In popular culture, obsessive-compulsive disorder is often portrayed by characters who are unable to step on cracks on the sidewalk, are germicidal, or are obsessed with cleanliness and organization. These "hang-ups" are often played for comic effects.
"There is a big misunderstanding that obsessive-compulsive disorder is cute and strange," said Shala Nicely, a licensed professional consultant (LPC) with a practice in Marietta, Georgia, that specializes in the treatment of obsessive-compulsive disorder and related illnesses. "Nothing is further from the truth. This prevents people from seeking help. They think they just have to" bring it together "and deal with it."
In reality, OCD can be debilitating, says Nicely, who has lived with the disorder since childhood. People with obsessive-compulsive disorder are haunted by unwanted and invasive thoughts that are often self-critical, triggering anxiety or disruptive. One of the classic portraits of OCD is the person who does not touch a doorknob without sleeves for fear of becoming infected with germs. However, this is only the tip of the iceberg when it comes to the different types of constraints – whether external like repeated hand washing or internal like ruminating – that people with OCD feel exposed to to protect themselves.
OCD can be "hell on earth", Nice assures.
“It puts people in absolute misery. It makes people's lives smaller and smaller, ”she says. “Having OCD is like living with an abuser around the clock. It is incredibly mean, very critical, and [it] can be violent. It is shouted at by your own brain and you can't get away from it. "
The turning point
Justin Hughes, an LPC who has a private practice in Dallas, specializes in treating patients with OCD, anxiety, and other mental health problems. He says that many of his clients seek treatment because they are overwhelmed with intrusive thoughts, or because their constraints and routines affect their daily lives – take a lot of time and cause them stress or even physical pain. Other clients come for treatment because a parent, spouse, or loved one noticed the toll the OCD was taking on the person and was concerned.
Karina Dach, who specializes in the treatment of obsessive-compulsive disorder and anxiety in her private practice in Denver, says that clients sometimes come to counseling sessions when they know that something does not feel right without realizing it, that they have obsessive-compulsive disorder. "You may say things like, 'I feel stuck', 'My brain doesn't let me go on' or 'I can't stop thinking about it or imagining it. "You may think that something is wrong with them, or worry that these thoughts and fears mean something bad about their character or about them," explains Dach, LPC and licensed psychiatrist.
Clients advising on OCD may experience self-criticism and intense feelings of shame, guilt, anger, worry, and fear, adds Nicely. Intrusive thoughts are common with obsessive-compulsive disorder, and some people may think that they may somehow kill, hurt, or sexually harass someone, including their loved ones. If these thoughts repeat themselves again and again, the individual may begin to believe the content of these thoughts and feel deeply ashamed or embarrassed.
Indeed, customers struggling with obsessive-compulsive disorder are reluctant to share the worst of their intrusive thoughts because they may involve criminal or dangerous things. "Some [individuals with OCD] really think they could be a stealth killer. They are afraid to share this, [thinking that] they could get into trouble, ”says Nicely.
Given this insight, consultants, Nicely said, should not hesitate to continue talking about intrusive thoughts and concerns at the meeting by asking customers if they found anything else too scary to share. These clients should be assured that counseling is a safe and confidential place where they can share whatever they are going through, adds Nicely.
Obsessions + constraints
The National Institute of Mental Health reports that an estimated 1.2% of adults in the United States suffer from OCD every year. This prevalence is higher in women (1.8%) than in men (0.5%). The lifetime prevalence of OCD in the United States is 2.3%.
Jeff Szymanski, clinical psychologist and executive director of the International OCD Foundation, notes that psychiatrists may see more people with this disorder in their illnesses in the future, even if the prevalence of OCD does not increase with a gradual, general increase in awareness and a decrease in Stigmas related to the disorder
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OCD is characterized by two components: 1) recurring and intrusive thoughts (obsessions) and 2) excessive urge to repeatedly perform certain actions (constraints) to prevent or counteract recurring thoughts. The types of obsessions and compulsions that people with OCD can suffer are broad.
