What to know when finding a therapist for OCD – Advice from experts

Finding a qualified, specialized therapist for OCD—even more, finding the right therapist for you—might be a daunting task. Living with OCD is overwhelming enough as it is! But you’re not alone: identifying an experienced professional who can diagnose and effectively treat OCD is a challenge for many people and their loved ones.

I know this firsthand. As someone with OCD, it took me a long time—and no small amount of stress—to find the right clinician. I want to share what I’ve learned, with expert insight from Keara Valentine, PsyD, a clinical assistant professor at Stanford University School of Medicine, who specializes in the assessment and treatment of OCD and related disorders, and April Kilduff, MA, LCPC, LMHC, Clinical Trainer at NOCD. Their goal is to make your path to recovery a little easier.

Did you know that, on average, it takes someone with OCD between 14 and 17 years to get an accurate diagnosis and proper treatment? There are a lot of reasons for this: A clinician who isn’t well versed in OCD might not spot it right away, shame and stigma could keep them from seeking help in the first place, or OCD could be misdiagnosed as another type of mental health condition. 

And even after OCD is diagnosed, research suggests that it can take nearly a year and a half before it’s actually treated. In addition to shame, stigma, and fear, there can be long wait lists for in-person therapy. If you think you may have OCD, though, you don’t have to wait to seek help, since virtual treatment is just as effective as in-person therapy. And with this expert guidance, getting access to the right therapist can be a lot easier (and even more affordable) than you think. 

Why OCD requires specialized treatment 

The most important thing you should know is that getting your OCD under control takes a unique kind of therapy. And this is due to how the condition actually works: OCD consists of obsessions—which are intrusive thoughts, images, urges, sensations, and feelings that cause extreme distress—and mental or physical behaviors, or compulsions, that are done in the hopes of relieving that distress, and/or to prevent a feared thing from happening. 

These primary symptoms create a vicious cycle: when you respond to the fear and distress of obsessions by engaging in compulsions, you don’t keep your intrusive thoughts and fears from coming back in the future. In fact, these compulsions make it more and more likely that obsessions will return—and as the cycle continues, the symptoms keep getting worse. 

The gold standard, evidence-based therapy to treat this disorder is exposure and response prevention therapy (ERP). OCD does not respond well to traditional talk therapy or other popular forms of therapy. In fact, they can even make OCD worse. 

How? Because if you have OCD, talking through your intrusive thoughts—what might be causing them, how to make sense of them—can lend more weight to them and make you focus on them more. In short, non-specialized talk therapy can keep you stuck doing compulsions like rumination, reassurance-seeking, and mental checking, which only make your obsessions stronger. 

ERP therapy, on the other hand, teaches you to not attach meaning to your intrusive thoughts and learn to just let them go. So if you’re seeing a therapist for another condition, it’s critical to find out if they’re trained in ERP. If they’re not, look for one that is. 

Important note here: ERP falls under the category of another type of therapy called cognitive behavioral therapy (CBT), but they’re not the same in how they help manage OCD. So if a prospective therapist says they use CBT, make sure to ask if it’s ERP specifically—this is a really important distinction for OCD treatment to be effective. 

Know the type of professional you need

There are several types of licensed mental health professionals who are qualified to treat OCD. These include psychologists, licensed clinical social workers (LCSWs), licensed marriage and family therapists (LMFTs), licensed professional counselors (LPCs), and psychiatrists, who can prescribe medication. But there are many, many different specific credentials that qualified OCD specialists may have attached to their names—the most important part is their specialized training in treating OCD.

“While all of these types of mental health professionals have different backgrounds and education levels, it’s important to remember that none are necessarily better or worse at treating OCD. A specific degree matters far less than your therapist’s overall experience level and specific background in relation to OCD—and how comfortable you feel with them,” Dr. Valentine says.

What questions should you ask a potential OCD therapist?

Most treatment providers offer free 10-15 minute consultation calls (like we do here at NOCD) where you can ask questions, get payment and insurance information, and go over anything else you need to know before getting started. You can go through all of this during your first appointment. Perhaps you can think of the first conversation sort of like a first date: you’ll want to stay curious and pay close attention to the information you’re getting.

Here are some things you should find out:

1. Do you use exposure and response prevention therapy (ERP)?

Because of the evidence showing how effective ERP can be at treating OCD, Kilduff says this is the first question she recommends asking. ERP should be the frontline method used by any provider who specializes in treatmenting OCD. Your clinician may incorporate other strategies, too, such as Accceptance Commitment Therapy (ACT) or medication, if needed. (Although a majority of people with OCD do well with ERP alone)—but again, if they don’t mention ERP, that’s a major red flag.

2. How much experience do you have treating OCD?

Kilduff notes that if a therapist has only treated a few clients with OCD—versus 

dozens or hundreds of them—that’s important to know. It doesn’t mean you shouldn’t see an early-career, or new-to-OCD therapist, but it is something to be aware of when deciding whether or not they’re right for you.

3. What themes of OCD have you treated?

All themes of OCD, whether it’s focused on contamination, your relationship, being a bad person, or something else, are treated the same way, so this doesn’t necessarily have to be a dealbreaker for you. However, each theme has its own unique challenges. It might be important to you that a therapist recognizes and knows how to navigate what you’re struggling with, especially if the theme is one that you might find taboo or sensitive. 

