FAQs

OCD is a disorder that benefits from a very specific type of treatment that few therapists conduct: cognitive behavioral therapy with, exposure and response prevention (CBT with ERP). 

The goal of CBT with ERP is to create a new relationship between the individual and whatever discomfort-producing thought, feeling, idea, or image is plaguing them. This comes primarily through decreasing compulsive behaviors, or any and all attempts to escape, avoid, or reduce discomfort when confronted with an unwanted thought or feeling. One core skill sufferers with OCD must learn through therapy and practice is to tolerate uncertainty. This means helpful therapy will gradually and purposefully help an OCD sufferer practice facing uncomfortable, uncertain situations. 

Even otherwise well-trained and well-meaning therapists may do more harm than good when it comes to treating OCD. For example, cognitive behavioral therapy without ERP might inadvertently provide counterproductive reassurance to people with OCD or guide them to develop skills aimed at reducing anxiety (e.g., weighing evidence, cognitive restructuring, relaxation training). While these approaches can be helpful for disorders such as generalized anxiety and depression, they are often unhelpful in treating OCD and they may actually make OCD worse. These cognitive skills and techniques can become safety signals, reassurance cues, or additional compulsions for OCD sufferers. If you’ve been in therapy for OCD before and you feel like it has not worked, it may be due to something like this.

Please take heart; there is hope and there is effective treatment available for OCD if you are willing to make the commitment and do the hard work of ERP.

If you have OCD, we strongly encourage you to seek treatment from an OCD specialist. To learn more about how to identify a true OCD specialist, see our Finding an OCD Specialist resource. OCD specialists are hard to find, most are out-of-network with insurance, and most require a waiting period to get in for a new patient visit. This is because the treatment for OCD, cognitive behavioral therapy with exposure and response prevention (CBT with ERP), is a very specific form of therapy that most therapists are not trained to conduct. ERP is somewhat counterintuitive for both patients and therapists, in part because it involves facing discomfort and distress head-on rather than fast-tracking to immediate relaxation and relief. It’s a challenging therapy for both the provider and the patient and takes a lot of practice for both.

OCD also varies dramatically in how it presents (see info here about the various presentations of OCD). While the core of OCD is the same across presentations, there are nuances related to identifying and targeting key components of OCD that vary across presentations. In order to become skilled in differentiating and tailoring treatment to OCD patients, it takes years of experience treating OCD as well as completing specialized training, continuing education, and ongoing consultation with other experts.

Cognitive behavioral therapy with exposure & response prevention (CBT with ERP) is a highly effective treatment for OCD. In treatment, you will first learn to understand OCD and you will become the expert on your OCD. You will learn to identify and differentiate between the obsessions (aka, intrusive thoughts) and compulsions that are keeping you locked in a vicious cycle. You will also learn what aspects of this cycle are within your control (and how to leverage attention and effort to control these aspects) and which are not in your control. You will learn how to accept what is out of your control and how to direct your energy toward what you value in life so that you no longer waste precious time and energy on OCD.

While SOAR specializes in the treatment of OCD and anxiety, we also recognize and appreciate that individuals coming in for treatment typically bring a host of other concerns that may need to be addressed in therapy. This may be another diagnosable disorder (e.g., depression, bipolar disorder, panic disorder, PTSD), marital problems (which may or may not be directly related to OCD), work stress, family issues, etc. Many people also find that psychotherapy can be a tremendous asset to managing personal growth, interpersonal relationships, family concerns, and the hassles of daily life. If appropriate, these matters can be addressed in therapy at SOAR; otherwise, you may need to be referred to a different provider with the appropriate expertise. 

The benefits you obtain from therapy depend on how well you use the process and put into practice what you learn. Some of the benefits available from therapy at SOAR include:

• Clinical assessment of the underlying problem(s)

• Education about the identified diagnoses

• Evidence-based treatment of the identified diagnoses/problem(s)

• Understanding and addressing treatment ambivalence

• Understanding how your thoughts, behaviors, and feelings interrelate

• Changing old behavior patterns and developing new ones

• Identifying problematic patterns of how you think and talk to yourself

• Attaining a better understanding of yourself, your goals, and your values

• Developing skills for improving your relationships

• Increased insight, self-reflection, and self-discovery

• Learning new ways to cope with stress and anxiety

• Managing anger, grief, depression, and other emotional pressures

• Improving your self-esteem and boosting self-confidence

It is well established that the long-term solution to mental and emotional problems and the pain they cause cannot be solved solely by medication. Instead of just treating the symptom, therapy addresses the cause of our distress and the behavior patterns that curb our progress. You can best achieve sustainable growth and a greater sense of well-being with an integrative approach to wellness. Working with your medical doctor you can determine what’s best for you, and in some cases, a combination of medication and therapy is the right course of action.

For OCD specifically, research tells us that there is a biological component of the disorder as well as a learning component. While medication may help with the underlying neurochemical processes and associated sensitivities that are the biological basis of OCD, it will not undo the learning that has taken place through a person engaging in compulsions after experiencing intrusive thoughts. This is where therapy can help! “Pills do not build skills”, but therapy can and does. Research indicates that combined treatment (medication + CBT with ERP) is most helpful when OCD is severe. Medications play an important role in reducing symptoms to a manageable degree so that patients have the capacity to build skills through therapy. If you start therapy with severe OCD symptoms and are not already on prescription medication to treat OCD, your therapist will likely recommend that you consult a psychiatrist to consider medication management.

Everyone goes through challenging situations in life, and while you may have successfully navigated through other difficulties you’ve faced, there’s nothing wrong with seeking out extra support when you need it. In fact, therapy is for people who have enough self-awareness to realize they need a helping hand, and that is something to be admired. You are taking responsibility by accepting where you’re at in life and making a commitment to change the situation by seeking therapy. Therapy provides long-lasting benefits and support, giving you the tools you need to avoid triggers, re-direct damaging patterns, and overcome whatever challenges you face.

Either way, it is most common to schedule regular sessions with your therapist (usually weekly).

The total number of sessions depends on the severity of the problem and the individual. However, the average total of sessions is typically about 12-18. Visit the fees tab or this link for more information about sessions, costs, and course of therapy: Fees

It is important to understand that you will get more results from therapy if you actively participate in the process. The ultimate purpose of therapy is to help you bring what you learn in session back into your life. Therefore, beyond the work you do in therapy sessions, your therapist may suggest some things you can do outside of therapy to support your process – such as reading a pertinent book, journaling on specific topics, noting particular behaviors or taking action on your goals. People seeking psychotherapy are ready to make positive changes in their lives, are open to new perspectives and take responsibility for their lives.