Not all recurring thoughts can be classified as obsessive-compulsive disorders, emphasizes Szymanski. "Obsessive-compulsive disorder is also selfish, which means that individuals don't like or want it… Some recurring thoughts that people like," he says. "In layman's terms, people say things like" I'm obsessed with baseball. " , This means that they like baseball. They may even spend a lot of time "compulsively" after baseball. However, this does not affect their lives and it is something that is invited and not something that they try to get away from. "
Obsessive-compulsive disorder can include unwanted sexual thoughts, religious obsessions, fear of contamination (from dirt, germs, chemicals or other substances), fear of losing control of yourself, fear of being responsible for yourself or others, fear of illness and countless other worries. Constraints can be:
Washing and cleaning tasks (including personal hygiene)
Checking behaviors (eg, checking the headlines again and again to make sure that nothing bad happened or checking several times to see if a door is locked)
Repeated actions such as blinking or typing
Performing certain actions several times (e.g. opening and closing doors, climbing stairs and descending).
Ask questions (possibly taking up the same or similar questions over and over) to calm down
Internal actions such as repeated prayers, counting rituals and repeated mental repetition or repetition of past scenarios and interactions
(For a detailed explanation of OCD, please contact the International OCD Foundation at iocdf.org/about-ocd.)
"If a consultant hears exactly the same things [from a client in session] that are formulated in similar words or behaviors, this is a good indicator [of OCD] to watch out for," says Hughes. "Many of my customers are good at referring to exactly what they said before. Obsessions are repetitions of a topic. If you are familiar with the topic, you can usually discover an obsession miles away."
Constraints can also include avoidance behavior. For example, Dach once had a client, a new mother who had intense thoughts and fears of harming her baby. She would avoid interacting with her child – especially being in the bathroom while the child was bathing – because she felt it was safer to be away from him.
OCD-related avoidance can affect the life choices customers make, such as: B. where they work or live, what their hobbies are, or even the words they use, says Dach. People with obsessive-compulsive disorder sometimes practice a different form of avoidance – they break off with a partner because they fear doubts, insecurity, and risks associated with a relationship. However, you will soon find that ending the relationship does not suppress rumination, Dach notes.
People with OCD "operate at a risky level," said Dach, a member of the American Counseling Association. “You often find them checking, asking for confirmation, taking up their fears and constraints. … It is scary and takes over people's lives. We see OCD as this mental bully. You are a total prisoner of your fears. People with obsessive-compulsive disorder only want to protect themselves and their families. "
Obsessions often reflect a person's deeply rooted values, such as: For example, being a good parent, protecting your family, or being a good person. Focusing on these values can have a leverage effect when advising clients with OCD. Working with the new mother, who had intrusive thoughts of harming her child, Dach spoke to the client about how her fears were based on the values she had, connecting with her child, being a good mother, and protecting him to want ]
"If you can find out what the customer's values are, it can be very powerful," says Dach. "Perhaps you fear rejection and failure, but an outstanding value in a career. Finding these values can be a really clear way [therapeutic] to work on and find motivation. "
Several of the consultants interviewed for this article recommend that practitioners use the Yale Brown compulsory scale to examine clients for obsessive-compulsive disorder and to get a full assessment of clients' obsessive thoughts and behaviors. If customers find a variety of behaviors and thoughts from the assessment's detailed checklist, consultants should work with them to develop a plan for addressing their most pressing or critical issues, says Nicely. Including the anxious thoughts and tortuous behaviors they have experienced on the checklist can help normalize clients' experiences and show that they are not alone in their struggles, she adds.
Distinctive OCD
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders divides OCD into a series of diagnoses, which also include body dysmorphic disorders, hoard disorders, trichotillomania (hair removal disorder) and excoriation (skin removal disorder).
