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Accessing OCD (Obsessive-Compulsive Disorder) treatment such as CBT (Cognitive Behavioural Therapy) can be challenging for many of us, so it is important when you do obtain CBT treatment that you give yourself as many opportunities as you can to benefit from this therapy.
To help you with this, OCD-UK has compiled a list of ten therapy tips to help you get more out of your treatment.
We hope these tips will become organic and grow with more or updated suggestions, so please do check back from time to time.
If you have a suggestion to help people with OCD improve their therapeutic experience please do send us an email to email@example.com to let us know.
1 – Ask for an introduction
It’s important you feel comfortable with your therapist, and part of this is knowing them by name as this will help with patient/therapist trust. If your therapist fails to introduce themselves at the start of the first therapy session, don't be afraid to ask them what their name is. Simply ask, 'Do you mind if I ask your name? My name is Ashley'. And if you feel more comfortable by being referred to by a nickname, that’s OK too. The therapist will only have a note of your official name, so you could say, 'Hello, my name is Ashley but I would prefer it if you would call me Ash please'.
Also, at subsequent sessions if you have forgotten your therapists' name, don’t be afraid to say, ‘Do you mind if I ask your name again please?’
2 – Educate yourself
It's important that you have a basic idea about what OCD and CBT is and how the illness and treatment works, so education is Key. With OCD, knowledge really can be power! We have plenty of information on the OCD-UK website and there are a plethora of OCD books out there, the two we would highly recommend are Break Free from OCD written by three of the country's leading OCD specialists, all of whom are NHS employed. Another book we would recommend also is Overcoming Obsessive-Compulsive Disorder.
3 – Notes
When you first start therapy, it can be scary and nerve-wracking, not to mention emotional and it is amazing how many important points you forget to mention to your therapist the first time you go for therapy.
So in the weeks leading up to therapy, in a notepad (or on your smartphone notepad) start jotting down the areas where OCD is the biggest challenge in your life. Then take it with you to therapy so you can be confident to ensure your therapist is fully aware of the majority of your OCD problems.
4 – Stop thinking that thought!
Sadly some therapists will still suggest you stop conducting compulsions or stop having those obsessive thoughts, if only it was that easy hey? If a therapist does ever suggest that to you there is a simple one word response you must give them, and that is 'How?' or if you prefer to be a little more polite, 'Yes I understand that would be preferable, but can you tell me how and help me stop thinking these thoughts please'.
5 – Audio record your therapy sessions
Talking about therapy can be emotional, and therefore it is inevitable during therapy that you will forget to mention something important, or forget what the therapist says to you. Therefore OCD specialists always recommend patients audio record the therapy sessions so that they can play the sessions back later and fully take in what was spoken about. It is important your therapist is aware you are recording, but rather than ask, tell them at the start of therapy by saying, 'Just to let you know I am audio recording the session to help me review my therapy between sessions'. You can often use your smartphone to audio record, or it may be worth investing in a small Dictaphone like this Sony 4GB dictaphone.
Listening back to the therapy sessions can be hard and even uncomfortable sometimes (nobody likes the sound of their own voice), but it is important you do listen back to your sessions to get the most out of your therapy. You may realise certain aspects of the discussions missed important parts of your OCD, so if you realise that, refer back to 'tip 3' and make a note to discuss it next time.
6 – Homework – Set it, check it!
CBT is actually nearly always going to be conducted away from the actual therapy office, and most of it will be you doing it alone at home. So your therapist will often set you homework to work on between sessions. If at the end of session three you have not been set any homework, be sure to ask them why not and invite them to set some for you.
Therapy requires work from you, therefore homework is an integral part of the therapy commitment so it is important it is set; you attempt it and the therapist checks it.
Sometimes therapists are a bit forgetful, so if at the subsequent session they fail to ask you about it, be sure to ask them, 'Would you like to hear about my homework from last time?' Don’t worry if you can't do the homework, the therapist needs to know this so you can work on it together and maybe set a slightly more comfortable exercise until you are ready to try that one again further down the line of therapy.
7 – Involve loved ones
If you live with someone, parents or partner or even flatmates they can’t help you if they don’t know how. So do ask them to help you with your homework by telling them what it is, and ask them to give you some motivational support when you need it, (not reassurance of course). Ask the therapist in session one or two to write a letter specifically for your loved ones about what they should and should not be doing to help you on your road to OCD recovery. An ideal scenario would be that the therapist invites them to attend for a one-off joint session with you, maybe for the last 20-30 minutes.
8– Treatment on location
For some people their OCD is primarily focussed on problems in one area, often at home, or public places like shopping centres. In an ideal world the therapist will get off their bum and come with you to those places to conduct therapy on location. NHS cutbacks may prevent that, so it may be something you have to do alone for homework, or involve a loved one to help you.
However, if you cannot manage it alone be sure to request the therapist to arrange a session on location (maybe at the start or end of the day so they don’t lose other patient time).
9 – Mind the gap (said in the London Underground tone of voice)
This is one area the NHS has generally improved on and these days most patients are offered therapy once a week, or once every other week. Initially at the start of therapy, 60 minutes every week is an ideal schedule for sessions. It gives time to work on the homework, but not too much time for thousands of other OCD problems to occur.
If your therapy service can't offer more frequent sessions, be specific and ask them for once a week therapy for at least one hour. Naturally there will be occasions where the gaps are longer due to you and/or the therapist being ill/away on holiday. Not ideal, but occasionally that happens. If this does happen ask for a double session upon returning from the gap in therapy.
10 – Too little, too late.
Too many NHS services offer too little therapy, too late, with reports of patients being offered just four sessions and then telling patients to go away for three months before they can come back for more. That should not be happening. If it does happen, say to the therapist, 'The NHS guidelines for OCD recommend up to 10-hours of therapy ideally, can you ask your manager to ensure I get those 10-hours please?' If they refuse to extend your sessions, ask them to put a letter in writing to you explaining why. Then forward a copy of the letter on to OCD-UK. If you feel confident enough, we would also suggest you write a letter of complaint to your local NHS Clinical Commissioning Group (CCG), but OCD-UK can do that for you if you need us to.
If a therapist refuses to do any of the above you need to ask why; is it service restrictions or is it an unhelpful bad therapist? If you're working in a private environment it may be worth considering ‘sacking’ your therapist for a better one. If you are within the NHS environment, politely ask them why they are refusing, is it because of service restrictions or for other reasons. Either way ask them to confirm in writing why they are refusing, and we can review that with you. Maybe you could show them this article and tell them these are tips recommended by OCD-UK, and if they still refuse and you feel it is a barrier to effective treatment, you may need to ask them to pass you over to another therapist within their team - be clear that you are not asking to be discharged, simply to work with a therapist who will agree to your requests.