If you suffer from obsessive-compulsive disorder (OCD), the odds are good you experienced something similar to what I went through when I first started searching for a therapist. At the time, I was on campus at the State University of New York at Potsdam—basically killing time until my girlfriend finished up her Bachelor’s.
I started seeing a therapist at the college counseling center. I struggled with OCD and depression, and at my girlfriend’s encouragement, it was time to address it. The thing was, I didn’t know how to explain the often violent intrusive thoughts I had. In fact, I was embarrassed and ashamed to admit that I had them at all. I thought if I told anyone—girlfriend included—they would think I was crazy.
The therapist at the school was very nice, but I don’t think they got what I was saying. So, I got frustrated after a few sessions and didn’t go back. It took a divorce from that girlfriend, and almost five years, until I looked for a new therapist.
As it turns out, this is a very common experience with people suffering from OCD. On our end, we have concerns about talking about the intrusive thoughts and things we become obsessed with. On the therapist’s end, many are simply not properly trained in treating OCD.
Why finding an OCD specialist is so hard
There are a lot of reasons for this, but I’m going to give you five to get us started:
1. Most therapists don’t get enough—if any—training
Some therapists treat OCD as if it is a bad case of anxiety. Others try to address it entirely through talk therapy. In both cases, this is well intentioned, but it’s also the wrong way to treat OCD. Don’t blame the therapists though, it’s simply a lack of training. “I feel a big part of it is that most of us don’t learn anything about OCD or the best way to treat it in grad school,” says April Kilduff, MA, LCP, LMHC. She’s a licensed therapist and Clinical Trainer at NOCD, the leading virtual provider of specialized treatment for OCD.
In fact, it wasn’t too long ago that the DSM—the Diagnostic and Statistical Manual of Mental Disorders, which classifies mental health conditions—had OCD listed as an anxiety disorder, rather than its own condition that warranted different treatment. They’ve since fixed this, but there are generations of therapists who were given bad information about the condition.
I can tell you, the experience between seeing a therapist who is trained in OCD and someone who’s not is like night and day. “A talk therapist may hold on to the belief that they can ‘talk you out’ of something” says Patrick McGrath, PhD, NOCD’s Chief Clinical Officer. “I can talk you out of the obsession. They may tell you, Well, you don’t have to believe that. Or Stop thinking that, as opposed to seeing someone like me who specializes in OCD, and who will say to you, You’re afraid of that? OK. Cool. Let’s work on facing those fears together.”
More importantly, he adds, talk therapy is known to make OCD worse.
2. Specialized OCD training requires an extra commitment and education
Here at NOCD, our therapists spend at least three months just honing their skills about OCD before they see their first client, and even after that, they have ongoing training about the disorder and how to best manage it. A lot of therapists just don’t get this type of training, and can’t truly serve people suffering from OCD.
3. You might not know enough about your OCD
As a long-time OCD sufferer, I know that one of the most critical keys to finding a therapist is educating yourself about your condition. At first, I didn’t really know much about OCD except in a vague, general sense. It was only years later that I started actively reading about the subject. Once I did, I learned that I had treatment resistant depression, and that it was triggering my predisposition to OCD.
Once I understood that, I started to examine my symptoms, like the intrusive thoughts I had. Having all that information was worth it. The more you can educate yourself about your symptoms, the better you can understand what you need from a therapist. Not to mention, all that information can help you find the right therapist. For example, knowing the type of OCD you struggle with can help you determine what questions to ask when screening possible therapists to work with.
4. You might avoid seeking proper treatment because you feel scared or ashamed
Sadly, there’s still some stigma attached to OCD—and you may be afraid to reach out for help because you’re afraid of being judged or deemed “crazy” because of your intrusive thoughts. This is especially true is you have a subtype of OCD like pedophilia OCD, where you have repetitive fears about sexually harming children, or harm OCD, which involves fears about harming yourself or others. But the fact is that OCD therapists have seen it all and likely treated it all, and nothing is taboo to them.
