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Doctors and Therapists

How to Find the Right Medical Professionals to Help your OCD

There are a lot of different kinds of mental health clinicians out there: psychiatrists, psychologists, clinical social workers, and so forth. As you go about searching for the right professional to help you with your OCD, it will help for you to be familiar with the kinds of practitioners and the services they offer. Keep in mind as you read on, though, that the most important qualification to look for in a doctor or physician is experience treating OCD. No degree or license substitutes for the kinds of insights that come for actually helping people just like you make progress against the disorder.

Medical doctors who are specially trained in diagnosing and treating psychological problems are known as psychiatrists. Psychologists, on the other hand, are professionals who hold a doctoral-level degree — a Ph.D., Psy.D., or Ed.D. — and a license from the state they work in to practice mental health care. Master's level counselors, like marriage and family therapists (MFTs), generally specialize in relationship counseling, although then sometimes they offer psychotherapy services. Social workers also sometimes provide therapy services, but more often their work focuses on their client's role in his or her family and community. Add to this mix the primary care physicians that you may have to consult with to satisfy the requirements of your managed care plan — well, it can be more than confusing to decide whom you should contact for help. (For a very thorough explanation of the roles and qualifications of mental health providers, we recommend you take a look at the book Getting Help (2007, Wood, New Harbinger).

Generally speaking, the two classes of professionals you'll want to focus on are psychiatrists and psychologists. Psychiatrists have the training, experience, and, most critically, the authority to administer medical treatment of OCD. Psychologists are trained to provide behavioral care and psychotherapy. Although some psychiatrists also use psychotherapy in their practices, many do not. Psychologists may not prescribe medication unless they are licensed in the states of New Mexico or Louisiana and have received additional training in psychopharmacology. If you elect medical care for your OCD, the chances are that you will have two doctors working for you, a psychiatrist to monitor your medical regimen and a psychologist to guide you through behavioral care and to generally supervise your progress.

The structure of your treatment is a very personal decision, and you'll do well do some research before you commit to a plan and continue to evaluate your choice as your treatment progresses. We've said it before, but it bears repeating: Some people with OCD benefit greatly from medical care. For others, behavior care alone can result in good outcomes. It is our opinion — though by no means proven fact — that medical care alone, without concurrent behavioral therapy, is only a limited fix for OCD. We feel that behavioral care is a critical component to any plan for OCD care.

To start your search for a doctor or therapist, a good place to begin is the website of the Obsessive-Compulsive Foundation (www.ocdfoundation.org). These folks maintain a listing of psychiatrists and therapists who claim to have additional knowledge and experience in the treatment of OCD. Because the OC Foundation does not specifically research the credentials and qualifications of every doctor and therapist on its referral list, you'll still want to research the qualifications and experience of anyone you contact. The Obsessive Compulsive Information Center of the Madison Institute of Medicine, the Anxiety Disorders Association of America, and the Association for Behavioral and Cognitive Therapies also maintain listings of therapists who have indicated special interest in treating obsessive-compulsive disorder.

Chances are that you're not too far from an experienced OCD clinician if you live in or around a major metropolitan area. If there are no practitioners in your area, though, you can explore one of a number of OCD centers that offer in-patient or out-patient care. Once again, the Obsessive-Compulsive Foundation is a great resource to locate these kinds of programs.

When to start to actually screen clinicians or programs, you'll want to have an idea about what your getting yourself into. Don't hesitate to ask about any professionals credentials, licensing, and professional affiliations. If your individual holds a state license, you can be sure that he or she has completed the minimum education requirements for licensure and that he or she is answerable to a professional board for matters of conduct and competency. Don't be awed by credentials, though. Remember what we said about experience; a master's level counselor with considerable experience treating OCD may be better able to help you than a general psychologist with limited clinical experience with OCD. You might also look for professionals who are members of the OC Foundation, the Anxiety Disorders Association of America (ADAA), or the Association for Behavioral and Cognitive Therapies (ABCT).

Ask your professional what methods of treatment he or she proposes. If you're talking to a psychiatrist, you can assume that he or she will focus on medication, although you can and should ask about concurrent behavioral care. With psychologists and other therapists, references to cognitive behavioral therapy or behavior therapy suggest that the professional uses techniques similar to the ones you've read about at this site. You may want to specifically ask about ERP, which is still considered the gold-standard behavioral treatment for OCD. If the professional you're speaking with dismisses or doesn't know about ERP, you might want to consider looking elsewhere.

You certainly should inquire of any professional about his or her direct experience with OCD: How many clients has he or she treated with the disorder? How many are under his or her care now? Where and when did he or she received training in OCD treatment? A good answer here points to specific clinical training in anxiety-disorder care along with ongoing case supervision during graduate school or subsequent, postdoctoral training. You might even ask whether OCD has personally touched the professional's life, either as a sufferer or the friend or family member of one.

Finally, you should explore your professional's personal stance on OCD treatment. How does he or she feel about medication? Exercise caution if he or she feels very strongly that medication is inappropriate or dangerous. Your best bet will be someone who believes in a combined care approach that includes medication and behavior care as well as psychoeducation and family support coaching. Since any treatment you undertake should include ERP, you might ask whether your professional is willing to leave his or her office to support you in doing "in vivo" exposure and response prevention (ERP) work. You can also inquire about whether he or she can offer telephone consultation and support if you need it between sessions.

About this Article: Excerpted from Coping with OCD by Bruce M. Hyman, Ph.D., LCSW and Troy DuFrene. New Harbinger Publications. By permission of the publisher.

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