How do you know a therapist is the right one for you? Educate yourself about OCD and its treatment. This will help you decide if the treatment a therapist is proposing is appropriate for OCD.
In the December 1996 OCF Newsletter, Dr. Michael Jenike advises people to ask the therapist what technique he or she uses to treat OCD. "If the therapist has never heard of exposure and response prevention [sometimes called exposure and ritual prevention] or is vague about discussing these treatments, it may be best to look elsewhere. You need to know what these techniques involve to interpret what you are being told," he says.
Dr. Jenike continues, "Thus, if the therapist says that his main technique involves relaxation therapy, you can be quite confident that he is not experienced because relaxation is not effective for treating OCD. If the therapist tells you that the root of your problem lies in some difficulty with your early toilet training and this is why you have OCD, you should also find someone else."
Compose a list of questions to ask your therapist including:
Please note that behavior therapy and cognitive-behavior therapy are very similar. Exposure and ritual prevention (ERP) is the cornerstone of behavioral treatment for OCD. Cognitive-behavior therapy uses ERP and cognitive techniques that will help you change the faulty beliefs people with OCD often maintain.
Note the potential therapist's response to your questions. A good therapist will be happy to involve you in the planning of your treatment.
What about the rest of your problems? In the April 1996 issue of the OCF Newsletter, Dr. Jonathan Grayson reminds readers of the importance of treating the whole person. He says, "Everyone who has OCD is a real person (not an obsessive-compulsive person), so treating an individual with OCD is more than running him/her through a technological set of procedures. This means you will want to feel that your therapist not only understands OCD, but understands you. Although OCD may be affecting every area of your life, you may have other issues that will also need attention."
In the same newsletter, Dr. Grayson adds, "The goal of treatment is not to be certain, but to learn to live with uncertainty without anxiety and rituals . . . Behavior therapy helps you learn to live with uncertainty by confronting it rather than avoiding it."
Accepting uncertainty is difficult, but an important concept. I want someone to make me feel better. I want to be rid of all uncertainty and anxiety. It won't happen. I also want a complete cure with no setbacks. This probably won't happen either. After the intensive part of behavior therapy, you will need to continue using what you have learned to further reduce urges and anxiety. Slips will occur. Accept them as a part of life.
Dr. Grayson continues, "I know no one wants to hear that OCD behavior can return if you aren't careful, but we have found that our most successful clients are those who accept the idea that slips are a normal part of life. This is not because OCD is a disease process, but because slipping occurs for any behavior that we try to change (how many people go off diets?). The problem isn't slipping, but how far you allow the slip to progress before you do something."
What if there is no therapist experienced in OCD treatment available to you? Find a good therapist who is willing to learn. He can obtain helpful books, as well as the names of professionals who would be willing to provide advice, from the OC Foundation. Dr. Bruce Hyman and I wrote The OCD Workbook with these therapists in mind. They can use the book to "coach" their patients in The Self-Directed Program for breaking free from OCD.
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