Creating a Treatment Plan for OCD: What to Include + Example

Obsessive-compulsive disorder is a mental health illness known for causing obsessions, compulsions, or a combination of both. Obsessions can be described as recurring and uncontrollable thoughts, whereas a compulsion is the act of engaging in repetitive behaviors. The presence of one, or both, of these symptoms can be time-consuming, distressful, and cause embarrassment, which can significantly impact a person’s level of functioning and overall quality of life. Keep reading to learn how to create an evidence-based treatment plan for OCD, with an example.

OCD can include several obsessions which can be described as thoughts, urges, or mental images that are unwanted and provoke anxiety symptoms. Examples of common obsessions include:

  • A fear of germs and contamination
  • A fear of losing, misplacing, or forgetting something
  • A fear of losing control of your behaviors
  • The presence of aggressive thoughts towards oneself
  • Experiencing unwanted, forbidden, or taboo thoughts about religion, harm, or sex
  • A persistent desire to have items symmetrical or in order

Examples of common compulsions that you may see in a clinical setting include:

  • Repeated or excessive hand washing and cleaning
  • The act of arranging items in a particular order
  • Repeatedly checking things, including that the stove top is off, or the doors are locked
  • Counting compulsively
  • Praying or repeating words quietly

It is important to recognize that individuals can experience both obsessions and compulsions without having OCS. Key factors that indicate the presence of OCD include:

  • Having an inability to control their obsessions and compulsions, even when they recognize that it is out of the norm
  • Spend a minimum of 1 hour a day experiencing their obsessions or compulsions
  • Feeling a temporary relief after engaging in compulsions or obsessions
  • Experiencing struggles in their day-to-day life because of their compulsions or obsessions. This can include poor work performance, isolation, and conflict within relationships

Aligning with many other mental health illnesses, the exact cause of OCD is unknown. We do know that some factors that can increase a person’s risk of developing OCD include their generics, brain structure and functioning, temperament, and a history of childhood trauma. OCD affects approximately 2-3% of Americans

Setting Goals and Objectives With Clients in Your OCD Treatment Plan

OCD treatment can be effective in helping clients improve their functioning at work and school, relationship satisfaction, and their use of leisure activities. Cognitive-behavioral therapy (CBT)  is a commonly used treatment for OCD, especially exposure and response prevention (ERP). ERP can help clients learn to manage their thoughts, without engaging in compulsions, and begin to recognize their thoughts as just thoughts. Over time, clients are slowly exposed to situations that provoke their anxiety, so they can practice using the coping skills they learned. Exposures can take place at home and in treatment sessions.

Medications, more specifically serotonin reuptake inhibitors (SSRIs), can be used to treat OCD. The effects of SSRIs do take one to two months to become apparent, which is why this treatment option is often used in conjunction with other evidence-based practices, like CBT or ERP.

Repetitive transcranial magnetic stimulation (rTMS) is another option that was approved by the FDA in 2018 for individuals who have not been responsive to other OCD treatment interventions. This is a non-invasive procedure that targets specific areas of the brain that are associated with OCD. Deep brain stimulation may be another option for some; however, this is an invasive option reserved for those with severe OCD that has not been improved with the use of other treatments. Deep brain stimulation effects for OCD are still being researched, which is why it is known to be an experimental treatment method.

Several assessment tools can be used to help us determine the presence and severity of a client’s OCD, including:

  • The Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
  • Obsessive-Compulsive Inventory-Revised (OCI-R)
  • Florida Obsessive-Compulsive Inventory (FOCI)
  • Obsessive-Compulsive Spectrum Inventory (OCSI)
  • Obsessive-Compulsive Drinking Scale (OCDS)
  • Child Yale-Brown Obsessive Compulsive Scale (CY-BOCS)

What to Include in a Treatment Plan for OCD + Example

For the duration of this article, we will be referencing a hypothetical case example for a client, John, and create an OCD treatment plan reflective of his clinical needs. Treatment plans should be tailored to each individual, making note of their symptoms, level of impairment, and other mental health concerns. Our case study will follow a TherapyByPro treatment plan outline with our OCD treatment plan sample.

