Online OCD Therapy

Q: What's with the name OCD123?

 

OCD123 is a virtual tele-therapy service led by professional therapists that provides integrated Exposure and Ritual Prevention (ERP) and Meta-Cognitive Therapy (MCT) for OCD. The treatment is structured in 3 phases, hence the name.  

 

Phase 1: Evaluation

Phase 2: Setting the Stage

Phase 3: ERP and MCT

 

Q: What does it mean that OCD123 embraces Client-Centered Principles?

 

An important distinction that sets us apart is that we believe treatment should be provided with and for the client, not to the client.  Although we have expertise in OCD therapy, we also respect that you have expertise in what works for you.  We encourage and value:

   

• Unconditional acceptance of client (no judgement or criticism)

• Collaboration and 2-way communication regarding decisions

• Transparency of treatment process, duration, and costs

• Client autonomy, input, and choices

• Recognition and affirmation of client strengths and values

 

Q: Who is a good candidate for OCD123?

 

A good candidate for OCD123 is a person who is 18 years of age or older, resides in California, and is ready to participate in specialized therapy for mild to moderate OCD.  It’s actually all that we offer!  Because OCD123 is completely virtual, clients need to be able to fill out forms and communicate electronically. And, they must have consistent and private access to the internet for video sessions. Most important, clients must be willing to do the work during and in between sessions. But don’t worry - we will help you with the process, step by step!

 

Q: How does OCD123 determine what is mild to moderate OCD?

 

We look at the whole picture, but the three factors we consider most are current levels of symptom severity, occupational function, and insight. If your OCD symptoms are more severe, your occupational function is very limited, or you lack insight into having OCD (in other words, you cannot entertain the possibility that your symptoms are irrational on some level), we recommend getting an evaluation at a regional specialty center that can offer more intensive services. You can rate the severity level of symptoms on your own using the Y-BOCS Symptom Severity Scale before you decide to contact us.

 

Q: Can people with co-existing challenges (comorbidity) utilize OCD123?

 

It depends. Clients with mild co-existing challenges can still utilize OCD123, so long as those challenges do not interfere with participating in OCD therapy. We encourage clients with any co-existing challenges to seek additional treatment and are open to concurrent treatment in most cases. If coexisting challenges appear to be severe at the outset or are interfering with participation at any point, however, we will recommend stopping OCD123 and direct the client to other referral resources. We do not provide therapy to those who are actively struggling with delusions, hallucinations, serious suicidal concerns, or acts of self-harm. We recommend that prospective clients treat and stabilize those issues first, or seek OCD treatment at a regional specialty center equipped to address those co-existing conditions. 

 

Q: Can a loved one (close friend, spouse, or family member) support the client in treatment?

 

Absolutely! Social support in the form of a “therapy buddy” or “helper” can be very valuable and is encouraged in most cases. If the client and therapist agree to include another person in the process, it starts with developing a Support Person Plan to clarify roles and expectations.  Often, a loved one joins the client during therapy sessions and independent skill practice, especially when getting started with a new activity. During Phase 2, clients also receive information and guidance about managing reassurance seeking. However, OCD123 is not a family-based treatment model, nor does it provide family or relationship coaching. If there are additional concerns about accommodation, dysfunctional family relationships, etc. we will recommend referrals for additional support. At OCD123, the focus is on helping the client.  

 

Q: How long does the entire process last?

 

A rough estimate of treatment time is 1-6 months, depending on the amount of time between sessions and the number of Phase 3 sessions that are completed. The pace and duration of treatment is ultimately the client’s choice. A client can stop at any point, for any reason. 

 

Q: Can the treatment process be accelerated?

 

Usually, yes. If a client wants to proceed more quickly and staff can accommodate appointment requests, sessions can be scheduled closer together.  Although we usually recommend gradual exposure to triggers, clients can opt for flooding (rapid and complete exposure to triggers) in some cases. We can provide options and recommendations, and the client can decide what may work best.  

 

Q: Can OCD123 be combined with other treatments?  

 

Yes, with some exceptions. OCD123 can be combined with medications and with therapies for other challenges such as ongoing counseling for substance use or depression. While participating in OCD123, however, we recommend that you limit other psychotherapies for treating OCD (for example, we strongly discourage concurrent psychoanalytic therapy to explore underlying reasons for obsessions). All combinations of treatments should be discussed among providers. Note: OCD123 does not provide medications.

 

Q: Can prospective clients talk with OCD123 staff before making an appointment for an evaluation?

 

Sure! We’re happy to schedule a brief “meet and greet” and answer questions.  However, we will not provide any specific evaluation, treatment advice, or determination regarding treatment at that time. Those types of questions can only be addressed during an evaluation.

