Monday, January 17, 2011

Finding a therapist for "Pure O" OCD: 5 Things to Watch Out For


I was in psychodynamic therapy for 6 years with a therapist who said I had OCD, but who didn't have a plan to treat my OCD beyond having me avoid my triggers. Previous to that I had several other therapists who didn't really have a clue about my OCD. Here are some things to watch out for--hopefully this will help you find help more effectively and not have to go through the delay I experienced in finally getting Exposure and Response Prevention(ERP) therapy.

  1. Affirmations. If a therapist tells you to repeat affirmations about being a good person, good father, good teacher, good Christian, good whatever, in order to counteract scary, violent, disturbing thoughts, this just feeds the fire, prompting ever more desperation in trying to prove it to yourself that you are not a monster or a danger to others. This is different from having a compassionate therapist who asserts your value as a human being and encourages you to take your life back from the OCD and any other negative deeply held beliefs about your worth, by doing exposure therapy.
  2. Deeper Issues. If a therapist tells you there are deeper issues you need to deal with, and then somehow your OCD thoughts will resolve or disappear once you've dealt with the issues, you can be in for a long long stint of therapy. Yes, there may be deep issues in your life, but resolving them is not a treatment for OCD, since the compulsions often complicate any attempts at resolution, and even if you gain a deeper understanding of your psyche, OCD can be incredibly resistant to magically disappearing.
  3. Thought Stopping. Snapping a rubber band everytime you have an unwanted thought, or imagining a giant stop sign will sensitize you to the thoughts even more. Mental compulsions, on the other hand, can be stopped(even if it seems impossible), which leads to the next point.
  4. Confusing obsessive thoughts with compulsive thoughts. Pure O isn't pure. I discovered with the help of my ERP therapist, that I have mental compulsions for trying to "undo" my intrusive obsessive thoughts, like freezing(and doing nothing until I solve the issue), retracing my thoughts or actions, analyzing, figuring out, avoiding all reminders of the thought, or researching.
  5. Disputing the thoughts ad infinitum. Cognitive Behavioral Therapy(CBT) is the larger category that ERP belongs to, but CBT applied to mental obsessions without an understanding of the nature of intrusive thoughts, perfectionism and "just right" feeling can turn dysfunctional thought analysis into compulsions. I would get sidetracked into figuring out whether I'd done a thought record thoroughly enough, and even if I disputed all the errors in my thinking, it didn't seem to stick.
Related Post
Finding a good therapist for OCD in the US and Canada

18 comments:

  1. Wonderful post! The first therapist that I ever went to (over 25 years ago!) had me doing the "thought stopping" exercise with a rubber band. Fast forward through NUMEROUS "CBT" therapists - none of which actually diagnosed me as having OCD - to about 10 years ago. I finally was diagnosed properly, but it still took until 6 MONTHS AGO to find a therapist who wanted to do ERP. For over two years prior to the therapist I am going to now - I worked with a psychologist who claimed to treat OCD but didn't do any ERP, and in fact exascerbated the problem by telling me to look for the logic in my thoughts and challenge my thoughts using cognitive therapy. I knew this wasn't helping, but this man was supposedly the best there was for treating OCD in a very large city. When I finally read Dr. Grayson's book that addresses this issue (Cognitive therapy becoming a compulsion) - I realized I had to find someone different. Now I Skype with a therapist in the U.S.

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  2. You always do great posts. I had a therapist try to dissect past trauma in my life. I went to her 1 time. Now I have the nicest therapist in existence (heh, well you know what I mean. She's a great person).

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  3. Thanks for the kind words ocdbloggergirl--I'm glad that you were able to realize quickly that the therapist dissecting the trauma wasn't going to help your ocd!

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  4. This is gold for therapists!

    I make it a regular part of my practice to request feedback from clients because it's proven to increase the effectiveness of treatment. Your blog is wonderful feedback that I can take into account when working with clients.

    That said, there are a variety of effective treatments for different issues, including OCD. What works for some may not work for others. For example, my therapist treated me cognitively, without ERP and without any behavioral component other than noticing my body's sensations to alert me that I was beginning to get triggered (it's a little more complicated than I can share in a comment).

    My treatment was very successful--for me. Psychotherapy fails when it doesn't recognize individual differences and seeks a one-size-fits-all treatment--match the diagnosis with the one "best" treatment and the client is cured (regardless of the client's unique context).

    Worse, psychotherapy fails when it values its theories more than the person. Dissecting trauma, seeking insight, etc. are all well and good--if they serve the client. Otherwise, we get a lot of experiences like yours and your readers where the therapist failed to meet their clients' needs (and I'm glad these therapists were fired).

