2024-07-06
21 分钟In today’s discussion, we’re delving into the seven mistakes some OCD therapists are making in 2024. While the title might seem provocative, the goal is to highlight concerning trends in OCD treatment and provide insights that could enhance therapeutic approaches. Remember, this is my opinion based on what I've observed in various forums. I don't claim to have all the answers, but I hope to spark a constructive conversation. Mistake #1: Insufficient Initial Education Importance of Education at the Start of Treatment Many clients report feeling thrown into exposure and response prevention (ERP) without adequate preparation. Therapists must take the time to educate clients about OCD, their obsessions, and compulsions, and what to expect from treatment. This foundational knowledge empowers clients, giving them a sense of control and a clearer understanding of their journey. Mistake #2: Failing to Instill Hope and Confidence The Power of Hope in Treatment Therapists must remind clients that they have the potential to succeed. Treatment for OCD can be highly effective, and it's crucial to communicate this. While maintaining a realistic perspective, therapists should focus on the positive aspects of available treatments and instill a sense of hope and confidence in clients. Mistake #3: Neglecting Evidence-Based Modalities Therapists should prioritize evidence-based treatments, particularly ERP. While it's important to integrate supplementary approaches like ACT, mindfulness, and self-compassion, the core of OCD treatment should be grounded in proven methodologies. Clinicians need to stay informed and ensure their clients understand the rationale behind chosen treatments. Mistake #4: Misconceptions About ERP Being Traumatic ERP: Not Abusive When Properly Delivered Concerns about ERP being traumatic often stem from poor delivery rather than the method itself. Proper education and a strong therapist-client rapport can mitigate these fears. It’s vital to ensure clients understand why they’re facing their fears and to provide a supportive environment throughout the process. Mistake #5: Rigid ERP Plans Flexibility in Treatment While structured plans are important, rigid adherence can be detrimental. Treatment should be flexible and tailored to the client's evolving needs. Engaging clients in the planning process and adapting as necessary ensures that the therapy remains client-centered and effective. Mistake #6: Overlooking Barriers to Progress Exploring Underlying Issues When clients struggle with certain exposures, therapists should explore the underlying barriers. Understanding the client's fears, trust issues, or other relational dynamics can provide insights that help adjust the treatment plan accordingly. This approach prevents avoidance behaviors from taking hold. Mistake #7: Not Assigning Homework The Role of Homework in OCD Treatment Homework is a critical component of OCD treatment. Without it, progress can be significantly hindered. Therapists should find creative ways to ensure clients complete their assignments, offering support and accountability measures. This empowers clients to practice skills outside sessions, enhancing overall treatment efficacy. Conclusion These seven mistakes highlight areas where OCD treatment can improve. It's essential for therapists to remain flexible, informed, and supportive, tailoring their approaches to each client's unique needs. Open communication and a collaborative mindset can help address these common pitfalls, ultimately leading to more effective and compassionate care. Remember, this discussion aims to foster growth and improvement. If you're a client, don't hesitate to discuss these points with your therapist. Together, we can create a more effective and empathetic therapeutic environment. Transcript Today we’re talking about the seven mistakes some OCD therapists are making in 2024. Now, I know the title sounds spicy, but in no way am I trying to be spicy. What my goal is today is to talk to you about some of the things I’ve heard, whether that be on social media, on podcasts, on blogs, or at conferences, when people are talking about the treatment of OCD that deeply concern me. Now, let me first say, in no way do I consider myself the moral police on OCD treatment. In no way do I believe that I am the knower of all things. In no way do I think that I know more than other people, my way or the highway. That is absolutely not what I’m saying here today. However, I am going to give you my opinion on some of the things that I hear that deeply concern me. I’m just here to share what I think is helpful. I hope, if anything, it’s here to really reassure clinicians that they’re on the right track because there are some amazing, amazing OCD specialists out there. If not, if this is something that you may find is calling you out a little, please, I’m here to hopefully bring some goodness into the world. Let’s talk about the seven mistakes some OCD therapists are making in 2024. As I said, this is all about my opinion. Again, in no way am I the moral police, but let’s talk about it. My guess is you’re probably going to agree with everything I say. If not, I’m totally okay with being disagreed with. Mistake #1: Not spending enough time at the beginning of treatment educating their client about the research and the science-backed treatment approaches that are here ready for us to use for OCD So often, I hear clients saying in my office that they had this experience of ERP exposure and response prevention where they were just thrown into it, and they were like, “Let’s just go.” I get that. I love an eager therapist. I love a therapist that’s not going to waste people’s time, but we have to spend a lot of time in the beginning educating them about the condition of OCD, helping them to understand their obsessions and their compulsions and how we get stuck in them and how they can be so seductive and how they can trick us, and also talking about what’s coming, what treatment’s going to look like, and what you can expect. We have to spend a lot of time talking about that as well so that the person who’s engaging in this treatment feels a sense of mastery over what’s about to happen. They feel like they can make decisions as they go because they’ve got a plan. They can see them crossing the finish line. They can keep that. They know what that’s going to look like, and they can use that to inform their decisions and how they connect and communicate with the clinician. Mistake #2: Not instilling hope and confidence in the client We have to remind our clients that they have everything that they need, that the treatment can be very, very successful, and that it’s an experiment. We don’t have to get it perfect the first time. This is a collaborative experience. There’s a lot of hope here that by us collaborating and by us talking through what’s working and what’s not working and having them understand that this is actually a really good thing to have in terms of there are many conditions that the treatment sucks, the treatment isn’t that effective. The treatment doesn’t help as much as it does with OCD. I never want to do the toxic positive thing with clients, but I also want them to acknowledge the conditions. This is one that we actually have some good research on. We have some good treatment options. We have these great supplement modalities that can help us along the way. We want to infuse them with hope. We want to infuse them with confidence in this process. I do often see particularly younger therapists not spending enough time really bringing a sense of hope to treatment because it’s so scary. They’re already in so much pain. They’ve probably been through treatment that sucked in the past. What we want to do is really focus on that hope, because hope is often what motivates us to take those first baby steps. Mistake #3: Not engaging in evidence-based modalities This is a huge one. I could spend a whole podcast episode or a week on this topic. There is so much misinformation about treatment and what is considered evidence-based. Now again, I’m not here to tell anybody what their treatment should look like. That’s a personal decision, and every client gets to make that decision. Who am I to judge? People need to come and know that they have agency over their lives and the decisions they make. But clinicians should be educated, and they should educate their clients on the options for evidence-based treatment modalities. Now, I am a huge supporter of exposure and response prevention. I have been trained in it. I have been doing it for 14 years. I have seen it succeed over and over and over and over again. As I’ve been public in saying, I see no reason to abandon that. Now, that’s not to say that I haven’t introduced modalities that supplement ERP. I love the use of ACT. I love the use of mindfulness-based cognitive therapies. I love the application of self-compassion. In many cases, I have applied dialectical behavioral health therapy to clients who are struggling with emotional regulation. Maybe they’re having self-harm or suicidal ideation. Absolutely. As time continues, we’re seeing newer approaches and modalities come up. But I see it in my job as a clinician to educate my clients on the treatment, what has worked, and what I’m skilled at doing too. The other thing is there is some research on other treatment modalities besides ERP. I think that’s wonderful. I mean, my hope is that one day we have something that is a sure thing, 100%, and we can absolutely promise that we’ve got guaranteed results. This is going to be something that I continue to learn and educate myself on, but my opinion is that I’m sticking with ERP. I love it. I find it so helpful and empowering. It lines up with everything and my treatment that has helped me. Fo