Wednesday, July 15, 2009

Finding a Therapist for your OCD

Based on my own experience, and reading about other people’s experiences, it’s extremely difficult to overcome OCD without the help of a good therapist. It can be very difficult to find one who’s both good and a good match for you.

The absolute key is finding someone who can help you with Exposure and Response Prevention (ERP).

If you have insurance, it makes sense to start within their system.

If you have an HMO (as I did), see if they have anyone who has experience with OCD. But you’ll need ask about ERP. My current HMO had me see 4 different therapists over about 6 months, and none ever mentioned ERP. I went outside the system at that point.

If you don’t have insurance, or find the therapists your insurance covers not helpful, or your insurance is so good that you can see anyone and be reimbursed, then your search begins.

The Obsessive Compulsive Foundation has a fabulous database of people who treat OCD. You can search by state and city, or by zip code. I believe therapists self-refer to the database, so there’s no guarantee they’re great. But I’ve seen two therapists from this list, and both really knew what they were doing.

If you’re lucky enough to find more than one person in your area, arrange a consultation meeting if possible. Most therapists will talk with you briefly at no charge to see if your needs and their skills are a good fit. Among the issues to consider: do their views about taking medication match your own, do you prefer someone of the same or different gender, do you just plain feel comfortable when talking with them? A good resource on this issue, including questions to ask, is this OCFoundation brochure.

Rates vary a lot. Generally (although not always) a Masters level therapist will charge less than a PhD, who will charge less than an MD. And an experienced Masters level therapist may well be just as good or better than an MD with little experience with OCD. Some therapists will work on a sliding scale, and you may be able to see someone a little less frequently than normal to keep costs down. You'll have to work a little harder this way, but I think it's doable. Consider what an incredibly important investment this is in you, and see if there's anyway to swing the cost, if you're paying on your own.

Hopefully this works. But what if there’s no one in your state or city?

Some therapists will work via phone consultation. Or, if you find a therapist you otherwise like and trust, see if they will work through an ERP self help book with you.

If your therapist isn’t a good match, don’t give up. My current therapist moved to town a year ago, after practicing a number of years in another state. If I hadn’t checked back at the OC Foundation database, I wouldn’t have found her.

Patience and persistence can be important; there is a therapist out there for you.

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