Often, a good way to find a capable therapist is to ask friends for referrals. If a friend feels his therapist has helped him, he will probably make a recommendation confidently (unless, for some reason, he spends a lot of time at the therapist's talking about you, in which case, it would be better for both of you to see different providers). However, unless your friend also has OCD, it's not necessarily likely that his therapist will be the right one for you. So what do you do?

Psychiatrist, Psychologist, or What?

If you are considering treating your symptoms with medication, or a combination of medicine and therapy, you might feel a little stuck when it comes to getting started.

First, let's try to clarify: As you may know, a psychiatrist can prescribe medication, while a psychologist cannot. (There are also licensed clinical social workers. They do not prescribe, either.) However, two things a psychiatrist probably will not do are work with you on reducing your OC symptoms (except inasmuch as medication can do that) or spend a lot of time with you. A clinical therapist (one who sees patients) — psychologist, psychiatric nurse, or social worker — will probably do both.

Of course, if you would like to use medication in conjunction with therapy (a very smart idea), you can engage a psychologist for CBT and a psychiatrist or psycho-pharmacologist for your prescription. (Your psychologist can probably recommend a doctor who can prescribe medication for you. In a way, this provides kind of a nice little checks-and-balances system: Both professionals will have to agree on your diagnosis before anything is prescribed.)

You will likely meet with your psychiatrist, psycho-pharmacologist, or doctor on a regular, but not necessarily frequent, basis to assess how well your medication is working. Generally, appointments with your prescribing doctor will take place more frequently at first, then taper off if your medication seems to be doing its job. You will still need to see your prescribing doctor every so often after that, just to make sure that all is working as it should.

Your sessions with the prescribing doctor will probably be short, perhaps as brief as ten minutes all told! You should use your appointment time to discuss any concerns you may have about your medication, in addition to how well it seems to be working (or not). Of course, if you should have any problems with it before your next scheduled appointment, by all means, make another appointment for a sooner time — or, at the very least, get in touch with your provider over the phone. That's what he's there for.

Getting to the Bottom of It

There are many kinds of therapy. However, many traditional psychological therapies rely on insights to help bring resolutions to problems. In the case of OCD, all the insights in the world will not necessarily suffice. An OC patient may know what triggered his OCD, but that usually has little, or nothing, to do with treating it.

(As discussed in Chapter 3, the condition is not believed to be “caused” by events, but rather by brain chemistry, usually hereditary. Often, a traumatic event can set off the first major episode in predisposed persons, but that does not mean the disorder itself is brought about by that one thing, or even by several things. Similarly, some researchers say that a childhood marked by strict rules can foster the development of OCD. Even so, it is now understood as a neurological disorder, and not the result of early trauma.)