Using Evidence-Based Therapy

graphBeyond OCD recently linked to this eye-opening article in the New York Times called “Looking for Evidence That Therapy Works.” It states that while the evidence-based treatment known as cognitive behavioral therapy (CBT) has been shown to be effective in treating many disorders, including OCD, the majority of therapists only use CBT occasionally, or in conjunction with other therapies. It’s not that they don’t know about the documented benefits of CBT, it’s that they view their craft as an art, where they individualize treatment depending on their own personalities and their relationships with their patients.

I find this highly disturbing. While establishing a good rapport with a patient is important, a good relationship in conjunction with the wrong therapy won’t help an OCD sufferer, and may very well be harmful. In my opinion, it’s similar to having cancer that is highly treatable, only to have your oncologist forge ahead on a new, unproven treatment path.

It’s interesting that, according to the article, “every clinician overestimates how well they [themselves] are doing.” In many cases, patients are not honest with their therapist. For example, instead of letting their therapist know they are doing poorly, they will simply say they’re fine and are done with treatment. They will then leave and look for another therapist. My son Dan’s first therapist did not use Exposure Response Prevention Therapy (the CBT used to treat OCD), yet I’m sure this therapist thought he was still helping Dan. We all did. It wasn’t until his OCD became severe, and I became more knowledgeable, that we realized the therapist had gotten it wrong. By then he had retired, so I never got the chance to talk with him about it. So yes, he is one of the many clinicians who overestimated his success.

I certainly don’t want to paint a negative picture of all therapists, as there are so many dedicated, caring, professionals out there who go above and beyond what is expected of them to try to help their patients. These therapists recognize their obligation to be aware of, and implement, evidence-based therapy whenever possible. If they are not well-trained in the appropriate therapy, they realize it is their responsibility to refer their patient to someone who is.

I am aware that many OCD sufferers also struggle with depression, additional anxiety disorders, or other mental health issues. Certainly these comorbid conditions  have the potential to complicate the path to recovery. That is just one of the many reasons why those with OCD should seek out therapists who specialize in treating their disorder.

How do we find these therapists, these specialists who use or at least work toward using evidence-based therapy? At the end of the article, the author proposes some great questions to ask potential therapists. I highly recommend reading it in its entirety, or at the very least, checking out the list of questions. With the right therapist and the right therapy, recovery from OCD is absolutely possible.

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22 Responses to Using Evidence-Based Therapy

  1. 71º & Sunny says:

    Great post, Janet. Wow, that really bugs me that a lot of therapists try to tailor their therapy based on the particular client, rather than stick with evidence based therapy. Yeah, sure, all therapy should be tweaked a bit based on each patient and their particular obsessions, but really, the base of the therapy should be the same. It does feel like an uphill battle fighting for OCD patients when even the docs don’t always get it.

  2. Janet, this is disturbing, to learn that the knowledge of the therapy is there, and perhaps even the ability to use it, and yet–it’s not being used where it might be helpful.

    I wonder if some of the overestimating done by clinicians is due in part to patients (and I’ve been one of them) who want to be “good patients” and go along with whatever route the therapist wants to take. So they don’t speak up and tell the therapist that he/she is not helping.

    The therapist/patient relationship is tough, I’ve found. And it really does complicate matters to have different diagnoses to deal with. My own therapy changed course when we started working on the chronic depression more than the OCD. I still don’t know if that was a good idea.

    • Excellent point, Tina. My guess is you are right about patients with OCD wanting to be “good.” Also, I know therapy is more complicated to implement than to write about, but I was still surprised by the study. I just always thought therapists didn’t use ERP because they simply weren’t familiar with it….

    • 71º & Sunny says:

      Awesome point, Tina. I agree – often times we patients are trying to be compliant and don’t always tell our docs when something’s not really working. I’ve been guilty of that for sure.

  3. grannyK says:

    I’m glad I found your blog. I can so relate to and learn from you! I nominated you for the versatile blogger award. Accept if you are so inclined.

    • Thank you so much for your kind words as well as the award, grannyK! I am truly flattered, but I decided a while ago not to participate in any awards, mainly because I have such little time. But thanks, and I hope to hear from you again…..

  4. rachel bar says:

    Inasmuch as everything in this post is true, it’s important to remember that just like you call a friend and ask for references when you want a dermatologist, so should you when looking for a therapist. There are good ones and bad ones and mostly mediocare ones. There should be due diligence on the part of the patient as well. When I had some illness, I did an extensive research on the illness and about people who specialized in it.

    Unfortunately, therapists are endowed with mythical power by patients, which in turn inflates their ego, and then they can become lazy. Actually, many therapists stop research and learning once they get licensed.