OCD can be difficult to identify because the disorder often occurs along with other problems, such as bipolar disorder, anxiety disorder, depression, eating disorders, and substance abuse, notes Nicole Hill, an LPC who co-authored an ACA practice, short on OCD. Because OCD clients often struggle with multiple presentation problems, it can be difficult to pinpoint the disorder. The counselors should not only look at the suffering of these clients, but also conduct extensive biosocial studies to get a clearer picture of their life and family history, social landscape, early childhood experiences, and other contextual factors, says Hill, professor and dean from the College of Education and Human Services at Shippensburg University in Pennsylvania.
Although there is no specific cause for obsessive-compulsive disorder, research suggests that a number of factors, including genetic and family-based factors, autoimmune problems, and the brain structure involved in the transmission of serotonin, may play a role in, or these Are interrelated. Knowing the full context of the client – especially whether other family members have obsessive-compulsive disorder – can give counselors a better understanding of the person's experience and risk factors, says Hill, an ACA member who shared a 2016 chapter on OCD and related illnesses wrote the book Diagnosing and Treating Children and Adolescents: A Guide for Psychiatric Professionals.
OCD is available to customers who describe obvious compulsory acts, such as B. Repeatedly checking the weather forecast, easier to locate. Asking questions to examine the depth and root of clients' fears can help uncover mental constraints that are not immediately felt, such as repeating times or saying a specific prayer, says Dach.
In order to investigate the clients' experiences, Dach first suggested to the consultants how they deal with stress and anxiety. It is certainly normal for people to experience anxiety from time to time, and it is true that people with anxiety disorders are confronted with intrusive thoughts, ruminating, and performing certain coping behaviors. With OCD, however, concerns, fears, and compulsive behaviors become so extensive that they interfere with individual functioning. For example, most people wash their hands to avoid getting sick, but people with OCD can wash their hands a few times, over a period of time, or until they feel "right," says Dach.
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"We all have this inner voice that tells us what is safe and what is not safe. But someone with OCD has a broken alarm system. They are more vigilant. A whole battle can take place internally when it comes to what is safe is and what is safe, "explains Dach.
In order to uncover constraints that are internal (and therefore less obvious to others), Dach suggests asking customers questions based on the following principles:
Are there words or statements that make you feel better or that you say to yourself? Do you do something in your head until it feels right?
When you are in bed, does your mind wander the most? What are you thinking about? Is it about your day and what could you have done differently? What did you do wrong
What do you do first when you enter a room? Are you going straight to where you need to go or scanning the area first to feel safe?
From there, Dach suggests asking customers what would happen if they were unable to complete the action they felt compelled to do. "If there is a clear problem in your answer, it could indicate an OCD," she says.
Another indicator that OCD is present is that the client is not responding to methods that consultants typically use to help people with their negative thoughts, says Hughes, the lawyer at Dallas-Fort Worth for OCD Texas, a regional citizen member of the International OCD Foundation. "If a client does not improve on certain methods – especially cognitive restructuring in cognitive behavioral therapy – this is" Getting Stuck 101 "and needs further evaluation," says Hughes. “Most of my clients had previous experience with a counselor who had no idea how to treat obsessive-compulsive disorder based on evidence, and were approaching it as was the case with normal old automatic negative thoughts. This is usually not helpful. ”
Obsessive-compulsive disorder affects not only the functioning of the individual, but also his family life, says Hill, whose previous clinical work has included treating adolescent clients with obsessive-compulsive disorder using game therapy. Parents and families often restructure or adjust their routines to circumvent a relative's compulsive behavior, especially if the person with OCD is a small child. Obsessive-compulsive disorder can be very worrying for parents and, in some cases, embarrassing in public situations. The family usually feels like they are doing what they can to help the person, but this approach is actually counterproductive, says Hill. In reality, giving in to obsessive-compulsive disorder can make the problem worse.
