Psychotherapy for OCD

For people suffering from OCD, it can be hard to find help. Being an informed consumer can make all the difference.

It is common for people who think they might have OCD to say, "I'd better see someone," and go to see a psychotherapist. So far, so good. However, there are different types of therapy for OCD, and evidence suggests that some work better than others. Many people who seek help for obsessions or compulsions with a psychotherapist find that sometimes, after months or years of therapy, their symptoms are still a problem. There can be many possible reasons for this.

One possibility is that OCD is not the only problem that the patient has. Other co-occurring conditions (e.g., depression, eating disorders) can worsen prognosis.

Another possibility involves the fact that even the most effective treatments for OCD don't work for everyone. Exposure and Ritual Prevention (ERP), a kind of psychotherapy for OCD, is often found to produce significant improvement in two thirds to three quarters of patients in clinical research studies (e.g, as described in a previous post). This means that a significant proportion of people trying this type of therapy will not see significant improvement.

The most alarming possibility, perhaps, is that the patient sees no improvement, and is not receiving the appropriate type of therapy. Many people have called me over the years saying that they are contemplating switching therapists. When asked why, they often say something like, "Well, I really like my therapist and all, but we've been talking about my childhood and my parents for 2-3 years now, and I'm still checking my kitchen stove 30 times a day. I'm getting tired of it!" If you think you may have OCD and decide to see a therapist to work on it, ask them whether they recommend ERP for you. They may have a good reason for not recommending it; however if they're not familiar with it, you might consider seeking out a second opinion.

How to Find a Therapist

Finding a therapist can be a confusing task. Where to start? Should you ask your doctor? Look on the internet? Ask a friend? Ask your insurance company?

These are all reasonable ideas on the face of them. However, some strategies may be more practical for you than others. Let's look at each of the above options.

If you have a good relationship with your primary care doctor, and feel comfortable asking him or her for a referral, than this may be a helpful step. Even if he or she does not have any suggestions for you, it can't hurt. If your doctor does give you some referrals, it is helpful to be an informed consumer and find out whether the names you are given are psychiatrists, psychologists, or other types of mental health professionals. Your doctor may be more likely to recommend a psychiatrist than other professionals, since they share a common training background. However, a psychiatrist may or may not be the right fit for you. If you are looking to meet with someone who can prescribe medications for your condition, psychiatrists are typically the best option. However, if you are looking for weekly psychotherapy, seeing a psychiatrist may prove to be less appropriate (or affordable) than some other options.

What about looking on the internet for a therapist? We search on the internet for so many things, why not therapists too? In fact, this can be a very helpful step to take. There are several "find-a-therapist" sites available at no charge on the internet. As described in an article on this topic from 2008, it can be helpful to educate yourself on which types of therapist are appropriate for your problem(s). If, for example, you have decided to pursue cognitive-behavioral therapy, I would recommend the therapist finder at http://www.abct.org -- just go to that website and click on "Find a Therapist." This service is provided by the Association for Behavioral and Cognitive Therapies, and organization serving the U.S. and Canada. If you're not yet sure which type of therapy would be best for you, you can peruse the listings at http://www.psychologytoday.com by clicking on "find a therapist" at that website. This resource is also only for those in the U.S. and Canada. For users in the U.K., I would recommend http://www.counselling-directory.org.uk/.

What about asking a friend for a referral? Some readers will be immediately uncomfortable with this idea, but for others, it can be helpful; however this option is somewhat perilous as your friend may assume that what is helpful for them will be helpful for everyone else, including you. This may not be true. For this reason alone, I recommend this option less than any of the others described in this posting. Additionally, if you get a therapist recommendation from your friend, and decide to see that therapist, then you have created the potentially awkward situation of your friend(s) knowing you are in therapy. You may even end up running into them in the waiting room! Only choose this option if you are not bothered by these potential problems.

For those of you who want to use an in-network provider for your insurance company, it may be that none of the above options will work for you, because many providers will not be in your network. In this case, I typically recommend that you contact your insurance company and ask them which providers are in-network, and in your area. Many insurers post this information on their own websites. If you are seeking a specific type of therapy, let your insurance company know. For example, if you are seeking Exposure and Ritual Prevention therapy for OCD, and if you have trouble finding a therapist competent with this type of therapy in your network, don't be afraid to call your insurance company and ask them to recommend someone. They may do just that, or may extend you in-network benefits for an out-of-network provider if none of their therapists have the necessary expertise. Unfortunately, the insurance company may have no recommendations, and just wish you good luck; you won't know unless you call them and see.