Imaginal exposure, as discussed in the last blog, is an important exercise in the treatment of OCD. A major problem can arise, however, in the manner it is applied—especially in the case of Christians. In fact, one of the main reasons people consult me is because of a bad experience with a therapist attempting to use imaginal exposure.
The problem occurs when therapists go beyond what is necessary in this treatment strategy, and direct people to exaggerate and magnify their obsessions—to think the worst thing possible. This isn’t a bad treatment strategy per se. Often it works very well. For instance, if a person suffers from thoughts of accidentally harming others, she may be asked to vividly picture the feared accident occurring, then getting arrested for it, being shunned by others, etc. This sort of ‘flooding’ can produce rapid habituation to a fear.
But now, suppose the OCDer suffers from blasphemous religious obsessions, such as intrusive swear words directed at God, or unwanted sexual images. Maybe the therapist recommends swearing more heartily, the worse the better. Or, in the case of the sexual idea, purposefully imagining as many deviant images as possible. The Christian has a problem here. She is being asked to commit what could reasonably be considered a sin.
The good news is that it is not necessary to magnify obsessional fears in order to effectively use imaginal exposure. All that is necessary is to purposefully expose oneself to the tormenting thoughts and images that are actually occurring. It’s difficult enough to convince Christians to do that! I sometimes spend whole sessions trying to convince people that it is not sinful, but rather necessary for growth in faith, to openly confront blasphemous obsessions.
My argument is this: It is one thing to conjure up sinful thoughts on your own; it is quite another to face up to sinful thoughts that are from OCD. In the first case, we are producing the thoughts—they come from us. In the second, we are simply recognizing and identifying the material that is coming from outside of our true selves and ruining our relationship with God.
God has a purpose in all this. He allows the trial of obsessional fears in order to teach us that we have nothing to fear. To learn this, however, we have to stop relying on ourselves to deal with our obsessions. We need to take the risk of having faith. We need to willingly tolerate them and suffer them, while simply waiting in hope for God to deal with them. Imaginal exposure can be a great tool for all Christian OCD sufferers if it is done correctly.