The Difficulties of Accessing Effective Treatment: OCD as an Example

I resonated with a recent article in Psychology Today about the difficulties people have in finding therapists who offer effective treatment. The authors Dean McKay and Scott Lilienfeld—especially Dr. Lilienfeld—have been extremely active in promoting science-based psychotherapies.

As an example, they offer the experience of “Jerry” (a pseudonym). Jerry struggled with obsessive-compulsive disorder (OCD). Having educated himself on OCD, Jerry knew that exposure and response (or ritual) prevention (ERP, for short) was the most researched and effective treatment for OCD. ERP involve systematically helping people with OCD learn to confront obsessions while resisting the urge to engage in compulsions or rituals.

Despite living in a major city, it took Jerry 3 years to find a therapist who offered and was proficient in ERP for OCD. Jerry’s experiences are similar to those of a Yale graduate student with OCD.

Many clients I’ve seen have similarly struggled. Some were misdiagnosed by prior therapists and did not even realize they had OCD until they did their own research. Some therapists correctly identified them as having OCD but when it came to treatment, they “just talked.”

Most people with OCD with whom I’ve worked have seen at least 1 or 2 therapists who have not been particularly helpful. Hair pulling (trichotillomania) and skin picking (excoriation) are two other problems that people with whom I’ve worked have struggled to find effective treatment.

The article by Drs. McKay and Lilienfeld provides a sober reminder that there are a number of people who would benefit from effective treatments such as ERP but cannot find therapists who practice it or are aware enough of their competency to refer out to a specialist. Unlike Jerry, many people with problems such as OCD, trichotillomania, and excoriation don’t even realize there’s a name for their struggles, let alone effective treatment, and they may drift in and out of therapists’ offices being misdiagnosed and receiving substandard treatment.

Drs. McKay and Lilienfeld recommend that:

The adoption of the new clinical practice guidelines is probably our field’s best hope for placing long overdue pressure on therapists to incorporate scientifically based approaches into their clinical practices. Practice guidelines would also assist mental health consumers with the daunting task of selecting more effective treatments.   


Sadly, there are many licensed therapists who do not believe in science-based approaches. For people with mild to moderate depression/anxiety, generic talk therapy and nonscientific approaches can offer some relief. For people like Jerry with OCD, these unscientific approaches are unlikely to be of much help.

I’m inspired that psychologists such as Drs. McKay and Lilienfeld take time from their busy schedules as full-time professors and respected researchers to promote scientific approaches. You can read their blog post here. I encourage readers to carefully research the therapists you or your loved ones see, and not to stay in therapy with someone who doesn’t seem to be very helpful.

Misophonia: what the heck is it and what’s a trigger?

Misophonia is a condition in which a person has an automatic, unpleasant internal reaction to specific sounds.  This reaction can vary from frustration to panic and even rage, and can be quite an intense experience for the sufferer.  Sounds that lead to this reaction are typically sounds from everyday life, such as others’ chewing food/gum, sniffling, or heavy breathing.  People with misophonia will often refer to “triggers”; a trigger, for someone with misophonia, refers to any sounds that produces the intense internal reaction.

Many people who have misophonia experience a lot of shame before they come to understand that this is a condition experienced by many others and that they are not alone in their struggles.  They can experience a lot of shame about both the intensity of the internal reaction and their response to those who have made a sound that is triggering.  I was one of those folks.

How I learned about my misophonia:

I learned about misophonia about 5 years ago.  I was talking with a colleague about my internal responses to certain noises and she noted that one of her clients had very similar experiences and told her that it was called misophonia.  I remember the first time I googled misophonia and found a video on YouTube, in which a man with misophonia was talking about his internal experiences of it.  After getting over the oddity of hearing this man talk about things I had never heard anyone else talk about, I began to feel so much more understood, by both myself and this larger community.  As I met others with misophonia, I discovered a community who could provide the sort of support that was difficult to garner from those who did not have misophonia.

Discovery and recovery:

Since discovering that I have misophonia, I have engaged with the misophonia community on a few different levels.  Given that I am a psychotherapist, I became interested in helping myself, and others with misophonia, learn to live with the condition and have relationships with others that thrive. I currently specialize in working with people with misophonia and am actively working on developing treatments that can help them to learn better ways to cope with the condition. I feel like being involved in the misophonia community and learning about the experiences of others has given me a lot of insight into the condition that I can share with others who are struggling. I feel grateful to have found this community and am thankful I get to pass on what I have learned to others.

Misophonia Treatment at Portland Psychotherapy

A Brief Video about OCD

I ran across this excellent 5 minute video on obsessive-compulsive disorder (OCD) by Helen Blair Simpson, MD, PhD through the Mental Health Channel. Dr. Simpson is a professor at Columbia University and director of the Anxiety Disorders Clinic. She is one of the leading experts on anxiety and OCD and related disorders.

In this brief video, Dr. Simpson walks through different types of OCD and describes the range of severity with which people may struggle. She provides specific examples of some of the people with whom she has worked. At the very end, Dr. Simpson gives provides a summation of our current understanding of OCD and the brain in plain language.

If you or someone you know struggle with OCD, I highly recommend you check it out. It’s very concise and yet covers a range of different OCD-related symptoms. You can watch the video here.

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