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Q: Why does OCD123 NOT post client testimonials on their website like some other clinics?

 

In short, we do not elicit or publish client testimonials because this practice is considered ethically problematic for various reasons.  Below is an excerpt from the American Psychological Association's Ethical Principles of Psychologists and Code of Conduct : 

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5.05 Testimonials

Psychologists do not solicit testimonials from current therapy clients/patients or other persons who because of their particular circumstances are vulnerable to undue influence.

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We also view publishing testimonials from past clients as a risk because OCD is a chronic condition, and past clients may become current clients again.  Our top priority is the client's best interest (vs. marketing/advertising).  

 

Q: Why are there so many intake forms to complete as part of Phase 1? 

 

We provide a comprehensive evaluation so we can determine your needs and offer guidance in an informed, ethical, and professional manner. The evaluation includes diagnostic evaluation of OCD, severity rating of OCD symptoms, functional analysis of OCD symptoms, evaluation for the presence of over 100 common types of obsessions and compulsive rituals, prior treatment history, screening for 4 additional obsessive compulsive spectrum disorders, screening for 17 other co-morbidities, screening for family accommodation, history about life events and circumstances related to the development of OCD, relevant childhood, family, and cultural history, a mental status examination, and identification of barriers and strengths.  All of these factors can make a difference in treatment planning and your response to treatment, and there is just no way to do it quickly. 

 

Q: Can a client participate only in Phases 1 and 2?

 

Absolutely!  Some clients who utilize OCD123 are waiting to see a local, in-person therapist for ERP and want to get started now.  Completing Phases 1 & 2 can be helpful to prepare for subsequent therapy, and the records can be easily transferred to a local therapist if the client provides written authorization. At the end of Phase 2, clients will have an evaluation summary, information about OCD therapy, a hierarchy of triggers, a list of compulsive rituals and safety behaviors, personalized scripts for motivation and commitment, and practice with alternative (non-avoidant) coping strategies. It's also possible that some clients who start OCD therapy are simply not sure if they want to commit to Phase 3. That’s totally fine. In fact, we would prefer that you commit to Phases 1 and 2 and have success with them, rather than reluctantly or partially commit to ERP and MCT. We respect your decisions and want you to succeed with your goals. 

 

Q: What are the groups like in Phase 2 (Setting the Stage)?

 

OCD123 offers the option of participating in group sessions for Phase 2 - Setting the Stage. The group meets for 90 minutes every day for five days, so Phase 2 is completed in one week!  The five group sessions follow the 5 Modules in the Client Workbook.  Phase 2 Group meets Mon-Fri from 5;00-6:30 PM during the first full (and non-holiday) week of the month.  Group size is limited to 6 clients. There is some limited interaction among clients in a group, but the group is primarily an educational and skill building group, not an interactive or process group. Groups can be a good option for reducing costs, and some clients find that a group format enhances support. If a client misses one of the group sessions, they are encouraged to make it up during an individual session.

 

Q: Can a client skip Phase 2 or topics addressed within Phase 2?

 

No.  Clients are required to complete Phase 2 to start Phase 3. Completing Phase 2 allows clients to develop trust with their therapist, understand how and why the treatment works, practice alternative coping skills, and build motivation and commitment.  Remember, clients can finish Phase 2 in group format in a week!  Or, highly motivated over-achievers can finish Phase 2 during 2-3 individual sessions.  In our experience, rushing into exposure-based treatments for OCD without adequate preparation can lead to confusion, hesitation, limited progress, and increased likelihood of dropout. We also believe that those who do not complete Phase 2 (for whatever reason) are generally not good candidates for Phase 3. Once clients complete a few sessions in Phase 3, there is more flexibility regarding your focus and pace. If clients want to slow down or skip forward to more challenging triggers, that is absolutely fine. 

 

Q: Why integrate both ERP and MCT in Phase 3?

 

Actually, almost all specialized OCD therapy integrates both of these approaches to some extent. Exposure and Ritual Prevention (ERP) is a set of behavioral strategies used to learn how to engage and tolerate triggers, eliminate OCD rituals, and replace them with alternative coping strategies. Metacognitive Therapy (MCT) is a set of cognitive strategies used to recognize and change views about how the mind works, especially regarding valuation of obsessions and compulsions. Although both approaches offer some unique aspects, they also overlap and support each other.  OCD123 explicitly utilizes both approaches to ensure a comprehensive treatment experience and to provide clients with options when possible.

 

Q: What are Phase 3 (ERP and MCT) sessions like?

