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Ashley

What would you want your therapist to know?

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Bit short notice, but tomorrow I have arranged for some mental health professionals here in Derby to be given specialist training on how to treat OCD. This partly came about through listening to my Derby OCD support group and the problems they have all faced in accessing good OCD treatment here. So it struck me, I should ask you guys too (not just for tomorrow, but for future training).

  • What things have therapists got wrong when treating you?  
  • What unhelpful (stupid) things have therapists said to you which really did not help?

Just for example, two from my Derby list that will be mentioned tomorrow....

- "Come back when you are ready to take a leap of faith."

- "If you can't commit to not doing compulsions, there's no point having therapy"

-Turning up at patients house unannounced.

There are lots more, but interestingly here in Derby, the same types of comments/complaints were made about the same therapy clinic over a long period, which does suggest the problem is the clinic, not the patients. 

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I haven't got much experience with therapists but the one I had just told me my anxiety would come down without compulsions, drew a graph and spent most other sessions telling me about what exposure exercises he did with other clients. He never offered to do any with me. He didn't mention pretty much anything at all that you might find in say Break free from OCD. This was a while ago now though, like 11 years. 

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The therapist I saw was useless and I didn't know I had ocd and she did not spot it. But basically all she did was give me a mountain of reassurance about everything which just made things a whole lot worse. I don't know if this would have been so much of an issue if she knew i had ocd but I imagine it would have been. So yeah, my answer is reassurance. 

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The first therapist I saw didn’t recognise I had OCD and I didn’t have a diagnosis at the time so I had no clue what I was dealing with. I went to see this university counsellor because I started having intrusive thoughts about self harm. He came to the conclusion that this was happening because I had unresolved grief about my grandmother who had died 8 years earlier and suggested getting a rubber band and hitting myself every time an instructive thought came in, as a distraction. I think that a lot of therapists don’t necessarily recognise OCD and it’s really problematic in places where they deal with young people, like universities, because when you come in with problems like these they completely panic and worry more about covering their backs than helping you.

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1 minute ago, malina said:

The first therapist I saw didn’t recognise I had OCD and I didn’t have a diagnosis at the time so I had no clue what I was dealing with. I went to see this university counsellor because I started having intrusive thoughts about self harm. He came to the conclusion that this was happening because I had unresolved grief about my grandmother who had died 8 years earlier and suggested getting a rubber band and hitting myself every time an instructive thought came in, as a distraction. I think that a lot of therapists don’t necessarily recognise OCD and it’s really problematic in places where they deal with young people, like universities, because when you come in with problems like these they completely panic and worry more about covering their backs than helping you.

OMG!!!

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5 minutes ago, gingerbreadgirl said:

OMG!!!

Yep, my first experience with therapy was really traumatic, but in the end I got a diagnosis and saw a specialist who turned it all around, so it all worked out in the end

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I'm not in England so my experience might be irrelevant, but when i went to see a mental health worker, they seemed to know what OCD was. However, they had no idea how to treat it. I was working through a self-help book that was really good and helpful but when I would share with the counsellor what i was doing, she would get really shocked because i would say that i needed to just let the anxious thoughts be rather than try to reassure myself--so i guess similar to what Gingerbreadgirl was saying about counselors doing the reassurance piece. She just kept encouraging me to increase medication and do mindfulness...

I would recommend all counsellors at least read through a CBT book for OCD!

 

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I would like to see therapists take more time to assess an individual and not leap in with a rushed decision on what THEY (the high and mightly) think the patient needs, rather than teasing more information out of the patient and having some options to try. 

If a patient has say black and white thinking, over-generalisation and mind-reading negative cognitive thinking distortions, or other ones from the 15 common ones, these will need the appropriate CBT too! Its a fairly simple process to assess other negative thinking, if the patient is asked to keep a thought log for several days. 

Professionals are not always right, and even patients with apparently similar problems may actually require different approaches.

Plus, having spent quite a lot of my career specialising in professional negligence insurance for all sorts of professionals, I know only too well how often they can make mistakes.

So, for me it's more time assessing and diagnosing, and listening to feedback from the patient, and coming up with plans that are actively discussed with the patient. 

