Should You Trust Your Therapist? Depends.

Got this excellent question from a blog reader:

I think I have HOCD but I’m not sure. My therapist is doing CBT but I don’t think it’s ERP and it’s making me anxious. Like what if this therapy goes know where and just becomes me talking about my problems.(what happened with my last therapist). Should I trust that she knows what she is doing? Her Website says she does CBT so by saying she does CBT does that mean she is also an expert on ERP?

It’s sad, but so many mental health professionals are not very educated on OCD or how to treat it. CBT (cognitive-behavioral therapy) is a pretty vague, blanket term, whereas ERP (exposure and response prevention) is a specific type of CBT.

Two things I’d suggest:

  1. Read up about ERP. As much as you can. It will help you recognize if it is being done correctly. Start with this article on the IOCDF website. Also read any/all of the CBT/ERP posts at
  2. Ask your therapist the following questions. These questions– and the answers you should listen for— are pulled from this page on the IOCDF website.
  • “What techniques do you use to treat OCD?”If the therapist is vague or does not mention cognitive behavior therapy (CBT) or Exposure and Response Prevention (ERP) use caution.
  • “Do you use Exposure and Response Prevention to treat OCD?”
    Be cautious of therapists who say they use CBT but won’t be more specific.
  • “What is your training and background in treating OCD?”
    If they say they went to a CBT psychology graduate program or did a post-doctoral fellowship in CBT, it is a good sign. Another positive is if a therapist says they are a member of the International OCD Foundation (IOCDF) or the Association of Behavioral and Cognitive Therapists (ABCT). Also look for therapists who say they have attended specialized workshops or trainings offered by the IOCDF like the Behavior Therapy Training Institute (BTTI) or Annual OCD Conference.
  • “How much of your practice currently involves anxiety disorders?”
    A good answer would be over 25%.
  • “Do you feel that you have been effective in your treatment of OCD?”
    This should be an unqualified “Yes.”
  • “What is your attitude towards medication in the treatment of OCD?”
    If they are negative about medication this is a bad sign. While not for everyone, medication can be a very effective treatment for OCD.
  • “Are you willing to leave your office if needed to do behavior therapy?”It is sometimes necessary to go out of the office to do effective ERP.


6 thoughts on “Should You Trust Your Therapist? Depends.

  1. Thank you so much for your reply. I can see that she is doing just CBT with me not ERP. Though on her website it says one of her speacilites is Anxiety disorder (which this falls under) so maybe I should just trust the process? I don’t want to offend her by asking why she is choosing to do just CBT over Specifally ERP. I know she is a lot more knowledgable on this than I am. Maybe we just haven’t gotten to the ERP part yet? I have seen her about 6 times now and it’s taking me a while to trust her and I think each time I come to see her I am improving a little with my talking. So maybe she is just waiting for me to get more comfortable for her to start ERP? Or should she have started it from the begging before building up trust? Do you know the average amount of sessions it should take for a person that is coming to see a therapist for HOCD to start the process of ERP? I still don’t know if she believes that I have it or not. So I want to ask her if she thinks I do. I don’t know what else it could be. Unless it just OCD and not HOCD but I am specifically having homosexual intrusive thoughts. I wouldn’t feel my feels are being validated if she says I don’t have it

    • Sarah, I met with my ERP therapist for 12 weeks. Week one was intake, and week two we began exposures. It sounds like she is not doing exposures with you at all. What she is doing is not effective for OCD. I would recommend finding someone who specializes in ERP.

    • And HOCD is just a theme of OCD. If you have HOCD, you have OCD by default. Without treating it, it may switch themes from HOCD to something else. Exposure therapy is the #1 choice of all OCD experts. Talk therapy is ineffective for OCD.

    • Don’t worry about offending her. You are paying for a service she is not providing. If you needed an electrician and a plumber showed up, it would not be offensive to say, “oops, sorry. I needed something else.”

      • I am not Jackie, and you didn’t ask me, but I will also add that saying to your medical provider, “I want this specific treatment” is entirely within your rights as a patient, and if they are unwilling to provide that treatment–especially when you know it’s the best course of action for you, you can go to someone else.

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