    And as to ERP as the only way for OCD, that’s also a bold assumption. ERP works for patients who are willing to engage in it. There are many OCD patients that would rather continue with their obsession than confront it. And another point: The treatment of PTSD for instance went through many cycles, systems and modalities. Today there are at least 8 approaches, each one is good and effective and should be used based on patients’ preferences. So should OCD. I used hypnosis which worked quite well with some and not so well with others, who responded very well to ERP. So as we often say: It’s complicated!

    I love the fact that this blog exist and that you are providing such important info.

    • Thank you for your insight, Rachel. I totally agree as much research as possible should be done before choosing a therapist. That’s a tough thing to do, however, when you are in the throes of severe OCD, and this is just one reason why it is so important to have a support system in place. I didn’t mention it in my post, but the IOCDF is also a good resource. I understand what you are saying about ERP also. As far as I understand it, ERP is still the accepted frontline treatment for OCD, and what OCD sufferers should seek out as they work toward recovery. That’s not to say there aren’t benefits to other therapies as well. I am not a therapist, so I can’t really contribute more than that. The most important thing, in my mind, is for those with OCD to connect with competent therapists who specialize in treating obsessive-compulsive disorder.

      • rachel bar says:

        Agree, and that therapists should be honest with themselves and future clients by acknowledging whether they know how to treat OCD and their experience.

  5. Adrian Soden says:

    AABT in the US & BABCP in the UK, is where you will find the therapists whom stick to evidence based practice, the problem is that CBT is not a protected term so anybody can say that they offer it (you only have to search on google etc. to find the multitude of counsellors whom claim to “offer” CBT amongst all of the other modalities they list). A good rule of thumb when looking for a therapist is if they claim to offer several modalities then you are unlikely to get any of them, go for the therapist whom offers one modality as that is the one that they have confidence in and belief that it works (subject to checking their qualification/experience etc)

    • You bring up a good point, Adrian, that a specialist who only uses CBT might be a better choice than someone who uses a little bit of everything. Thank you for your suggestions on how to find the best health care provider. It’s not easy!

  6. The Hook says:

    Your work needs more exposure, my friend.
    “That is just one of the many reasons why those with OCD should seek out therapists who specialize in treating their disorder.”
    Well said.

  7. Gina says:

    My son started showing OCD symptoms at a very young age. He suffers from the contamination, germ phobia type, for the most part, but there seems to be no end to new obsessions for him to deal with. the effects of OCD on our family was devastating, as Ben, (my son with OCD), believed his younger brother was contaminated. All of their growing up years were spent basically trying to find the best help for Ben, and trying to minimize the damage to his younger brother. We tried numerous therapists, all swearing that yes, they knew how to use CBT to treat OCD. Thousands of dollars, many years, and much emotional damage later we finally found an OCD institute that specialized in exposure/response prevention and other CBT interventions. They actually did what they said they could do.
    Navigating the mental health field can be a nightmare and can truly be a damaging experience. It seems counterintuitive that getting help for a well known disorder like OCD could be so tricky, but it surely was.
    I am very happy to say that my son responded so well to therapy he has even been able to go off his meds. OCD will always be something he has to deal with from time to time, but hopefully with regular “tune ups” from a true CBT practioner he can continue to have a happy, normal life. (And a gratefully healing relationship with his “little” brother, who is now 21.)

    • Gina, Thank you so much for sharing your incredible story. I wish I could say it is unusual, but unfortunately so many OCD sufferers and their families go through similar experiences. That is really the main reason I started this blog. How could therapists not know how to treat OCD? I am so glad your son finally found the help he needed and I am sure he will “continue to have a happy, normal life.”

  8. This is a fantastic post, and SO needed. I did talk therapy as my OCD was heating up, and it was one of the things that contributed to my OCD manifesting (she was trying to get at the “root” of my problems, which I know now is a big red flag for OCD sufferers).

    The need really is quite desperate in many areas for trained professionals. I live in a university town with lots of counselors and therapists, but after interviewing 15 of them, have not yet found one with a solid understanding of and treatment plan for OCD. Thanks for spreading the word.

    • Thanks for sharing. I hear similar stories to yours all the time, yet they still amaze me. I think that’s what we need to do…….keep spreading the word about the proper treatment for OCD. So glad you got away from that talk therapy!

  9. I really enjoyed this entry, Janet–thank you for your comments on the piece from the NY Times, which I thought was great. These kinds of articles are good reminders because it IS tempting at times as a therapist to deviate from evidence-based practices.

    Coincidentally my colleagues and I had an article published yesterday that addresses some of the same issues, in the context of evidence-based treatments for PTSD. It’s available here:
    The article is quite long and the most relevant sections are on pages numbered 79-84. I believe it’s freely available to the public as it’s published in a journal called “Psychological Science in the Public Interest.”

    Keep up the great work!

    • Thanks for letting me know about your article, Seth. That is a coincidence! I took a quick look at the pages you mentioned but would like to read it thoroughly when I have some more time. Congratulations on the article!

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