERP, or Exposure and Response Prevention? We know you’ve heard this over and over again, but ERP is the gold standard in OCD treatment, and research shows us that it’s by far the most effective treatment for helping people recover from OCD. If you’re truly committed to recovery, then ERP should be the first thing you try.
Of course, there will always be exceptions to any rule, and it’s not a 100% guarantee that ERP will work for you. But it’s the gold standard of OCD treatment for a reason: research says that around two-thirds of people who receive ERP treatment from a qualified professional find that their OCD symptoms get less intense. That’s why we use it in our program, and why you should make sure that any therapist you work with knows how to use it, too.
How does ERP work?
We can look at ERP as having two parts: the “E”, or the exposure, and the “RP”, or the response prevention. Essentially, patients who are going through ERP treatment are tasked with completing exposure exercises – this is any activity that triggers an obsession or OCD anxiety for you. For example, if you suffer from harm OCD, your therapist may ask you to pick up a knife around someone you love. That’s the exposure part.
Exposure alone isn’t enough, though – after your anxiety is triggered, you need to go through the “RP”, or sitting with the horrible discomfort of the obsessive thought without doing any compulsions, mental or physical, to ease the anxiety. No rituals, no seeking reassurance, no avoidance. The idea is that eventually, the thought gets less and less powerful; it won’t go away completely, but you can let it live in your brain while still going about the rest of your life. You won’t lend it more power by performing a compulsion.
It sounds scary, and it is – but it’s also incredibly effective. A good ERP therapist should help you structure your exposure exercises so that you’re not starting with the exposures that cause the most debilitating anxiety for you – that could scare you away from treatment forever. The therapist should start you with exposures that are lower down on your “ladder”, and keep you accountable to gradually increasing the amount of anxiety you can tolerate.
Other therapy techniques that are helpful
Although ERP is the gold standard and should be what you’re looking for first, there are other interventions that have also been shown to help people with OCD, like:
Mindfulness: Mindfulness-based CBT has a lot of promising research behind it for OCD treatment when paired with ERP. With mindfulness, you can learn how to notice obsessive thoughts (and urges to perform a compulsion) and just notice and accept them with peace – and stay in the present moment instead of losing yourself in fear.
Acceptance and Commitment Therapy: A form of CBT which is based on the principles of mindfulness, ACT can help people with OCD to be able to sit with the pain and discomfort of an obsessive thought without acting on it.
Medication: Some categories of antidepressant medication (called SSRIs) have been shown to help reduce the symptoms of OCD. Not all therapists can prescribe medication, though – we’ll talk more about that in detail later on.
Questions To Ask Prospective OCD Therapists
So how can you figure out if a potential therapist is going to be able to help you recover from OCD? Whether you’re looking for a therapist to help with OCD symptoms or anything else, don’t be afraid to ask them questions before you enter into a professional relationship with them.
Here are some ideas of questions you may want to ask prospective therapists to get a better sense of whether they’re actually going to be able to help you:
“What methods do you use to help clients with OCD?”
Like we talked about extensively before, ERP is the best treatment in the world for OCD. If the therapist doesn’t mention ERP when telling you about how they help clients with OCD, that should be a big red flag. If they only mention CBT in general, ask for specifics – most therapists are trained in CBT, but you’re looking for a therapist who can help you using ERP specifically. If you’re interested in other methods like mindfulness, you can look for this, too – but only in conjunction with (not instead of) ERP.
“How many clients have you successfully helped to recover from OCD?”
It’s one thing to claim that you’re experienced in ERP; it’s another to actually have used it to help people successfully reduce their OCD symptoms. Ask this question to get a sense of how experienced the therapist is in using ERP with real clients. Not having any real-world experience may not necessarily be a deal-breaker, though; for example, many Masters-level interns have little experience, but offer reduced fees.
“Where did you receive training in ERP?”
Again, this question will help you to understand exactly how experienced and knowledgeable this person is in ERP. A reputable place to receive training in ERP is through the International OCD Foundation’s Training Institute, although there are endless other options.
“What kind of homework do you assign between sessions?”
A huge part of ERP treatment is creating an exposure ladder and making sure you commit to doing exposures in between sessions, whether it’s through imaginal exposure or actual physical tasks. It’s important to have a therapist who can help you think of and structure these exposures, and keep you accountable for actually completing them in the time between sessions. WIthout this piece of treatment, ERP will be ineffective.
“Can I bring in my own self-help materials?”
