I believe one of the most difficult aspects of obsessive-compulsive disorder is finding the right treatment. Evidence-based exposure and response prevention (ERP) therapy, a type of Cognitive Behavioral Therapy (CBT) is the first-line treatment for the disorder, and it works. Yet so many people, including therapists, have never even heard of ERP. I am doing my best, along with other advocates for OCD awareness, to spread the word.
But knowing that ERP therapy is what you need is only half the battle. The other half is finding a good therapist who is properly trained in ERP and really knows how to utilize it correctly. Imagine thinking you are getting good ERP therapy when in actuality you’re not. You wonder why you’re not getting better; after all, ERP is supposed to work. Maybe you’re even feeling worse. You worry that your OCD is not treatable. After all, ERP is the gold standard for treating OCD. You lose hope.
So how do you know if you are getting good ERP therapy?
In this wonderful article, Finding the Right OCD Therapist, we are given some great suggestions on how to find a good OCD therapist, including questions to ask and things to look for in a health-care provider. What I think is particularly helpful is the last section of the article which lists some ways to evaluate the effectiveness of your ERP therapy. We are told that good OCD therapists:
- Collaboratively create hierarchy items.
- Collaboratively choose exposures and agree on specifics. A therapist should not force you to complete an exposure.
- Individually tailor treatment for you. Even standardized treatment is not a one size fits all.
- Do not provide reassurance that will temporarily reduce anxiety and interfere with natural habituation and learning.
- Identify covert rituals that get in the way of progress, such as mentally reassuring yourself, mentally undoing/neutralizing the exposure, distracting, or counting silently.
- Get at the core fear. Choose exposures at the top of the hierarchy that go “above and beyond” to fully target core fear, without being truly unsafe, harmful, or outside of what is accepted in your culture or religion.
- Help you grow into the role of becoming your own therapist.
When my son left his intensive residential treatment program we connected with a therapist who told us he specialized in treating OCD with ERP therapy. Once we heard that, my husband and I didn’t ask any questions or request any specifics about his approach. I realize now how incredibly lucky we were, as this psychologist turned out to be an excellent therapist with extensive experience using ERP. Of course, not everyone is so fortunate.
If you are in the process of looking for a therapist, or things aren’t going well with your current health-care provider, please take a few minutes to look at the above-mentioned article. It could help steer you in the right direction – toward the road to recovery from OCD.