Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Many licensed therapists claim false specialty in OCD – How to find a true specialist

9 min read
Stephen Smith
By Stephen Smith

Obsessive-compulsive disorder (OCD) is a complex disorder that can become completely debilitating—even life-threatening—when it’s left untreated. The good news? It’s highly treatable. In fact, experts in OCD treatment have used a specialized form of therapy for decades to help thousands of people regain their lives from this complicated, severe condition. So if you or someone you love is struggling with OCD, you can feel encouraged: effective treatment is out there, and it’s more accessible than ever—particularly thanks to the effectiveness of virtual therapy. 

However, you should be wary as you search for treatment, because many licensed professionals who claim to specialize in OCD actually lack the specialized training needed to treat it effectively. Even experienced therapists may know nothing about OCD treatment beyond what they learned in graduate school or during a weekend workshop. But to treat such a severe, chronic condition, much more intensive and specialized training is needed—and a specific form of treatment that was developed for OCD specifically. 

Why the wrong treatment can be harmful: My story

One therapist I saw after my severe OCD onset was a licensed therapist who claimed to be an expert in treating OCD. She did standard Cognitive Behavioral Therapy (CBT) with me, which revolved around challenging my thoughts, but not accepting the uncertainty behind them. During my OCD episodes, she would encourage me to say to myself, “You’re a good person Stephen; you’ll never do that. In fact, every time you have a specific thought about yourself or your girlfriend, I want you to tell yourself that you’re a good person.” 

I followed her advice closely and spent every waking second reassuring myself. About six months later, my OCD took a turn for the worse. This caused me to leave college and become housebound, suicidal, and completely disabled. Below are two pictures that depict what I looked like before my OCD onset, and then after receiving talk therapy. You can read more about my story here.

As the CEO of NOCD—the leading telehealth provider of specialized OCD treatment—and an OCD patient advocate, I regularly witness the tragic and unnecessary suffering that thousands of people with OCD and their families endure from working with licensed therapists who falsely claim expertise in treating OCD. Because of this and my own personal experience, I am passionate about educating others on what to look for when seeking treatment for OCD.

Why is specialized care critical for treating OCD?

Tragically, people with OCD are 10x more likely to die by suicide than the general population without evidence-based care. Tracie Ibrahim, LMFT, CST, one of our fantastic therapists here at NOCD, says it best: “Using something that is an evidence-based practice is critical, because the majority of therapies out there, if used on OCD, can and will make it worse.”

Talk therapy, including standard CBT, is not just ineffective for OCD, it’s actually harmful, as it was for me. Unbeknownst to the client or therapist, it actually encourages people to engage in their compulsions and try to “solve” or “get to the bottom of” intrusive thoughts. This can look like seeking reassurance (“do you think my thoughts are really true?”), ruminating (“I’ll run these thoughts over and over in my mind and see if I can figure out what they mean”), or mentally reviewing (“Let me reflect on past memories and see if I can find evidence to support my intrusive thoughts”), for example. 

Compulsions are what feed the cycle of OCD, so it’s a little like encouraging a person who’s addicted to alcohol to drink more. Compulsions reinforce the sufferer’s false belief that intrusive thoughts are dangerous and have to be taken seriously. Specialized treatment, on the other hand, teaches you to become desensitized to intrusive thoughts and recognize that thoughts are just thoughts, they don’t have to mean anything at all.

What does specialized training in OCD actually mean?

Ibrahim says that as of now, therapists are not taught how to treat OCD in school. In fact, she says it’s barely covered. So, seeking the right training is something therapists have to do on their own, which can get costly. At NOCD, this training is at the heart of our onboarding process at no cost to clinicians. Learning from OCD experts who have spent decades in the field, our therapists develop an extensive understanding of the gold-standard, evidence-based treatment for this condition: Exposure and Response Prevention therapy (ERP). 

According to Patrick McGrath, PsyD, NOCD’s Chief Clinical Officer and a Scientific Advisor of the International OCD Foundation, “Exposure and Response Prevention therapy is the gold standard of care for OCD. ERP therapy is what helps people with this condition see significant reductions in OCD severity and then stay better long-term. ERP therapy can be done alone, or in conjunction with medication, depending on what you and your clinician decide.”

Using ERP, therapists guide you in facing your fears and learning not to engage in the behaviors that keep you stuck (compulsions). They will help you practice sitting with discomfort and uncertainty without giving you reassurance or encouraging you to ruminate. Over time, after resisting compulsions and realizing that nothing terrible happened, you become desensitized to intrusive thoughts.

Our therapists at NOCD also receive ongoing clinical support, routine evaluation, and continuous training for skill mastery. All these factors are crucial to providing high-quality care.

4 things to beware of when searching for an OCD therapist

When searching for an OCD therapist, you should feel free to ask questions in order to make sure they have the training you need. As Evan Vida, PsyD, a psychologist at the Center for Anxiety & Behavior Therapy says, “No need to simply accept what’s written in their bio—ask! Ask what training they have or if they’ve received supervision in ERP. You are allowed to get specifics in order to make a well-informed decision.”

Here are some potential red flags.