 

Phase 3 integrates ERP and MCT in each session. Before starting, the client and therapist agree on a plan with goals, strategies, and time commitments. Clients usually start with exposure to less distressing triggers with more therapist support, and transition to more challenging triggers with less therapist assistance gradually, over time. Initial sessions are scheduled for 90 minutes, and the session duration can be increased or decreased based on client response. We recommend that sessions are scheduled more frequently (2-5 times per week) at the beginning, less frequently (1-2 times per week ) as therapist support fades out, and then monthly for checking in and troubleshooting as needed. Clients also are encouraged to work on ERP and MCT on their own for about one hour per day in between sessions. The total number of sessions in Phase 3 varies, but 5-20 sessions during Phase 3 is a good estimate.  

 

Q:  What if I find it challenging to start or continue Phase 3 treatments?

 

We work collaboratively with you to try to understand and resolve barriers. No judgment. No criticism. No bullying. Remember that Phase 2 is designed to help prepare clients for Phase 3. Phase 2 focuses on building a shared understanding of the rationale for interventions and a detailed plan for how the interventions will occur with input from the client. It allows you to build motivation, recruit support, and rehearse coping skills to prepare for exposure treatments. If starting Phase 3 is still a challenge for you, we suggest finding less distressing triggers so that you can build success and confidence - no matter how small the accomplishment may seem. If necessary, we can also add additional rungs in the ladder - things like response commission techniques or utilizing ritual restriction, interruption, or delay (vs. prevention).  Once you start ERP and MCT sessions, you can work your way up the hierarchy of triggers in any way you want. You can work on gradual approximations to the next trigger, stay with the current trigger for a while, or focus on strategies to tolerate and build commitment.  Some clients aim for the most challenging triggers during the middle of Phase 3.  In the end, it will always be your choice. There are many ways we can try to support you, so please communicate with us about any challenges. If you decide to not pursue or discontinue Phase 3, we will honor your decision and welcome you back later if you change your mind. It’s completely your call!   

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Q: Can a client utilize MCT exclusively (without ERP) in Phase 3?

 

When a prospective client asks that question it usually means they have reservations about planned exposure sessions. Maybe the client has seen something sensational on TV or has already had a negative experience - they felt pressured into starting ERP without adequate preparation or full consent. Remember that OCD123 is a sequential model that embraces client-centered principles; treatment is done with the client in a collaborative manner. Ultimately, the client chooses which exposures to work on and is not criticized or judged for their decisions. The client is in control of those aspects of treatment.  

 

That said, the direct answer to the question is usually, “No.”  OCD123 integrates ERP and MCT into Phase 3 sessions. There are exceptions to pursuing some exposure interventions, such as when imaginal exposure may further sensitize vs. desensitize the client. But even in those situations, gradual situational exposure is usually still a valuable aspect of care. So, not including ERP is rare. Our philosophy is to be honest and open about what to expect so clients can make informed decisions.  We do not want to mislead clients. From our point of view, even well-intended efforts to “get clients in the door” or “get clients started and see if they come around” pose a risk of backfiring and can be potentially harmful. Instead, we prefer to acknowledge that exposure-based interventions often evoke client distress. However, the distress is usually temporary and some clients report it was not as intense as anticipated. In the end, only the client can decide if it is worth pursuing based upon an understanding of what it entails.  

 

Finally, it should be noted that experts who write about MCT for OCD recommend integrating planned exposure within the first few sessions (see Wells, 2009). Doing so is arguably one of the most effective and direct ways to test meta-beliefs surrounding obsessions and compulsions. So, clients should exercise caution if promised MCT for OCD that does not include exposure-based interventions as part of the process. 

 

Q: Are professional therapists in California mandated to report certain obsessions to authorities?

 

No. There are no laws mandating therapists to report the content or nature of their clients’ obsessions. We are accustomed to helping people with obsessive thoughts such as running somebody over with a car, pushing a stranger off the subway platform, molesting children, incest, drowning their baby in the bath tub, poisoning the family cat, yelling obscenities at church, having sex with the devil, cheating on a spouse, etc., etc., etc. We are empathic about what it is like to suffer with obsessions and how much courage it takes to disclose them openly. We are not required by law to report obsessions to authorities or agencies. In fact, we have a duty to maintain confidentiality and safeguard Protected Health Information (PHI), which would include what you share about your obsessions. However, there are laws that require therapists to report suspicion of actual harm to others in some situations. These laws include reporting suspicion of neglect or abuse (physical, emotional, mental, sexual) of children and others who may be vulnerable. In 2014, California passed Assembly Bill 1775 to expand the Child Abuse and Neglect Reporting Act, requiring therapists to report if they know or suspect that a client has downloaded, streamed, or accessed child pornography on the internet. If you have any questions about this topic, please review our Practice Policies and Consent Form and Notice of Privacy Practices, ask your therapist about hypotheticals, or consult an attorney.  

