ERP (Exposure and Response Prevention) has earned its place on my blog after I repeatedly received questions from clients asking whether I provide this type of “therapy.” Apparently, some psychologists and physicians — including general practitioners and psychiatrists — refer people with OCD specifically to this “therapy.”
There is plenty of information online stating that ERP is a first-line treatment for obsessive-compulsive disorder. However, the way it is sometimes presented as a completely separate type of therapy can create confusion. The problem is not that people call it therapy. The problem is that it may be understood as an entirely separate profession or a distinct type of specialist — an “ERP therapist” — without considering the therapeutic framework and clinical competence behind the method.
What is ERP?
ERP is a specialised, structured approach within the cognitive-behavioural tradition and is one of the main treatment approaches for OCD. Therefore, when looking for a therapist, it is reasonable to seek someone with training in CBT and specific experience in treating OCD and applying ERP.
ERP is not simply one or two techniques. As a structured therapeutic approach, it involves a particular conceptualisation of the problem, assessment criteria, a sequence of interventions, a framework for the therapeutic work, principles for adaptation, and between-session tasks. Because OCD has specific characteristics, it often requires a specific set of CBT interventions, which, for the sake of convenience, we refer to as ERP.
The fact that ERP is a leading recommended approach for OCD does not mean that it is applied in exactly the same way for every person or that therapy consists solely of exposure exercises. The specific treatment plan depends on the individual clinical picture, co-occurring difficulties, and the individual case formulation.
Who practises ERP?
When your doctor, psychologist, or psychiatrist recommends ERP, this gives you a clear starting point: look for professionals with training in CBT and experience working with OCD and ERP.
One difficulty is that professionals may use different terminology. One therapist may say that they provide CBT for OCD without using ERP as the primary label for their service, while another may specifically describe themselves as an ERP therapist.
When you ask, “Do you provide ERP?”, the question may therefore be too narrow. A more useful question would be:
“Do you work with OCD? Do you have training and experience in applying ERP?”
Of course, these statements are not absolute. ERP, like other CBT techniques, can also be taught as a separate protocol to professionals whose primary training is outside CBT. This practice also exists in Bulgaria, for example in some crisis centres, where, due to the nature of the work, professionals may be trained to apply specific therapeutic protocols without this necessarily being part of comprehensive CBT training.
It is also possible for a professional with a different professional background to apply ERP effectively. Ultimately, the choice is yours: what kind of training, experience, and therapeutic perspective would you like the professional you work with to have?
Of course, I could simply answer “Yes, I do” when someone asks whether I provide ERP. And while that would certainly be the easiest answer, it could also reinforce a misunderstanding that I would rather not perpetuate.
I would not want to use ERP as a marketing label that creates the impression that it is a separate therapeutic identity. When ERP is appropriate for a particular case, of course we may use it. However, I would not want to reduce therapeutic competence to a single acronym.
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