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.

Get help coping with your loved one who has persistent mental illness

Do you have a loved one with Bipolar Disorder, Schizophrenia, or another type of persistent mental illness? Having a loved one with a persistent mental illness can feel stressful and overwhelming. The mental health system can be confusing and resources can be difficult to find. I specialize in working with family members to help them develop practical and useful skills to cope with their loved one’s mental illness and improve family relationships.

I offer one-to-one or group training based on evidence-based principles shown to reduce relapses of mental health problems, and improve the well-being of family members. The training is done in a collaborative and supportive style, and is focused on the hands-on skills you can use to improve your and your loved one’s mental health. As a family member of someone with a persistent mental illness, you may have that you are to blame for your family member’s illness. You are NOT to blame for their illness, but there ARE things you can do to improve the quality of life for your family and loved one with mental illness.

Why do I use evidence-based principles in what I do?

The whole team at Portland Psychotherapy has a strong commitment to using evidence-based principles in our work. Evidence-based means that techniques, treatments, or principles were tested in rigorously controlled experimental studies, as well as in studies in settings similar to our center (i.e., outpatient treatment centers), and were shown to be effective in reducing distress, relapses, or functioning. We use what works based on scientific findings, not on fads or untested techniques. Although we have a strong commitment to evidence based principles, we work hard to flexibly tailor these principles to best meet the needs of the individual and the family.

What kinds of things will help me and my family member?

Numerous research studies have shown that certain techniques are more effective in improving your well-being and your family member’s mental health. Communication skills, particularly skills that decrease the expression of negative emotions, can decrease symptoms of and relapses of persistent mental illnesses, such as schizophrenia (Butzlaff & Hooley, 1998). Problem solving and education about mental health problems and treatments can improve your well-being and help your loved one and family resolve problems more effectively (Malouff, Thorsteinsson,  & Schutte, 2007; Dixon, Stewart, Burland, Delahanty, Lucksted et al., 2001). Self-care strategies for family members can decrease stress, anxiety, and even, health problems (Cuijpers & Stam, 2000). I help family members learn these evidence-based skills that will help you and your family member improve your lives.

What will I learn if I work with you?

If you contact me, we will schedule an initial consultation, from which we will develop a plan on how to help you with your family member. The plan could include any of the following elements:

  1. Information about the mental illness your loved one has and treatments for that mental illness.
  2. Information about the mental health system and community resources.
  3. Communication skills training to more effectively express your needs and emotions, set limits, and reward your loved one’s actions.
  4. Help with identifying limits you are comfortable with and how to reward actions that promote mental health and recovery.
  5. Problem solving skills that generate multiple solutions tailored to your unique circumstances.
  6. Realistic self-care strategies that you can implment in your life.
  7. You will also get access to a support group of families struggling with a similar situation that I run.

What can I expect during our meetings?

In the first couple of sessions we will focus on a developing a detailed understanding of your loved one’s mental health symptoms, the impact of the symptoms in your lives, and your own mental health. Then, we will create specific and action-oriented goals that we will use to evaluate our progress. The following sessions will focus on learning and practicing skills described in the section above (i.e., communication skills, problem solving, education about mental health, and self-care). You will be asked to practice the skills in between meetings so we can make any revisions or adjustments to how you use the skills.

I do my best to create a supportive and collaborative environment. I will work with you to learn and tailor the skills to your unique situation. You have valuable information and knowledge about the situation you are in. I actively seek out your contributions and experiences and incorporate them into the learning process. I work hard to create an accepting and positive environment where you can share your experiences and practice the skills. You are not defined by your difficulties, therefore, your strengths and values will also be incorporated into the training.


General Mental Health Resources

Resources for Specific Mental Health Problems

  • has list of resources on schizophrenia and topics related to schizophrenia (e.g., schizophrenia and drug use).
  • is a website that has information about Bipolar Disorder, including links to support groups.
  • Depression and Bipolar Support Alliance is a national organization for individuals with depression and Bipolar disorder. It includes a helpful tip sheet for family members of what to say and what not to say to a loved one with Bipolar Disorder.
  • The National Center for PTSD is part of the Veterans Administration dedicated to researching, educating, and treating PTSD. Although there is a strong focus on Veterans, the website includes useful information and resources on PTSD for people who are not Veterans.
  • Families for Depression Awareness is a national organization for families who have loved ones with depression.
  • Anxiety and Depression Association of America has information and resources for people with anxiety disorders or depression.
  • Substance abuse resource website at Portland Psychotherapy has links to information about, organizations, and support groups (for people with addictions and for family members of people with addictions) for addictions.

To learn more:

You can learn more about me at my therapist page. If you’d like help coping with mental illness in your family or learning how to better support your loved one who is suffering, I am here to help. If you have any questions or want to set up an appointment, please give me a call at 503-281-4852 x5. You can also contact me using the confidential contact form below.