Finding the Right CBT Therapist

Aureen Pinto Wagner, Ph.D.
The Anxiety Wellness Center, Cary, North Carolina

Cognitive-behavioral therapy (CBT), and especially the technique of exposure and response prevention (ERP), are very important to a youngster’s recovery from OCD.  However, finding a therapist with expertise in ERP for a child or teen may be quite challenging.

There are many types of therapy that do not have scientific backing to show that they work for OCD. There are also many types of therapists, and many may not provide ERP for a child or teen.  All too often, parents and youngsters may find themselves with a therapist who is warm, understanding and well-intentioned, but does not provide ERP. Unfortunately, the child’s OCD does not improve and may even get worse, resulting in a waste of precious time and resources.

Therefore, it is wise to think carefully about choosing a therapist for a child or teen with OCD. You are the best advocate for your child.

Be an informed consumer.

Know what you are looking for and to be assertive in finding it.

• Learn as much as you can about ERP, so that you have a good understanding of what it involves and how it works.
• Understand the educational background of the therapist: The many degrees you might come across, such as MD, Ph.D., Psy.D., Ed.D., MSW, MA, etc. can be quite confusing. There are many different professionals such as psychiatrists, psychologists, social workers and counselors who may be licensed to provide therapy for mental health conditions.

However, these professionals have different training backgrounds and diverse skills to offer. Clinical Psychologists (Ph.D. or Psy.D.) are more likely to be trained in CBT and ERP. However, child psychiatrists (MD or DO), social workers (MSW) and mental health counselors (MA, MS) may also be trained to provide ERP.  

• Find a licensed therapist.  The educational degree of the therapist does not necessarily mean that he or she is licensed to practice.  Therapists may display their license information either on their brochure, website, or on a certificate in their office. State licensing boards often provide an online database where you can check a therapist’s license.  The listing of therapists on this website consists only of professionals who are licensed in the state in which they practice.    

However, neither the educational degree of the therapist, years of experience or license are enough to ensure that they are experienced in ERP for OCD in kids and teens.

Ask questions.

You won’t know unless you ask.  The questions below are a guideline to allow you to understand the therapist’s expertise in ERP with kids and teens.  You may find the answers to some of these questions in the brochures or on the websites of therapists. You may hear it from a primary care physician or word-of-mouth through another parent.  If you do not find the information, think about asking the therapist directly.

• Are you trained to work with children and teens, or just with adults?
• What is the treatment you provide for OCD in children/teens?
• What other treatments are known to work for OCD?
• Do you use ERP? Please explain how ERP works.
• How long have you been using ERP to treat children or teens with OCD?
• How effective do you think your treatment has been?
• How do you get a child ready for treatment?
• What is your approach to working with parents and families?
• How often do you meet with us and/or our child?
• Can we meet with you alone, without our child present, if needed?
• Will you be able to help us with day-to-day parenting issues?
• How long will the treatment take?
• What signs do you look for to know if treatment is working?
• At what point can we expect to see results?
• What do you suggest if no improvement is seen at that point?
• What is your attitude towards medication for OCD?
• Are you available if we have questions or a crisis between sessions?

The therapist’s responses to your questions will give you a good idea of their expertise in treating OCD in kids or teens. Does the therapist seem to be able to explain clearly how he goes about treatment, and how he would get your child ready for ERP?  If the therapist is vague or is not able to describe ERP for OCD correctly, he or she may not have sufficient expertise to treat your child.

Decide if you are comfortable with the “bedside manner” of the therapist

Exposure involves facing fears, which may be a scary thought for a child and parent.  Therefore, the child and parent must be able to trust the therapist.  Does the therapist respond to your questions openly, with good information, such that you feel you can trust her to do a good job?  Does the therapist respect your role as parents of your child and welcome your involvement in the therapy? 

Good therapists convey genuine compassion and empathy, and are good listeners. They welcome questions, and share information readily. They appear comfortable in their knowledge and experience. They give you a sense of confidence and hope.  They are also balanced in their views regarding CBT and medications. A therapist who is against medications may not be able to guide you through treatment decisions.

If you find that the therapist clearly has expertise in ERP for kids with OCD, understands your concerns, is open, willing to share information, and compassionate, you may have found the right therapist.  On the other hand, if the therapist does not seem to know enough about ERP, or is evasive, annoyed, or challenged by your questions, keep looking till you find the right one for you and your child.