5. The treatment you do get doesn’t work, and you give up
As Dr. McGrath says: “Many therapists are taught that when you are treating people who are anxious, you recommend things like diaphragmatic breathing, muscle relaxation, and coping strategies, and they will make the intrusive thoughts, images, feelings, sensations, and urges go away. Of course, no. Those things do not make them go away! It makes it worse actually, because those things very often turn into compulsions.”
According to Dr. McGrath, people with OCD will often see a therapist, not like what they hear, not feel helped, and then quit. Then, after an indeterminate amount of time—it took me almost eight years—they’ll try another therapist. This process will continue until they find a therapist that will hopefully be able to treat their OCD. In fact, research shows that it can take up to 17 years for some people to get a correct OCD diagnosis and treatment. (There are many reasons for this, but not finding the right therapist is definitely one of them.)
What is the proper form of treatment for OCD?
The most effective therapy for OCD is something called Exposure and Response Prevention (ERP). It’s considered the gold standard in treating people with OCD. It works by slowly exposing you to your intrusive thoughts, images, feelings, sensations, or urges, and then guiding you on how to avoid the compulsions that would typically follow. “The majority of people get better—so it’s highly effective,” says Kilduff.
Now, ERP isn’t a cure-all. But for so many, ERP—and sometimes even ERP paired with medication like an antidepressant—has proven time and time again to be one of the best forms of treatment. And by that I mean that it can get your obsessive thoughts and compulsions to a manageable level, or even to the point where your intrusive thoughts don’t bother you at all.
And once you get effective treatment for your OCD, not only will your symptoms be managed, you’ll be able to enjoy the things that matter most to you—the exact things that your OCD tried to erode.
“One of the things that helps,” says Kilduff, “Is that we always start ERP with very low level triggers. I call it pitching softballs for the first couple of times because we want you to practice your behaviors and get some easy wins. And once you have those easy wins and see how ERP works and how helpful it can be, then I think you’ll find the shift to fully approaching your OCD with ERP is a lot easier—especially if you’re someone who is used to talk therapy.”
After that, you can start taking on bigger and bigger challenges. And once you have those wins, your brain actually learns that there’s nothing really to fear, and your OCD will no longer rule you.
(Finally!) Finding the right OCD therapist
OK. You might be thinking, That sounds amazing. But how do I find a therapist that does ERP given everything you’ve just told me?
Here’s Kilduff’s advice: ”I would look at their website first of all. Look at what they treat, and what kind of modalities they use. If someone says they treat OCD on their website, but there’s no mention of ERP, that’s a red flag. Another thing you can do that I think a lot of people don’t realize, is to book a quick call or Zoom with a new therapist before going to an official session. Doing this is great because it helps you get a feel for the chemistry you have with the therapist, and you kind of get to interview them.”
She recommends asking questions like:
- Tell me about your experience treating OCD?
- How do you treat it? Do you use ERP?
- How many people have you treated with OCD?
- How many people with my subtype of OCD have you treated?”
- How has that treatment plan gone for your patients?
It’s worth underscoring: Make sure you find a therapist that uses ERP. If they don’t, it’s kind of like taking a car that needs repair to a hairstylist instead of a mechanic. Sure, the hairstylist may be able to help you figure out what’s wrong with the car, but they’re not going to be able to actually fix what’s wrong with it.
What results can you expect?
OCD can’t technically be cured, but it doesn’t have to make you feel awful. “You can expect to live the kind of life you want to live, as opposed to the kind of life your OCD wants you to live,” says Dr. McGrath.
And I agree with that assessment. If OCD does anything, it eats time. Getting your OCD under control gives you that time back. “It isn’t that you’ll never have an intrusive thought, because you will,” explains McGrath. “But it doesn’t mean you have to do anything with it. It can just be there. It’s about not caring that you have that thought, image, feeling, sensation, or urge in the first place.” Kilduff adds: “You can go on to live a life where you have some obsessions or triggers in the background, but you don’t need to engage with them.”
Take it from me, getting those thoughts in the background and out of the foreground of your life? That alone is life changing.