Why counsellors are so important to recovery from OCD

For those suffering from this condition which can affect their lives in many ways, obsessive-compulsive disorder (OCD) has become a constant for them working in the background and creating doubts in the minds of sufferers. 

It is not just doubt that OCD creates, since it also looks for certainty through the lens of 'black and white' or polarised thinking. There is also a risk that such thinking can become entrenched over time. The longer the individual reacts to it in trying to manage it, the greater the distress and the higher the intrusive thoughts and anxiety. Pushing against intrusive thoughts simply consolidates and entrenches them. It gives them greater life.

The core of this 'black and white thinking' is based on what I call 'risk management', the attempt by an individual to try and control risk to their well-being via compulsions, such as hand washing or through excessive ruminations and obsessions so that they can counter a deeply disturbing thought.

The reality is that everyone has intrusive thoughts and the nature of intrusive thoughts varies across the population. Those who suffer from OCD have the same intrusive thoughts, though it is the type of meaning that they attach to the thought and the frequency of the thoughts that hyper-fuel anxiety within someone with OCD. Over time, given the higher frequency of intrusive thoughts that OCD sufferers have, this can have a debilitating and deleterious effect on their sense of who they are and on their self-confidence.

It is also important to note that OCD pivots on the core values of individuals and is therefore different in the manifestation of the types of intrusive thoughts that people have. So, for example, 'blasphemous' intrusive thoughts may affect those who are very religious, or intrusive thoughts about hurting children may affect a young mother who has just had her first child. 

The reality is that in both situations, the individuals will neither harm their child nor start hurling abuse in a church, and the OCD seeks to pivot on what matters to them. 

It is also important to note that OCD is usually linked to high anxiety states and it is important to state that some people have been affected by OCD at points in their life because of early childhood traumas caused by adverse childhood experiences (ACEs). ACEs can include events such as being sent to boarding school, bereavement, bullying and racism - and there are numerous examples, but the key here is that the event left a significant and lasting negative impact on the person. So, trauma is definitely one trigger for OCD and high anxiety states, and this does not take away from a genetic predisposition to the condition being an underlying factor as well.

There is real hope on the horizon for OCD sufferers. As we get to know more about the condition, the triplicate combination of cognitive behavioural therapy (CBT), psychotherapeutic work on understanding triggers and core thoughts and where they emanate from, as well as the use of SSRI's (selective serotonin re-uptake inhibitors), can give people a real sense of relief and control over their lives.

Allied with these treatments, OCD sufferers should work with their therapists to try not to react to obsessions and compulsions and to let the impulses of them drop over time without any attempt to fuel them. Furthermore, the range of obsessions and compulsions can vary across a spectrum from those who need to compulsively wash their hands to those who try and counter thoughts in their minds without any outward demonstration of compulsions. Behaviour maintaining OCD and intrusive thoughts, therefore, does not have to be overt and can be conducted very subtly in the mind. Again, the key here is to learn to live with uncertainty and not react to the OCD, however subtle that is. This is difficult work but it has led to many sufferers seeing a marked downturn in intrusive thoughts and the associated anxiety. It is also work that needs trust, and a strong therapeutic alliance between the client and counsellor.

Lastly, I would add that conventional thinking has been that medication and CBT can help. I would argue that much deeper work through counselling is needed to work through whether there is underlying trauma in clients and also where their core intrusive thoughts originated from. Knowing the root/s of the problem is part of the recovery problem.

CBT work may touch on this, but it does not go into depth into the trauma and significant life events that people may have suffered. Furthermore, CBT work in the NHS is time limited with an average of 10 sessions.

This is why the role of counsellors and therapists is so fundamental to the recovery process. We should not forget this. The truth is that today we know that obsessive-compulsive disorder (OCD) can be managed through the use of CBT or cognitive behavioural therapy.