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. Many OCD specialists can attest to this deficient training: “In school they teach you a lot about depression and anxiety. And they tell you that OCD is part of the family of anxiety disorders,” explains Megan Ocando, LMHC, LPC. “That’s pretty much it […] They don’t go into any more depth about it.”
The results can create havoc across the mental healthcare industry, with countless clinicians believing, often in good faith, that they know how to treat OCD, without actually understanding even its most basic requirements. These therapists may mean well, but decades of research and evidence have made one thing clear: to treat a severe, chronic condition like OCD, much more intensive and specialized training is needed—and it needs to involve a specific, evidence-based form of treatment that was developed for OCD.
Why the wrong treatment can be harmful: My story
I understand the impact of this systematic problem firsthand. I spent years of my life suffering needlessly from OCD because I worked with licensed therapists who proclaimed that they specialized in my condition, when in reality they had hardly scratched the surface.
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 horrifying, disturbing intrusive 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.
Today, I’m fortunate to say that I successfully manage OCD every day, all because I was eventually able to access the specialized treatment I needed. My own experience led me to co-found NOCD—the leading telehealth provider of specialized OCD treatment—and make an impact for the OCD community, a community that is underserved in the world of mental healthcare, as I learned firsthand.
As the CEO of a specialized healthcare company and a tireless advocate for the OCD community, 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. I know that every person in the OCD community who learns how to find effective care for their condition is one less person who has to spend years suffering like I did. And if you or someone you love is suffering from OCD today, I sincerely hope you continue reading.
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 Zinman-Ibrahim, LMFT, CST, an OCD specialist who has experienced decades of OCD herself, 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.”
The majority of therapies out there, if used on OCD, can and will make it worse.
Tracie Zinman-Ibrahim, LMFT, CST
Talk therapy, including standard CBT, is not just ineffective for OCD, but 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. Here are some examples of how compulsions can be reinforced during talk therapy:
- Seeking reassurance: “Do you think my thoughts are really true?”
- Rumination: “I’ll keep thinking about my fears to see if I can figure out what they mean.”
- Mental review: “Let me reflect on past events and see if I can find evidence to support my intrusive thoughts.”
- Thought suppression: “These thoughts are making me feel horrible, so I should pinch myself every time they occur.”
Compulsions are what feed the OCD cycle, 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, and they don’t have to mean anything at all.
What does specialized training in OCD actually mean?
Zinman-Ibrahim says that as of now, therapists are not taught how to treat OCD in school. In fact, she says it’s barely covered. As a result, seeking the right training is something therapists have to do on their own, and it can be extremely costly, take weeks or even months, and requires highly experienced experts in the field of OCD treatment for training and consultation. At NOCD, we’re stepping up to address this shortage by building a truly OCD-specialized therapist network and providing training and consultation from top experts at no cost to our clinicians. To effectively treat the over 8 million people in the U.S. alone who struggle with OCD at some point in their life, every one of our therapists demonstrates an extensive understanding of how to treat OCD properly, using evidence-based treatment.
NOCD’s approach is a revolutionary change in the status quo from the time I received improper treatment for OCD that had a devastating effect on my life. What I learned is that the reason for my mistreatment was insufficient training: in order to conquer OCD, people have to work with professionals who deeply understand the ins and outs of OCD, rather than reinforcing harmful compulsions that make OCD stronger.
That’s why using the correct approach to treatment is only the tip of the iceberg for our therapists’ training. To start, only the most qualified therapists gain the opportunity to enter NOCD’s training program, and those who are admitted must display a deep understanding and empathy for the OCD community. After passing an intensive, months-long training process in OCD and exposure and response prevention (ERP) therapy, and training in many other conditions that commonly afflict the OCD community, qualified therapists at NOCD must pass a rigorous evaluation process. Only then do they join the NOCD Therapy Network and begin serving people with OCD directly. And even after they begin to treat therapy members, they continue to receive ongoing clinical support, routine evaluation, and continuous training for skill mastery.
Part of the success of our approach lies in the evidence-based therapy our therapists use for OCD. Using ERP, considered the gold standard for OCD treatment, therapists guide members in facing their fears and learning not to engage in compulsions. Throughout treatment, they gain response prevention skills, allowing them to manage their symptoms throughout their lives, rather than remaining trapped in a cycle of fear and compulsions. Practicing these skills—both in therapy sessions and during everyday life—helps members mindfully identify their triggers and obsessions, and employ response prevention techniques to accept uncertainty and discomfort. I know this firsthand, because that’s what specialized treatment did for me.
As the co-founder and CEO, I am committed to uncompromising, high standards for the care we provide for the OCD community—after all, I know all too well how devastating it can be to receive anything less than the very best treatment.
4 things to watch out for 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
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 uncaring or judgmental
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 free from judgment. At NOCD, empathy is paramount when assessing prospective therapists to admit into our training program. Our commitment begins at the very top: Dr. Patrick McGrath, our Chief Clinical Officer, has actually spent countless hours standing at a train station with a therapy member, all to help them confront their fears of harming someone in a real-life setting.
3. During sessions, 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 virtual therapy, but also has made finding a therapist easier than ever. To help the OCD community find high-quality treatment, we’ve launched a directory of trusted OCD specialists through the KnowOCD Foundation.
This directory is free to use, vetted by experts, and includes providers both at NOCD as well as external specialists for a greater range of choices. Accepted insurances are listed to help you find cost-effective treatment. If you’re in need of care, find a specialist in the KnowOCD Provider Directory—whether you seek treatment with NOCD Therapy or another trained specialist, it is our paramount priority to help you access effective, life-changing treatment. And if you’re interested in working with a therapist in the NOCD Therapy Network, I encourage you to thoroughly read reviews from NOCD Therapy members. We share every review our therapists receive, without filtering or censorship, because we believe that transparency is crucial to our mission of restoring hope for people with OCD through better awareness and treatment.
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.