Engaging the Ambivalent OCD Client
by Reid Wilson, PhD
Working with therapeutic resistance is often discussed in psychotherapy training, but the ambivalent OCD client poses a unique challenge for clinicians. Here, anxiety expert Reid Wilson demonstrates a counterintuitive cognitive-behavioral approach to confronting safety-seeking behaviors that can help these clients maintain commitment to recovery.
Kathleen struggles with anxiety about two main issues: accidentally setting her house on fire, and getting vulnerable relatives sick from her germs. Compelled by pervasive self-doubt, she repeatedly checks to make sure her stove is turned off and washes her hands up to 30 times a day to ward off contamination. This need for absolute certainty also extends to checking her door locks and kitchen faucets, which robs her of valuable time. She tells Wilson this behavior is distressing and time-consuming, yet her belief in the persuasive content of her fears requires Wilson to skillfully manage her ambivalence.
In two live sessions with Kathleen, Wilson shows us how a pragmatic assessment, clear protocols for exposure experiments, and a thorough briefing about the insidious nature of OCD can alleviate, rather than validate, the need for reassurance that drives anxiety. With humor and clarity, he passionately encourages Kathleen to rise above the content of her obsessive thoughts and practice moving towards that which she fears, supporting her in learning to tolerate uncertainty. With practice and patience, Kathleen’s checking behavior decreases significantly.
If you’re looking for a fresh understanding of OCD and effective ways to treat its self-reinforcing nature, you’ll find it in Wilson’s engaging, lively approach.
Given Kathleen’s belief in the content of her obsessive thinking around safety and cleanliness, she’s to be commended for her strides with the therapeutic exposure practices Wilson offers. Many of Kathleen’s obsessions are grounded in reasonable concerns we all deal with; but OCD’s ability to exaggerate these concerns makes treatment a challenge for therapists and clients alike. Over two sessions, Wilson proposes several tailored modifications intended to support Kathleen in “moving toward” the anxiety that drives her compulsive behaviors, helping her more fully engage with her recovery and see real change.
By watching this video, you will:
- Learn the core concepts of Wilson’s approach to treating the ambivalent OCD client.
- Understand how to conduct a highly focused assessment.
- Identify tools for helping clients increase their tolerance of uncertainty and discomfort.
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