Should I switch OCD therapists? How to approach this difficult decision

Like any important relationship, you and your therapist can go through mini ups and downs. Hey, we’re all human, and some days—and sessions—are better than others. The thing is that regardless of where you are in your mental health journey, you should always feel rock solid that your therapist has your back, and that you’re continuing to see progress.

But what if you’re not, or even if you’re not sure that you’ve found the right fit for you? It’s not always easy to know. And you could feel conflicted. After all, you’ve invested time and bared your soul to this person. So: What’s the best way to know that it’s really time to move on and switch therapists? Also, how can you communicate your needs, and make sure you find a better match the next time?

Here are some things to consider.

Make sure it’s the therapist, and not the therapy

The gold standard treatment for people with OCD is exposure and response prevention, or ERP. Most people—no matter the subtype of OCD they have—respond well to this type of therapy. It involves working with your clinician to slowly face and confront the fears that are driving your compulsions. That’s the “E,” or exposure part of the therapy. This process is inherently a little uncomfortable. The goal is to evoke the feelings that cause you distress, learn to sit with them, and then change your response by not engaging in compulsions. 

As you consider whether your therapist is right for you, make sure you think about the origin of your negative or uncomfortable emotions. Meaning that they’re truly coming from your relationship with your therapist, and aren’t due to feelings from intentionally stirring up prickly emotions, since that’s the goal of ERP. 

“A good ERP therapist will prepare you to expect that the therapy in and of itself is intended to evoke some amount of distress,” says Nicholas Farrell, PhD, a licensed clinical therapist, and Regional Clinical Director at NOCD who specializes in OCD treatment. “If there’s no discomfort—or too much discomfort—that’s an indication the treatment is not working or not being done well.”

He explains that ERP can be looked at as akin to physical therapy. A physical therapist will tell you that when you start doing things like bending your knee, or rotating your shoulder, you can expect that it’s going to cause some pain. But with time, that pain will gradually dissipate—and most importantly, you’ll start to feel better, and gain your full range of motion back. 

The point here is that you want to know that your clinician is in your corner, says Dr. Farrell, and not that they’re rescuing you from distress. You need to feel that emotion to move forward.

Although it doesn’t happen often, he notes that the most common reasons clients switch therapists are when they don’t feel they’re being understood by their therapist, or that they aren’t really keyed into their lived experience. If that happens, the treatment can feel off. 

“The therapist’s strategies and suggestions, while not inappropriate, may be wide of the mark, and not address the specific feared issues or areas of your life that are most affected,”

says Dr. Farrell. 

One more good reason to seek a new therapist: If you’re not currently seeing someone who is an expert in ERP. That in itself is an important reason to make a switch.

Before you break up, bring it up

There’s actually a technical term for that icky feeling when it’s just not working: It’s called “alliance rupture.” It’s used to describe a situation when there’s been some detraction from the quality of the therapist-client relationship.

“We can feel it, and clients can feel it,” says Dr. Farrell. “So what we try to encourage is if an alliance rupture occurs, that it not necessarily be viewed as a deal breaker or a catastrophe.” 

In some cases, he adds, these weird feelings can just be the result of a miscommunication or misunderstanding: “Maybe your therapist explained a concept in a certain way that ruffled feathers and the client says, ‘When you explained this to me, I was pretty offended.’ And the therapist can say, ‘Oh, I get it. I can see how I explained it inappropriately. Let me try to clarify.’” 

Yes, it can be awkward and uncomfortable to directly address a rift, but it gives your therapist the opportunity to fix the rupture or explain the misunderstanding. You’re the boss though – if the explanation satisfies you, great. If not, you’ve communicated your feelings, and you can choose to move on.

The best way to break up

If you’ve determined that it’s time to make a move, your next step is, of course, letting your current therapist know. And the best way to do that comes down to personal choice: 

• Face to face: A live conversation is always the best way to transition, but can also sometimes be potentially challenging and a source of distress. So think about what feels best for you.

• Send them a message: If a live conversation doesn’t feel right, or like it would be too much, you can also send them a message, whether it’s via email, text or within your providers’ app. In your note, clearly explain your feelings and that it’s time for you to move on.

In either case, just know that your therapist will understand and won’t be wounded or hurt. It happens!

How can I find the right therapist the next time?

Your next goal is to find the right new therapy partner. What should you look for? The International OCD Foundation suggests asking potential therapists these questions (among others):

• “What techniques do you use to treat OCD?” Make sure the answer is ERP, and not talk therapy, which has not been shown to be effective treating OCD.
• “What is your training and background treating OCD? Look for a therapist who has either a doctoral degree (PhD, PsyD, EdD) or a master’s degree (MSW, MA, MS) in their field. Make sure you are satisfied with how long they have been treating OCD patients. 
• “How much of your practice currently involves OCD?” According to the International OCD Foundation, a good answer is “more than 25%” 
• “Do you have experience treating people who look/identify like me?”

You want the answer here to be “yes” of course including an explanation of their experience.

See the full list of suggested interview questions from the International OCD Foundation

After you’ve established the basics, now it’s about how well you get along. “Finding the right therapist, provided they have the right training, is about a good connection and working relationship with that person,” says Dr. Farrell. “You feel comfortable confiding in them, even when it comes to things that might be sensitive or embarrassing to you. You want a sense of trust, and to feel supported—not judged—and that your therapist truly, deeply understands what you’re going through.”