Counselors should not hesitate to involve a client's family in the OCD (if applicable and with their consent) or to work with social workers, family counselors, or other professionals who may work with the family, Hill said. Counselors can play an important role in educating parents and family members about what an OCD diagnosis means and in clarifying the therapy goals for their loved ones. They can also provide helpful, non-courteous ways to intervene when the person's OCD increases. Hill says that in her earlier work with adolescent clients, she often noticed a decrease in the severity of OCD when she used out-of-the-box therapy with children and parents. This approach strengthened their relationship, problem-solving skills, and communication patterns. It has also sparked a focus on positive behavior and child empowerment, she says.
Cooperation with other treatment providers
Research has shown that a combination of therapy and psychotropic drugs, especially exposure and response prevention therapy (ERP) and serotonin reuptake inhibitors, can be particularly helpful for people with OCD.
"Working with clients' socio-emotional and cognitive problems [in counseling] will be helpful in addition to medicine," says Hill. "Research shows time and time again that both / and the approach with medication and therapy is best."
Medicine can make clients' OCD quieter so therapy can help them manage their rituals and constraints, says Nicely, who estimates that three-quarters of her clients take medication. If clients and their prescribers feel that this is the best course of action, their medication can be cut back as their coping skills in counseling are strengthened.
Although professional counselors cannot prescribe medication, when considering the overall picture of obsessive-compulsive disorder treatment, they must always consider their clients' use of medication – and work proactively with the prescribing client. With the consent of the client, consultants can search for symptoms and progress in advising the client from these other providers.
"I have always worked in a team with other professionals," says Szymanski, who was previously head of psychological services at the OCD Institute at the McLean Hospital in Massachusetts. “It is important to ensure that some time is spent coordinating care and that all employees complement each other and do not interfere with each other. It is equally important to ask the customer how the team format works for them, to ask them for specific feedback, and to encourage them to give direct feedback to each of their team members. "
Coordinating care between multiple care providers can be challenging, but it is worth working towards the best outcome for the client, Hughes claims. Incomplete, one-sided communication also benefits the customer.
"Although seamless communication and seamless exchange of records between providers is probably ideal, this rarely happens in real life," says Hughes. "In complex cases it is almost unknown to me [reach out to] not to have any other provider that is somehow associated with common treatment issues. I think we need to be realistic about other providers' schedules and communicate what we can and how we can. It often looks like I leave a voicemail to a psychiatrist after he is released and don't listen back, but at least they have the information. "
In addition to professionals prescribing medication for them, clients can go to other doctors to treat problems such as depression and substance abuse that often occur with obsessive-compulsive disorder. This not only offers the opportunity to coordinate care, but also to draw the attention of other healthcare professionals who do not specialize in the treatment of OCD to the nuances of the disorder. These professionals can also be made aware of the dangers of accidentally undermining the client's counseling work by satisfying their housing or insurance constraints, says Hughes.
Many other comorbidities in clients often improve by treating their OCD first, Hughes adds.
Exposure and reaction prevention
Research has identified ERP, a type of cognitive behavioral therapy, as the most helpful and effective therapeutic method for the treatment of obsessive-compulsive disorder. All consultants interviewed for this article recommend use in patients with OCD. The International OCD Foundation describes ERP as the "gold standard" for the treatment of obsessive-compulsive disorder and more helpful than conventional conversation therapy methods.
In ERP, clinicians gradually expose customers to OCD-related thoughts, constraints, situations, or objects that cause fear and worry in them. With each exercise, the client tries to overcome a triggering thought or scenario without responding with an obsessive action. This is part of ERP's “response prevention”. The educational work is carried out both in the session with a consultant and outside the session as homework for the clients themselves.
Consultants should be aware that customer obsessive-compulsive disorder is likely to increase when they begin ERP treatment. This removes the constraints that have calmed them down in the past.
Over time, ERP enables customers to face thoughts and situations that they have often tried to avoid before, says Dach. “When someone has intrusive thoughts, they tend to push them away, and this effectively leads to boomerangs. Pushing things away and avoiding them only strengthens [the OCD] and gives them too much value, ”she explains. "This [ERP]
puts them in the driver's seat. They are the driver instead of being afraid to make their decisions."