Self-help tools, including the Impulse Therapy program, can be excellent in starting the process of reducing OCD symptoms on your own. If you’ve gone through these materials already, or if you want to use them as a supplement to your work with your therapist, you’ll want someone who is open to going over these materials together with you so that you can use all the resources at your disposal to recover from OCD.
What to Avoid – Red Flags
Just like there are things to look for when you’re searching for the best OCD therapist, there are also things to actively avoid. Certain things aren’t complete dealbreakers, like we talked about before – other things, though, definitely are. If you notice any of the following things when you’re looking for an OCD therapist, that’s a red flag that should be avoided:
Psychoanalysis or Freudian theories: Look – we have nothing against Freud or psychodynamic therapists in general. For OCD, though, it’s just not helpful – and can even be harmful. Nobody with scary OCD thoughts needs to be told that their issues come from some complex father issues or sexual repression. That doesn’t help anybody with OCD actually stop their compulsions, and it’s just confusing at best. Although psychoanalysis can be great for other issues, it’s best to steer clear if you’re looking for help with your OCD.
Cognitive-Behavioral Therapy that’s not ERP: Yes, ERP is considered a type of CBT. But CBT is a theoretical category that includes an enormous number of interventions, and many CBT-based interventions that aren’t ERP are useless, and even harmful, when it comes to OCD treatment. Take, for example, the technique known as “thought-stopping”, in which clients are asked to just interrupt or suppress negative thoughts. If you have OCD, you already know how impossible that would be – not to mention that the reason ERP works is because it requires people with OCD to become comfortable with the thought’s presence without trying to avoid it.
Lack of ERP experience: We’ve made this point, but we’re going to say it again just to really nail it in – the best OCD therapist for you will have experience in ERP. Especially if they don’t even mention it when they’re talking about how they will help you, this is a huge red flag. On a similar note, if they talk vaguely about CBT when describing how they treat OCD, but they don’t mention structured exposure exercises, then that might be a sign that they don’t really know how to work with OCD specifically.
Relying solely on relaxation techniques: There’s nothing inherently wrong with relaxation techniques. In fact, they can be a great supplemental tool to learn how to de-escalate your central nervous system when you’re having an intense OCD episode. But it takes a lot more than that to really recover from OCD. OCD isn’t just anxiety – it’s an incredibly complicated cognitive disorder that requires intense and specific treatment.
By all means, use relaxation techniques to cope with the acute distress that comes with an OCD flare-up. But at some point, you will have to use ERP exercises to stop the obsession-compulsion cycle and learn to live with the scary uncertainty that life brings. In other words, you’ll have to kill OCD at its root, instead of continually distracting it with relaxation techniques.
Reassurance: A therapist who provides you with reassurance might be the most dangerous red flag of all. It’s human nature to want to give reassurance to someone experiencing OCD obsessions; assuring them that their fears are unrealistic and irrational, that it’s very unlikely they’re secretly a pedophile, that it wouldn’t be their fault if their mother got hurt, or whatever their obsession might be.
But if you have OCD, you know better than anyone that this kind of reassurance helps for about 5 minutes before the obsession-compulsion cycle starts back up again. To recover from OCD, you need to learn to accept the uncertainty that your obsessions try to scare you with – and providing reassurance only allows you to escape that task.
Seeking reassurance is a compulsion that just keeps people stuck in an OCD loop and can even make it more powerful. Any therapist working with OCD clients should know how harmful it is to participate in that cycle by providing reassurance. Avoid, at all costs, therapists who try to reassure you when you tell them about your OCD fears. It may feel like kindness in the moment, but it’s actually hurting you in the long run.
The Importance of the Therapeutic Relationship
Now that we’ve gotten the most important stuff out of the way, let’s talk about other things to look for when you’re looking for the best OCD therapist for you. Having experience in ERP is a great start, but it’s not as though that’s the only thing that will make for a successful therapeutic relationship.
Something that the research has shown time and time again is that the trust and rapport you have with your therapist is crucial to how effective your treatment will be. Think about it: it would be hard to be completely honest and open with a therapist who you didn’t feel safe with. If you don’t have the solid foundation of a good relationship built with your therapist, none of the treatment that comes afterward will be as effective as it could be.
