Imagine Taylor, a young woman with OCD. As her senior year of college got more stressful, she started experiencing intrusive thoughts out of the blue—images of self-harm, thoughts about harm coming to her family, and disturbing thoughts about people she passed on the street. She couldn’t seem to stop thinking about these horrible things and became consumed by fear that she was becoming a violent person and losing the parts of her identity that she valued the most.
Taylor reaches out to her primary care physician, who indicates that her symptoms may be a result of OCD, but can’t refer her to any specialists in-network. She researches more about OCD online and finds a couple of therapists in her insurance plan’s directory. One of them mentions that they have experience treating OCD. They list over a dozen conditions that they can treat, so Taylor doesn’t know whether she should be impressed or suspicious; however, she feels like she simply doesn’t have any other options, so she books an appointment online.
In her first session, her therapist says that they will be working together to figure out the root cause of her intrusive thoughts so that they can stop coming back in the future. He also mentions that there’s no need to worry: he can personally guarantee that Taylor isn’t a bad or violent person, and that she could never harm herself or others. By figuring out where her thoughts come from, he says, they’ll stop coming back, and she won’t be plagued by any doubts about herself—essentially, she’ll be “cured.”
Hearing all of this makes Taylor feel a lot better as she leaves her first session, but later that evening, her thoughts return. In response, Taylor digs into them, trying to figure out what they mean, and repeatedly tells herself what her therapist told her: “There’s no need to worry, I could never, ever do that.” This happens almost daily; Taylor’s intrusive thoughts strike, she’s seized with anxiety, and she reassures herself to calm down, often going somewhere to be by herself.
All along, Taylor’s therapist encourages her, telling her that she’s doing exactly what she needs to do to get better, and that eventually, her thoughts will stop. Taylor is concerned: why doesn’t she feel any better? In fact, things have been getting worse. More and more, Taylor confines herself to her room, because whenever she’s around others, her thoughts strike and she gets lost in her head, trying to figure out her thoughts and reassure herself. She skips class when she has a particularly disturbing thought. She skips meals. She finds that she can’t even watch TV—what if her thoughts are even worse then? Eventually, she has to take a leave of absence from school. She simply can’t keep up, no matter how hard she tries to force her thoughts away.
False claims are all too common
OCD is one of the most widely misunderstood mental health conditions out there. The general public tends to think of OCD as nothing more than a personality quirk, or a set of personal characteristics that can benefit one’s life. Unfortunately, it’s also commonly misunderstood and underserved in clinical settings, as well, as many mental health professionals claim that they can treat OCD, without actually receiving the specialty training needed to treat OCD effectively. In fact, studies have shown that people with OCD spend an average of 14-17 years with the condition before starting effective treatment. Experiences like Taylor’s are shockingly common in the OCD community.
As a result, many people with OCD may start to feel hopeless about ever getting better. Sadly, many people with OCD who are able to find the courage to try a different provider can wind up in the same spot—working with another clinician who is unsure how to treat them and makes their symptoms worse.
So how can you tell if your therapist actually specializes in OCD? Here are 5 ways you can find out:
Do they have knowledge about how exposure and response prevention (ERP) therapy works and training in treating OCD with ERP?
The truth is that though other forms of therapy may provide short-term relief, it is not likely that they provide long-term relief for OCD. The gold-standard and research-based treatment of ERP is what is recommended for the treatment of OCD. ERP was developed specifically to provide long-term symptom management and relief from OCD, and is backed by decades of clinical research proving its effectiveness.
Licensed therapists who truly specialize in OCD are ERP therapy experts and have received the specialty training needed to treat all subtypes of OCD with ERP. When you meet any therapist to seek treatment for OCD, ask them about their ERP training, inquire about how ERP works, or talk with them about potential exposure exercises they might do to help someone with your OCD symptoms. If they are unable to help you understand how ERP breaks the OCD cycle, and they can’t give you concrete examples of how you might do ERP together, they probably won’t be able to treat you effectively.
Do they claim that OCD can be “cured”?