For example, there’s a theme of OCD called pedophilia OCD, where you may worry that you’re secretly attracted to children. These unwanted, intrusive thoughts can feel especially shameful—even though they’re really no different from any other intrusive thought.

“Simply knowing that a therapist has worked with your specific theme before can go a long way in lessening shame and helping you feel more comfortable,” says Kilduff. 

4. How would you describe your approach to the client-therapist relationship?

Research suggests that one of the biggest predictors of treatment success is having a good relationship with your therapist. “You need to have a collaborative alliance to do the hard work of OCD treatment,” says Kilduff. “Having a solid relationship as your foundation is going to lead to better treatment experiences and outcomes.”

You need to feel free to be open and honest with your therapist. So ask yourself: What are the qualities that make you feel safe? Do you want someone who is especially warm and kind? Or do you prefer someone who is empathetic, but has a more direct, tough-love attitude? Considering these questions can help you find someone you truly click with. 

5. Do you treat conditions that might co-occur with OCD?

OCD has a high comorbidity rate—meaning that it can occur at the same time as another condition, such as anxiety or depression. It might be important to you to be able to work with a therapist on things that aren’t strictly about OCD. This is another point that’s not necessarily a deal breaker, but could be depending on your personal needs.

6. Are you comfortable working with varying identities—such as race, sexual orientation, religion, and socioeconomic status? 

If a therapist has never helped someone who holds an identity that you do, 

you may want to know that. And it’s worth asking how they approach working with someone who holds your identity. 

Your identity intersects with your life experience, including your mental health, so you want to ensure that your therapist can acknowledge, uplift, and listen to your perspective. A good therapist will understand why you’re interested in their answer to this. If they seem standoffish or annoyed by questions regarding identity, you should probably keep looking.

Are there any other red flags to watch out for in an OCD therapist?

I mentioned one red flag—which is if a therapist doesn’t use ERP. But here are some others to be on the lookout for either in an initial consultation call or during your first few sessions together:

• If they’re strongly against the use of medication, and you’d like to consider it as an option.
• If they seem annoyed that you’re asking questions during a consultation call, or like they want to get through it as quickly as possible. All therapists should understand the importance of clients finding their best fit and not take questions personally.
• If their words or actions make you feel negatively judged. Your therapist may provide insight into your actions that you are unable to see, but it should always be with a tone of empathy and support.
• If they say or do anything that crosses personal or professional boundaries. Therapy is personal, of course, but your therapist shouldn’t make you feel uncomfortable, taken advantage of, or disregarded.
• If they provide you with reassurance—like repeatedly telling you Everything’s going to be okay! Of course you would never actually do that thing you’re scared of doing! Don’t worry, it’s just OCD!—instead of letting you sit with discomfort. Learning to be uncomfortable is an integral part of ERP. “OCD therapists are trained to be comfortable with patients’ discomfort, and your therapist isn’t there to rescue you from your feelings,” Dr. Valentine explains.
• If they seem bored, annoyed, or particularly tired during your sessions. Yes, your therapist is human and is bound to have bad days like anyone else, but it is their job to remain engaged during sessions.
• If they don’t seem interested in learning as much as possible about your specific experience of OCD. Your therapist should treat you like a whole, complex person—not just a diagnosis. No two experiences of any condition are exactly the same, and it’s important for your treatment to be highly specific to you in order for it to be successful.
• If they claim to treat everything. Kilduff says this is often an indication that they don’t really have that specialization in OCD that you need, and are probably more of a general counselor.
• If they claim they can “cure” your OCD for good. While you can make vast improvements and get to a place where OCD doesn’t interrupt your day-to-day life, you can’t necessarily be cured of OCD—it’s considered a chronic condition.

Keep in mind that you may not “click” with your therapist immediately. It can take three or four sessions to really know whether they’re a good fit. The above factors, though, may immediately signal to you that it’s not going to work.

Do try to make sure that you’re not confusing your discomfort addressing your OCD with discomfort about the therapist themself. A good therapist will make you feel at ease with them, but they will also gently push you to leave your comfort zone and tackle your fears.

If you do decide to switch providers, your therapist may be able to refer you to someone else so you don’t have to go all the way back to square one. If your current clinician is part of a practice or company involving other specialized therapists, the organization may already have a process for transferring clinicians smoothly—like we do at NOCD.

Can I get virtual treatment for OCD?

Yes! Both Dr. Valentine and Kilduff have successfully treated many clients in a virtual setting. It can be even more convenient, and very effective.

In fact, a recent peer-reviewed study in the Journal of Medical Internet Research that examined the effectiveness of virtual ERP therapy found that treatment was equally effective and can get results even faster than traditional in-person ERP for many patients.

Virtual treatment allows you to perform therapist-assisted ERP at home or other settings where your triggers may be rather than in a therapist’s office. This means that—with your therapist’s support—you can face your fears in real time as they arise, making it more applicable to your daily challenges. 

Plus, for some people, in-person treatment isn’t always an option due to the severity of their symptoms or a lack of available resources in their area. Virtual treatment eliminates that barrier and allows more people to receive quality care. There are some people who do best with in-person treatment, however, so it’s important to consider your own needs. 

Personally, I enjoy the ease and accessibility of virtual therapy. There’s something about not having to drive or walk to an office that makes the process feel easier and makes me more likely to do it. 

Whether you choose to pursue online or in-person therapy, I hope you begin or continue your therapist search with a little more guidance and a little less stress. There’s a good fit out there for you somewhere, ready to help you conquer OCD.