Today’s tool for coping with OCD might provoke criticism from those who believe OCD is exclusively a biological disease that should be treated in a solely behavioral and non exploratory context. However, those of us who practice CBT know that what really needs to happen for you to soften your OCD patterns is for you to learn to tolerate the feelings that will come up if you stop engaging your compulsions. These feelings include – discomfort, uncertainty, anxiety or distress. Stopping compulsions though can be a tall order for many people. So my suggestions here are for people who are hesitant or too scared to start exposure right now or even for those already doing it.
Typically when people come to therapy to treat their OCD they describe terrible distress and ask that we work on getting rid of OCD as soon as possible- which is completely understandable given the suffering involved. When OCD takes over it can make even 10 minutes feel like a nightmare when you’re caught in the throws of it and it feels maddening and you want it to just get out of town and NOW!
The interesting dilemma though is that when we discuss exposure or techniques for letting go of OCD, patients often say “I can’t do that. I’m just not ready. I’m not willing to accept the possibility that I can become contaminated…to accept the possibility that not checking the outlets could lead to my family being harmed etc..” In this case, exposure may be delayed a lot longer than you might expect of someone who wants to “get rid of this thing” because despite attempts to teach them cognitive behavioral skills and doing gradual exposure- the person remains ambivalent.
In his book “ Freedom From Obsessive Compulsive Disorder” John Grayson writes about the necessity of learning to tolerate uncertainty in order to heal from OCD. This means allowing for the possibility that you could/ might get sick if you touch the doorknobs you avoid or you might cause harm to your family if you stopped checking the outlets.
This is the uncertainty we all have to face in living as humans who don’t have total control over our safety. Grayson’s point is that you have to face the LOSS of that security you have worked so hard to establish in a world that for your own particular reasons has felt very unsafe to you. (How do you do this and is gradual exposure enough of an intervention to help you do this? another blog!) But this is really hard for people with OCD!
So back to the mixed feelings. What’s going on when people hate their OCD but can’t let go of it nonetheless? It’s ambivalence. It’s “ I hate you OCD but I also need you sometimes.. You’re all I think I have right now to feel safe… I dread you and sometimes I feel I’ll do anything to get rid of you but then I can’t let you go.” It’s a very conflicted relationship that makes complete sense when you first begin considering the process of exposure. Kind of like if you were approaching your first AA meeting and were feeling “uh oh. How am I gonna do this and give up alcohol completely?”
What to do with it though? The most compassionate thing you can do for yourself until you become ready to engage in exposure is to appreciate that tension. It’s a form of accepting what IS and making peace with the present moment even if the moment is unpleasant (see a theme here?!) I want it and I don’t want it.
You can still use brainlock and other cbt techniques while doing this. But if you can face why you want to keep OCD around sometimes (hard to admit I know), you will learn something novel about yourself and you may even come to really validate yourself instead of thinking maybe you’re just crazy. The more you can begin to accept your experience- the closer you are to learning you can accept more and more about your feelings/ experiences which is one way you will learn to feel safer inside yourself. With most of our fears- it’s not about what’s happening in the world, its about what’s happening inside us!
Allowing your feelings is the beginning of your healing. Think of it as an even more protracted exposure on the road to exposure. In Gestalt therapy, the old patterns that we still struggle with but wish would disappear at this point, are referred to as “creative adjustments”. These patterns are the ways we creatively adjusted somewhere down the line to difficult circumstances.
This means perhaps your OCD developed because at the time it emerged it was the best way you learned to support yourself when things felt out of control or unsafe. (I’m not suggesting OCD does not have biological influences or causes but I also believe our environments play a significant role. We were not born in sensory deprivation tanks!)
So ask yourself this : What does following my OCD enable me to avoid? What MIGHT I feel if I didn’t go into this OCD cycle right now? How does my OCD work for me? What am I afraid to feel in THIS moment?
Feelings such as fear or shame or high anxiety may come up. You may also find that you’re unable to do this without the support of a therapist which is perfectly okay. If you’re new to navigating your feelings, have someone who specializes in this guide you. Just by your willingness to entertain these questions you are creating dents in the armor of your OCD and that’s a beginning.
Asking yourself about your feelings does the following: 1) it creates a pause or delay before you engage your automatic behaviors (enabling them in time to become less automatic and more of a choice) 2) it helps you cultivate a curious and compassionate stance towards yourself as well as an acceptance of your ambivalence instead of fighting OCD (which only reinforces your fear of it) 3) it enables you to learn more about yourself and your inner life which is one way to begin to soften OCD 4) it interrupts the fixedness of your patterns by introducing something new.
See if you can allow yourself to be JUST where you are right now… stuck.. or maybe not yet ready for exposure.
As with addictions- when you have OCD you want to avoid your feelings. Why? Because your OCD may have served some kind of VERY important function in your life from early on. OCD may have somehow become the pattern your brain went into when you had to face difficult feelings or feared you’d be overwhelmed by them (or a parent might have been..). So wow- doesn’t it make sense that if feelings were dangerous for you or you didn’t know how to be with them- you might try to find another place to be?! It was your survival mechanism and probably still is even though it pisses you off that it is!
In either case- OCD was/ may be the best way you know how to cope right now with what you feel. The desire to change these patterns usually comes about when we start feeling our patterns are reaching an expiration date or we are reaching our boiling point.
