Post by alison on Mar 22, 2016 13:24:39 GMT
I don’t have enough experience to say with certainty whether I find OCD easy or difficult to work with. I’ve only had 2 clients present with OCD – and one I found difficult and the other very easy. So it can be either!
The first client, I referred to in an earlier thread, re: identified ‘warning flags’ of suspected psychosis and an appropriate referral via the client’s GP. The reason I found this case difficult is because the client was not consistently able to recognize obsessive thoughts as irrational. Furthermore, there were times when the client could not distinguish between thoughts and what appeared to be hallucinations. For example: ‘seeing’ particles of fecal matter floating up from surfaces/door handles/taps/toilets/dog excrement on the street and landing on his hands.
I recognized that this was a complex case and that whilst the client believed he had OCD, this may not have been an accurate diagnosis. However, working with this client did leave me feeling that OCD is potentially very difficult to work with.
However, my second experience of working with OCD could not have been more different. This client made initial contact by email and described himself as having ‘severe OCD’. More than 10 years of excessive checking - doors, windows and a lengthy ritual of ‘mentally photographing’ the cards in his wallet, counting them, ensuring they were in the ‘right’ order and all present etc. He bought as much as possible online to avoid a public display of the ‘embarrassing and lengthy counting rituals’ that followed opening his wallet and his life was becoming increasingly limited as a result. He also described a ‘rage’ that could lead him to punching walls when he could not satisfy himself that a door is properly locked.
On reading the email I viewed the case as difficult and in different circumstances I might not have had the confidence to take the client on. However, because he was the partner of a previous client that I had worked with successfully, I agreed to meet for an exploratory session.
I was very surprised that by the end of that first hour I felt confident that he would experience a positive therapeutic outcome.
The reason for this was that there appeared to be sensitizing circumstances in his teenage years and a relevant one-off event in his early twenties. As a teenager he described himself as an independent thinker and did not ‘follow the herd’. For example, he stood by a friend who was unpopular and bullied by others. That decision cost him his own popularity. This was one example, amongst others, whereby his decisions caused inner conflict. Where he ‘knew a decision was right and morally sound’ but came with the price of some personal pain. In his early twenties his wallet was stolen in particularly cunning circumstances – an organized scam that tricked him into giving the thief his bank details. This left him feeling ‘very stupid’. The client couldn’t remember when ‘the OCD’ started but thought it was some months or even years after the wallet theft. Certainly well into adulthood.
On this occasion I think I found working with OCD easy because I was listening to – and working with - the client’s process, not content or symptoms. I heard how this client placed huge value on ‘doing the right thing’. I heard how making ‘intelligent and morally sound’ decisions was an important part of his identity. As a teenager this brought conflict and caused him at times to question his judgment – am I right to stick by this kid, when it causes me pain I could otherwise avoid? And as an adult he was mortified by his ‘stupid decision’ to give out his bank details/fall for the scam.
A time-line intervention (resolving negative emotion and self-blame for the wallet theft) at session 2 was very effective. After this session the wallet ritual completely disappeared and the door/window lock checking reduced by 50%. After 4 sessions the OCD symptoms had completely disappeared. It was such an incredibly satisfying experiencing working with this client and I was so thrilled for him. I very much felt like facilitator, after session 2 he ‘did all the work’ on his own, making connections, joining up dots and resolving many areas of conflict in his life, cutting ties with unhelpful friendships that he had outgrown and no longer served him etc.
But as I said, above, with just 2 case examples I don’t have much experience of working with OCD. But these cases helped me to learn that, as ever, an open mind with each and every client is helpful!
The first client, I referred to in an earlier thread, re: identified ‘warning flags’ of suspected psychosis and an appropriate referral via the client’s GP. The reason I found this case difficult is because the client was not consistently able to recognize obsessive thoughts as irrational. Furthermore, there were times when the client could not distinguish between thoughts and what appeared to be hallucinations. For example: ‘seeing’ particles of fecal matter floating up from surfaces/door handles/taps/toilets/dog excrement on the street and landing on his hands.
I recognized that this was a complex case and that whilst the client believed he had OCD, this may not have been an accurate diagnosis. However, working with this client did leave me feeling that OCD is potentially very difficult to work with.
However, my second experience of working with OCD could not have been more different. This client made initial contact by email and described himself as having ‘severe OCD’. More than 10 years of excessive checking - doors, windows and a lengthy ritual of ‘mentally photographing’ the cards in his wallet, counting them, ensuring they were in the ‘right’ order and all present etc. He bought as much as possible online to avoid a public display of the ‘embarrassing and lengthy counting rituals’ that followed opening his wallet and his life was becoming increasingly limited as a result. He also described a ‘rage’ that could lead him to punching walls when he could not satisfy himself that a door is properly locked.
On reading the email I viewed the case as difficult and in different circumstances I might not have had the confidence to take the client on. However, because he was the partner of a previous client that I had worked with successfully, I agreed to meet for an exploratory session.
I was very surprised that by the end of that first hour I felt confident that he would experience a positive therapeutic outcome.
The reason for this was that there appeared to be sensitizing circumstances in his teenage years and a relevant one-off event in his early twenties. As a teenager he described himself as an independent thinker and did not ‘follow the herd’. For example, he stood by a friend who was unpopular and bullied by others. That decision cost him his own popularity. This was one example, amongst others, whereby his decisions caused inner conflict. Where he ‘knew a decision was right and morally sound’ but came with the price of some personal pain. In his early twenties his wallet was stolen in particularly cunning circumstances – an organized scam that tricked him into giving the thief his bank details. This left him feeling ‘very stupid’. The client couldn’t remember when ‘the OCD’ started but thought it was some months or even years after the wallet theft. Certainly well into adulthood.
On this occasion I think I found working with OCD easy because I was listening to – and working with - the client’s process, not content or symptoms. I heard how this client placed huge value on ‘doing the right thing’. I heard how making ‘intelligent and morally sound’ decisions was an important part of his identity. As a teenager this brought conflict and caused him at times to question his judgment – am I right to stick by this kid, when it causes me pain I could otherwise avoid? And as an adult he was mortified by his ‘stupid decision’ to give out his bank details/fall for the scam.
A time-line intervention (resolving negative emotion and self-blame for the wallet theft) at session 2 was very effective. After this session the wallet ritual completely disappeared and the door/window lock checking reduced by 50%. After 4 sessions the OCD symptoms had completely disappeared. It was such an incredibly satisfying experiencing working with this client and I was so thrilled for him. I very much felt like facilitator, after session 2 he ‘did all the work’ on his own, making connections, joining up dots and resolving many areas of conflict in his life, cutting ties with unhelpful friendships that he had outgrown and no longer served him etc.
But as I said, above, with just 2 case examples I don’t have much experience of working with OCD. But these cases helped me to learn that, as ever, an open mind with each and every client is helpful!