Virtual Therapy for OCD: Allison Solomon

This has been the year of virtual everything: happy hours and weddings, work and school, and, of course, therapy. Many therapists had to unexpectedly make a switch to 100 percent virtual sessions, but Allison Solomon has been offering virtual care for several years. Always wondered if virtual therapy was right for you? Read on to learn more about it, and how Dr. Solomon came to treat obsessive-compulsive disorder (OCD) and related disorders. Welcome, Allison!

How long have you treated OCD? Why did you decide to focus on OCD and other anxiety disorders?

I remember treating my first case of OCD as a graduate student about 25 years ago. My doctoral dissertation was focused on the evidence-based treatment of childhood OCD. Early in my career I treated a wide range of issues but narrowed my focus to specializing in the treatment of OCD and related disorders for the past 15 years. My practice now is solely focused on treating OCD, anxiety disorders (such as panic, phobias, social anxiety), BFRBs (trichotillomania, dermatillomania), and tic disorders with children, adolescents, and adults.

I decided to focus on these issues for several reasons. The first reason is more personal. My younger sister started showing symptoms of OCD, separation anxiety, and Tourette syndrome at around five years old. Her symptoms worsened over the next ten years and my family struggled along with her. I remember my parents desperately trying to find doctors who could help her, and it was very difficult, especially in the 1980s. She was put on extremely heavy-duty medications and she experienced many serious side effects. Not one therapist or physician ever mentioned exposure and response prevention (ERP). I remember feeling horrified, helpless, and frustrated. She was teased by other children for her tics and rituals; even some teachers at school made rude comments. I spent a lot of time standing up to bullies and protecting her, even while I didn’t understand her seemingly illogical fears and rituals. As a family we tried our best to come up with strategies to help her. Over time, her tics dramatically reduced (which tends to happen with some children as they age). In her teens, she finally found a therapist who knew how to treat OCD and anxiety. We worked together as a family and she got dramatically better. I had always had an interest in psychology, and after watching my sister make so much progress, I decided that being a therapist would be my career path in life. She is now a very successful adult and manages her OCD quite well most of the time.

As I progressed through graduate school and my internship and postdoctoral fellowship, I worked in many different settings with very diverse populations. I saw how often OCD was misdiagnosed, misunderstood, and mistreated across all these settings and people from all ages and backgrounds. It was both frustrating and enlightening to see that the struggles my family encountered in trying to get help was something that was happening all over the world.

I have always been fascinated with the human brain and how it impacts our thoughts, feelings, and behaviors. OCD is horrific yet fascinating in the ways it takes deeply held values and creates terrifying scenarios to violate our sense of safety and identity.

Due to the pandemic, a lot of therapists have transitioned from in-person to virtual therapy, but your sessions are always virtual. Why did you decide to open the Virtual Center for Anxiety & OCD?

That’s a great question. For years I was in private practice in Arizona. I did therapy in my office, as well as in patients’ homes and in the community (due to the need for ERP to be delivered in settings where it would be most effective). I carried a large caseload and had a long wait-list, mostly due to the lack of OCD experts in the state. It was very difficult to juggle out-of-office appointments and travel time with my in-office patients. I began doing virtual sessions from my office and my patients and I were encouraged with the results.

In the fall of 2016, I relocated to New York for my husband’s job. I referred my patients to other therapists, but most decided to continue on with me virtually. I planned on setting up an office in New York as well as continuing virtually with my Arizona patients. Unfortunately, my husband had an emergency back surgery that led to him having to stay in the hospital for months. I was able to continue caring for my patients as well as my husband by keeping my entire practice virtual. It was then that I saw how virtual therapy benefited my patients as well as (and often better than) in-person treatment.

Needless to say, 2020 has been a doozy. Have you noticed an increase in people seeking treatment who haven’t experienced anxiety before? Do you think they could learn from some tenets of OCD treatment?