Johns Case:

John S. is a 35-year-old man who sought treatment after being encouraged by his wife to get help. John reported that his symptoms started in his early twenties but have worsened over the past few years. He spends several hours each day performing his compulsive rituals, which significantly interferes with his daily functioning and productivity at work. His wife has expressed concern over the amount of time he spends on these behaviors, and it has started to strain their relationship. John indicated that he experiences both obsessions and compulsions. His obsessions include intrusive thoughts about germs and contamination, which he fears will harm his family. Though he has tried to suppress or ignore these thoughts, they are quite distressing and persistent. John estimates that he washes his hands 30 times each day, and encourages his family to wash their hands throughout the day as well. John explained that he does experience temporary relief when he washes his hands, however, his obsessions tend to reoccur throughout the day. John noted that his symptoms have begun to affect his concentration and work performance because he keeps getting up to wash his hands.

John denied receiving treatment in the past for this, or other mental health concerns. He reported being in good physical health, exercising regularly, and denied taking any medications.

Agencies Involved and Plans for Care Coordination

Though John initially reported that he was in good health and was not taking medications, based on his presentation a component of his treatment plan will be to refer him to a psychiatrist for an assessment, and to explore possible medications that could enhance his treatment. If John is agreeable, you can sign the needed consent and include the referred healthcare provider in this section of your treatment plan for OCD.

Example for John:

Other Agency: Psychiatrist, Doctor Smith

Plan to coordinate: Initiate a referral for John to see Dr. Smith for an evaluation of OCD symptoms, and to explore possible medications that could enhance his treatment experience.

Clinical Diagnoses

Based on the provided information, John meets the criteria for obsessive-compulsive disorder. His symptoms that support this diagnosis are his experience with obsessions and compulsions, and that he has had similar obsessions and compulsions since he was younger. The overarching theme of his obsessions and compulsions is germs and contamination, which could lead to illnesses.

Example for John:

Diagnosis: Obsessive-compulsive disorder, F 42

Supporting Assessments:

  • Yale-Brown Obsessive Compulsive Scale : Total score 32
  • Obsessive-Compulsive Inventory-Revised (OCI-R): Total score 40

Current Medications and Responses

At this time John is not taking medications, however, should this change, it should be reflected in his treatment plan.

Example for John:

No medications at this time

Presenting Problem and Related Symptoms

This section of your OCD treatment plan can be used to highlight your client’s symptoms, impairment, and other factors contributing to the development of their treatment plan. You can use this as the location for your clinical summary that provides clarification into your case conceptualization and where your work will be focusing. You can be detailed and specific in this section to support your treatment plan.

Example for John:

John Smith, a 35-year-old software engineer, presents with severe symptoms of obsessive-compulsive disorder (OCD), specifically characterized by intense contamination obsessions and compulsive hand washing behaviors. His intrusive thoughts about germs and contamination lead to significant anxiety, compelling him to wash his hands up to 30 times a day. Despite efforts to suppress these thoughts, they persist, causing considerable distress. His Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score of 32 and Obsessive-Compulsive Inventory-Revised (OCI-R) score of 40 indicate severe OCD symptoms, particularly related to washing.

These symptoms profoundly impact John’s life, affecting his productivity at work due to frequent interruptions for handwashing and creating social isolation as he avoids public places and social interactions. His compulsions also strain his marriage, disrupting daily routines and causing emotional stress. To address these impairments, a comprehensive treatment plan involving cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP), alongside possible medication, is recommended. This approach aims to reduce his symptoms, improve daily functioning, and enhance his overall quality of life.

Goals and Objectives

Your goals and objectives should be specific to John, along with being reasonable and realistic based on his current presentation. If you find that your client is having a hard time working through their objectives, it may be necessary to adjust them so they are more attainable. As you develop your goals, keep in mind where your client falls within the stages of change, and how important the goals you selected would be to them.

Example for John:

Goal 1: Reduce the Frequency of Compulsive Hand-Washing

  • Objective 1: Identify and document-specific triggers for handwashing.
  • Objective 2: Gradually decrease the frequency of handwashing.
  • Objective 3: Practice exposure to contamination triggers without engaging in compulsive handwashing.

Goal 2: Increase Social Engagement and Reduce Avoidance Behaviors

  • Objective 1: Identify and challenge negative thoughts related to social situations.
  • Objective 2: Gradually reintroduce social activities in a controlled manner.
  • Objective 3: Enhance social support and communication skills.

