OCD and Evidence-Based Therapy

There is an eye-opening article in the New York Times called “Looking for Evidence That Therapy Works.” It states that while the evidence-based treatment known as cognitive behavioral therapy (CBT) has been shown to be effective in treating many disorders, including obsessive-compulsive disorder, the majority of therapists only use CBT occasionally, or in conjunction with other therapies. It’s not that they don’t know about the documented benefits of CBT, it’s that they view their craft as an art, where they individualize treatment depending on their own personalities and their relationships with their patients.

I find this highly disturbing. While establishing a good rapport with a patient is important, a good relationship in conjunction with the wrong therapy won’t help someone who suffers with OCD, and may very well be harmful. In my opinion, it’s similar to having cancer that is highly treatable, only to have your oncologist forge ahead on a new, unproven treatment path.

It’s interesting that, according to the article, “every clinician overestimates how well they [themselves] are doing.” In many cases, patients are not honest with their therapist. For example, instead of letting their therapist know they are doing poorly, they will simply say they’re fine and are done with treatment. They will then leave and look for another therapist.

My son Dan’s first therapist did not use exposure and response prevention (ERP) therapy (the CBT used to treat OCD), yet I’m sure this therapist thought he was still helping Dan. We all did. It wasn’t until his OCD became severe, and I became more knowledgeable, that we realized the therapist had gotten it wrong. By then he had retired, so I never had the chance to talk with him about it. So yes, he is one of the many clinicians who overestimated his success.

I certainly don’t want to paint a negative picture of all therapists, as there are so many dedicated, caring, professionals out there who go above and beyond what is expected of them to try to help their patients. These therapists recognize their obligation to be aware of, and implement, evidence-based therapy whenever possible. If they are not well-trained in the appropriate therapy, they realize it is their responsibility to refer their patient to someone who is. They care.
I am aware that many people with OCD also struggle with depression, additional anxiety disorders, or other mental health issues. Certainly these comorbid conditions have the potential to complicate the path to recovery. That is just one of the many reasons why those with OCD should seek out therapists who specialize in treating their disorder.

How do we find these therapists, these specialists who use or at least work toward using evidence-based therapy? At the end of the article, the author proposes some great questions to ask potential therapists. I highly recommend reading it in its entirety, or at the very least, checking out the list of questions. With the right therapist and the right therapy, recovery from OCD is absolutely possible.

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