Detailed Program Description - Obsessive Compulsive Foundation

Intensive Treatment Program Interview with Dr. Gary Geffken of
University of Florida’s OCD Program in Gainesville, Florida
June, 2013
1. When did you open your program
Founded by Dr. Gary Geffken and Dr. Wayne Goodman in 1991, The UF OCD Program in the
Division of Medical Psychology has been in existence for over 20 years.
2. Please describe the staff that works at your program in terms of their backgrounds,
credentials and experience
• Gary Geffken, Ph.D., directs the UF OCD Program and the UF Division of Medical Psychology.
He treats both children and adults and has served as an IOCDF lecturer and supervisor in the past.
Dr. Geffken has specialized in the treatment of OCD for over 22 years. While he has researched
and published on a variety of topics in clinical psychology (e.g., Autism, Bed Wetting, Diabetes),
the majority of his over 200 published articles or book chapters have focused on the assessment
and treatment of OCD and OCD spectrum disorders. He has been the direct mentor of several
leading OCD therapists and researchers.
• Joseph McNamara, Ph.D., completed doctoral programs in Counseling and Developmental
Psychology, an Internship in Clinical and Health Psychology, and a Psychology Residency in the
Division of Medical Psychology. He has served as faculty in the department since XXXX. He
treats both children and adults and has received extensive training in ERP under the mentorship
of Dr. Gary Geffken and Dr. Eric Storch. Dr. McNamara has extensive expertise in working with
patients with OCD and comorbid conditions such as tic disorders, sleep disorders and substance
use disorders. Dr. McNamara has published several articles investigating ways to improve
treatment for OCD and was the lead therapist on a recently completed National Institute of
Mental Health funded study on the treatment of children and adolescents with OCD.
Cindi Flores, Ph.D., earned a doctoral degree from UF’s graduate training program in School
Psychology. After earning her doctorate, she worked as a Psychology Resident and Postdoctoral
Associate for the Division of Medical Psychology where she acquired specialty training in ERP.
Dr. Flores has since joined the Division of Medical Psychology where she specializes in the
evaluation and treatment of Autism Spectrum Disorder and Obsessive Compulsive Disorder.
Additionally, she has special expertise in the behavioral treatment of individuals with and without
OCD who have Autism Spectrum Disorders, eating disorders, school refusal, and Anxiety
Disorders.
• Regina Bussing, M.D., is a board-certified child and adolescent psychiatrist. Her primary clinical
interests are combined pharmacological (medication) and behavioral treatment of patients with
anxiety or disruptive behavioral disorders. Dr. Bussing's clinical research includes
pharmacological treatment of OCD, and behavioral interventions for early childhood disruptive
behavior disorders. She specializes in the assessment and treatment of Activation Syndrome, a
side effect sometimes observed in children or adolescents who are being treated with common
medications for anxiety or depression.
• Mathew Nguyen, M.D., completed a psychiatric residency at Georgetown University and a child
fellowship at the University of Florida. Currently, Dr. Nguyen serves the UF Department of
Psychiatry as the Associate Chief and Medical Director of the Division of Child and Adolescent
Psychiatry (housed directly next to the UF OCD program). He oversees the training of all UF
Psychiatry Fellows working in the Division of Child and Adolescent Psychiatry and specializes in

the psychopharmacological treatment of children and adolescents with anxiety or mood disorders.
In this capacity he supervises the psychopharmacological treatment of pediatric OCD in both
inpatient and outpatient settings, often working in direct collaboration with the UF OCD Program
when medication is needed in combination with ERP treatment.
• In addition, the Division of Medical Psychology has interns and postdoctoral associates who are
trained in the areas of CBT-ERP and have received specialty training in the treatment of children
or adults with OCD, anxiety disorders, depressive disorders.
3. Is this program devoted entirely to treating individuals with OCD or will other OCD
spectrum disorders or anxiety disorders also be addressed
• The UF OCD Program therapists also provide the leading treatments to address OCD spectrum
disorders and other anxiety disorders. In general, CBT-ERP would be used for other anxiety
disorders and Habit Reversal Training would be implemented for OCD spectrum disorders.
Additionally, a wide range of comorbid conditions can be addressed during OCD treatment.
4. Please describe the core treatment components of your program (e.g., use of medication,
ERP, group therapy, etc.).
• During the first appointment, a comprehensive intake is completed. For those with OCD, an
assessment of symptom severity is conducted using the Children’s Yale Brown Obsessive
Compulsive Scale or the Yale Brown Obsessive Compulsive Scale at intake and various points
throughout treatment so that we can track improvement in various OCD symptom domains. For
those where the use of CBT-ERP is the best line of treatment, pyschoeducation is provided to the
patient about OCD and why CBT-ERP is the most effective method to treat it. A fear hierarchy
will be generated and a discussion will occur about how the patient and the treatment team will
work in a collaborative manner, at the pace of the patient, to do exercises that prove OCD wrong.
CBT-ERP will then occur until symptom severity is reduced, at which point a discussion of
relapse prevention will occur at the end of treatment. We will address other psychological
symptoms that we know interfere with treatment and, in this vein, we are always adjusting CBT-
ERP treatment to incorporate other treatment techniques to improve treatment response (e.g.,
Motivational Interviewing, Acceptance and Commitment Therapy) as needed. Patients may be
referred to receive consultation with our psychiatry team regarding a medication consultation on
an as needed/as requested basis. However this occurs in rare cases as the research from our and
others clinics and our clinical experience support only using medication in combination with
therapy in very specific cases.
5. Please describe the treatment planning process at your program.
• After the intake, all treatment providers will meet with Dr. Geffken or Dr. McNamara to discuss
the case and create the best individualized treatment plan. This is a collaborative process in which
the family’s stated goals at intake are addressed. This plan will be conveyed to the patient and
their caregivers or family members, as it is important for everyone in the home to understand
OCD or OCD related disorders so that appropriate support can be provided and so family
members understand how to not accommodate to the patient’s symptoms.
6. If someone has a co-morbid condition, can he or she participate in your program Will
there be treatment for the co-morbid condition If so, can you give an example

