Verified by 
Key points
- Not all compulsive rituals are the same in structure or even in their purpose of what we might call "logic.”
- Some rituals arise from the belief that doing so can prevent a feared outcome, while others are thought to make something positive happen.
- It is important for OCD patients to trust their therapist and have an effective rapport with them.
Treatment of OCD can be done effectively in eight to 11 sessions. It must be reiterated, however, that the relationship in therapy is of utmost importance and gaining trust and building an effective rapport will lead to the patient following us in our requests. This ultimately results in a more rapid and successful treatment outcome. For OCD patients, it is important that they trust the therapist and that they believe they are in the hands of a specialist and an expert, capable of helping. Our questions and our knowledge of the disorder and its functioning are uppermost in gaining this trust. The use of effective metaphors—questions with the illusion of an alternative and effective cognitive reframing (Gibson, 2022; Nardone, Salvini, 2007)—all provide the context for successful outcomes. It must also be said that the use of effective persuasion, and our use of hypnotherapy techniques without trance, aid us greatly in overcoming the problem.
Compulsive Action
While we can distinguish obsessive compulsions based on fear (such as washing hands in order to prevent contamination) from the ones based on pleasure (such as compulsive shopping, vomiting syndrome, or pathological gambling, and so on), compulsions are aided greatly by the structure of the brain and its ability to find pleasure in repetition (Laboritt, 1978), however not all rituals are the same in structure or even in their purpose of what we might call "logic." While some rituals have to be done a number of times, some are done in specific sequence and others can be done to feel a certain way or to achieve a specific sensation. The logic underlying these rituals is important, because if the clinician doesn’t recognise the logic supporting the compulsion, they won’t be in a position to know what kind of intervention will be necessary to treat the problems radpidly and effectively. We have spoken about this at length elsewhere (Gibson et al., 2022; Gibson, 2021; Nardone and Balbi 2013).
Below is a general description of the structure and type of most compulsive rituals when viewed from a strategic perspective (Gibson, 2019).
Strategic Description of Rituals
Rational, preventive: These rituals are specific actions that arise from the patient’s belief that doing so can prevent a certain feared situation from happening. For example, getting contaminated or infected, losing control, losing body energy, and so forth.
Reparative: The performance of these ritualised actions or thoughts hold the illusion of protection for the person from something that could have happened already. This includes washing hands as an attempt to eliminate dirt left on them, or checking whether a job has been done several times for fear that it is wrong, or repeating the name of a certain person to exorcize their negative gaze or bad luck. These rituals are carried out to intervene in and repair the damage after a feared event has taken place, so that the patient will not feel in danger. Therefore, it is oriented toward the past
Propitiatory: The performance of these rituals or thoughts (seemingly magical) appear to make something positive happen, or have the illusion of helping the patient avoid something negative. An example may be arranging objects in a particular position to bring good fortune, or to avoid misfortune. These rituals are a form of magical thinking, linked to highly fatalistic religious beliefs, superstitious convictions, or confidence in extraordinary powers or faith, and so forth.
The compulsions described above constitute a failed attempt to control a patient's fear, and other failed solutions also create and maintain the disorder. The failed attempts at a solution are:
- Avoidance of any anxiety-provoking places, people, or objects. This is essentially an attempted solution that feeds the problem.
- A continual search for reassurance or help from family members, friends, or partners, who can eventually become entangled in the pathological mechanisms.
- Execution of a ritualized sequence of actions in order to fight the fear or fulfill the compulsive search for pleasure. As already mentioned, compulsions can be based on a phobic (fear) based perception or an irrepressible tendency to search for (pleasurable) sensations or sensation-seeking.
Family and Friends
Interactive patterns of OCD are those which maintain or worsen a system's balance. We cannot forget about the impact family members can have on a patient with OCD. Family members are very often involved in the dysfunctional rituals or control. Patients who suffer from OCD can become more anxious and aggressive over time toward friends and family. This is why it is very important that others participate in the treatment to increase its effectiveness. It is important that family members step aside from this pathological and vicious circle and allow for the restoration of the patient’s responsibility for their problem.
To find a therapist, please visit the Psychology Today Therapy Directory.