With the new mother mentioned earlier in this article, Dach used incremental exposure exercises to overcome her fear of harming her baby. First the baby was left with a caretaker in front of the advice center while the client met with the roof. They started out small and exposed the client to triggering words such as "baby" or "bathing". As the client progressed, Dach asked her to take the baby into sessions. Even taking the baby off his car seat and laying it on his knee was a trigger for the customer, Dach recalls. Dach spoke to the client about each exercise and asked her to monitor the degree of her stress on a scale of 1 to 10.
Finally, the customer completed exercises in which the baby's diaper was changed during the session. Over time, the client was able to work on bathing her child at home, which was one of her most fearful obsessions.
According to the umbrella, it is a critical part of ERP to give customers exposure assignments for work between sessions. This can include creating a “worry script” in which customers write down imaginary worst-case scenarios themselves. For example, the scenario for a customer might be to go to the mall or other public place and lose control of themselves, causing them to throw up or scream and trigger a scene, says Dach. The client imagines everyone staring at them, the client dies of embarrassment, and then banished from the mall. The client writes down all the details of what he feels, sees and experiences in this imaginary scenario. Next, the client repeatedly reads or writes the story script or records it himself and listens to the recording again and again, explains Dach.
"It's like watching a scary movie 1,000 times. It may be scary when you watch it for the 1000th time, but [it’s] not as terrorist as the first time," she says .
Dach uses the metaphor of a garbage disposal to explain the effectiveness of ERP: on your first day you notice the smell of the garbage and it is so disgusting for you that you can't even eat your lunch. But the smell is less of a concern if you return to work every day, and at some point you don't notice the smell at all.
ERP grants permission to "open the doors to your dungeon and hang out with all the skeletons you hid there," says Dach. "If you take your sleeping bag and pillow and hang out there, you will eventually find it more convenient to be with them."
Hughes recalls an OCD client who had serious concerns about harming their children. The client had no history of harm or abuse. Over time, the client found it difficult to differentiate between the reality – that she would never deliberately hurt her children – and her pushy thought of having impulses to stab her children, says Hughes.
"She knew [these fears] were irrational, but it felt so real to her," says Hughes. "As it can be very typical, the stress took a toll in almost all areas of their lives, [including] which made their work more difficult."
The ERP work began with small exercises that the client learned to conquer while remaining present in her need and not facing any constraints, says Hughes. With the support of her loved ones, the church community and her own desire to deal with her family without fear of hurting her, she was able to integrate ERP tasks into her everyday life.
She soon completed her studies with script writing and larger exposures, holding knives and speaking her feared thoughts out loud (appropriately and not in front of her young children), says Hughes. For example, the client worked outside in the family garden, repeating for herself the worst-case scenario she wrote in her scripts: "I want to use these garden tools to kill my daughters." Later she added even more distress. "I want to stab her and I am arrested and divorced and hated by my children."
Other exposures included holding a butcher knife for 15 seconds (and possibly longer) while their scripts were being repeated. Over time, the client endeavored to be alone with her children, bathe her children, and finally cook for her children (including knives) while her husband was out of town.
Now, the client's OCD symptoms on the Yale-Brown Obsessive Compulsive Scale are so low that they would be classified as subclinical, says Hughes. "In relapse prevention planning, [this client] understands the chronic nature of OCD and the need to keep up with its good progress and plans to follow it up periodically for" refresher "sessions," said Hughes. "I am so happy about such stories."
Tolerating Uncertainty
ERP is effective because it enables customers to tolerate the insecurity that is at the heart of their fear and worry, Nicely explains. Der Kern des Problems ist nicht die Sorge eines Klienten, sich mit HIV zu infizieren oder seinen Ehemann zu erstechen, sondern die Ungewissheit, ob diese Befürchtungen auftreten könnten oder nicht.
