Option Three: Intensive Therapy
For especially resistant cases (and for other reasons detailed elsewhere in this book), you might want to look into intensive therapy. Intensive programs are generally residential and of short duration (usually a few weeks, depending on the severity of the case). Inpatient programs provide CBT (and medication, if appropriate), just as out-patient treatment would, but it is done in a controlled environment where the therapist is available to see you do the exercises.
For many, if not most, patients, CBT can be scary. But it has demonstrated a high rate of success. Getting started is usually the hardest part. Think about how much better your life can be after you complete your treatment. In other words, “Keep your eyes on the prize.”
McLean Hospital in Belmont, Massachusetts, runs the country's oldest in-patient program. You can search the International OCD Foundation's website to find others. There's also a list of some inpatient programs provided here.
To ascertain whether your treatment in the program is working, you'll have to give it a chance. This does not mean that you should keep taking a medication that makes you sick. (In fact, if this should happen, talk with your prescribing doctor right away.) However, if you want to know whether a therapy or medication is working, you'll need to do it or take it long enough to draw a reasoned conclusion.
If you don't have a therapist or health insurance, a self-directed program, such as the one in The OCD Workbook by Bruce Hyman and Cherry Pedrick, might be helpful. However, because support is such an important component of CBT, working with a therapist is still your best bet. If you begin treatment, particularly CBT, early, it may take less time to reduce your symptoms than if you wait for things to get worse. (Plus, you'll spend less time feeling anxious and miserable!) Even the worst cases often improve significantly with treatment.