HOW TO GET HELP

Obsessive Compulsive Disorder (OCD): Selecting the Right Therapist

By Frank Morelli, MA, LMHC
Used with permission of the author.

Frank Morelli is a Licensed Mental Health Counselor in Jacksonville, Florida, and president of  OCD Jacksonville. He is a cognitive behavioral therapist and a 2009 graduate of the Behavior Therapy Training Institute.  Mr. Morelli has been in private practice for over 25 years. He began treating OCD in the mid 1990s.

Across the nation, and here in northeast Florida, healthcare providers underserve the OCD community.

In 2004, Michael Jenike, M.D. reported in the New England Journal of Medicine, that most people with OCD spend, on average, nine years seeking treatment before getting an accurate diagnosis. Many will see up to four healthcare providers. The fact is most of us do not recognize OCD, even mental health professionals. Selecting the right therapist is crucial to a successful treatment outcome.

Many with OCD often share a common frustration with being misunderstood.  Some who have experienced counseling were told the cause of their OCD can be traced back to childhood, such as in unresolved trauma or loss.  Relationship counseling is the usual prescription. The goal of this therapy is to unblock impediments to personal growth.  The client with OCD who perceives this course of treatment is usually left feeling frustrated or even feeling worse.  Unfortunately, this is an all too common experience.

The International Obsessive Compulsive Foundation published a pamphlet in 2006 entitled “How Do I Know If My Therapist Can Treat Obsessive Compulsive Disorder?” It was written to help those with OCD to address the problem of selecting the right treatment provider. It contains questions for interviewing a prospective therapist to determine whether or not there is a correct understanding of what is required to adequately treat OCD. The essential component to good OCD treatment is Exposure and Response Prevention (ERP).

Although the cause of OCD is not exactly known, it does appears to be a biological disorder affecting brain circuitry and brain chemistry. Traditional talk therapy, which emphasizes examining underlying psychodynamic processes is typically ineffective in treating OCD.  The reason is that obsessions, and the fear that accompanies these intrusive thoughts, appear to be the result of a brain circuit problem, not unresolved conflicts. ERP is the only evidenced-based treatment that we know works for OCD.  ERP is a cognitive behavioral therapy.

The purpose of ERP is to reduce anxiety by exposing clients to their obsessive fears or discomfort, while simultatneously resisting the urge to act on compulsions. Compulsions have been termed safety seeking behaviors, neutralizing behaviors, or undoing behaviors.  Like obsessions, compulsions are repetitive in nature.  The client does them to seek relief.  The relief from escape is temporary at best, however.   Furthermore, it is the rewarding nature of escaping discomfort that is reinforcing.  In other words, this keeps the OCD cycle going.

It is hypothesized that ERP works because it makes use of the brain’s inherent ability to habituate to repeated over-exposure to stimuli.  The client gets used to their intrusive, unwanted thoughts.  The fearful or distressing idea behind the obsession gets neutralized:  a thought is just a thought.  The result is significant reduction in anxiety or its elimination altogether.  Under the guidance of a trained therapist, and with the support of others, clients gain confidence over their OCD and get back control of their lives.

Outcome studies show that 60 to 80 percent of patients who practice ERP receive significant relief from the distress caused by OCD. Treatment can be done without medication in many instances.   ERP teaches clients essential coping skills for maintaining recovery from OCD.  CBT helps those with OCD to reassess the importance they give to their thoughts, including the tendency to overestimate danger.  Family and couples counseling is viewed as an important component to treatment.  The objective is to help those with OCD live better, more fulfilling lives.  Selecting the right therapist for the job is necessary and essential to achieving this goal.

Looking for help? The International Obsessive Compulsive Foundation is a great resource for the consumer.  Here you will find information about books, treatment programs, and activities for those with OCD and their families.  All the best to you!