The providers whom you entrust with your treatment should not only have a firm understanding of ERP therapy, but they should also recognize the chronic nature of OCD. It sounds straightforward, but it’s unfortunately common to see people who are unlicensed, unqualified, or improperly trained market services aimed to “cure” OCD.
OCD is highly treatable and can be managed effectively with proper treatment, and many people who have gone through ERP therapy report that their intrusive thoughts and/or continuing symptoms occur much less frequently and no longer interfere with their day-to-day functioning or cause them significant distress. That being said, there is no evidence to suggest that OCD can be fully cured—any clinician who markets a miracle cure should be viewed with skepticism.
Do they provide reassurance about your obsessions?
Therapists who specialize in OCD and ERP will be highly empathetic to the struggles of people with OCD, but they also recognize that providing reassurance about one’s obsessions only feeds them over time, as OCD demands 100% certainty about questions where doubt will always persist. Refusing to offer you reassurance about your obsessions (e.g., “You could never hurt your pet! There’s no need to worry”) may cause discomfort and uncertainty, but it is necessary to help you learn that you can tolerate discomfort and uncertainty, which is the key to managing OCD in the long term.
On the other hand, therapists falsely claiming expertise in OCD will give in to the requests of their patients and consistently offer reassurance, because they don’t truly understand how recovery from OCD is achieved. They may mean well, but seeking reassurance becomes compulsive and inadvertently reinforces OCD over time. Try to observe the amount of time your therapist spends talking with you about your OCD fears vs. practicing exercises to teach you how to resist compulsions and respond to them effectively.
Do they want you to practice thought-stopping techniques?
When you have OCD, the issue isn’t your thoughts; the problem is the meaning that you attach to a thought, and the way you respond to it. OCD tries to convince you that you wouldn’t have had an intrusive thought if it didn’t mean something. The truth is, that everyone has intrusive thoughts, and most people without OCD are able to dismiss them as insignificant. People with OCD, however, get stuck on them, find meaning in them, and feel the urge to engage with them.
That’s why you should steer clear of thought-stopping or thought-replacement techniques to treat OCD: you’ll never be able to fully stop or replace intrusive thoughts. Everyone has them. Instead, by learning to respond to intrusive thoughts differently when they occur, you can manage OCD long-term.
Do they urge you to “figure out” your intrusive thoughts?
Your therapist may suggest talk therapy, where you try to challenge your intrusive thoughts, focusing on negative thought patterns. In doing so, they encourage you to explore the meaning behind the thoughts, or even argue with the thoughts. In essence, they want you to recognize that the thoughts are illogical.
The problem is that you already know that when you have OCD. Someone who is a specialist in OCD knows that engaging with or trying to argue with the thoughts will only make them come back again and again, and can never satisfy the certainty that OCD demands. If your provider is “digging” for meaning in your thoughts or trying to “figure them out,” this should be a wake-up call to seek another source of help.
Get treatment from a therapist who specializes in OCD
The good news is that today, effective treatment with a therapist who truly specializes in OCD is more accessible than ever before, and overall awareness of what OCD is really like is increasing. If you are struggling with OCD and need to work with a licensed therapist with specialty training, there’s no better time than right now.
ERP treatment teaches you to respond to your fears without responding to a thought, image, urge, or feeling by performing compulsions. In ERP, a therapist guides you through exposures that trigger your fear and anxiety and helps you learn to sit in the discomfort that this causes. Over time, you’ll begin to recognize that you can handle distress and accept uncertainty about your fears, even though you may not like it.
At NOCD, we have licensed therapists who can work with therapy members in all 50 states and outside the US. Every NOCD Therapist has received specialty training in treating OCD with ERP therapy, from clinicians who designed some of the world’s leading OCD treatment programs. If you are struggling with OCD and think you may benefit from ERP therapy, schedule a free 15-minute call to speak to someone on the NOCD Care Team. They can answer all of your questions about starting treatment, getting matched with a qualified and licensed OCD specialist, and more.