As Good As It Gets? Comparing ERP Clients’ and Providers’ Perceptions of Engagement Barriers and Facilitators for OCD Treatment

Author

• Samuel Mutschler-Aldine, Portland State UniversityFollow
• Eric S. Mankowski, Portland State UniversityFollow

Sponsor

Phi Kappa Phi Honor Society, Pioneer Award

First Advisor

Eric Mankowski, PhD

Date of Award

Spring 6-12-2025

Document Type

Thesis

Degree Name

Bachelor of Science (B.S.) in Psychology and University Honors

Department

Psychology

Language

English

Subjects

Client, Effectiveness, Engagement, Exposure and Response Prevention Therapy, Mixed-methods, Obsessive-Compulsive Disorder

Abstract

Background

This mixed-methods study compared clients’ and providers’ sentiments toward research-based themes on barriers and facilitators of client engagement in treatment. For individuals with Obsessive-Compulsive Disorder (OCD), engagement in Exposure and Response Prevention (ERP) therapy is a crucial ingredient of successful treatment and symptom remission. Therefore, it is imperative to thoroughly understand the perspectives on engagement barriers and facilitators of people with field experience: ERP patients and therapists.

Methods

The researcher administered two Qualtrics surveys to thirty current providers and six current or former clients of ERP for OCD. Each survey contained five-point, Likert-style scales to measure the level each participant agreed with themes derived from current best practices research.

Results

After quantitative and thematic analysis of the data in SPSS and ATLAS.ti, it was found that the two groups’ sentiments differed significantly on themes in seven of the nineteen Likert-style scale items examined, four of the five treatment administration experience questions, and that written testimonies of providers supported existing themes identified in previous studies as well as critical themes unrepresented in current literature.

Future research on this topic would be largely beneficial for bolstering OCD treatment efficacy. The author will now repeat this study with a larger sample size.

Comments

Sample:

Introduction

“I do think it is important to recognize that us therapists are notoriously terrible at accurately identifying our client’s experience without directly asking them”

- Study Participant

Like individuals attempting to predict a partner’s thoughts, psychotherapy relies on overt communication to come to accurate conclusions. Obsessive-compulsive disorder (OCD), a fairly common and debilitating mental health condition, has many evidence-based treatments. Exposure and response prevention (ERP) works extremely well at treating OCD, although there is a relatively high frequency of clients who drop out of treatment before crucial milestones are passed.

At its core, we had two research questions. First, do clients and providers see eye-to-eye on barriers and facilitators to engagement in ERP? Second, what recommendations do clients and providers have for increasing engagement and reducing attrition in ERP? This research aims to further the understanding of what the most effective form of OCD treatment looks like. Many issues exist within and beyond treatment that can lead to patients breaking up with their therapists, yet many promising studies like ours have shown the potential of individuals and systems to change this.

“What if this is as good as it gets?”

- Melvin Udall, As Good As It Gets (Brooks, 1997)

Recommended Citation

Mutschler-Aldine, Samuel and Mankowski, Eric S., "As Good As It Gets? Comparing ERP Clients’ and Providers’ Perceptions of Engagement Barriers and Facilitators for OCD Treatment" (2025). University Honors Theses. Paper 1905.