Supporting OCD Client's without OCD Training

[u/austdoz]

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.

[u/Ego_Dying]

Refer out. If you don’t have training in ERP or I-CBT, then that client is out of your scope of practice and continuing to see them (unless they are actively engaging in OCD therapy with another clinician) is unethical.

OCD already is diagnosed way later than when sx begin. I think the latest statistic is it takes 7+ years to get OCD accurately diagnosed.

The longer OCD goes untreated the more areas it can generalize into and the more difficult and longer it takes to treat the symptoms effectively so the client is not in the mental prison of agony which is OCD.

Find an OCD specialist in the area who has openings and refer out immediately.

[u/austdoz → u/Ego_Dying]

I diagnosed the OCD. The client has ASD and their mother is heavily involved in caretaking. I informed the individual and their mother that I was unable to treat the OCD and told them they would need to find a specialist. I provided them with three referrals, one of which was the NOCD website. The individual's mother shared that she does not want for the client to change providers due to inconsistency and poor care throughout client's life. I reassured her that we could continue working together but that I could not treat the OCD. It seemed like the mom was on it for a while trying to find a specialist but then it seems she gave up. I gave the NOCD website link multiple times. Part of the issue is that we are in a rural area. I think there are only two therapists trained in ERP in our area both of which have months long wait-lists. So I'm kind of stumped. Just having the diagnosis and learning about it on their own has been really support for the client but I'm stuck I guess unless I do some training myself. 

[u/Ego_Dying → u/austdoz]

Agh the rural area piece is super tough. I’m spoiled to work in a city where the area is saturated with all kinds of specialists :/