The metaphor I use when I treat OCD which I learned from ACT (Acceptance and Commitment Therapy) but have expanded on it a bit is this: Imagine you’re driving down the road towards your desired destination and unexpectedly you see an obstacle on the road that really frightens you. You may not even know what it is but you can sense your fear building so instead of moving towards your desitnation- you avoid it by going into the rest stop on the road which initially helps you calm down but then you end up getting stuck there.
You keep driving around and around that rest stop until finally you start to become very involved in life at the rest stop (not much going on at the local gas station and McDonald’s- but you find some drama that occupies you!). After awhile you forget about your destination and you don’t even remember why you went into the rest stop in the first place or how you came be involved in the drama of the people there but somehow you’re in it. This OCD detour starts to take on a life of its own and CBT as well as other tools are how you learn to get back on the road and face the feared obstacles which were the main issue in the first place.
Once you know the function of your symptoms (why you can’t face that road obstacle)- you can learn what you are really avoiding and how to begin to approach THAT experience. It may be you’re avoiding uncertainty but personally I think psychoanalytic theory has got a few things right in describing OCD as an interrupted impulse around certain feelings or experiences you think are unacceptable (frequently your aggression).
If we just focus on your detour only and not the reasons why you keep avoiding heading to your destination- well you may find another detour.
drama at the rest stop?!
I can’t tell you how often OCD flares up for people in situations where something deeper than what OCD tells them they’re afraid of – is going on. Sometimes there’s fear about connecting more intimately with others in a relationship or walking down the street feeling afraid of being so open around people or standing up for yourself in your relationships and other times it can be about facing a fun or enjoyable experience.
OCD is in part, an interruption to keep you from feeling your feelings about what is unsafe up ahead. Learn about this. Become curious about it and it will help you tackle your OCD in a deeper way by helping you find the message it may have for you (Not the specific message you fear such as “uh oh – maybe it MEANS I AM GAY” but a more authentic one regarding how OCD works for you and helps you cope with otherwise difficult road conditions). This method will help you build tools to face the sometimes deeper fear than the OCD- if you can imagine that.
So what is your destination?! What is it you most want in your life right now or wish you could do in your relationships and what gets in the way? Maybe you’re not even sure. That’s okay too. It will clarify in time. And how can you learn to ease into facing your feelings about what you want but are afraid of?
Here’s an example of how this tool works. I worked with someone (who consented to this being mentioned anoymously) who kept noticing that her OCD story would pop up not coincidentally whenever she was about to enjoy her life in some way. When she looked more closely she discovered the message/ the function OCD served for her which was to protect her from living a life she could enjoy. We could say her core fear was “I can’t be happy…”
Why did that particular pattern emerge for her? This pattern was related to her early family experiences and was important to explore however we did not do this at the exclusion of the behavioral piece. We did however, have to delay beginning exposure because she really believed deeply she was not entitled to be happy.
Often you can’t move forward and just allow yourself to be happy if you don’t feel you’re allowed to. If you don’t understand what’s scary about doing so and if I, as your therapist make you go forward or convince you its safe on a rational (but not limbic brain level), that doesn’t usually work.
The healing is in the doing AND also in the understanding of why you do what you do. How what you do serves you. If people could change their patterns overnight- exposure would work for everyone and immediately.
When my client and I began her exposure she found a million and one reasons to sabotage it. When we talked more about it she said “I need to work on allowing myself to be happy but I realize I’m not yet ready to be happy”….” And that had to be respected. That doesn’t mean we stopped working behaviorally. We chipped away at it. We challenged it with very small gradual exposures or experiments we set up together but we also needed to spend some time in the learning about how OCD had come about and what she believed would happen if she were to enjoy her life. She acknowledged her ambivalence about just now letting go of OCD. Gradually we began to see if that was a way she still wanted to live.
Just to clarify , my approach with this client did not become “talk” psychotherapy ie launching her into a lengthy analytic treatment to help her avoid engaging her in exposure (a comment I once had to field from a staunch CBT psychiatrist and from a few recent NY times commentators here: http://opinionator.blogs.nytimes.com/2012/07/09/two-way-mirror-facing-a-daughters-o-c-d/)
In addition to my CBT training, I am also a gestalt, somatic and relational therapist. This means that I incorporate movement and work with my clients’ experiences of their bodies as well as the support of the relationship between us to enhance their feelings of safety in within and in connection with others. These approaches ready them for exposure.
What I’m proposing here is one tool and the message to you is that you may need time (and sometimes maybe other forms of therapy such as somatic work) to help you feel safer in moving forward. Yes, there is research behind somatic psychotherapy. Perhaps not yet with regard to OCD but there is also room for trusting your intuition.
It’s less about WHY you have the OCD in the first place (certainly the why is complex- and involves multiple factors) and more about HOW OCD functions for you and what it helps you avoid. If you’re one of those people who can just do exposure without this piece –you’re lucky.
Most of the people I see are not ready to dive into the shark filled waters until they understand more about how their boat protects them. Gradually- either with exposure and response prevention or with other tools, you can be helped to discern if the sharks are really sharks or maybe just large fish you learned to see as sharks.
And in time, you may choose to let go of your boat and learn to swim but usually it helps to know more about how the boat helps you, so you can learn what tools will enable you to swim more easily. Most importantly is asking yourself what function the sharks play in keeping you in the boat. Where would you go if there were no sharks in the water?!. Maybe you’d like to swim to a beautiful island. Oh the places you’ll go …
Wishing you all the awareness to see what you need to see to heal and the courage to face your feelings in time.