Another great question! I have a few thoughts about this. First, my general observations are that almost everyone has been experiencing heightened stress and anxiety this year at a more significant level than I have seen since the terrorist attacks on September 11. I have definitely noticed an increase in people seeking treatment who have never seen a therapist or sought help for anxiety or OCD-related issues. In my experience, these individuals tend to have had a history of anxiety or OCD in the past but may not have recognized it until they experienced a much higher level of distress or were stable until this year, leading them to seek help. Also, there has been much more conversation and content about stress, self-care, coping, and seeking help on many media outlets, which seems to have prompted validation of emotional distress and normalization of seeking treatment.

To answer your second question, yes! I may be biased, but I think every single person in the world could benefit and learn from tenets of OCD and anxiety treatment. Every human being has experienced fear, anxiety, and doubt. Every human being, at some point in their lives, has engaged in avoidance or ineffective coping behavior. Ultimately, the tenets of OCD treatment I find the most applicable to everyone are: 1. Learning about the brain and how we experience fear and anxiety as well as learning about the cycle of avoidance and other unhelpful responses to these emotions. 2. Understanding the role of acceptance of our discomfort and distress and how it can ultimately lead to a decrease in suffering and a more effective way of dealing with challenges. 3. Developing a plan for increasing exposure to unhelpful thoughts, feelings, and situations while decreasing avoidance and behaviors that reinforce fear is incredibly powerful. 4. Thoughts are not facts and feelings are not facts! 5. Self-compassion is essential when facing life’s challenges. 6. Uncertainty is a fact of life. Nothing is certain except for this fact! Making space for living with uncertainty is the path to freedom!

What’s a common question or misconception people have about virtual OCD treatment?

The most common misconception about virtual OCD and anxiety treatment (or treatment in general) is that it is not as effective as in-person treatment, that it will be difficult to connect with a therapist, and that you cannot do exposures virtually. Another misconception is that virtual therapy for children or adolescents is not possible or helpful. 

This year has bombarded us with so many awful and painful experiences. One incredibly positive thing I have witnessed this year has been a massive decrease in the misconception (by sufferers, family members, and therapists) that virtual therapy is not as effective as traditional treatment. Many of us have now been well-versed in meetings, school, or social get-togethers over video conferencing and I believe this has contributed to a decrease in the belief that it is impossible to meaningfully connect with others this way. Another big “win” for virtual mental health is that many insurance companies are now covering virtual treatment and reimbursing at the same rates.

I have found there are so many advantages of virtual therapy for OCD over exclusively in-person therapy. There are definitely disadvantages for both the therapist and client. There are also situations in which ongoing virtual treatment might be contraindicated. All things considered, I believe the advantages far outweigh the disadvantages, and I am so grateful I am able to connect with clients near and far and provide much needed evidence-based treatment.

Speaking of misconceptions, what do you consider the biggest misconception people have about OCD? What can we do to combat it?

There are so many misconceptions about OCD and people with OCD that I am having a hard time picking just one. This may not be the biggest misconception, but it is one that I hear and see often: The idea that if a sufferer recognizes their obsessions and compulsions as irrational, it means that they can and should “just stop” them. People with OCD are some of the bravest, strongest, and kindest people I know. The idea that you can “just stop” is so harmful and invalidating. If that was possible, OCD would not be a problem and we would all be thrilled. Not only is this not true, but it leads to more shame, feelings of inadequacy, and hopelessness and prevents many from seeking treatment because of the fear that this message will be reinforced.

If you could share just one piece of advice with someone who has OCD, what would it be?

Wow, one thing? I guess that would be to always remember that you are not alone and don’t have to hide in shame. You are not broken. You are not the only one who has these thoughts, compulsions, and fears. Do not give up. Even if you have sought help and have not received adequate treatment. Do not give up. There is effective treatment and support out there. Educate yourself through the International OCD Foundation (IOCDF), read about evidence-based therapy, join a support group, inform your support system on ways they can better understand OCD, and follow blogs and content by advocates with lived experience (like this one)! The OCD community is a wonderful group of brave and passionate sufferers and advocates, devoted family members and friends, and treatment providers who have dedicated their careers to OCD research, treatment, the provision of education and training to students, clinicians, and providing outreach and education for the community who misunderstands OCD. You are not alone, you are not broken, and you have the chance for a much better future. Never give up.