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Finding a Good Therapist

Finding a therapist who really knows how to use cognitive behavior therapy to treat OCD involves two steps:   First, getting some names; and second, evaluating qualifications and ability.

1. Getting names

Often the best way to find good therapists in your area is by asking the leaders or members of local OCD support groups. The International Obsessive-Compulsive Disorder Foundation (IOCDF) allows you to search for local support groups on their web site. Even if the nearest support group is some distance from you, they may know of good therapists near you.

The IOCDF can also provide you with a list of professionals in your state who have indicated that they treat OCD; especially recommended are those who have completed advanced training from their Behavior Therapy Training Institute (BTTI). The Association for Behavioral and Cognitive Therapies (ABCT) and the Anxiety Disorders Association of America (ADAA) also list professionals by geographical area with their areas of expertise on their web sites.

You can also contact your state's mental health, psychological, and psychiatric associations, who generally keep referral lists. If you don't have health insurance and cannot afford private therapy, these organizations may be able to offer suggestions.

If you live near universities that have graduate programs in mental health (e.g., psychology, psychiatry, social work), find out if they have any clinical training programs where you could receive therapy from their therapists-in-training. Although they are students, they are closely supervised, and the quality of their therapy is usually very good.

2. Evaluating qualifications and ability

Look for a mental health professional who is licensed to practice in your state. Although their specific academic discipline is not as important as their experience and ability, in general, you will find that cognitive behavior therapy is practiced by psychologists (PhDs and PsyDs), social workers (MSWs), licensed professional counselors (LPCs and LMHCs) marriage and family therapists (MFTs) and occasionally by medical doctors (MDs). Medications need to be prescribed by MDs, although some psychologists now also have prescribing privileges.

Be aware that being listed with IOCDF, AABT, ADAA, or other professional organizations does not guarantee expertise in treating OCD. Usually all that is required to be listed is proof of state licensure. Often professionals pay a fee to be listed. In a way, then, these are a little bit like yellow pages listings -- an OK place to start, but not to stop.

Once you have some names of potential therapists, call each of them on the phone. There's no point in paying for a session to get this information. Try to get past the receptionist to talk with the therapist directly. First, say you're looking for a therapist who has experience (use that phrase, not "who has expertise" or "who specializes") in treating OCD. They will all say yes. Then say, "Can I ask what approach you take?" You want to hear "behavioral" or "cognitive-behavioral." "Cognitive" needs a little follow-up (see below). If they say anything else specific, like "psychodynamic," "psychoanalytic," "gestalt," "Rogerian," or "Jungian," say, "Thank you, but I'm looking for someone with a cognitive-behavioral approach. Can you recommend someone who takes this approach to treating OCD?" (No harm in asking.)

If they say they have a cognitive or eclectic approach, or that they would need to evaluate you because no one treatment works for everyone, or that a treatment plan should be individualized, they're still in the running, but you need more information. Say, "I've heard of a technique called exposure and . . . uh . . . exposure . . . uh . . . darn, what was it again? Something about prevention . . . " If they can't identify "exposure and response (or ritual) prevention" after all that prompting, then they're not sufficiently familiar with the treatment of choice for OCD, and you should look elsewhere.

Be cautious if someone:

What if the therapist you've found isn't in your HMO's panel of providers?

If you belong to an HMO or PPO, you may need to decide whether to see someone who doesn't have special training in treating OCD just because it'll cost you less. It may be cheaper in the long run to pay for someone outside of their network of providers who does have special training. You may be able either to get a referral from your gatekeeper (usually a primary care physician) to see a specialist outside the network, or to get them to reimburse you at a higher rate for someone outside the network if you can show that there is no one in their network who is trained in treating OCD. (You have a powerful argument if in fact none of the providers in their network are familiar with the name of the treatment of choice for OCD!) See also: Fight for Your Health Insurance Rights.

Finally, if there is simply no one near you who knows how to treat OCD, you might consider telephone therapy with a reputable therapist. Therapy by e-mail, however, is generally not recommended, especially if either party is essentially anonymous. Each needs to be able to telephone the other in case of emergency.