3 Things I Wish I Had Known About OCD Treatment


After a decade of struggling, multiple tries at talk therapy and several failed prescriptions, I remember feeling relieved when I received my obsessive compulsive disorder (OCD) diagnosis. I assumed that with the missing piece of the puzzle — I would finally feel better — but knowing is only half the battle. The other half is finding a therapist who knows how to do exposure response prevention (ERP) and can utilize it correctly. I never in my wildest dreams imagined that I would have to fight to find and receive treatment for my condition.

These are three things that I wish I had known:

1. The gold standard, evidence-based treatment for OCD is called exposure response prevention, or ERP. This is a type of cognitive behavioral therapy (CBT) that has been proven effective and frankly, if a therapist is not doing CBT/ERP, then I think they are wasting your time.

In a nutshell, this therapy involves the person with OCD facing their fears (exposure) and then refraining from performing the compulsions (response prevention), usually under the guidance of a skilled therapist. That may sound simple, but the benefit of working with a therapist is that they can help you identify your behaviors and triggers, determine which exposure techniques to use and at what pace, and work with you on how to manage the uncomfortable feelings and anxiety that can come from exposures.

2. Very few therapists are trained to do ERP or know how to treat OCD. This is probably the most frustrating thing anyone might face when trying to access treatment. While searching through providers who would treat OCD on my health insurance website, I came across things like “art therapy,” “hypnosis,” “thought stopping,” and my personal favorite, “aligning your chakras.” These people were in-network with the insurance that I pay good money for and they can’t be bothered to go by national guidelines for treatment protocols? Why is this even allowed? It really makes me angry that these people are wasting our money and time by using techniques that I don’t think are going to work and might even make my OCD worse.

I want to emphasize this point a little more. OCD can be a serious and debilitating illness if left untreated. Imagine finding the strength to admit that you’re going through these issues, get a diagnosis and start treatment, only to never feel better, or even feel worse! This might cause some people to think they are a lost cause and lose hope. This breaks my heart and it’s unacceptable that we must be guinea pigs for professionals who cannot be bothered to keep up to date with recommendations in their field.

I have heard from other individuals who struggle with OCD that they were advised to do things by their therapist such as wear gloves to reduce the anxiety of contaminants, reassure themselves that a worry is going to be OK, get a family member or friend to do a task for them if it troubles them and so on. I don’t think any of these things are going to help. Unfortunately, many people don’t know what questions to ask when starting therapy and they trust that the person treating them is licensed and therefore knows what they are doing.

In their defense, OCD effects such a small number of people compared to other anxiety disorders, so many graduate psychology students might never encounter a person with OCD during their clinical training. Even so, I don’t think it’s unreasonable to say that someone advertising treatment for OCD should be trained in CBT/ERP therapy. What are we paying for if not evidence-based practice?

3. If you do find a therapist who knows how to do ERP, you may still be stuck in a rut due to the cost of treatment. None of the trained therapists that I spoke to accepted my health insurance and charged 200 to 300 dollars per session. Do they think I’m married to Bill Gates?!

Don’t feel bad if you can’t afford that price tag because you are not alone. Unfortunately, the cost of treatment is what prevents a lot of people from receiving care. Many ERP therapists might feel no need to take insurance, since they are so rare, they have no shortage of clients.

The International OCD Foundation (IOCDF) website estimates that it can take up to 14 to 17 years from the onset of symptoms, to getting an appropriate diagnosis and treatment for OCD. This is largely due to lack of training in health professionals, difficulty finding therapists and the cost of treatment. Nobody should have to struggle for a decade or more with a debilitating illness that can be managed and treated.

So after reading these three things, you might be thinking: Well, time to give up hope before I even start! Sorry, I have that effect on people! Seriously though, I wanted to share these three things, as hopeless as they sound, to spread awareness of this issue. It is up to us to demand the quality of care that we urgently need and if more people are asking therapists for this treatment, they might be compelled to take training. One thing I have learned on this journey is that you must be your own self-advocate and sometimes that means fighting like hell.

If you are looking for a therapist, you can start by going to IOCDF.org and searching for one in your area. You might also try the Association for Behavioral and Cognitive Therapies. If you live near a university that has a training program in psychology or a medical school with a psychiatry department, you could call and find out if they have a clinic that offers treatment from their therapists in-training. Lastly, you could try self-directed treatment as a last resort option if you cannot find access to treatment. There are several workbooks available that you can purchase online and if you wholeheartedly throw yourself into the work I believe that healing is possible. The important thing is that you keep trying and don’t give up on yourself, because we have come too far to give up now. Keep giving them hell, y’all.

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Getty image via Victor_Tongdee


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