Goal 3: Improve Overall Daily Functioning and Productivity

  • Objective 1: Develop a structured daily routine to minimize time spent on compulsions.
  • Objective 2: Enhance coping strategies for managing work-related stress and anxiety.
  • Objective 3: Increase participation in pleasurable and meaningful activities.

Specific Interventions to Be Used

The interventions that you use should align with the goals and objectives that you have outlined in your treatment plan. Your interventions will be the most impactful if they are evidence-based for OCD treatment. If you find that your client needs more support to achieve a goal or objective, you can amend your treatment plan to reflect the necessary changes.

Example for John:

Intervention/Action: Keep a daily log of triggers that you experience that lead to an urge to wash your hands. Bring this list into your therapy session to review

Responsible Person: John and Counselor A

Intervention/Action: Set specific time intervals of when to wash hands, slowly increasing the time between washed. Utilize relaxation techniques, such as deep breathing, to manage anxiety and discomfort that arises in between washes

Responsible Person: John

Intervention/Action: Use cognitive restructuring techniques to identify irrational thoughts about contamination in social settings.

Responsible Person: John with assistance from Counselor A

Intervention/Action: Create a graded exposure plan starting with less anxiety-inducing social activities.

Responsible Person: John, with the support and guidance of Counselor A

Intervention/Action: Set specific, achievable goals for social interaction each week.

Responsible Person: John

Family Involvement

If John is agreeable, it sounds as though including his wife in his treatment can be beneficial. Depending on their needs, you could facilitate educational sessions about OCD and effective treatment options, and discuss what could be done or modified in their home environment to better support John. Couples counseling could be another option, depending on the strain in their marriage.

Example for John:

Family sessions with his wife focus on providing psycho-education about OCD, causes, and treatment. 

Additional Services and Interventions

Because this treatment plan is using CBT, there are a number of additional services and interventions that align with his treatment plan and objectives that you could use. Some clinicians find that using worksheets can help facilitate and guide interventions. Examples of relevant worksheets that could be used to treat OCD are the TherapyByPro OCD worksheets. John may also benefit from a support group for those living with OCD, and working with a psychiatrist. 

Example for John:

Additional Services:

  • Attend OCD support group
  • Referral to local Psychiatrist for assessment and to explore possible psychotropic medication options

Estimation for Completion

There are a number of factors that can affect the duration of your treatment. This can include the type of OCD you’re experiencing, the severity of your symptoms, and the length of time that you have been struggling. Individuals who begin taking SSRI medications may not notice a change in symptoms for a few months, which too can lengthen the duration of treatment. Treatment for OCD can last up to one year.

Examples for John:

Duration of 12 months with the use of weekly individual sessions. Family sessions can be included if he and his wife are agreeable

Aftercare Plans

Aftercare plans should reflect what is recommended if John were to terminate treatment today. There are a number of reasons that treatment can end early, so it is best to be prepared in case this happens. Your aftercare plans can be modified as you move throughout the treatment process, to continue providing accurate recommendations. 

Example for John:

Aftercare Plans: Continue engaging in counseling and therapy services, follow up with primary care physician for medication management services if medications are being used

Final Thoughts On Creating a Treatment Plan for OCD

Creating an effective OCD treatment plan involves a thoughtful and personalized approach, addressing the specific symptoms and challenges your client faces. Using evidence-based therapies like cognitive-behavioral therapy (CBT) and exposure and response prevention (ERP) can help your clients reduce their compulsions and manage their obsessions. This can help your client enhance their daily functioning, improve their quality of life, and provide ongoing support throughout the treatment journey. 

TherapyByPro is an online mental health directory that connects mental health pros with clients in need. If you’re a mental health professional, you can Join our community and add your practice listing here. We have assessments, practice forms, and worksheet templates mental health professionals can use to streamline their practice. View all of our mental health forms, worksheet, and assessments here.

Resources:

Kayla Loibl, MA, LMHC
Author: Kayla Loibl, MA, LMHC

Kayla is a Mental Health Counselor who earned her degree from Niagara University in Lewiston, New York. She has provided psychotherapy in a residential treatment program and an outpatient addiction treatment facility in New York as well as an inpatient addiction rehab in Ontario, Canada. She has experience working with individuals living with a variety of mental health concerns including depression, anxiety, bipolar disorder, borderline personality disorder, and trauma.

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