This matters more in OCD than almost anywhere else in therapy, because the wrong treatment here doesn’t merely fail to help — it actively strengthens the illness. So the screening is worth doing properly, and no competent clinician will be put out by it.
The five questions
1. “Do you use exposure and response prevention, and roughly what proportion of your OCD work is ERP?” You want a specific, confident answer. “ERP is the core of it” is right. “I use a range of approaches including ERP” is worth probing. “I use CBT for OCD” without mentioning exposure is a flag — standard cognitive work on obsessions is a compulsion.
2. “How do you handle mental compulsions?” The single most diagnostic question on this list. A trained clinician will light up: they will talk about identifying covert rituals, about response prevention applying to internal acts, about how exposures fail silently when someone is neutralising in their head. A clinician who hasn’t been trained won’t really have an answer, because this is exactly what training teaches.
3. “What’s your position on reassurance?” You want to hear that they won’t give it, that they will help you notice when you’re seeking it, and that this will be uncomfortable and is the point. A therapist who promises to reassure you when you’re distressed is offering the compulsion.
4. “What does homework look like?” ERP is mostly homework. Daily exposures, self-directed, tracked. A clinician who describes treatment as happening entirely in the session has misunderstood the format.
5. “What’s your training specifically in OCD?” Answers that mean something: the IOCDF Behavior Therapy Training Institute (BTTI), an OCD specialty clinic placement, a postdoctoral fellowship, supervised ERP hours with an OCD specialist. Answers that mean less: a general CBT certification, a continuing-education webinar, “I have worked with a lot of OCD.”
Where to look
The International OCD Foundation maintains a resource directory, and its BTTI graduate list is the closest thing to a gold standard. Academic medical centres with anxiety and OCD programmes. NOCD and similar specialist services, which are ERP-only by design. And since therapy is regulated where you sit rather than where the clinician sits, everyone licensed in your state is reachable —remote ERP works well, and for contamination and checking themes it’s often better.
Two good signs
A clinician who asks about your compulsions in unusual detail during the consultation — including mental ones, including reassurance-seeking, including things you had never thought of as compulsions — is showing you their training rather than telling you about it.
And one who declines to reassure you during the consult call itself, gently and with an explanation, is demonstrating exactly the stance the treatment requires.
One thing to watch in yourself
Vetting therapists can become its own compulsion — the search for the perfect clinician, the fifth consultation call, the certainty that this one isn’t quite right either. If you notice that pattern, pick a clinician who passes these five questions and start. The doubt won’t resolve before treatment. It resolves during it, and only by being left unanswered.