Obsessive Compulsive Disorder
The development of basic competence and the progression from basic to expert competence in delivering cognitive behavioral therapy (CBT) for obsessive compulsive disorder (OCD) is a complex endeavor that has rarely been the focus of discussion in the lite
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Martin E. Franklin · Sophia Talbott
Abstract: The development of basic competence and the progression from basic to expert competence in delivering cognitive behavioral therapy (CBT) for obsessive compulsive disorder (OCD) is a complex endeavor that has rarely been the focus of discussion in the literature despite the obvious importance of the topic. In this chapter we endeavored to develop a basic set of therapist skills that range from: 1) comprehensive and yet focused assessment of core symptoms; 2) differential diagnosis from disorders that overlap OCD; 3) clinical management of the common comoridities likely to be encountered; 4) providing a clear rationale for the treatment procedures that flow logically from a neurobehavioral framework; 5) conveying the current state of the treatment literature and its implications for treatment choice; and 6) developing reliance on the conceptual model of OCD to inform treatment progression. The movement from basic competence to expert delivery of CBT for OCD requires continuing education and monitoring of the extant literature, treating a sufficiently high volume of cases to master the heterogeneity of OCD presentation, and therapists’ willingness to acknowledge what they do not yet know and persistence in seeking out professional opportunities to bridge the gaps in their knowledge.
5.1 Overview In keeping with the spirit with which this book is intended, our purpose in writing this chapter is to provide a sufficiently detailed description of obsessive compulsive disorder (OCD) and its treatment, so that practicing psychologists can learn about what in our view constitutes the requisite and the expert competence in assessing and treating this condition with cognitive-behavioral theory (CBT). OCD is a complex disorder that is associated with significant morbidity, comorbidity, and functional impairment across the developmental spectrum, and there are important subtleties to its evaluation and treatment that may not be immediately apparent to the novice practitioner. That said, there is a recent evidence from a relatively large case series conducted in middle Norway indicating that treatment outcomes achieved by master’s-level clinicians without any prior expertise with pediatric OCD were both statistically and clinically meaningful. Interestingly, these outcomes were also comparable to what has been achieved in the context of tightly controled randomized studies of CBT conducted in the academic context under conditions that emphasized internal validity (Valderhaug, Larsson, Gotestam, & Piacentini, 2007). This is an encouraging news indeed, indicating that substantive and durable treatment outcomes can be achieved in community clinical settings with youths suffering from OCD. The study included supervision by psychologists who were knowledgeable about OCD and its treatment; these psychologists had access to one of the world’s leading experts in the application of CBT to children and adolescents, Dr. John Piacentini at UCLA, and thus the generalizability of this J. Thomas
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