Why Your Therapist’s Training Matters for OCD and Anxiety
When it comes to OCD and Anxiety, not all therapy is created equal
Talk therapy is a wonderful thing. Having a space to express thoughts, explore the past, analyze relationships, and delve into questions of meaning and purpose can be an incredibly healing experience for many.
However, individuals whose primary issues stem from anxiety or OCD sometimes have a slightly different experience of traditional talk therapy. A common refrain I hear from clients who have had past experience with traditional talk therapy is something like the following: “I’ve done therapy before. I loved my therapist, and I learned a lot about myself and my past, but my OCD (or panic attacks, or health anxiety, etc) never got better. Talking about my symptoms didn’t seem to help.”
Why doesn’t regular talk therapy always work for OCD and anxiety-related issues?
For one, most anxiety disorders, as well as OCD, are both created and sustained by specific patterns of behavior. In order for a person to improve, specific behavioral change is often required. Traditional talk therapy, where the client directs the course of sessions, might not help clients identify what behaviors (both external and internal) need to change, much less provide opportunities in session to practice those changes. Therapists are often trained in graduate school to let clients take the lead, to listen empathically, and to reflect back to the client the emotional content and underlying meaning of their expressed thoughts. This supportive listening can be immensely helpful for many, but for individuals with significant anxiety, it might not help, and a more structured, diagnosis-specific approach is often more helpful.
For example, someone suffering from health anxiety may spend lots of time in talk therapy talking about physical symptoms that they are worried about, but never learn how to respond to those worries in a different way, such that the cycle of anxiety gets interrupted and their symptoms get better.
At worst, traditional talk therapy can make folks with anxiety disorders more sick. Specifically in the case of OCD, where sufferers often seek reassurance that their worst fears are not (or will not come) true, well-meaning therapists without training in OCD may inadvertently provide the client with words of comfort (“No, there’s no way you are a [insert scary thing here]!”) that end up reinforcing the anxiety cycle, keeping the person stuck. Other therapists may argue with the client or try to convince them that their fears are irrational, which can end up further confusing the person and pulling them deeper into their content (what ICBT refers to as “inferential confusion.”).
The best available evidence suggests that effective treatments for anxiety are cognitive and behavioral in nature. Meaning that they involve modifying the individuals thoughts and beliefs, as well as changing the client’s relationship to those thoughts and beliefs and sensations. Behavioral therapy focuses specifically on identifying what clients are doing to reinforce and sustain their anxiety symptoms and helping them to change those behaviors. Unfortunately, very few if any Masters-level graduate programs train therapists in approaches that endeavor to do this, such as Exposure Therapy, ICBT, or Metacognitive Therapy. This means that specialized training is required in order for clinicians to effectively treat serious anxiety disorders and OCD.
Why don’t all therapists have training in effective treatments for anxiety disorders and OCD (ERP, ICBT, etc)?
For most therapists, especially graduate-level clinicians such as myself, graduate school was primarily focused on teaching the basics of therapy. Skills like empathic listening, diagnosis, timely and meaningful reflection, as well as master over basic theoretical concepts such as assessment, treatment modalities, and ethical practice take considerable time to learn. As such, the majority of our Master’s degree is spent learning them.
Furthermore, post-graduate training and professional development can be extremely costly and time-consuming. As a result, therapists generally must pick and choose which treatment modalities to focus on and hone their skills in. This is why you will generally not find a therapist who claims to specialize in more than a couple of disorders or treatment approaches.
As for why more therapists don’t have experience or training with OCD, this gets to larger issues with awareness of the diagnosis in the public at large, a general failure of graduate training programs to teach students to identify OCD, as well as a tendency among new therapists to gravitate towards treatment modalities for more well-known diagnoses, such as PTSD.
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I offer specialized treatment for Obsessive-Compulsive Disorder (OCD) and anxiety issues like Generalized Anxiety Disorder (GAD), Social Anxiety Disorder, and Panic Disorder both in-person in Lake Charles, Louisiana, as well as online throughout Louisiana. Reach out now to schedule a free consultation.