    I'm sorry it took you so long to find someone who was able to recognize and provide you with what you needed. My own goal in learning different treatments is so I can provide a broad range to diverse clients, and my use of client feedback is to measure the effectiveness of our work together (if it's going nowhere, we talk about Plan B, which may be a different treatment or therapist).

    Thank you so much for sharing your experiences with the world. I have learned a lot and appreciate the resources you provide (can't wait to read Grayson's book!).

    Invite Beauty,

    I.

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  5. Ivan--Welcome! Thank you for your thoughtful detailed comment. If this blog is gold for therapists, I am thrilled! The mission of treating clients as individuals, who matter, who do not fit a formula, is essential, and I am heartened by your commitment to this. There is evidence that ERP works for OCD, but there's also a high drop-out rate, and the cutting edge is discovering why this is, rather than saying clients are "non-compliant," which is the danger with using ERP as a formula.

    Mindfulness is also being studied extensively, and my therapist has incorporated Hayes' ACT therapy(although Hayes himself rubs me the wrong way), and awareness of body sensations, leaning into them, instead of fleeing.

    I admire therapists who have integrity, and put the client's well-being first, and it's a pleasure to have you as a reader of this blog. Grayson's book was the first time I found someone talking about the role of uncertainty in OCD, and it propelled me into finding treatment.

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  6. "Mindfulness" is a process based in oriental spirituality and I read it extensively in the writings of Jiddu Krishnamurtii. Of course, being a mental case, I felt it was right and could help me, but was unable to use it. Now that I read it from psychiatrists, probably my OCD mind will go with it!:)

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    1. Welcome Dionisio,
      I'm not sure what you mean by your OCD mind going with it. I do know that there is much I've read that I couldn't use because I understood it intellectually but didn't have the support to actually face the fear and do the treatment. Exposure therapy really helped.

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  7. great post! so true! i have been through variuos therapies that have at somepoint incoperated these ideas with the same results....you have to be vigil about what therepists are suggesting and tell them if its making it worse.therapy must be tailored around an individual, what works for one wont work for another.

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    1. Welcome lizz! One of the greatest strengths of my exposure therapist was his willingness to tailor treatment to my feared consequences.

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  8. THANK YOU!

    I also have Pure O OCD, I don't see it talked about very often, I am SO happy I found your blog.

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  9. I'm really upset to find after all the years (25) of different therapists and not feeling any better,ruined relationships and different medications....I've at least been diagnosed as having ROCD. And now it all makes sense. I feel so guilty and sad about the strained relationships I caused but one inparticular I so regret not knowing beforehand or when I was with him what was driving me. I broke his heart so many times until he finally had enough. I'd like to apologize and explain to him now but he's been involved with someone almost 2 years. Oddly enought, he did recently stop by to talk to me but I was busy that night. (i have a current boyfriend also who was coming to pick me up that night). He said he'd come back the next night. He never did show. I contacted him and asked what happened to him, he said it was a mistake, he's still with his girl, no need for apologies, please don't text me, take care. Now my OCD is going mad. HE STOPPED BY MY HOUSE OUT OF NOWHERE AND THEN DIDN'T FOLLOW THROUGH WITH COMING BY TO TALK! I wished he would've come by. So I emailed him to reconsider coming to talk, just one conversation for closure. Things had ended so messy. He wrote back, "please do not contact me anymore, there's no need for a conversation, take care". I don't know what his reasons were for changing his mind. I wouldn't have been looking to get back with him, I just wanted to apologize and explain a little bit. Even though I think I will forever love him my life is moving on. Now I'm feeling bummed. I think he came by thinking he was doing me a favor and when he heard I was involved he changed his mind. I so need a therapist now...

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  10. Great post! I've just found your blog! I'm a long time pure-O sufferer! This is gold for me!

    And, researching, yeah, that's another of my compulsions! :)

    Thanks! ¡Gracias!

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  11. Welcome Mario,
    Yeah, researching is my most well practiced compulsion! The fact that I was a librarian didn't help!

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  12. isnt #2 considered Mindfulness?

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  13. I imagine #2 as an active digging around for the true meaning of obsessions, which fuels the obsessions even more.

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  14. Thank you so much! That did the trick, you saved me more endless hours of searching for a fix.


    Therapeutic Treatment NJ

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  15. Does anyone know a good OCD therapist for Pure Obsessional OCD in the Northern NJ area? Trying to avoid going into NYC but will if that's my only choice.-thank you!

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