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The last therapist I saw four times.  One home visit and three office meetings for checking and hoarding. During the home visit she did not look around my property. It was clear that she knew very little about hoarding in OCD terms and non OCD terms in respect of the DSM 5 classification system. She knew nothing about the basic principles of churning and other basic terms used in therapy. 

 If you do a home visit do an assessment and look around the property. Otherwise what is the point of a home visit.

She asked me during the office sessions to recall what  I had learnt in therapy some years previously. She did not assess my current state. We did no common formulations of my problem.

She lacked basic social skills which are required in therapy. These are mentioned in the book CBT for OCD. 

I have seen two therapists at the Institute of Anxiety. When they visited me we discussed my living accommodation. They were interested in me and my plight. They were socially skilled in terms of facial expression, tone of voice, nature of questions used and inputting recommendations. They had knowledge of hoarding and checking OCD. We had rapport and trust.

So therapist need to 

1. start each session with a conversation about the current state of the patient’s state of mind and behaviour.

2. have knowledge of OCD

3. not endlessly ask what a patient remembers about therapy some years previously. She said  that had read my notes. She was unaware that things change. Was the therapy a test of memory?

4. the therapist should possess social skills as presented in CBT for OCD. I think we need to video - not only to assess the patient - but also to assess the the therapist. Teacher training and lecturer training involves video sessions in order to improve performance. As do many professions. Such as the police and lawyers. Therapists should be assessed on a regular basis

5. Therapy is a collaboration. It needs the active engagement of the therapist not just the patient. 

6. At the end of therapy the patient should fill out a questionnaire about their experience. which is independently monitored for quality control. Standard procedure in higher education as well as many service sectors. 

Edited by Angst

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Not discussing their training, where they went to college, what methods they use & how successful those methods are, what alternative treatments there are, & just sitting around chatting which is pointless when treatment should be very hands on. 

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I concur. I have sat in front of various people in my life who have an extremely high opinion of themselves and draw hasty, uninformed, conclusions, which I challenged. 

I like a therapist to not be dogmatic, to treat each patient as completely different. 

In the words of Shania Twain, "that don't impress me much!" 

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I think the worst one is when they say why don’t you just stop it.

Also negative talking isn’t at all helpful like saying if your not willing to put in the work then there is no point continuing. 

Why don’t you just ignore the thoughts and then you wouldn’t have these problems. 

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My psychiatrist says I don’t have OCD it’s just delusions from schizoaffective disorder.

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2 hours ago, daja said:

My psychiatrist says I don’t have OCD it’s just delusions from schizoaffective disorder.

They use a book which is very similar to the one used in USA, DSM~5 You can ask a psychiatrist to give your your diagnosis code from that book. Most with OCD have other conditions, known as comorbidity. 

Edited by Handy

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I would like therapists to know that not everyone who suffers displays external signs!

I was refused specialist treatment because my therapist said that my symptoms were not bad enough, & he then gave an example of one of his patients who did, and how this person needed to use a stick in a gloved hand to turn on/off his light switches due to contamination OCD.

The thing was, for me, even doing the simplest of task, such as putting clothes on/off, or turning electrical appliances on/off, or walking over door thresholds meant carrying out a whole range of mental rituals and other things including making sure that digits on the clock did not add up to what I regarded as unlucky numbers, for example. It was like every wakeful hour was controlled by it.

 

 

 

 

 

 

 

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I have to agree with Handy. Do not involve in the patient's ways to get reassurance and that could be anything. When I was in group I saw a women who gave advices about which selfhelp-books were the best... which book had the right solution. 

At least the therapist should be out of touch for OCD's manipulative ways. Not accepting that an OCD-sufferer will twist everything to get reassurance is not a good start.

Edited by OCDhavenobrain

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Handy suggests therapists discuss alternative treatments.

There are none. To begin recovering from OCD and hopefully to recover, the sufferer MUST change the way they think about obsessions and MUST change the way they behave in response to the thoughts. There is no discussion on this. Those two things must be done.

Cognitive therapy looks to change the way you think. Behavioural therapy looks to change your behaviour. C + B + T = CBT.

 

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