Obsessive Compulsive Disorder is difficult to identify and to treat. You may think...Why? Most therapists are put in agencies untrained to serve severe mental illness. Graduate school covers alot but does not cover the details that are required to be able to diagnose all mental illness properly. Obsessive Compulsive Disorder is one of those diagnosis that needs more in-depth training to identify and treat.
1. Early in my private practice career I had a client with OCD and I could not diagnose it. I did not have the proper training to identify it and know how to treat it. Even a psychiatrist did not diagnose it.
2. I had personally been in therapy for over a decade and none of my therapists ever said I had obsessive anxiety. I have had OCD loops and intrusive images, but do not qualify for the OCD diagnosis.
3. Monthly I get a few OCD sufferers who have been to other therapists, and have not been diagnosed, sometimes for years.
Now this is not malicious. Therapists as a whole are rule followers and take their job seriously. We truly want to do things correctly and help!
How Do we improve our profession?
Obsessive Compulsive Disorder is misdiagnosed and treated improperly frequently. Clients think they are psychotic, serial killers, pedophiles, over responsible for the safety of family and themselves, tormented by intrusive images, or hyper-focused on germs and protecting loved ones.
OCD is incessant and one of the most tormenting diagnosis I see in my office.
Knowing this and witnessing successful treatment time after time has propelled my love for its sufferers and my passion in educating therapists. We all know how hard it can be to treat clients with moderate to severe mental health issues. Being able to give a name to a suffer is powerful. Many say I am not crazy which a sigh of releif. So finding a solution is like finding water in the desert. Being able to recreate that solution with certainty is priceless.
OCD consists of obsessional fears followed by repetitive internal or external behaviors the sufferer does to relieve the distress. It is a cycle that can be done throughout the entire day. Avoidance can be a compulsion. They sometimes make their loved ones abide by their compulsive behaviors or they make them part of their reassuring or confessing loop. Other times they secretly do the compulsions out of shame of what others will think.
ERP is the gold standard for treating OCD. It consists of clients gradually exposing themselves to their distress while abstaining from their compulsive behavior. It is counter intuitive, and so the lengths that we must push our clients in ERP can feel uncomfortable, and the opposite of how we are trained. So taking continuing education on the subject provides you with map and confidence to do this process completely.
Helpful tips for ERP:
Do not become a part of your clients OCD loop by reassuring them.
Therapists reassure their clients and listen to confessions and clients feel better, but with OCD they continue using compulsive behaviors to manage their distress. Confessing is cathartic and what we try to get client to do to release shame. In OCD this just reinforces their compulsive behaviors.
Therapists undertreating.
This is done when we do not use the gold standard treatment for a client because the client does not want it. For OCD talking is not helpful, it ends up being part of their compulsions. We do talk in the beginning to educate.
ERP is counter intuitive so reading a book on the subject is not enough to understand the full length you must push your client to treat this issue. ERP works because of the Inhibitory Learning Model. ILM states that intensity in exposures is essential to learning a new relationship in how sufferers respond to their obsessional fear.
Continuing Education will provide the knowledge, support, and certainty on treating this tormenting diagnosis properly and successfully. Once you successfully treat the symptoms that come into your office, it is infectious.
The more we know, the better our clients' outcomes are!
KD Holmes, LPC: Feb 21, 2023 8:51:52 AM
