How To Choose a Behavior Therapist

By
Michael Jenike, MD

 

Optimal treatment for most people with OCD involves the combination of medication plus the behavior therapy techniques of exposure and response prevention.

Many psychiatrists are familiar with the use of serotonin selective reuptake inhibitors (SSRIs). It is often quite easy to locate psychiatrists who can prescribe medications.

There remains a shortage of competent behavior therapists who have experience in treating OCD patients.

It is important for the consumer to be armed with information and questions that can help them determine if a therapist is indeed competent and experienced.

 

To gather information on this subject, I asked a number of experienced behavior therapists what they would recommend.  The following behavior therapists were consulted: Drs. Lee Baer, James Claiborn, William Minichiello, and Nancy Keuthen.   In addition, I reviewed Dr. Jonathan Grayson’s article in the April 1996 issue of the OC Foundation Newsletter and Dr. Baer’s book “Getting Control.”

In “Getting Control,” Dr. Baer notes that…

*most behavior therapy is done by psychologists*
usually at the doctoral level (Ph.D., PsyD, EdD).   Although some psychiatrists (MD) and some clinical social workers (MSW) provide behavior therapy too.

 

Dr. Grayson emphasized…

the importance of finding a behavior therapist who is willing and able to understand you as a person, not only as an OCD patient.  Your relationship with the therapist is of the utmost importance Especially since they will be asking you to do things that you find inherently uncomfortable.

 

You will need to ask the therapist what technique they use to treat OCD.

If the therapist has never heard of exposure and response prevention therapy or is vague about discussing these treatments, it may be best to look elsewhere.

You need to know what these techniques involve to understand what you are being told.

The exposure part of the therapy involves actually confronting the source of the anxiety and/or discomfort.   A person afraid of contamination from public bathrooms will be asked to go with the therapist to a bathroom and touch some “contaminated” item in the bathroom.

The response prevention part of the therapy occurs when the patient does not wash her hands while feeling contaminated. With repeated sessions, the discomfort diminishes until the contaminated item no longer produces anxiety or discomfort.  The behavior therapist then has the patient tackle an even more stressful situation until all of the fears have been confronted.

This gradual process of exposing oneself to a fearful situation and not giving in to the ritualistic response is therapeutic for the patient.

 

For many patients, pretreatment with medication makes the process less anxiety provoking and hastens or facilitates the overall improvement.

 

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 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.

In the not too distant past, parents were told that they had caused OCD symptoms in their child by incorrect toilet training or even some type of abuse. We do not know precisely why OCD symptoms develop, but it is certainly not the parents’ fault.

 

You should ask where a potential therapist learned about this type of behavior therapy.  Did they go to a behavioral psychology graduate program or do a post-doctoral fellowship in behavioral treatment?

How many patients have they treated with behavior therapy, and what is their success rate?

How much of their practice currently involves anxiety disorders and especially OCD.

There are other ways that a therapist can learn effective behavior therapy techniques.  An American Association of Behavior Therapy (AABT) or Obsessive Compulsive Foundation workshop can help prepare a therapist for this type of work.  If your potential therapist is a member of AABT or SBM (Society of Behavioral Medicine), this may increase your confidence that they are heavily involved in behavior therapy.

 

The behavior therapists that I consulted felt that a good behavior therapist for someone with OCD should acknowledge the role of medication in treatment of this disorder.

 

Another useful and important question addresses the therapist’s willingness to leave their office if needed to do the behavior therapy.  It is sometimes necessary to go out to touch garbage in the real world, visit public bathrooms as in the example above, drive with the patient, and a therapist that will only sit in his/her own office will not be as helpful as a more active therapist.

 

These are some broad guidelines that help the consumer determine whether or not a therapist is qualified to do exposure and response prevention.  The therapist’s response to your questions is a good guide to what you want to know about a prospective therapist.  If he or she is guarded, withholding of information, or becomes angry at your requests for information, you should probably look elsewhere.  

If the therapist appreciates how important a decision this is for you and is open, friendly, and knowledgeable, you may have a gem of a therapist.

You have a perfect right to ask questions; this is your life and health.

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Information courtesy of the IOCDF – International OCD Foundation