The treatment of OCD usually involves both medication and psychotherapy. Both components are valuable, and together, give someone with OCD the best chances for recovery.
So what is psychotherapy exactly? Psychotherapy is also known as "talk therapy." There are numerous schools of psychotherapy, ranging from Freudian psychoanalysis to behavior therapy. There are less formal aspects to therapy as well. The relationship formed between a patient and his therapist, and the trust and support that relationship provides, is helpful in and of itself. When the therapist teaches the patient about his disorder, that education is a part of therapy too.
Who does psychotherapy? In general, mental health professionals who are trained in psychotherapy perform it. These professionals include psychologists, psychiatrists, nurse practitioners, social workers and therapists/counselors. Years ago, one's psychiatrist may have prescribed meds and initiated psychotherapy. With the large number of psychiatric medications now available, though, most psychiatrists choose to focus on prescribing, leaving the therapy to other mental health professionals.
Why is therapy important for people with OCD? While medications for OCD undoubtedly have their place, psychotherapy is essential. Pills can help but understanding one's symptoms and what one can do about them is key.
The following are a few of the major types of psychotherapy that apply to OCD:
- Cognitive-Behavioral Therapy (CBT): This type of therapy is probably the most widely used for OCD today. Cognitive therapy involves identifying and changing "distorted thoughts." An example of a distorted thought might be the idea that touching a doorknob will give one a disease. A cognitive therapist would work with a patient to help him realize that the idea is unrealistic. Behavioral techniques are closely related. Behaviorial therapy is a structured way in which behaviors are changed. The undesirable behavior associated with the above thought distortion might be washing one's hands 10 times after touching a doorknob. A behavioral therapist would work on eliminating that behavior. An important technique for treating OCD is Exposure and Response Prevention (ERP). Imagine that the person has touched a doorknob (the exposure) and wants to wash (the response). ERP would involve learning skills to get through the discomfort of not washing: deep breathing, relaxing imagery, etc. Desensitization is another technique, where the person with OCD may try touching "slightly dirty" items first, working himself up to the most-feared contaminated object (the doorknob).
- Psychoanalysis: The famous Sigmund Frued founded the school of psychoanalysis. He focused on unconscious desires, childhood events and defense mechanisms. Frued's techniques included free association (saying the first thing that comes to mind) and dream interpretation. The classic image is of a person lying on a couch while the analyst listens quietly. Psychoanalysis is still practiced today, although many providers prefer using other techniques.
- Supportive Therapy: For fairly high-functioning people with OCD, supportive therapy may be helpful. This type of therapy involves regular contact with a therapist, who provides sympathy, encouragement, feedback and a safe environment.
- Family Therapy and Group Therapy: Since OCD so often affects the relationships of those who have it, family therapy and couples therapy can be useful. Participating in groups with other people who also have OCD can be helpful as well.
Many therapists use combinations of the above categories, individualizing treatment to suit the unique person with whom they are working. Arguably, the most important aspect of psychotherapy is the relationship between therapist and client. Finding a therapist with whom you feel comfortable and at ease is absolutely essential.