A stay-at-home Mom voiced her disappointment with the counseling she had received for her OCD. Her main obsession had centered around contamination fears from a dead mouse her husband removed from the house. “My therapist wanted me to soothe myself when the fear hit,” she explained. “So I tried to employ good reasoning. I would tell myself ‘My husband is okay, and I didn’t even touch the mouse.’” That really helped for a while, but actually not too long, because then I got to thinking, ‘He could be okay, he could be immune or something. But the kids or me could still get it!’”
I see this frequently. A person receives what seems like good therapeutic advice, and it backfires. It is because of a snare that lies hidden in the process of reasoning with obsessions. If a person has anything more than mild OCD, it is probably going to turn compulsive. At first the “good reasoning” works fine. After all, that’s what “normal” people do. But then it begins to lose effect as it is used repetitively for reassurance, and new obsessions arise that directly counter the reasoning. It’s back to doing compulsions with no improvement in the OCD.
This is an enticing trap for therapists as well as their clients—one I used to fall into myself. In student health, for instance, we would sometimes see students with no history even suggestive of OCD, who suddenly were brought to their knees by the occurrence of a single, awful, violent or sexual obsession. Explaining to them what was really happening, an acute obsessional fear caused by anxiety and nothing else, was, indeed, sufficient in some of these acute cases. Just understanding what was happening was enough.
If a person has the strong degree of genetic loading typical to most OCDers, however, reassuring oneself on the basis of what is “reasonable” is not going to do the job. Research backs this up. All successful treatment trials for OCD have included exposure and response prevention. We must fully experience obsessional fears and resist compulsions in order for therapeutic gain to take place. This is the process of habituation, the cornerstone of OCD treatment.