It is common for people who think they might have OCD to say, “I’d better see someone,” and go to see a psychotherapist. So far, so good. However, there are different types of therapy for OCD, and evidence suggests that some work better than others. Many people who seek help for obsessions or compulsions with a psychotherapist find that sometimes, after months or years of therapy, their symptoms are still a problem. There can be many possible reasons for this.
Reasons counseling sometimes doesn’t work
One possibility is that OCD is not the only problem that needs attention in counseling. Other co-occurring conditions (e.g., depression, eating disorders) can worsen prognosis. For example, if someone has OCD as well as depression and a history of trauma, some of those other issues might need to be addressed first.
There is no perfect treatment
Another possibility involves the fact that even the most effective treatments for OCD don’t work for everyone. Exposure and Ritual Prevention (ERP), a kind of psychotherapy for OCD, is often found to produce significant improvement in two thirds to three quarters of patients in clinical research studies (e.g, as described in a previous post). This means that a significant proportion of people trying this type of therapy will not see significant improvement.
Importance of getting right kind of counseling for OCD
The most alarming possibility, perhaps, is that the patient sees no improvement, and is not receiving the appropriate type of OCD counseling. Many people have called me over the years saying that they are contemplating switching therapists. When asked why, they often say something like, “Well, I really like my therapist and all, but we’ve been talking about my childhood and my parents for 2-3 years now, and I’m still checking my kitchen stove 30 times a day. I’m getting tired of it!”
If you think you may have OCD and decide to see a therapist to work on it, ask whether he or she thinks ERP is appropriate for you. He or she may have a good reason for not recommending it; however if your therapist IS not familiar with it, you might consider getting a second opinion.
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