This interview was conducted in webinar format in July 2019. Stephen Smith, CEO of NOCD, was joined by Dr. Patrick McGrath to ask him a variety of questions about what he’s learned through decades of treating obsessive-compulsive disorder.
Patrick McGrath, PhD, is the Assistant Vice President of Residential Services for AMITA Health Behavioral Medicine Institute. He is the Executive Director of the Foglia Family Foundation Residential Treatment Center, and the Clinical Director for both the Center for Anxiety and Obsessive Compulsive Disorders (OCD) and the School Anxiety and School Refusal Programs at the AMITA Health Alexian Brothers Behavioral Health Hospital in Hoffman Estates, IL.
Dr. McGrath is a member of the Scientific Advisory Board and the Conference Planning Committee of the International OCD Foundation (IOCDF), as well as the President of OCD Midwest, the official affiliate of IOCDF in the Midwest. He is also a member of NOCD’s Scientific Advisory Board.
Stephen Smith: Hi Dr. McGrath, it’s good to speak with you today. Let’s start with a common question from our community: why do you think OCD is so misunderstood?
Dr. McGrath: Well, first of all it’s unfortunate that OCD has been the butt of many a joke in the past. People tend to say, “Well, oh, I have a little OCD” because they cleaned something twice or checked something a few times. Nothing stops a party like saying you run an OCD clinic, because everyone suddenly wants to tell you all the things they think they do that “are OCD.” So I’ll ask people, “Do you say to yourself ‘ I have a little schizophrenia’ every time you have an odd thought?” Because nobody says that.
The other thing, too, is that we are all used to thinking about OCD in certain ways, typically in the form of handwashing or checking. But as NOCD’s research has shown, so many people with OCD are dealing with intrusive thoughts about harming themselves or someone else. People are still afraid when they hear these things; there is a real lack of awareness about the full breadth of OCD symptoms and what they can mean. We have a very narrow focus, which we need to change.
Stephen: Definitely. We’re leaving so many people out of the conversation.
Dr. McGrath: Yeah, and I have even seen memes that make light of OCD—things that say “I have Obsessive Cleaning Disorder” and so on. Within the OCD community, it’s imperative that we as therapists really make sure we’re quite serious about these things. You may be the first person your client has ever trusted with any discussion of their compulsions or what they’re really afraid of… you always have to keep that in mind.
Stephen: How do you know as a clinician if you’d be good at treating OCD?
Dr. McGrath: First I look at someone’s personality: can they maintain a poker face about certain things? Are they able to hear what might be the most strange or bizarre thing they’ve ever heard and still respond with “Okay, tell me more about that”? If somebody says something that’s just way out there and you look startled, they may never come back to see you—they got up the courage to tell you, and you didn’t react in a way that seemed supportive. You have to be very serious when someone tells you about themselves, and sit with what you hear. It could even be something deeply offensive to you on a personal level, but you have to be able to sit there and talk about it. Don’t take anything that they say personally!
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Stephen: Very true.
Dr. McGrath: I also do this little test—and I challenge all clinicians to try this—where you take a pen and a piece of paper and write “I hope [name of someone you love] dies tonight.” And I want you to consider how you feel about doing that. How many of you refused to write it down? How many of you wrote it down but immediately scratched it out? How many of you tore it up? If you did any of these things, then I ask you to reconsider treating others with OCD, because you yourself just used a safety-seeking behavior. You basically just performed your own kind of ritual right there, by trying to neutralize something that made you feel uncomfortable. And if we’re going to ask our patients to do things that are uncomfortable, we as clinicians are going to have to do things that are uncomfortable too.
I have had a card that says “I hope my parents die tonight” and has 666 drawn on one side in my wallet for the last fifteen years. It has stayed in my wallet for a very long time because I want to show my patients that I would be willing to do very uncomfortable things right alongside them, and that nothing they’re going to say will scare me, bother me, or make me think they’re weird.
Stephen: Those are great points. So, with that said, where can someone go to get trained to treat OCD?
Dr. McGrath: There’s a couple places where a therapist can get specialized training.
The International Obsessive Compulsive Foundation (IOCDF) runs the behavioral therapy training institute (BTTI), which takes about 30 therapists at a time for a weekend-long program. Therapists get intensive OCD training, and then faculty members stay in touch and help them review cases over the phone. I myself am a faculty member there, and have worked with tons of therapists getting the BTTI certification.
Mass General Hospital also does some beginning training on cognitive behavioral therapy and OCD treatment through the IOCDF.
If you’re in the Chicagoland area, we do a lot of talks and education programs at AMITA Health. There are also individual therapists who do consultations. I do those as well, and usually therapists charge by the hour if that’s something you might be interested in.
Stephen: It’s good to know there are some established options out there. In addition, NOCD has a network of providers, called the NOCD Pro Network, which leverages our technology to give people video-based therapy sessions. We are continuing to build this network as we speak. NOCD Pros have access to a weeklong OCD training, with continued check-ins. We are offering it to individuals looking to treat OCD in different states who don’t have that expertise yet.
Dr. McGrath: Yes, exactly, and even educating yourself can be extremely helpful.
Dr. McGrath: There are so many great resources. To add just one more, I wrote a book called The OCD Answer Book with answers to around 250 questions about OCD, collected from people I knew. I just asked them “What do you want to know about OCD?” and answered their questions. It might be helpful to give the book to friends and family members and say, “Hey, here is everything you may want to know about OCD.”
Stephen: We have a copy of that book in the NOCD office—it’s very helpful. It seems like the most important takeaway today is that the best way to get better is to work with a licensed provider with specialized training in OCD treatment. The training is the most important element, because providers are in the position to educate in the most engaging way, answer questions, and help people through exposure and response prevention (ERP), which can be extremely challenging. That’s one of the main reasons we’re grateful to have spoken with you today, Dr. McGrath. Thanks for being here.
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Dr. McGrath: Absolutely. Thank you for having me!