"Das Markenzeichen von OCD ist" Was wäre wenn "und Zweifel", sagt Nicely, der Autor des Buches "Is Fred in the Refrigerator" von 2018. OCD zähmen und mein Leben zurückfordern. Wenn Sie nur den Inhalt der Sorgen eines Klienten behandeln, ohne ihn zu lehren, Unsicherheit zu tolerieren, wird die Zwangsstörung einfach dazu führen, dass sie in einem anderen Lebensbereich des Klienten aufsteigt (oder wieder aufsteigt), bemerkt Nicely.
Damit ERP effektiv ist, ist Engagement und Vertrauen zwischen dem Kunden und dem Praktiker erforderlich. Schön erklärt jedem Klienten, dass die Arbeit eine kognitive Verschiebung erfordert – der Versuch, Ängste und Zwangsstörungen zu vermeiden, macht sie tatsächlich schlimmer.
In der Arbeit mit Kunden mit Zwangsstörungen verwendet Nicely das Akronym FREUDE: In die Angst springen, sich für mehr Gutes entscheiden und der Angst nachgeben. Schön ins Detail geht über diese Methode in dem 2017 von ihr gemeinsam mit Jon Hershfield verfassten Buch Everyday Mindfulness for OCD.
Sie fragt Kunden: "Was wäre, wenn wir die Angst nicht vertreiben würden? Was wäre, wenn wir es uns bringen würden? Können Sie damit umgehen? “Dann zeigt sie ein Beispiel auf, wie die Klienten bereits mit Unsicherheit umgehen, indem sie den ersten Schritt zur Beratung machen. Ihnen Angst zu machen, ist gleichbedeutend damit, OCD die Macht zu nehmen, erklärt sie.
Bucht eine Doppelsitzung mit Klienten für ihre erste Expositionsbehandlung. Nach der Belichtungsarbeit verarbeiten sie, was gemeinsam passiert ist. Stellt nett Fragen wie: War es so schwer, wie Sie dachten? Was hast du gelernt? Hast du erfahren, dass du das tun kannst, um dein Leben zurückzugewinnen?
"Wenn Sie [triggering things] immer wieder machen, beginnt das Gehirn zu lernen, dass diese Dinge nicht das Problem sind", sagt Nicely. "Der Grund, warum unser Gehirn diese Gedanken in den Vordergrund stellt, ist, dass wir auf sie reagieren. Das Gehirn lernt, wenn Sie ihm erlauben, auf einem hohen Niveau der Angst zu bleiben. "
"Zwangsstörung ist ein biologisches Problem", sagt sie. „Unsere Gehirne [in those with OCD] unterscheiden sich strukturell und funktional von denen ohne Zwangsstörung. Daraus können Sie nicht herausfinden. Es ist eine Störung des Gehirns, und ERP verändert die Funktionsweise unseres Gehirns. "
Verwendet ein Konzept, das sie sowohl für sich selbst als auch für ihre Kunden als "Schultern zurück" bezeichnet. Sie sagt, dass das Abwinkeln der Schultern eine physische Erinnerung daran sein kann, dass es egal ist, was die Zwangsstörung einer Person ihnen sagt, und dass sie so tun können, als wäre es irrelevant.
„Letztendlich wollen wir, dass die Leute all dies [OCD triggers] in ihren Köpfen hören und es ihnen immer weniger stört“, sagt Nicely. "Wir wollen, dass sie in einer Welt der Unsicherheit leben und sich nicht von ihnen stören lassen und so tun, als ob ihre aufdringlichen Gedanken keine Rolle spielen."
Es kann für Kunden auch hilfreich sein, sich vorzustellen, wie ihr OCD-Monster aussieht, oder ihm sogar einen Namen zu geben. Schön, dass sie das selbst macht und sogar mit ihrer Zwangsstörung spricht, wenn sie anfängt zu schwanken. Denkt an ihre Zwangsstörung als etwas, das immer ein Teil von ihr sein wird. Es ist etwas, das im Kern möchte, dass sie sich sicher fühlt.