• Those with any co-morbid conditions are eligible to receive treatment. Treatment priority will be
determined based off what the patient ranks as the most distressing symptoms, what conditions
may interfere with the treatment of others, and time available for treatment. This decision is made
after extensive discussion with the patient and their family. In most cases, treatment can
simultaneously target multiple symptoms. Our providers have stated interests in treating
comorbid anxiety disorders, eating disorders, sleep disorders, school refusal, medical regimen
adherence, bed wetting, and Autism Spectrum Disorders.
7. Are parents, family members, friends, teachers, etc. included in the treatment If yes, please
describe how.
• With OCD treatment, as with many mental health conditions, family members can play a seminal
role in shaping and maintaining treatment outcomes. Thus, we offer Family-Based CBT-ERP
when feasible and appropriate which directly includes family members in the treatment of OCD.
Research shows that involving family members increases familial understanding of patient’s
symptoms and teaches them how to balance supporting the patient versus doing behaviors that
actually maintain the patient’s symptoms and increase stress on the family. In short, involving
individuals who interact with the patient frequently outside of the therapy room often improves
treatment effectiveness. However, familial involvement is up to the patient and in some cases is
not appropriate. In addition, key stakeholders such as teachers may be provided with consultation
to help increase sustainability and adherence to the treatment protocol maintenance in a wide
variety of settings.
8. How often do patients in the program meet with staff individually How long are these
individual sessions
• Decisions regarding the frequency of how often patients meet with staff members is determined
following the intake. In general, patients receiving treatment attend sessions lasting
approximately 60 to 90 minutes. Treatment is offered on a monthly, weekly or daily basis.
9. Is there a set time period for a patient’s treatment in the program What is the overall time
commitment to the program (for example, attend daily for three weeks) How much
flexibility is there in extending someone’s stay if needed
• The frequency and intensity of sessions is determined on a case by case basis. Generally, patients
receive treatment on a weekly basis for approximately 15 sessions lasting approximately 60-90
minutes. Those who participate in the intensive treatment program receive treatment on a daily
basis for 15 sessions lasting approximately 60-90 minutes. There is flexibility in booster sessions
after these 15 sessions, but based off research and clinical experience we generally encourage
patients to at least try a period of time away from treatment (e.g., 1-3 months) at this point to
practice treatment skills before returning to address any remaining symptoms.
10. Is there a homework or “self directed” component to the treatment
• Patients are asked to complete daily homework as part of their treatment in order to facilitate the
treatment, provide opportunities to practice strategies that they have learned in treatment outside
of the office, as well as to help extend treatment gains to the natural environment (e.g., school,
home).
11. Please describe the relapse prevention strategies you use in your program.

• As a way to prevent relapse, prior to concluding treatment, patients are provided with information
regarding the signs of relapse and methods to prevent relapse or seek out help should relapse
occur. As mentioned above, for those where it is feasible, we may slowly decrease the frequency
of treatment after the initial 15 sessions in order to practice relapse prevention. For those who
travel to our clinic from other cities, states or countries, we will offer referrals to trusted treatment
centers closer to home for those who may benefit from additional support.
12. What kind of follow-up do you do for those who complete your program Will the members
or your treatment team be in contact with or willing to consult with the individual’s regular
treatment provider(s)
• Therapists are available to provide consultative support following completion of the program.
Treatment maintenance following participation in our program is key to sustain progress;
therefore, it is our pleasure to provide additional services to support patients’ needs.
13. Do you offer a sliding fee scale or scholarships for those who cannot afford your program
Is the discounted lodging at Ronald McDonald House
The capacity to offer discounted treatment is limited by the current economic climate, although
exceptions are occasionally made and we are always flexible in the amount of sessions for each
patient (although 15 is recommended for best outcomes). Lodging at the Ronald McDonald
House is determined on an individual basis.
14. Does your program only work with individuals who are local or are there arrangements for
those who come from farther away (for example, lodging arrangements)
• Treatment services have been provided to individuals across the United States and internationally.
Those who are interested in receiving services are provided with information on lodging in the
area. Many local hotels, motels, and bed and breakfasts offer a “hospital rate” for those seeking
treatment. For those who may not be able to afford lodging, they may apply to stay at the Ronald
McDonald House. Patients are required to provide their own transportation.
15. Please add any information you think would be helpful in describing the unique aspects of
your program if this has not been covered in the questions above.
• In addition to clinical care, our group conducts research with implications for clinical practices.
Based on research evaluating treatment outcomes for those participating in our program, 80-85
percent show at least a 50 percent reduction in their OCD symptomology after 15 sessions.