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When Once Isn’t Enough – Help with OCD

Daniel Chorney, Ph.D.

Almost everyone has heard of obsessive-compulsive disorder, or “OCD,” given how often it is featured in television and movies. Despite the benefit of increasing public awareness of OCD, the negative side effect can be the spread of misinformation.

On screen, individuals with OCD can be portrayed as “quirky” or simply “irritated” when things don’t go to their liking. Sometimes they are shown as eccentric or even comical. While it makes for entertaining television, in reality OCD can be one of the most distressing, misunderstood, and problematic childhood mental health concerns. To complicate matters further, OCD often affects more than just one individual. It can cause problems for the person affected, their friends, and family members who are often forced to work around the numerous rituals that continue to grow and become more severe and time-consuming over time when left untreated.

While it’s normal to have worried and anxious thoughts, children and adults with OCD can’t stop their upsetting thoughts without performing some behaviour to make the thoughts go away. Everyone goes through a day when they can’t shake a song or picture out of their mind but children with OCD “obsess” over these thoughts that can sometimes be very painful or upsetting to have (e.g., thoughts that are graphic, violent, or bizarre). These thoughts persist until the “compulsive behaviour” or ritual occurs – a behavior the child does in order to banish the thought temporarily.  This cycle repeats itself continuously, with a constant build-up of anxiety and frustration followed by the release felt immediately after a compulsive behavior occurs. Again, and again, and again.

Sometimes this chain of events seems somewhat logical, while in other situations, OCD makes no sense at all. Common compulsions seen in children include specific touching or arranging of items, asking the same question repeatedly, excessive counting of objects, or prolonged hand washing or cleaning. Other children show the urge to confess (divulging information almost uncontrollably), hoarding (collecting otherwise useless objects), or checking behaviors (e.g., repeatedly questioning whether doors are locked, stoves are shut off, or someone is safe). It’s not uncommon to hear a child say something has to be or feel “just right” before they can stop doing whatever it is they are doing.

Once OCD is properly assessed and diagnosed, finding the right treatment provider and approach can feel like a daunting task. There are effective treatments for OCD that are supported by research evidence (such as exposure and response prevention, or “ERP”) that help children gradually face their fears and break the cycle of obsessions and compulsions. It is important to note, however, that these treatments should only be used under the guidance of a professional. The approach may sound simple at first, but it requires a careful and balanced approach to make sure that progress is gradual, safe, and always forward moving.  While the work involved in overcoming OCD can be challenging to everyone involved, the reward for successful treatment completion is often well worth the effort!


Getting the Psychological services you need

Victor Day, Ph.D.
Dr. Victor Day is president of APNS and in part-time private practice at Marsh-Knickle and Associates.

More than 50 years of research has shown the effectiveness of psychological treatment for many problems, and psychological assessments are very useful for a great variety of issues. Nevertheless, many people who would benefit from psychological services do not access them. There are a variety of reasons for this. One is that many people are unsure of how to do so. In this article I will outline some ways you can do this.

It can seem complicated, because each psychologist specializes in only certain areas of psychology, and some may only work with children or with adults. Moreover, the common ways of accessing other professional services, such as by going to the same person who serves other members of your family, or by asking neighbours or co-workers for recommendations, may not be something you wish to do. It’s not quite the same as looking for a dentist or an accountant.

First, it is helpful to know that about half of practising psychologists in Nova Scotia work just for some public institution or agency, such as a health authority, school system, or university; and about half work full or part-time in private practice.

Public-service and private-practice psychologists are equally qualified and collectively offer similar ranges of services, and sometimes are the same people (e.g. when psychologists working for public institutions also do part-time private practice). The big advantage of accessing psychological services through a publically-funded institution or agency is that the services will be provided without direct cost to you. For some people, this is the only way that they can access psychological services.

However, public services usually are not organized in a way that lets you directly make an appointment
to see a psychologist. Often you will need to be first screened by someone else, who may or may not arrange for you to see a psychologist, depending upon whether you meet certain criteria; or you may need to be referred by some other professional (e.g. a student’s teacher in order to see a school psychologist, or a physician to access some psychologists who specialize in particular health problems). Nevertheless, you have a right to influence the decisions about your care and services. If you want to see a psychologist because you want that type of service a psychologist can provide, then say so, to the person who is doing the screening or referral.

How can you find out what psychological services are available? If you are wondering what’s available within some particular health authority, university or school system, that information is probably available on that institution’s website. If you’re wondering what’s generally available within your community, you can phone 211, or ask your family physician, since family physicians are knowledgeable about local resources.

Alternatively, you may wish to see a private practice psychologist. Private practice psychologists operate out of private offices and charge you for their services. Almost all private health insurance plans, including the ones typically offered to employees of major employers (including the government), cover psychological services, at least up to some limit. An advantage of seeing a private practice psychologist is that it is usually easier and faster to get an appointment. It can be as simple as phoning the psychologist’s office directly yourself, and arranging an appointment within a couple of weeks. But how do you know which psychologist to go to?

There are a variety of ways:
• Search via the APNS website at www.apns.ca, which provides a list of private practice psychologists, which is searchable by areas of expertise, location, gender and languages spoken.
• Phone APNS 902-422-9183 to ask for the contact information of psychologists who can help you with your concerns.
• Ask the advice of your physician, physiotherapist or other health professional whom they might recommend.
• If you have a need for some very specialized service or other special requirements, such that it is not clear from generally available information which psychologist is appropriate, then you may wish to ask a psychologist who is in more general practice whom they would recommend for that particular issue.

Of course, you will also want to meet the psychologist for an initial session, and discuss your concerns and how they might help you, and then decide whether you wish to continue with that person, as you would with any professional relationship.

This Op Ed piece appeared in the Nova Scotia Chronicle Herald newspaper February 28, 2015.


 Globe & Mail Series on Mental Health

We have the evidence… Why aren’t we providing evidence-based care?
Globe & Mail, May 22, 2015

Psychotherapy: A better funding model must be found
Globe & Mail, May 26, 2015

How to fix Canada’s mental health system
Globe & Mail, June 1, 2015

The Association of Psychologists of Nova Scotia (APNS)  is a voluntary professional organization established in 1965 to represent psychology in Nova Scotia. APNS is the only provincial association devoted to representing the needs of psychology professionals in the province. APNS promotes psychology as a profession, as a science, and as a means of promoting human welfare.

Visit About APNS for more information