“It’s exceptionally important [for clients] to realize that OCD is part of them, but it is not them,” she says. “That will help them to conceptualize the process. Think of it as something that has been torturing you. Talk back to it and tell it where you want it to go.”
Reassurance
The compulsions associated with OCD often arise out of a person’s urge to find reassurance and feelings of safety, Dach says. As helping professionals, counselors’ natural reaction may be to try to comfort these clients by telling them that their worst fears will not come true. But in the case of clients with OCD, offering reassurance is actually doing harm and reinforcing behavior, Dach stresses.
“No one knows whether or not the fear will happen — not the therapist [and not] the client. But the client will search and search and search for reassurance, an illusion of security and control,” Dach says. “If a practitioner gives them reassurance, they’re making the condition worse.”
When Dach finds clients asking questions as a means of seeking reassurance in sessions, she explains that she will answer questions to provide education or information but not for the purposes of offering reassurance. “It may be a hard pill to swallow, but we [counselors] need to sit with their uncertainty together and model what it looks like to sit with distress,” Dach says.
When clients express anxiety over the possibility of vomiting in a public place or some other OCD-related fear coming true, counselors shouldn’t reassure them that it won’t happen, Dach says, because there is no way to ensure that it won’t. Instead, she says, counselors can respond with questions such as, “If you did vomit, what’s the worst thing that could happen? What would it feel like? How do you know it’s going to happen?”
“The possibility is there, but the probability is low,” Dach says. “I can’t tell [the client] whether or not something is going to happen. The best we can do is put ourselves in a situation [via exposure] to learn what’s going to happen. Then I offer to lean into that discomfort [with the client].”
On the same team
There is sometimes a misconception among mental health professionals that exposure work can traumatize clients, but that simply isn’t true, Dach stresses. Therapy with a practitioner specially trained in ERP is hard work — it’s asking a client “to walk into their worst nightmare and have a party” — but it’s also incredibly effective and rewarding, she says.
“This is an extremely collaborative intervention. We’re on the same team. It’s not forcing [clients] to do things. It is asking them to get close to the thing they’re afraid of the most. You [the counselor] are there to offer gentle pushing, but it’s all choice-based,” Dach says.
Nicely and Hughes say that clients with OCD tend to be incredibly brave and also deeply caring. It is inspiring, Nicely says, to watch clients tackle such hard things in therapy and become more resilient.
“For many reasons, I love work with clients who have OCD,” Hughes adds. “I have found that they are some of the kindest, hardest-working and most conscientious individuals on this planet. This is where I believe many of their personality strengths arise once [they move] through pathology. It is a joy every day to see recovery, growth and maturity bloom out of suffering.”
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The International OCD Foundation offers a wealth of resources and information on its website, iocdf.org, as well as training programs, an annual conference, and local affiliates around the country.
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Contact the counselors interviewed for this article:
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OCD is not an adjective
It’s not uncommon for people to describe themselves in casual conversation as “obsessed” with a television series or “OCD” about the way they organize their closet.
Professional counselors can be agents of change when it comes to casual use of the language related to obsessive-compulsive disorder (OCD), says Shala Nicely, a licensed professional counselor in Georgia who specializes in treating the disorder. She encourages counselors to be mindful of their own language and to gently correct those who misuse OCD-related terms.
One place to begin: Stop using OCD as an adjective, she says. Someone might be meticulous or detail-oriented or neat, but he or she is not “OCD.” To say “I’m so OCD” about something can discourage people who really do have OCD from seeking treatment, especially if that offhand pronouncement comes from a mental health professional, Nicely says.
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Bethany Bray is a senior writer and social media coordinator for Counseling Today. Contact her at [email protected].
Letters to the editor: [email protected]
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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.
