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Psychotherapy for Obsessive Compulsive Disorder by Paul Lohkamp, MSW, LCSW  Page #2

Guidelines for selecting a behavior therapist for OCD:

1.  The therapist must be licensed at the appropriate level, either a psychologist, a clinical social worker or a professional counselor.  The therapist should be willing and able to understand the client as a person, not only as an OCD patient. The client’s relationship with the therapist is most important, especially since behavior therapy involves asking the client to do things that are usually uncomfortable, such as touching the “contaminated” object or not checking the air in the tires. 

2.  The client will need to ask the therapist what technique he or she uses to treat OCDIf the therapist does not say “exposure and response prevention (E/RP)” therapy,  has never heard of E/RP or is vague about discussing these treatments; it may be best to look elsewhere.  The therapist should be able to explain exposure and response prevention (E/RP) in some terms similar to the following:   

The “exposure” part of the therapy involves actually confronting the source of the anxiety and/or discomfort. For example, a person afraid of contamination from public bathrooms might be asked to go with the therapist or helper to a bathroom and touch some "contaminated" item there.  The “response prevention” part of the therapy occurs when the patient does not wash her hands while feeling contaminated. With repeated sessions, the discomfort diminishes until the contaminated item no longer produces excessive anxiety or discomfort. The behavior therapist then has the patient tackle an even more stressful situation until all of the fears have been confronted.   In summary, this gradual process of exposing oneself to a fearful situation (exposure) and not giving in to the ritualistic response (response prevention) is behavior therapy for OCD.

3.  If the therapist says that his main technique involves relaxation training,  or that he treats OCD like other anxiety disorders, you can be sure that he is not experienced. Relaxation training is not effective for treating OCD. If the therapist tells you that OCD comes from some difficulty with your early childhood, you should also find someone else. Not too long ago, some people thought OCD symptoms were caused by incorrect toilet training or even some type of abuse. We do not know precisely why OCD symptoms develop, but it is certainly not because of faulty parenting.  

4.  You should ask where a potential therapist learned this type of behavior therapy. Did they go to a behavioral psychology graduate program or do an internship in behavioral treatment? How many patients have they treated with behavior therapy, and what is their success rate? How much of their practice currently involves anxiety disorders and especially OCD. There are other ways that a therapist can learn effective behavior therapy techniques. An American Association of Behavior Therapy (AABT) or Obsessive Compulsive Foundation workshop can help prepare a therapist for this type of work.  

5.  To be effective in treating OCD, the therapist needs to be flexible and available to see the client in various settings.  It is sometimes necessary to go out in the real world to do behavior therapy; for example, to visit public bathrooms or to ride in a car with the patient.  A therapist who will only see people in the office may not do the job. 

These are some broad guidelines that help determine whether or not a therapist is qualified to do exposure and response prevention therapy. The therapist's response to the above questions is a good guide to what you want to know about a prospective therapist. If he or she is guarded or unsure about your requests for information, you should probably look elsewhere. If the therapist appreciates how important a decision this is, and is open, friendly, and knowledgeable, you may have found the right one. 

In summary, in this article we have discussed the importance of a skilled assessment for OCD because of the complexities and complications of the illness.   A therapist needs to have specialized training and experience treating OCD.    We have offered several guidelines for selecting a therapist for OCD.   

If you have any questions about OCD or about finding a behavior therapist, don’t hesitate to call Paul Lohkamp  at Phone 314 837-2050, or email paul@stlouispsychotherapy.com

See Paul's Website at www.stlouispsychotherapy.com

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