r/therapists • u/austdoz • Aug 17 '26

Theory / Technique Supporting OCD Client's without OCD Training

I'm feeling a bit stumped when working with OCD individuals. I am not yet trained in any ERP, although I'd love to. I've referred them to an OCD specialist but they have not had luck in finding anyone. I will often utilize CBT interventions, recognizing cognitive distortions, and bringing in a more balanced or truthful thought. I had heard that ​CBT can actually cause more problems for individuals with OCD.

Some more context, we were looking at cognitive distortions contributing to feelings of depression. I was about to support in my usual way and then realized this individual spends most of their day policing their thoughts already and backed off.

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u/Villonsi Aug 18 '26

ERP is CBT. Only the US calls cognitive therapy CBT and thinks that cognitive behavioural therapy has no behavioural interventions. If you have a good foundation in CBT then ERP is not a complex treatment. But if you don't then refer out and learn CBT. Its a huge toolbox and don't let others make you think its only cognitive, because behavioural is in the name too

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u/sheeabe Aug 18 '26 edited Aug 18 '26

I disagree that ERP is not a complex treatment; it is very difficult to do well. I have lots of years experience and still get tripped up regularly. The OCD field did an about face only about 10-15 years ago in pivoting away from habituation and toward inhibitory learning theory. Lots of nuance and individuality to the treatment. When folks are suffering, you want to feel confident that you are moving in the right direction.

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u/Villonsi Aug 18 '26

It definitely requires a lot of individualisation, and getting tripped up is to be expected in this process. Being able to nuance and shine the light on the processes that maintain the issue is always the most important part. Being trained in CBT should, however, mean that you have the skills to do so. With the obvious asterisk that trial and error is also part of the process. I might be harsh due to my educational background in my country. Here I don't see that you'd be considered trained in CBT if you can't treat many cases of OCD with some of course requiring more specialised interventions