June Quarterly Presentation:
Allen Weg, Ed.D. Presented on
“ERP treatment? Yes, but first… A clinical review of essential treatment interventions which should be utilized prior to the introduction of ERP in therapy”
by Rachel Strohl, Psy.D.
On Monday June 11, 2018, Allen Weg, Ed.D. presented at the quarterly meeting of OCD NJ. Dr. Weg is a New Jersey Licensed Psychologist. He is Founder and Director of Stress and Anxiety Services of New Jersey, an independent multi-clinician practice with offices in East Brunswick and Florham Park, specializing in cognitive behavioral treatment of OCD spectrum disorders and anxiety disorders in children, adolescents, and adults. Dr. Weg is also co-founder and President on the Board of Directors of OCD NJ and is on the Clinical and Scientific Advisory Board of the IOCDF. He has received certifications for the treatment of compulsive hair pulling and skin picking from The Professional Training Institute (PTI) of The Trichotillomania Learning Center (TLC) Foundation, and for the treatment of OCD from the IOCDF’s Behavioral Therapy Training Institute (BTTI).
Dr. Weg began by explaining the presentation is about what the therapist should do before starting exposure and response prevention (ERP) treatment for OCD. Some important preliminaries include: 1) assess drug and alcohol use – if a person using, this is problematic for treatment, 2) assess depression/ suicidality – OCD and depression can be comorbid up to 85%, 3) differential diagnosis rule out, 4) utilize interview instruments as needed, e.g., YBOCS, accommodation scales, 5) identify thought processes associated with obsessions – “what is the person specifically afraid of?” 6) determine what medications the person is taking and if there should be any concerns in this area, and 7) identify safety behaviors that the client may be engaging in to “protect” him or herself from feared consequences.
Before starting ERP treatment, Dr. Weg emphasized the importance of a therapist building a client’s motivation for treatment. A therapist can utilize the following questions: 1) Are you here on your own accord? 2) What are the symptoms of your OCD? 3) How are the symptoms a problem? 4) What would be different if the symptoms got under control? 5) How would your expectations about your life change beyond that? 6) How would your day be different tomorrow?
Dr. Weg suggests helping a client articulate his/her goals. These include short and long term goals, and assessing values: 1) What’s important to you? 2) How do you spend your time now? 3) Are you living your values? 4) What are you working towards? It is also important to address the fear of ERP therapy. He explained a client does not so much need courage and strength, but rather motivation and self discipline to just follow through with agreed upon homework assignments.. A therapist should support, empathize, challenge, encourage and reinforce, but refrain from manipulation, threat, guilt, or tricks.
An ERP therapist should 1) anthropomorphize , or personify, the OCD as if OCD is talking right to the person. 2) Label the source of self doubt – OCD arguments can include “you can’t do this because you are too weak” or “you can only fight me in the therapist’s office.” 3) Define CBT and ERP – therapist as coach, goal directed therapy, and a collaborative relationship. 4) Review ERP basics – facing fears, engaging in behaviors designed to trigger anxiety, and hierarchy construction. 5) Review homework basics – expected nearly every session, collaborative, once committed, expectation high, and shift responsibility to client. 6) Explore family accommodations and set boundaries. This includes a) interviewing family members or other accommodators, b) empathize with them and validate their attempts to help, but explaining that this is not good for OCD, c) educate them about accommodations and appropriate boundary settings, d) review process of disentanglement from OCD demands, and e) negotiate with client and persons who have been accommodating a schedule for implementation of disentanglement.
DVDs of this presentation are available through the OCDNJ website.
Dr. Rachel Strohl is a licensed psychologist at Stress and Anxiety Services of NJ in East Brunswick. She is on the Board of Directors at OCD New Jersey. She may be reached at 732-390-6694.