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Dr. Mark
Dr. Mark, Psychotherapist
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I am located in upstate New York, and I am seeking help for

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I am located in upstate New York, and I am seeking help for a friend. She is diagnosed with OCD. While suffering most of her life, a year ago she was coping and actually running the entire graphic design program for a multi-million dollar company. She is now reduced to being in and out of acute care facilities, searching for help, and running out of insurance care. Is there legitimate help out there for her, or is it only available to people who have unlimited resources?

Hi! I believe I can be of help with this issue.


First let me say that I can imagine how difficult and frustrating this situation must be for your friend. She must be extremely distraught and scared as well. She's very fortunate to have you there caring about her and trying to find some form of help that might work to give her some relief.

I imagine that the second opinions all agreed with the OCD diagnosis, so we need to focus on that. In one sense you're right about the unlimited money. There are some national centers, like Harvard's McLean Hospital and at UCLA in California. They are intensive treatment centers as are some other recognized centers. That model requires the person going there for 3-4 weeks and living there to work with therapists and psychiatrists intensively on the particular OCD and then there are the follow ups. I'm sure insurance doesn't cover much of the cost.

But the more typical treatment is medications from the psychiatrist and therapy with a psychologist 1-2 times a week. I'm rather concerned about the treatment model you describe. Seeing a psychiatrist that often seems counterproductive: medications don't need to be monitored that often after the 1-2 months if there's a psychologist involved who can alert the psychiatrist if there are changes needed. Your description indicates that her symptoms are extremely severe at this time. So medications are crucial in today's treatment methodologies. But the main treatment still needs to be the therapy.

And this is where it sounds as though it's not nearly intensive enough for the level of severity of symptoms. So, getting authorization from her insurance or from Medicaid if she's on disability for intensive treatment is essential. I've never had problems with insurance allowing 2 times per week for OCD with severe symptoms and I urge that as the first step.

My second concern for her, though, is to make sure that she's working with a psychologist in that intensive therapy who is extremely experienced in OCD work if not specializing in it. I want to urge you to make sure also that the modality the psychologist works in is
Behavioral Therapy for OCD. In my experience it is vital that this type of treatment especially geared to OCD be followed. It is a systematic approach to the problem and has the best success rate. Regular CBT therapy or other types of therapy for anxiety just aren't useful enough for severe OCD symptoms, okay? This is vital.

My first thought is really for you to contact the big university in your area of NY and talk to the head of the psychology department and see if he/she can find out from faculty who the number one person in OCD treatment is in your area. Or do the same with the head of psychiatry at the big university hospital. It means being "spunky" so to speak and seeing if you can get them to put in effort on your friend's behalf in finding out who are the best practitioners.

I am not sure how helpful it will be but here is the web address for Psychology Today's therapist directory. You can sort by zip codes and when you see someone who seems like they might be helpful (they show you a photo of the therapist) look at the listing and see if they list CBT therapy in their orientations and OCD as one of the areas they work with. This is important: make sure they are experienced with OCD.

http://therapists.psychologytoday.com/rms/

You can also become knowledgeable on the disorder with her. This is important in helping her take charge of your treatment. Here are some books to start with:

Stop Obsessing:? How to Overcome Your Obsessions and Compulsions by Foa and Wilson. Make sure to get the revised edition. Dr. Edna Foa is a renowned expert.

The OCD Workbook by Hyman and Pedrick. The exercises here are excellent.

Brain Lock: Free Yourself from Obsessive Compulsive Behavior by Schwartz. He's purely cognitive in approach and I've had some people really like his approach though some find it a little too vague. See what you and she think.

Tormenting Thoughts and Secret Rituals by Osborn. Dr. Osborn has OCD. The book is based on his group therapy and the techniques may appeal to her very much.


It's true that going for residential treatment can be very helpful for extremely severe symptoms. But it sounds as though that's not an option for her. So let's hope finding a psychologist who is experienced will give her the help she needs.


Okay, I wish you and her the very best!


My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX

Customer: replied 4 years ago.

I greatly appreciate your answer. The only follow up I have is questioning how your answer would change if the second opinions didn't agree. One psychiatrist was adamant that her obsessive thoughts were most likely part of a bipolar diagnosis. She has several of the classic OCD symptoms such as hair pulling and skin picking, and I was unsure how that related to a bipolar diagnosis. I'm obviously not asking for a diagnosis, but simply if a bipolar diagnosis is often so closely related to OCD?


The one important piece of information I left off is that she attempted suicide about 2 weeks ago.


I thank you in advance of your answer. I appreciate the time and experience you have given me.


 


-Chad

Chad,


I teach graduate classes in psychology and semester ending meant I had papers to grade and was away for a few days. I apologize.


I would not be surprised if there was a mood disorder also diagnosed. It is not uncommon to have OCD be a comorbid condition with other disorders. Often as a child (around 9-11 years old is one common occurrence) OCD shows up and then in late adolescence, early adulthood, or later a mood disorder shows up.


So, you're right that I am not able to diagnose or even confirm a diagnosis. However, I can say that it is certainly possible. And you might ask the doctors to confer and reach a consensus if that's possible given her severe condition. I'm so sorry to hear about her suicidality. The symptoms must be overwhelming her.


That might be enough to get the doctors to confer and to agree on a pharmacological treatment plan. And now therapy becomes even more important as well.


I wish you and her the very best!


My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX

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