  1. They don’t mention ERP when describing their approach to treating OCD. You’ve probably guessed this already from all the info above. If a therapist doesn’t bring up ERP, definitely keep searching.
  2. They come across as judgemental. Empathy should be at the root of all therapists’ practice. It’s especially important when it comes to OCD. You have to feel comfortable opening up about your intrusive thoughts, which you might feel ashamed of—even though there’s no need to. Your therapist should make you feel safe and unjudged. At NOCD, prospective therapists are specifically assessed for empathy skills. Dr. McGrath actually carries a piece of paper in his wallet that says “666 – I hope my parents die tonight” to portray his willingness to hear thoughts that are considered taboo from his clients.
  3. During session, they try to get you to challenge the validity of your fears. Remember, effective OCD treatment is about sitting with discomfort and uncertainty. The goal is not to give your intrusive thoughts too much attention by engaging in compulsions. You and your therapist shouldn’t be digging into the thoughts themselves, but rather focusing on how you respond to them.
  4. They don’t create a personalized ERP treatment plan based on your unique experience. ERP works by targeting your specific intrusive thoughts, triggers, and compulsions. A therapist will first take the time to learn all about your unique experience. From there, they will create a hierarchy of exposures, meaning you’ll start with exposures that bring low distress and work your way up to ones that bring high distress. If they don’t seem to be approaching you as a unique individual who needs a unique treatment plan, you’ll want to keep searching.

Where to find an OCD specialist

The internet has not only allowed for accessible telehealth therapy, it also has made finding a therapist easier than ever. The top two OCD-specific therapist directories include the International OCD Foundation’s and ours at NOCD. All you have to do is enter your location, and you’ll find results of providers who are licensed in your state.

I believe that you, your loved ones, and the experiences of our shared OCD community are the best resources we can use to support one another and find the care we need to get better and stay better. 

Real stories of receiving the right care

“Treatment was difficult, but nowhere near as difficult as dealing with OCD symptoms daily. I was able to learn how to exchange temporary relief for long-term relief of symptoms. I was asked to do exposures of writing the word schizophrenia out over and over. I literally felt like I wanted to throw up. I wrote out imaginal exposures about killing my best friend. I wrote stories about sexually abusing my nephew. At the end or at the root of all of these fears were the same ones. The ultimate fear was that everyone that I cared for would hate me. That they would leave me. I would end up alone and die alone. These were my core fears. Seeing the similarities in my fears and coming to terms with what I was really afraid of was a pivotal moment in softening the intensity of the intrusive thoughts. I started to wear shirts that I had believed were ‘bad luck’. I refused to text my partner for reassurance and instead sat in the unknown.” Read more of Jeanine’s story here.

“I started to get better. Treating my sexuality OCD through ERP was the most difficult thing I have ever done. It took months of daily work-sitting down with my exposure journal and writing out my worst fears. The craziest thing happened after a few months of doing my ERP around sexual orientation OCD. When the pedophilia OCD would creep up, I knew how to handle it. I would write scripts and intentionally spend time around children even though my OCD wanted me to avoid, pray, and punish myself the way I had as a teenager. When the intrusive thoughts still arose, I now knew how to handle them.” Read more of this anonymous story here.

“Recovery is a process. It isn’t as though the OCD is suddenly gone, but I am recognizing it more. I am not allowing it to be in control. My advice to anyone suffering from this is to get help right away, don’t put it off. Face it head-on as hard as it is. Don’t give up, keep pushing forward. You will be so happy that you get treatment. There is no such thing as a ‘perfect’ recovery or treatment. When I have bumps in the road, I get back into therapy and get a quick refresher. You are never all the way back to zero, you cannot unlearn all of the tools you have been taught. You don’t lose progress. These days I am utilizing ERP in my life, exercising regularly (I even have a personal trainer), and cycling. I am very involved in my church and in Bible study groups. I am living the life that I want to live. I am no longer caged by my fears.” Read more of Manny’s story here.

NOCD Therapists specialize in treating OCD

View all therapists
Ilyas Patanam

Ilyas Patanam

MBA

I’m a licensed therapist with specialized training in treating OCD using Exposure and Response Prevention (ERP) therapy, the gold standard of treatments. ERP treats all types of intrusive thoughts, including violent and taboo, so that you can overcome OCD.

Ilyas+1 Patnam

Ilyas+1 Patnam

LCSW, LCSW-2

I’m a licensed therapist with specialized training in treating OCD using Exposure and Response Prevention (ERP) therapy, the gold standard of treatments. ERP treats all types of intrusive thoughts, including violent and taboo, so that you can overcome OCD.

Ray Li

Ray Li

LCSW, LCSW-2

I’m a licensed therapist with specialized training in treating OCD using Exposure and Response Prevention (ERP) therapy, the gold standard of treatments. ERP treats all types of intrusive thoughts, including violent and taboo, so that you can overcome OCD.

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Stephen Smith

Stephen founded NOCD after feeling frustrated with a lack of treatment resources and support during his own OCD recovery. He enjoys running hill sprints, listening to audiobooks, and eating breakfast no matter the time of day.