About the author: Jenna Overbaugh has been treating OCD and anxiety since 2008, and has had it basically her whole life. She’s worked with some of the most severe, life-consuming cases out there, quit her job in 2023 to teach people all over the world how to be their own therapist, and has a book coming out in 2027. She’s been terrified for most of her life and keeps doing the things anyway, and she’s going to show you how to build a life so big and so bold that OCD and anxiety just can’t keep up. She runs on chai tea and the conviction that this is possible for you, too.
If you had chest pain and went to a general practitioner, they’d run some tests, stabilize you, and send you to a cardiologist. They wouldn’t just try to treat your heart condition themselves - that would be terrifying. They can’t do that, they don’t know how to do that. That’s where a specialist comes in, like cardiologists who are trained to actually fix the heart. The system (GP) routes you to the right person (cardiologist).
Mental health doesn’t work like this.
Mental health works like if you went to a GP with chest pain and they said yeah, I’ve seen a few heart things, I’ll just take a crack at it, how’s your childhood going? And then they tried to treat your cardiac issue by validating everything right back to you, throwing you some meds that may or may not work, and challenging a maladaptive belief here and there.
Unfortunately, I’m not being very hyperbolic because this is basically the equivalent of what can happen when someone with OCD walks into a standard therapy office.
The average time between OCD symptom onset and receiving an accurate diagnosis and appropriate treatment is 17 years. Seventeen. That means people like you are spending nearly two decades in the wrong office getting the wrong intervention, sometimes getting actively worse, while a treatable disorder gets louder and their world gets smaller and nobody thinks to say… hey, maybe I should refer you to someone who actually.. like.. specializes in this.
What makes me really want to flip a table like Teresa Giudice from The Real Housewives is that it doesn’t HAVE to be like this. The medical field already solved this problem (one of the 9834094 they have). We just refuse to apply the solution to mental health.
In a sensible world, therapists would work like physicians. General practitioners would handle the basics - a hard season, a breakup, some situational anxiety, the stuff that doesn’t require deep specialization. And then, for the deeper issues, specialists would exist. Therapists who have done additional training, additional supervision, actual credentialing in a specific area: OCD, eating disorders, trauma, personality disorders, kids, whatever. And these specializations would actually be regulated to ensure quality (not like Psychology Today where any therapist can say they specialize in anything without any vetting process). The GP recognizes when something is outside their scope and refers out. I literally remember my roommate in college having to declare a speciality before going to medical school (oncology, pediatrics, psychiatry, cardiology), like.. why do we not have to do this as therapists!?
Instead, we have a system where every licensed therapist is theoretically qualified to treat everything. OCD. Psychosis. PTSD. Eating disorders. Childhood trauma. Relationship issues. All under one credential, which means a therapist who has never once received specialized training in OCD can see a client who has been suffering for a decade and just... figure it out as they go. With a real person whose life is on the line.
I don’t want to dig therapists, I hope it’s not coming off that way. Most I know are really devoted to their clients and they do this work with the best of intentions, never knowing any other way. What I’m doing is digging at a system that doesn’t require therapists to know what they don’t know. It’s a system that lets someone practice OCD treatment without ever having learned what OCD actually is. This system that has produced, as a direct and measurable consequence, that statistic we saw above. Seventeen years. That number is not an accident, and it does not have to be that way.
The mental health system needs to mirror the medical model. Require therapists to designate whether they’re generalists or specialists. If you’re a generalist, great, you see those low need cases on an every-so-often basis, and if you see something that flags a need for more specialization, you break out your little Rolodex (or whatever they use), and you refer out. Require real credentialing for specializations, not just continuing education hours that could mean literally anything. Make it so that treating OCD (or any other disorder) requires proving you know how to treat OCD (or that disorder). Wild, I know. Almost unthinkable, even.
Until that happens, as a client, you’re kind of on your own to figure out whether your therapist actually knows what they’re doing. I hate that. And as a therapist, you’re on your own to develop that additional specialization. For example, if it weren’t for me actively going out of my way to seek out internships, jobs, research opportunities, and education that specifically dealt with OCD and anxiety, I wouldn’t know what I know. I hate that this is the world we live in. But it is, and knowing what to look for might save you years.
With that said, here are five red flags, specifically “your therapist is missing the OCD piece and that piece could be why you’re still stuck” flags, and what you can do about it.
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