What makes for a positive therapeutic relationship will differ for each person – just like any other relationship. Think carefully about what it is that helps you to feel safe. Most people, unsurprisingly, appreciate empathy, genuineness, and a non-judgmental attitude in a therapist. But what else do you need? Maybe you feel more comfortable with people with a good sense of humor, who can give you a tough-love approach when you don’t follow through with your homework, or who shares your racial or religious background. Be open and give it some time, but also don’t be afraid to look for a new therapist if you just don’t feel comfortable with who you’re working with.
At the end of the day, though, a positive therapeutic relationship should never be prioritized over experience in treating OCD. No matter how much you adore your therapist, it’s unlikely that they’ll be able to help you recover from OCD if they aren’t trained in the right methods (ERP) to do so. They might be fantastic for helping with the other issues in your life, however, so don’t burn your bridges with them.
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What Type of Therapist is Right For You?
You might already know that there are different types of licenses which allow mental health professionals to practice psychotherapy. Although they’re all equally qualified (and an LCSW with ERP experience will be much more helpful to you than an M.D. without it), there are slight differences between them that might matter to you.
Here are some of the most common licenses that you’ll see after potential therapists’ names:
- M.D.s or DOs are psychiatrists who have gone through medical school. All medical doctors have this license, so make sure you choose someone who is a psychiatrist, rather than just a general practitioner. Psychiatrists are the only type of psychotherapist who can prescribe you with medication. They also sometimes offer therapy as well, although many people choose to see a therapist as well as a psychiatrist.
- PhDs and PsyDs are licensed psychologists with a doctorate-level education. The difference between these two degrees is slight (PsyD programs usually are more clinically based), but they are both qualified to provide therapy.
- LMFTs, LPCs, and LCSWs are masters-level licensed psychotherapists. They all have completed a similar amount of graduate education and post-graduate clinical hours; some slight differences are that LMFTs receive an education focused on marriage and family therapy, and LCSWs, being social workers, may be more focused on issues of social justice.
- Pre-licensed therapists: Many mental health clinics employ pre-licensed therapists who are completing their masters education or post-graduate clinical hours. These therapists often work at reduced rates under the direction of a clinical supervisor.
Note that life coaches are not included on this list because life coaches, although they can be helpful in helping people meet their goals, are not licensed mental health therapists and can not help you recover from OCD.
The Importance of an Identity-Affirming Therapist
OCD can feel overwhelming sometimes, and that’s totally valid – but this disorder is not 100% of who you are. Yes, you may be a person who lives with OCD, but you are also a daughter, brother, friend, teacher, Christian, married, single, gay man, musician, immigrant, and the list goes on.
The point is that all of the other aspects of your identity are important to who you are, too, not just your OCD – and they should be considered when looking for the right therapist for you. After you’ve narrowed down therapists who have experience in treating OCD using ERP, you might start to consider what else is important to you in a therapist.
Having an identity-affirming therapist is extremely valuable, and that becomes even more true if you identify as part of a marginalized group. It’s important, for example, for people who are part of the LGBTQ community to work with a therapist is not only accepting but affirming of that identity. If you’re a woman of color, you might find that it’s important to you to work with a female therapist of color. Of course, this is up to each person to decide what is important to them when looking for a therapist, so think about it carefully.
Where To Look For an OCD Specialist
So now that you know what to look for, you might be wondering: where can I find a therapist with the qualifications I’m looking for?
One place to start looking is the IOCDF (International OCD Foundation) Directory, which guarantees that all of the therapists listed on their page are qualified to work specifically with OCD clients. You might also look for local clinics in your area that specialize in treating anxiety and obsessive-compulsive disorders.
Of course, there are also more general therapist directories that you can use, like the Psychology Today directory. Keep in mind, though, that just because a therapist states that they work with people with OCD on their profile doesn’t necessarily mean they know how to use ERP; there’s no governing board that checks that, unlike the IOCDF directory. If you choose a therapist from these types of directories, make sure you ask them the questions that we walked you through earlier.
Choose Your OCD Therapist Carefully
Finding the best OCD therapist for you is a delicate process that involves so many factors. Choosing a therapist who isn’t specially qualified to treat OCD using ERP can lead to years of heartache and ineffective treatment, so it’s crucial that you find someone who actually knows how to work with your symptoms. Good treatment for OCD is out there, and it’s possible to recover from this disorder.
While you look, consider using the Impulse Therapy program to start getting your OCD symptoms under control. Although it’s not a replacement for therapy, our self-help program is based in all of the evidence-based practices described here, including ERP. With the right treatment, you can lessen obsessions and compulsions and start living a life that’s free from the shackles of OCD.