Five Questions to Find Out if Your Therapist Can Effectively Treat OCD
Reviewed By Patrick McGrath, PhD
•6 min read
We live in a world where it’s rare to scroll through social media without seeing a catchy ad for a new online therapy company. For many, the increase in affordable access to therapy is like a dream come true, but for people with obsessive-compulsive disorder (OCD), the abundance of choice opens the door for doubt and confusion.
How do you know if your prospective therapist has worked with someone before who has similar intrusive thoughts to yours? Has the therapist that you’re seeing gone through the training needed to not only become a licensed mental health professional, but to effectively build personalized OCD treatment plans? What is the therapist or therapy company’s motive – is the main goal to profit by keeping you in therapy for life, or is it to empower you to manage OCD with greater and greater independence?
These are legitimate questions that shouldn’t be mistaken as being symptoms of OCD. My goal is to give you clarity, so that you can navigate this rapidly changing therapy environment with confidence. Life is short, and it doesn’t need to be constantly spent trying to disprove your OCD thoughts, images, and urges. Instead, I hope that you will find a credible provider who can help you effectively manage OCD and I want you to feel like you can get your life back. The key is to find a qualified licensed therapist who specializes in OCD.
Here are five questions to ask your prospective therapist, so that you can find the right provider to help you conquer OCD:
Question 1: What type of treatment do you provide for people with OCD?
Answer: Exposure and Response Prevention (ERP) therapy is the go-to treatment, since it is the gold-standard, long-term therapy intervention for OCD. If your therapist answers this question with confidence, that’s likely a good sign. When doing ERP therapy, many OCD specialists will also integrate principles of mindfulness and acceptance commitment therapy. In addition to ERP, some people are prescribed SSRI medication to help them manage OCD symptoms, which eventually gets them to a place where they can do ERP therapy. Your therapist may bring up the benefits of taking medication for OCD. When considering SSRI medication, be sure to understand all of the potential side effects with your doctor.
Tips For Asking the Question: Be sure to not use the terms “Exposure and Response Prevention” or “ERP” in the question first. Instead, let your therapist state for themselves that they provide ERP. If you propose a leading question such as, “Do you use ERP for OCD?” your therapist might say they do (when they in fact don’t) to get your business. It’s pretty unethical, but it happens all of the time. Beware of the types of therapists who claim false speciality in OCD!
Question 2: What types of taboo intrusive thoughts have people with OCD shared with you in the past?
Answer: A true OCD specialist should offer at least a few interesting stories about OCD cases that may be considered taboo. In fact, he or she may even answer the question saying, “There isn’t an OCD thought that I haven’t heard before, so try me by sharing some of the ones that you’re experiencing.” Therapists who truly become specialized to treat OCD typically have a personality type that embraces discomfort. For example, NOCD’s Chief Clinical Officer, Dr. Patrick McGrath, worked with a patient who had violent intrusive thoughts. As part of his patient’s personalized ERP treatment plan, Dr. McGrath once conducted an exposure where he stood on a train platform and asked this patient to push him in front of a moving train, knowing that it would be a valuable exercise. (Dr. McGrath is fine and still with us today, as his patient did not push him into the train as his OCD made him fear he would. Instead, the exercise led to significant treatment gains for the patient).
Tips for Asking the Question: Let the therapist do most of the talking here. If the therapist broady talks about the hallmark symptoms of OCD or says something such as “Everyone has a little OCD,” watch out. However, if the therapist gets into the weeds and starts talking about the variety of subtypes that he or she has seen or shares stories related to taboo, aggressive, or sexual intrusive thoughts, you might have the right therapist in front of you.
Question 3: Have you received extra training to specifically treat OCD?
Answer: The therapist should say yes. In addition to being a licensed psychologist, social worker, marriage and family therapist, or counselor, a licensed therapist who specializes in OCD will have gone through additional training. For instance, true OCD specialists might have studied under a world-renowned OCD expert, completed a specific and reputable training such as the The Behavior Therapy Training Institute (BTTI), or worked within an ERP-specific treatment network.
Tips for Asking the Question: After asking this question, watch the expression of the therapist. If the therapist seems to be annoyed by the question, he or she might actually be defensive due to a lack of expertise. Or worse, they may be someone who has claimed false expertise in treating OCD. A true OCD specialist may actually commend you for asking the question and will likely be delighted to share more about their training.
Question 4: Can you help me make my intrusive thoughts, images, or urges go away?
Answer: The answer is no. The goal of OCD treatment isn’t to make your OCD thoughts, images, and urges go away; it’s to make sure that you can change your reaction to them, so that eventually they stop bothering you as much. A therapist whose expertise is treating OCD will explain this, while a therapist who doesn’t know as much might be more agreeable to the question and make false promises.
Tips for Asking the Question: You might want to ask for specific examples of how the prospective therapist helps people respond to their OCD thoughts. An experienced therapist might give examples of how he or she helps patients do “response prevention” even if they don’t say verbatim that it’s response prevention.
Question 5: When treating OCD, do you typically stay in an office setting, or do you venture out with your patients to additional locations?
Answer: Good OCD specialists will get creative with their treatment exercises, and many will go to different locations with you if possible. Telehealth has actually made it easier for therapists to venture out into the community with you, since the convenience of meeting with them over a screen means you can take them with you to other places to confront – and overcome – your fears and anxieties in your daily life. Therefore, it isn’t surprising to learn that many specialists believe that OCD is more effectively treated in a virtual environment.
Tips for Asking the Question: If the therapist avoids getting specific about some of their past treatment exercises, it might be a good idea to ask additional questions. In this case, you should consider specifically addressing the types of treatment exercises other patients with your subtype(s) have done in the past with the therapist. Although ERP therapy is the gold-standard treatment for all OCD subtypes, there are specific types of treatment exercises therapists often conduct for each subtype.
The good news about ERP treatment for OCD is that it’s proven to be effective. That’s why it’s critical to invest the time upfront to ensure that you find the right therapist who specializes in it.
Now that you’re equipped with the right questions to ask, you may be wondering if there is a good place to start your therapist search. The answer is yes. Although I’m biased since I’m the Co-founder and CEO of NOCD, I’d recommend starting your search by browsing the NOCD Therapist Directory. NOCD can guarantee that each therapist in our directory has been trained in ERP, and our world-renowned clinical leadership team invests in training and actively mentoring them. Further, NOCD Therapists have training to do personalized treatment exercises in a telehealth setting, and many accept insurance.
If NOCD Therapists aren’t the right fit for you, I’d recommend the International OCD Foundation Therapist Directory. The IOCDF is a nonprofit organization that is dedicated to helping people with OCD get treatment and live healthy. They do great work and also run training for OCD treatment for licensed therapists looking to treat OCD with ERP.
If none of these options work for you, or if you have already started with a therapist that you suspect might not be the right fit, you can leverage this five-question guide as a tool.
Good luck! I know that managing OCD isn’t easy, but with the right treatment I was able to get my life back and hope that you can, too.