Signs your therapist may not be trained in OCD

Many therapists claim they treat Obsessive Compulsive Disorder (OCD) but have limited training in this highly specialized area. This article outlines a few red flags to look for that may indicate your therapist is not specifically trained in the gold-standard CBT+E/RP (cognitive behaviour therapy with exposure and response prevention) for OCD:

1. Your therapist focuses too much on other issues

OCD therapy is intensive. The bulk of the sessions should be focused on psychoeducation, exposure and response prevention (E/RP). If your therapist is taking up more than a few minutes each session on issues such as relationships, resolving past traumas, strategies for mood or something else, they are not fully treating the OCD and are less likely to encourage real results. As a client, this avoidance of OCD symptoms during sessions may make the sessions feel easier and more enjoyable, but they will not be effective in reducing or eliminating OCD.

2. Your therapist focuses too heavily on the Cognitive component of CBT, rather than the behavioural work of E/RPs.

Some therapists put emphasis on cognitively restructuring your OCD thoughts to be more helpful and realistic through fact-checking or thought records. Although this strategy may be helpful sometimes, it is not shown to be helpful on its own, without daily Exposure and Response Prevention practice. Cognitive work should be one strategy to have in your back pocket, but breaking OCD compulsions through E/RP should always be the bulk of the work.

3. Your therapist doesn’t do E/RP practice in sessions.

Challenging your OCD through purposefully exposing yourself to triggers and not engaging in your compulsions is the hardest thing someone might ever ask you to do. If your therapist is not setting up E/RP practice in their sessions and coaching you through how to handle the uptick of anxiety or distress (while also carefully watching for compulsions), then how should you be expected to do the very difficult work on your own for home practice?

4. Your therapist doesn’t get creative.

Being familiar with E/RP is not enough. OCD, by definition, is very sneaky and therefore, exposures and response prevention need to be robust and creative to break through the cycle. Mapping of your OCD symptoms, as well as building hierarchies (or ‘ladders’) should be done often to ensure OCD isn’t morphing or changing along the way. Exposures should be carefully tailored to each one of your symptoms, be unique and always evolving.

5. Your therapist encourages self-reassurance or relaxation strategies.

To shrink OCD, you need to teach yourself that the uncomfortable feelings that arise with an intrusive thought are tolerable (and not bad or dangerous) and will go away on their own. If your therapist is encouraging you to practice relaxation or self-reassurance such as “it’s ok, I’m not going to get sick from touching that”, then you are not fully participating and allowing the uncomfortable feeling and associated urges. Rather, this is a type of sneaky avoidance and is not helpful in shrinking OCD. Your therapist should be coaching you through fully embracing the distress and waiting it out until it naturally comes down, ultimately learning that the compulsion is not necessary to get rid of the feeling.

If you are experiencing OCD symptoms, with or without diagnosis, contact Brookhaven Psychotherapy to talk to a therapist trained to treat your symptoms.

Find out more about Obsessive Compulsive Disorder Therapy here