OCD ERP DBT: A Winning Combination

OCD ERP DBT: A Winning Combination

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by Magda Rodriguez, Psy.D.

When I was a schoolgirl, I remember a family member of mine staring at the wall moving their eyes in what seemed like a square pattern and repeating numbers over and over while tapping their fingers.  I did not understand why they were not moving or answering me, but by the look in their face, I could tell that they were in great distress. 

What I did not know then was that they were engaging in a compulsion. It was not until early in my graduate program that I put two and two together and realized that while my family member did not meet full criteria for OCD, it was evident that they were taunted by traits of OCD. I wanted to know more about treating OCD and early in my graduate training I sought an externship at the Behavior Therapy Center where they specialize in treating OCD and related disorders.

During my post-doctorate work, I know I wanted to make a real difference in people’s lives.  I saw how effective ERP was at helping individuals gain their lives back.  The only other time I observed a therapeutic intervention be so successful was during an internship in the outpatient and inpatient adult units where patients participated in the comprehensive Dialectical Behavioral Therapy (DBT) Program.  I observed those patients improving their lives more effectively and faster than those that were doing more standard treatments.  With results like that, I knew I had to pursue yet another specialization in DBT.

My DBT skills group are effective for clients who have failed out of ERP, when life-threatening behaviors are present, quality of life behaviors are present, or present therapy interfering behaviors are getting in the way of ERP.

I received my DBT training at the University of Washington’s Behavioral Research and Therapy Clinics led by Marsha M. Linehan, Ph.D. and returned to the east coast to be closer to my family and to continue my work with OCD clients.  I began to incorporate the use of DBT principles and skills to help those OCD clients that were having difficulties engaging in ERP, being consistent in executing ERP treatment, were suicidal, self-injurious, had a personality disorder, and or low tolerance for distress.  With great efforts and supportive colleagues, I was able to configure an approach for those individuals that had failed out of traditional ERP or were unable to start ERP because of low tolerance for distress, life stressors or other diagnosis affecting their ability to engage in ERP treatment. 

I thoroughly enjoy seeing my clients gain their lives back by increasing their confidence in being able to manage their symptoms, become their own mentors and therapists, and contribute to society in the way they had always envisioned.  Another added benefit to utilizing DBT to enhance the success of ERP is the opportunity to collaborate with colleagues that specialize in OCD treatment. These esteemed professionals refer clients to my DBT skills group or even for short-term individual therapy when their clients have failed out of ERP, life-threatening behaviors are present, quality of life behaviors are present, or present therapy interfering behaviors are getting in the way of ERP.  I often work with those clients and encourage them to return to the referring therapist to continue their work. It is rewarding to work as a team, serve the community of providers, and help those who suffer relieve the distress of OCD.