With new research comes new treatment options for clients. This includes evidence-based treatments for obsessive-compulsive disorder (OCD). The majority of my training has been in Exposure & Response Prevention (ERP) to treat OCD. In the last couple years, I have been expanding my Acceptance & Commitment Therapy (ACT) skills. Then in the last year, I was intrigued by and learned more about Inference-Based Therapy, or Inference-Based Cognitive Behavioral Therapy (I-CBT). I now have more options than ever to provide for my clients and this is a huge benefit for them.

Before jumping into how I approach this with clients, I am sure a few are asking “What is I-CBT?” In short, I-CBT conceptualizes OCD in a different manner. Traditional appraisal models suggest that obsessions begin with a random intrusive thought. Then based on how we respond to, or appraise this intrusive thought, an obsession is born. However with I-CBT, it is suggested that these thoughts are not so random at all. Instead, they are inferences, created through a faulty reasoning process. This is a cognitive approach, which is not synonymous with cognitive restructuring. We are not challenging the content of the thought; we are looking at the reasoning process that created the thought in the first place. 

With the emergence of I-CBT (which is not new, just new to many of us), we have additional options. This does not mean we are throwing away other effective treatments like ERP and ACT. In fact, we are doing the opposite!  We have more tools  to provide clients to make sure they have the highest chance for success. As we already know, not one model works for everyone. There is not one model that shows a 100% success rate. So wouldn’t we want our clients to have more options? Here is why I am letting them be part of the decision-making process:

1. Clients are more likely to commit to therapy if they have a choice in it.
2. Clients will have a better connection with the therapist and treatment, as well as a better understanding of why we are doing what we are doing.
3. Providing multiple options and allowing them to be part of the choice increases their hope. Imagine we told our clients there is one “gold standard” treatment. This can feel quite shaming and hopeless if they do not succeed. It can cause clients to wonder “What did I do wrong?” or “Is there no hope for me?” because this “gold standard” was not helpful. Instead, they are provided with the psychoeducation that we have several evidence based options.
4. Clients always have the option to switch treatment approaches if we find that one is not working for them. This will improve their chances of success.

How do I include them in this choice? Following the intake as we are discussing goals, diagnosis, treatment options, and treatment plans, I provide a run-down of all the approaches I offer. After sharing a summary of what these will look like, I enquire if anything stands out to them. Do they connect with a certain treatment? Does one sound like a better fit for them?

I have received responses like:

“I connect to ERP because I like a challenge, and exposures sound like something I would want to do.”
“I connect to I-CBT because I see my doubts as created, not random at all.”
“I connect to ACT because the concepts sound like they can be helpful for so many things (which they can).”

I still provide my professional input. For example, if they have tried ERP for the last 10 years with multiple therapists with no success or have plateaued in progress, I may encourage a new approach. Otherwise, I respect and validate their decision and we begin our OCD journey together.
 

This post is presented in collaboration with ADAA's OCD and Related Disorders SIG. Learn more about the SIG.