If you are ready to get treatment for your OCD, congratulations on starting this important journey! Your first step will be to find a therapist.
A therapist is someone who works in the mental health field and provides therapy as a treatment. Therapists can have doctoral degrees (including PhD, PsyD, EdD) or masters degrees (including MSW, MA, MS), and can be in disciplines such as psychology, social work, counseling, and marriage and family therapy. This describes the main backgrounds and titles for therapists in the United States - depending on where in the world you live, there may be other professional titles and backgrounds that are able to help you.
Therapists have different types of education and training, but there's no inherent benefit or drawback to seeing one type over another. All types of therapists, whether they have a doctorate or a masters, are trained to do this work and are qualified to help you.
While there are many therapists to choose from, finding one who can diagnose and effectively treat OCD can be a challenge for many patients and families. Some estimates indicate that it can take up to 14–17 years from the onset of symptoms for a person to get an appropriate diagnosis and effective treatment for OCD. One reason for this delay is the difficulty in finding a local therapist who can effectively diagnose and treat OCD.
Why the Delay?
- Not enough public awareness of OCD.
- Until recently, many people did not know there was even a name for their disorder and with no name, they assumed there was no treatment.
- Stigma.
- Some people choose to hide their symptoms, often in fear of embarrassment or stigma. This causes many people with OCD to not seek the help of a mental health professional until many years after the onset of symptoms.
- Lack of proper training for mental health professionals.
- People with OCD often get the wrong initial diagnosis from mental health professionals and may wind up seeing many doctors and therapists over the course of several years before finally getting the right diagnosis.
- Difficulty finding local therapists who can effectively treat OCD.
- Most therapists do not receive training on how to work with OCD and related disorders as part of their graduate education and training. They therefore must seek out additional training themselves.
- Not being able to afford proper treatment.
- Specialized OCD treatment is often not covered by insurance, leading to expensive out of pocket costs.
Effective Treatment for OCD
The 2013 APA Practice Guideline for the Treatment of Patients with Obsessive Compulsive Disorder recommends beginning OCD treatment with a type of cognitive behavior therapy (CBT) called exposure and response prevention (ERP), which has the strongest evidence supporting its use in the treatment of OCD. When you search for a therapist in the IOCDF Resource Directory, all of the therapists that come up in the search will have self-reported that they use this therapy to treat OCD.
There are other types of treatment with promising research backing that can help with OCD symptoms. Acceptance and commitment therapy (ACT) used alongside ERP, for example, has also been shown to be helpful with OCD patients. Read more about acceptance and commitment therapy (ACT). Other examples can include Supportive Parenting for Anxious Childhood Emotions (SPACE), metacognitive therapies, etc. You can read more about emerging treatments and what to avoid on our “From the Experts” pages.
Tips for Finding the Right Therapist
There are many factors to consider when choosing the right therapist. In addition to the practical matters, such as whether they accept your insurance, whether their office location is convenient for you, and so on, you also need to make sure that your new therapist is someone who you will feel comfortable working with.
Also, remember that some therapists are better at treating OCD than others. It is important to interview therapists to find out if they know how to do exposure and response prevention (ERP) therapy well. Your initial consultation may be done over the phone or in person.
Mental health professionals are also increasingly providing their services via video conferencing or over the phone, a practice called "teletherapy." Find a teletherapy provider in your state.
Whichever way you receive your OCD treatment, remember:
- You have the right to ask questions. This is your life and mental health!
- If the therapist is guarded, withholds information, or becomes angry at your requests for information, you should probably look elsewhere.
- If the therapist appreciates how important a decision this is for you and is open, friendly, and knowledgeable, you may have a gem of a therapist!
- Your relationship with the therapist is important, especially since they will potentially be asking you to do things that you find uncomfortable as part of your treatment.
Here are some good questions to ask as you consider whether the therapist is a good fit:
- “What techniques do you use to treat OCD?”
If the therapist is vague or does not mention cognitive behavior therapy (CBT), exposure and response prevention (ERP), or other evidence-based treatments, use caution. - “Are you familiar with exposure and response prevention to treat OCD?”
Be cautious of therapists who say they use CBT but won’t be more specific. - “What is your training and background in treating OCD?"
Training backgrounds and licensing titles for mental health professionals that treat OCD can look different, as described at the beginning of this page. You might even want to consider seeking a pre-licensed trainee that works directly under the supervision of a specialist. In the end, the important thing is to ask about their familiarity with OCD and treating it following evidence-based practices.
Some positive signs that can help you learn more about a therapist’s training:
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- They are a member of the International OCD Foundation (IOCDF)
- They are a member of the Association for Behavioral and Cognitive Therapies (ABCT)
- Have they attended specialized workshops focused on OCD and its treatment, like the one offered by the IOCDF’s Behavior Therapy Training Institute (BTTI)?
- Have they ever attended the Annual OCD Conference?
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- “How much of your practice currently involves OCD?”
A good answer would be over 25%, as this likely means they have a specialty in working with OCD. That said, if they answer your other questions to your satisfaction, don’t let a low number or percentage prevent you from seeing them. - “Do you feel that you have been effective in your treatment of OCD?”
This should be an unqualified “Yes.” - “What is your attitude towards medication in the treatment of OCD?”
If they are negative about medication, this is a bad sign. While not for everyone, medication can be a very effective treatment for OCD. Learn more about OCD medication and their dosages. - “Are you willing to leave your office if needed to do exposure work?”
It is sometimes necessary to go out of the office to do effective ERP, so the answer should be “Yes.” If they say “No,” ask them “How come?” to figure out what limitations they may have and how they might be able to work within or around them to support your treatment journey. - "Do you include families in any of the treatment?"
OCD can be very isolating, and also may involve or otherwise heavily impact the family. Parents/guardians, caretakers, and other family members are an important part of a person's OCD treatment, and should be involved in many ways. The therapist should be open to including family members as part of the treatment plan and team. - "Have you received cultural competence training or taken courses on issues surrounding race, ethnicity, or culture?"
Use caution if the therapist is vague or says they have not pursued opportunities to do so. - "Are you or members of your staff bilingual? If not, have you received appropriate training in working with interpreters?"
If you or a family member speak a language other than English, use caution. - "Do you have experience treating people who look/identify like me?"
The answer should be “Yes.” - "How would you include aspects of my cultural identity, such as age, faith, gender, race, or sexual orientation, in my care?"
Symptoms of OCD, and treatment recommendations, can vary across cultures. The therapist should be able to state examples of how they will take a culturally mindful approach to provide services to you/your family.
Search the Resource Directory for a therapist today.
These tips have been adapted from “How to Choose a Behavior Therapist” by Michael Jenike, MD