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Individual Psychotherapy:Primarily cognitive-behavioral interventions, including exposure with response prevention, cognitive restructuring, relaxation training, social skills training, and stress management. Individualized home based challenges are an essential component of the therapeutic process. Typically persons have to be willing to commit a total of 15 to 20 minutes per day toward their between session therapeutic process. The exercises are generally based on a graded hierarchy from least to most challenging exposures.Telephone Consultations:A highly effective treatment alternative for individuals living outside of the metropolitan New York area. (In recent years, Dr. Phillipson has successfully worked with clients from around the world.) This option is available for persons who do not otherwise have access to expert treatment. Approximately eight years ago, when Dr. Phillipson's first article received national distribution on treatment for the purely-obsessional client, he received numerous phone calls from persons who did not have available to them local expert assistance for their particular form of OCD.
Group Therapy:Weekly Obsessive-Compulsive Disorder groups co-led by Dr. Phillipson and graduate interns. Groups meet Tuesday evening 6:45 pm and Friday evening at 6 pm. Each group lasts an hour and a half and consists of approximately eight to twelve people. Fee for group is $45 per week. The group's specific focus involves more senior members providing newer members with support and guidance related to their own progress. The group has a behavioral component to it and generally each week home-based challenges are assigned. The group is a great opportunity for persons to establish relations with others who can appreciate the daily challenges of this potentially disabling condition.
Family Coping Skills:We understand that watching a loved one struggle with OCD can be quite overwhelming for family members who do not know how to effectively manage the emotional pain. A family's lack of understanding about the mental illness, as well as feelings of helplessness, guilt, frustration, or intolerance, may incite negative or rejecting reactions which can further exacerbate obsessions and compulsions. Frequently, people with OCD must shift their role functions, as they no longer can support themselves financially, engage in social activities, or attend to household tasks. The families repeatedly are left with the added burdens of paying bills, taking care of the person, fulfilling household chores, and adapting to the life changes and hardships that accompany the mental illness. Undoubtedly, OCD is a highly distressing and disabling disorder that can significantly impair one's occupational functioning, hinder the quality of one's leisure activities, and result in upheaval and disruption in a person's social relationships. In addition to the various instrumental responsibilities of the family members, their troubled loved ones often rely on them for emotional and informational support in their daily struggle with OCD. The pathological doubting, so commonly associated with OCD, causes people to doubt their senses (i.e. what they see, hear or touch) and can profoundly impair their daily performance. Thus, they may rely on relatives to offer them constant reassurance or may request that the family participate in their ritualistic behaviors to assure them that they indeed have completed a task or performed it correctly. In order to alleviate a loved one's fear and anxiety, families may become overly involved in his/her avoidance behaviors, decision making and daily responsibilities, further fostering the dependence and insecurities that are characteristic of this disorder. The coping skills group will help family members and significant others to clarify the dubious boundaries between a healthy therapeutic involvement and a maladaptive one which acts to reinforce the symptoms. The goal of this focus will be to educate families about the benefits of behavior therapy, and will assist them in helping their loved ones recognize the need for treatment if they are not already in treatment. Family members will assume an active role in the behavioral intervention by encourage their loved ones to participate in and comply with treatment. Families will learn how to expose them to anxiety-provoking stimuli in a step-by-step fashion, gradually habituating them to the stressors. Relatives may be asked to participate in the response prevention exercises by supervising and monitoring the time and frequency the person engages in certain ritualistic behaviors. The more stringent and detailed the response-prevention instructions are for the person, the fewer decisions the person has to make with regard to what is normal and what is ritualized, ultimately resulting in better compliance. In addition to encouraging active family participation in exposure and response prevention exercises, the coping skills group will offer an open forum for questions, discussions and concerns about obsessive compulsive disorder. The group will allow for people to share their experiences, and confide in others who have family members with OCD. The group will strive to minimize the daily stressors that families of people with OCD often experience. Moreover, the group will educate the family members about beneficial support methods, helpful coping mechanisms, and better ways to communicate their feelings and frustrations. Through the support and guidance of weekly group sessions, families will learn how to provide their loved ones with a greater sense of self-confidence and self-efficacy. Home-Visit Options:For those clients with particular subtypes of OCD, such as hoarding or contaminating or for those who may have a difficult time leaving ones home, home-visits may be available to conduct in vivo flooding and exposure exercises. What this translates into is the opportunity to have professionally trained help available to guide clients through the challenging home-based exercises. Generally these exercises are conducted in a very gradual systematic approach. Research findings suggest that behavior therapy's potency is increased through greater frequency of weekly exercises, which is reinforced during the home visits with the therapist. Ultimately, these exercises, conducted in the presence of the therapist, are performed independently by the client.
Psychological TestingWithin recent years obsessive-compulsive disorder has been classified as a handicapping condition. Therefore, persons who qualify for this diagnosis have special privileges available to them pertaining to standardized testing procedures. Tests such as the SAT, GRE, LSAT, and MCAT have special testing conditions available to those with handicapping conditions, whereby these tests might be read to the subject, or special time extensions may be granted.
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