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Why Isn't Psychological Therapy for OCD Working?

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Updated September 02, 2010

Question: Why Isn't Psychological Therapy for OCD Working?
Answer:

Although psychological therapy for OCD has come to the forefront in treatment for OCD, it is not always effective. Let's explore some reasons why psychological therapy for OCD may not be working for you and what you can do about it.

  • Receiving the Wrong Form of Psychological Therapy for OCD. Are you receiving the proper form of psychological therapy for OCD? Only cognitive-behavior therapy (CBT) and exposure response prevention (ERP) have been scientifically proven to be effective in the treatment of OCD. While these treatments don't work for everyone, they are considered first-line treatments in the management of OCD symptoms. Other psychological techniques such as psychodynamic/analytic psychotherapy and supportive psychotherapy are much less likely to improve your symptoms, although an analytic/exploratory approach may be complementary in some cases to explore the less conscious conflicts and inhibitions around change.
  • Not Being Ready for Therapy. Undertaking CBT and/or ERP for OCD is not simply a matter of attending weekly appointments. It requires a lot of hard work in between sessions and a healthy dose of motivation in order to succeed. If you are having trouble completing homework assignments be sure to speak with your therapist. It can often be very helpful to explore why you are afraid of undertaking exposure exercises.
  • Enabling by Family Members/Spouses. Although family members often have the best of intentions, they can sometimes unknowingly undermine the treatment goals of CBT and ERP by helping carry out the affected family member's compulsions or by helping them to avoid experiencing anxiety. For this reason, it is essential that family members be educated about the goals and methods of treatment. In some cases, the family member may want to attend therapy sessions.
  • A Poor Relationship With Your OCD Therapist. If you have a poor relationship with your OCD therapist, don't trust his or her, or don't feel comfortable discussing the nature of your obsessions and/or compulsions, you are very unlikely to benefit from therapy. Things to look for in a therapist include empathy, good communication skills and proper training in CBT or ERP.
  • A Lack of Social Support. A chaotic, abusive and/or unsupportive family environment can make it very difficult to get the most out of psychotherapy. Loneliness and isolation can also hamper treatment efforts. If there are problems at home bring this to the attention of your therapist. Additional help and support may be available.
  • Financial and/or Employment Difficulties. If you have OCD, you know it can often be difficult to find or maintain steady employment. This can cause severe, chronic stress and lower self-esteem which can undermine the best of treatment plans. Not to mention, psychotherapy often has significant out-of-pocket expenses which can be an added stress. Be sure to mention any financial/employment difficulties to your therapist as additional resources may be available.
  • The Presence of Other illnesses. Dealing with OCD on its own is hard enough. Treating and coping with OCD can be especially challenging if you have other physical or psychological illnesses to contend with. For example, depression, in particular, can make it very difficult to follow through with the difficult work of exposure therapy. Be sure to mention any other symptoms you may be experiencing so that your therapist can adjust your treatment accordingly.
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