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.


“reasonable doubt”

I read an interesting article today called “Casey Anthony, Reasonable Doubt, and OCD” by Stacy Kuhl-Wochner at the OCD Center of Los Angeles — you can read the entire article here.

Just wanted to quote a little bit of it for all you blog readers to consider, especially after having an interesting phone conversation along these same lines with my college roomie Megs.

Being a therapist who specializes in treating those with OCD, I can only imagine what an especially difficult task quantifying reasonable doubt would be for many of my clients.  People with OCD and related OC Spectrum Disorders such as Body Dysmorphic Disorder (BDD), Hypochondria (Health Anxiety), and Social Anxietyare on a constant quest for answers to unanswerable questions.  They seek to quantify that which cannot be quantified, to gain certainty when it is only possible to be “pretty sure.”  These are questions that most people who do not have OCD can accept despite their inevitable doubts.  But for many people who experience OCD or a related spectrum condition, “reasonable” doubt often feels unbearable.

Doubt is such an intrinsic part of OCD that the condition has often been referred to as “the doubting disease. Some common doubts seen in OCD and related OC Spectrum Disorders include:

  • Are my hands clean enough to ensure that I won’t accidentally make someone sick through casual contact?
  • Am I straight enough to to be certain that I am not actually gay?
  • How do I know if I really love my spouse?
  • What level of pain is a enough that I should visit a doctor to see if I have a serious medical condition?
  • What is the right amount of eye contact to avoid being seen as socially inappropriate?
  • How do I know whether I am a good person or a bad person?
  • If I become angry at my child, does this mean that I do not love them enough, and that I am close to mentally snapping and harming them?

The only realistic answer to these and similar questions is to accept that nobody has 100% certainty on these issues*, and to stop the mental checking.  The goal is to make decisions based on what is “most likely”, given all the evidence.  For people with OCD, it may feel terrifying** to make that leap and take that chance because their brain is telling them that absolute certainty is required.

*JLS adds: That is why the point of cognitive-behavioral therapy is not to remove uncertainty but to make one okay with uncertainty.

**”Terrifying” doesn’t even touch it.

Thoughts?  What’s the most basic thing you know that you have doubted before?  (I have sometimes wondered if all of life that I’ve “experienced” so far is only a dream.)