 

Q: Can I enroll a loved one in OCD123?

 

No. Participation in treatment must be voluntary. Only the client can provide consent to start OCD123. However, you can assist your loved one with completing intake forms, as long as you make a notation on the form that you have done so.

 

Q: Does OCD123 offer therapy for persons with all forms of OCD?

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No. If your presentation of symptoms is particularly rare, our staff may not have the requisite background, training, or resources to offer what you need. We would offer alternative referrals instead. Other times we may be able to help you with your OCD, but will want to partner with a Local Collaborator who has expertise in a particular topic relevant to your case. For example, we may want to collaborate with a trusted member of your faith organization if you are unsure about response guidelines for prayer or how to observe religious rituals in a non-compulsive manner.  Another example would be if a client works in a laboratory setting with rare and dangerous chemicals or processes. We may want to get confirmation about safe industry protocols and standards. However, we are prepared for clients who present with the following type of obsessions: contamination, harm, violence, danger, sexuality, sexual orientation, gender identity, religious, superstitious, magical, perfectionistic, just right, order, symmetry, loss, responsibility, health and body. If you are concerned about your fit with OCD123, please schedule a “meet and greet” session. We will do our best to be forthright, because we want to have a good match between what you need and what we can offer.

 

Q: Does OCD123 offer therapy for persons primarily wanting help with other Obsessive Compulsive Spectrum or Somatic Symptom Disorders?

 

No. We do not offer therapy focused on helping persons with body dysmorphia, hoarding, trichotillomania (hair pulling), excoriation (skin picking), somatic symptoms (hypochondriasis), or illness anxiety.  As mentioned earlier, you may still be a good candidate for OCD123 if these challenges are coexisting with OCD and do not interfere with participation in treatment. However, we would recommend you seek additional help for co-existing challenges during or after treatment.. 

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Q: What are OCD123 costs and billing policies?

 

Current and detailed treatment costs for services are provided in the Good Faith Estimate which can be found on our website Resources page. Clients are required to pay for initial evaluation with a credit card at the time of making that appointment but can receive a full refund if they cancel via phone or email more than 72 hours before evaluation.  Clients pay for subsequent services at the time of service with a credit card on file.  Clients who do not cancel appointments at least 48 hours before an appointment time are charged for the service. Clients are NOT obligated to continue treatment and can stop at any point.

 

Q: Can clients use health insurance benefits?

 

It depends. OCD123 staff are licensed mental health professionals, and we will submit electronic claims to the client’s insurance provider. Or, we can provide a “superbill” with information needed for clients to submit claims themselves. Both options are available as a courtesy at no cost to the client.  However, whether and how much an insurance company reimburses a client depends on the coverage details of the policy.  OCD123 providers are not “in network” for any insurance company and will not sign a “single case agreement.” Therefore, only clients with “PPO” or “out of network” coverage are likely to receive reimbursements. Clients are encouraged to contact their insurance company to discuss their coverage and expected benefits. We will not address specific issues with insurance companies, such as determining why a claim was rejected, or return phone calls from insurance company staff. Clients are required to resolve insurance matters on their own.  These policies are in place to ensure that clinical decisions such as the duration and intensity of treatment are determined by the clinician and client (vs outside influences such as insurance companies).

 

Q: Can clients use Medicare, Medi-Cal / Medicaid benefits?

 

Sorry, no. OCD123 providers opt out of Medicare, which means that neither the providers nor clients are allowed to submit Medicare claims. OCD123 therapists do not participate in Medi-Cal / Medicaid (often referred to as Medi-Medi)..

 

Q: Are there ways to reduce costs?

 

Somewhat. Clients who participate in group therapy for Phase 2 can reduce treatment costs. However, we do not offer a sliding scale, reduced fees, or scholarships. 

 

Q: Can licensed mental health professionals with training and experience in treating OCD join OCD123?

 

Maybe. We would definitely love to hear from any qualified candidates - please email us at info@OCD123.us. 

 

Q: Does OCD123 provide supervision or training for mental health professionals who want to learn more about how to treat OCD?

 

Sorry, no. Training is not part of our mission. We do not employ any clinical interns, fellows, or trainees. We recommend that you connect with the International OCD Foundation or local universities for those opportunities. 

 

Q: Does having an FAQ with this many questions and answers suggest that OCD123 is obsessive about treating OCD?

 

Maybe.  :)  For sure, we are passionate about making it work!  We provide so much information in an effort to be transparent.

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