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May 29, 2013

Obsessive compulsive behaviors can be described as the repeated occurrence of intrusive thoughts (obsessions) followed by repeated attempts to rid one’s self of these thoughts through irrational behaviors (compulsions).

I had a client who had this rule, before leaving his home he would grip and release the door handle twelve times, before he was satisfied about two things.  First, that the house was truly secure and secondly that the house wouldn’t burn down. On the first day of our appointment he said to me,

“I don’t understand why I am like this, I had a good childhood and I have no problems with my life.” By now I can predict without fail that a new client whose has highlighted issues with obsessive compulsive behaviors on his or her intake sheet is going to tell me something like this.


I have found in my practice that most OCD clients are truly baffled by their obsessive thoughts and compulsive behaviors. Like the example statement written in the previous paragraph, most clients with OCD, will insist that they have no reason to be distressed, however upon further examination all sorts of traumatic stories come to the surface. Usually after the first time these revelations are made, I wait until the following session to bring to the client’s attention about how his or her revelation contradicted their initial statement that they have experienced no traumas in their past.

Clients are usually surprised and in agreement when I bring this to their attention. It’s not that they came to intentionally lie about their past, it’s that they have been conditioned to be in denial about their stories for a long time.

When people find themselves in emotionally painful situations they truly have no power over, if they are not afforded an outlet to express what they are experiencing, it’s not unusual for these people to develop maladaptive behaviors to feel like they have some type of control over their lives. These maladaptive behaviors can be a result of obsessive and plausible thoughts (touch the door knob twelve times to make sure it’s locked) to obsessive and irrational thoughts (wash your hands twenty times, counter clockwise  or else someone you love dies.)

Bringing OCD to an End

From my experience, the most effective strategy for helping clients end their traumatic experiences with OCD, is by helping them identify real life issues they have been hiding from. It could be issues with assertiveness from early life experiences with a controlling parent, to issues of codependency and abandonment from having been orphaned at an early age, and bounced around from one foster home to the other.

People will usually carry their denial of unresolved issues into all types of relationships in their adulthood. So for the guy, who felt bullied by his father and has a habit of washing his hands every five minutes for good luck, what happens when he is finally able to assertively ask his supervisor to stop sending him emails with prejudice jokes he finds offensive?

For the young lady who was bounced around from one foster home to the next from the age of two, what happens if she lets go of her fear of being abandoned and sets a firm boundary with her boyfriend about being sexually faithful, or she just decides to leave the relationship?

I have found that when people start addressing issues they have been too fearful or shamed to address, they forget about their obsessive thoughts and the compulsive behaviors cease.

From the first session to the identification of underlying issues, there are short term behavioral strategies that the client is introduced to, designed to end maladaptive habits along the way.

My favorite is to have clients identify the behaviors or habits they will like to end, and having them document the number of times they were triggered by the intrusive and obsessive thoughts while practiing to do nothing in response. This exercise helps the client develop emotional resiliency, where the client learns not to become behaviorally reactive to uncomfortable feelings.

For the more technological savvy clients, mobile apps like Habit Streak Pro, allows clients to track their daily progress to ceasing bad habits and practicing good habits for days in a row until the next session. The goal as with the previous example is to help the client develop emotional resiliency while underlying issues are being identified.

These behavioral strategies, are effective coping strategies for not responding to obsessive thoughts, but unless the true underlying issues are identified, the client will likely replace retired compulsive behaviors with new ones.

So what are your thoughts? All feedbacks are welcome in the comment section. Also, if you know anyone who might benefit from this information, please share this post with them.

Ugo is a psychotherapist and owner of Road 2 Resolutions PLLC, a professional counseling private practice.

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1 Comment
June 2, 2013 @ 6:15 pm

I would have write that this makes a lot of sense. Going into the deeper issues is the best way to get rid of those urges.

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