Are obsessions and compulsions the result of your brain going haywire, or could they have a meaning and a function, which can be addressed through psychological therapies?
Although there is some evidence that severe forms of obsessions and compulsions, such as excessive cleaning rituals or time-consuming fears about contaminating others, might best be treated with medication, we should not rule out alternatives to pharmacological therapies for less severe forms of OCD.
Behavior Therapies for OCD:
One such form of therapy which has been well-established as the psychological treatment of choice for OCD is Exposure and Response Prevention. Exposure and Response Prevention is a behavior therapy that focuses on exposing the person to the very thing they are anxious about and preventing them from engaging in rituals intended to ward off their anxiety.
If somebody, for example, has an excessive fear of being dirtied or contaminated, believing that they might contract a deadly disease from any contact with a soiled surface, they may be instructed to deliberately touch all door knobs in a public office space, and then tolerate the spike in their anxiety that ensues without engaging in any cleaning rituals to rid themselves of dirt and germs. Over time this exercise retrains the brain to not fear, and leads you to “habituate” to the anxiety, which slowly decreases without any need for rituals.
Behavior therapies can be an excellent alternative or adjunct to pharmacological treatments for OCD. They often reduce distress and increase your sense of control over your life, and they don’t come with all the side-effects of anti-depressants and anti-anxiety agents (which are often the drugs of choice in the treatment of OCD).
In the Houston area, you can contact the following providers, to learn more about this approach to treatment of OCD:
Going Beyond Behavior Therapies:
If you want to not simply experience relief, but to find out if deeper underlying issues may be causing your obsessions and compulsions, then psychodynamic therapy might be a good next step.
According to a psychodynamic viewpoint, obsessions and compulsions are defenses against underlying feelings or conflicts of which the person is unaware.
In this kind of therapy the content of a person’s obsessions is not simply treated as arbitrary or irrelevant, but is seen as a meaningful and significant clue that will help unlock the larger unconscious struggles in which the person is caught.
What Obsessions and Compulsions Mean:
If a person is having fears of their own aggressive impulses, such as fretting about the perceived likelihood that they will run somebody over when they are driving their car, this could indicate that anger is not a comfortable emotion for them.
The exaggerated fear that one has the potential to kill another person may here be an outward expression of the inward experience of guilt or shame one feels about one's anger.
A person may develop guilt or shame about feeling and expressing anger for a variety of reasons.
Further analysis may reveal that:
- The person feels intense anger at their deceased mother, who was never really there for them when growing up, but whom they feel they need to love and respect
- The person may hate their boss, but may have learned that it is bad to challenge people in authority.
- The person knows in their heart of hearts that they really want to divorce the person they are married to, but cannot bring themselves to admit this to themselves or to their spouse.
In each of these scenarios, the outward expression of anger or dissent in their rightful situations has been blocked.
The result is the manifestation of a symptom that displaces their conflict to another arena that is perceived to be psychologically "safer".
The exaggerated fear that one might run a person over is here a displaced fear of the calamities what would happen if one were to be honest with oneself and admit to feelings of anger directed at actual people in ones life.
The obsessional nature of the fear of hurting a stranger is fueled by energy from the original dilemma which must be defended against at all cost. The obsession represents a fear of the danger of the truth erupting.
As a consequence, the obsession is likely to intensify at times when the actual conflict is threatening to erupt. The person may for example become particularly paralyzed after being told to handle job responsibilities that are not in their job description. This kind of experience threatens to bring anger at the boss to the surface, thus necessitating a greater degree of mental control to keep the truth from breaking forth into the person's reality.
The trick here is that the person who experiences the OCD symptoms are not themselves able to discover the logic that keeps their obsessions and compulsions in place. Their truth is hidden from themselves precisely to avoid the shame and guilt they need to defend against. It is for this reason that seeing a psychodynamic therapist can be useful and sometimes necessary.
Benefit of Psychodynamic Therapy for OCD:
Psychodynamic therapy is about helping people figure out why they are experiencing the symptoms that are making it difficult for them to live a good life. It is about discovering the meaning in the seemingly meaningless. It is about gaining control, not just of your behaviors, but of your psychological life.
The benefit of this goes beyond simply resolving or dissolving a particular symptom.
When a person realizes that they have unresolved issues related to the expression of anger, they are able to not just stop the ruminations and rituals, but to address the guilt or shame that blocks them from having healthy access to their assertive emotions. They can then be helped to grieve the love they did not receive, or to feel better able to express their needs without feeling guilty or ashamed.
The treatment of the symptoms of OCD, now gives way to the treatment of the person. Obsessions and compulsions are now no longer the focus of the therapy. Instead they are the starting point for understanding something deeper about a person’s life.
About me: I am Rune Moelbak, Ph.D., a psychodynamic therapist in Houston, TX. I help people discover the causes of their symptoms.