Why Most OCD Treatments Don’t Work

Why Most OCD Treatments Don't Work

Perhaps, nothing in all of mental health causes more psychological and emotional suffering as severe OCD (Obsessive-Compulsive Disorder). Imagine constant intrusive thoughts that could be related to the necessity of engaging in a particular behavior, such as hand-washing, counting, or endlessly checking on a specific task. 

Or worse yet, a person is obsessively fearful of offending God and being tortured for all eternity, harming their child in some violent manner, or having unwanted sexual attractions to a member of the same or opposite sex. Many individuals can still recognize the irrationality of these obsessive thoughts but cannot stop them or their associated compulsions. While another segment of people fear the possible validity of them, such as a mother who experiences intrusive images of harming her infant. 

Your OCD May Actually Be PTSD

I myself experienced a period in my early twenties of having intrusive hyperreligous OCD symptoms that tormented me to no end. As a result of this experience, and helping numerous clients recover from OCD, I can also encourage anyone that OCD is a resolvable condition. However, what I have learned is it is often a very complex process and that almost all of the traditional treatments for OCD do not work, and in many cases can increase its severity. 

My motivation for writing this article came from a short video I did for our counseling center’s YouTube channel asserting that a great deal of what is diagnosed as OCD is actually PTSD (Post Traumatic Stress Disorder). The video has been viewed thousands of times and a countless number of individuals have reached out to me to inform me they resonated with what I was saying and validated none of the treatments they have received have worked for them. 

If you would like to view the video, you can go to the Gateway Counseling Center’s YouTube channel and search for, “Your OCD may be PTSD.” I would now like to walk you through the journey of how I came to this understanding, which is when I was able to finally start helping my clients improve and eventually recover. 

The Ineffectiveness of CBT

When I began studying the literature on OCD in graduate school, one of the common themes I kept discovering was that OCD could be very intractable (i.e., very difficult if not impossible) to treat. The standard treatments of the day were all based around what is referred to as CBT (cognitive behavioral therapy). The suggested intervention was called exposure and response prevention. 

This consisted of allowing the intrusive thought and then attempting not to engage in the compulsive behavior. This approach immediately seemed to me completely irrational and ineffective. I thought to myself the person must have tried this thousands of times already to no effect. Furthermore, practicing this method would flood the person with overwhelming anxiety. From my perspective, this was akin to leeching or bloodletting. There had to be a more human way to address this issue. 

Parallels with Addiction

The parallel would be with OCD’s closest cousin – addiction. Imagine putting a pile of heroin in front of an individual in active addiction and telling them you want them to sit in front of the substance and attempt not to use it. Hopefully, this analogy displays the ineffectiveness of this approach. 

Since there were no other alternative treatments I was aware of at the time, I attempted to do a modified version of the standard approach, which had no effectiveness either. However, I have always had a competitive drive and was committed to figuring out how to help my clients stop suffering and improve. 

The Connection with Trauma

Simultaneously, I was becoming more skilled at working with trauma. I realized within my first few months as a psychotherapist if I was going to become proficient at helping people, I had to get good at working with trauma. One of the first breakthroughs in my understanding was I began to notice all of my clients with trauma had some form of OCD type behaviors, even if was on a lower scale than what would be categorized as traditional OCD. 

I realized these behaviors were resources regulating their anxiety symptoms stemming from their trauma. This was further validated when the symptoms would generally remit following the treatment of their trauma; the resource was no longer needed, which made perfect sense of why the behavior would disappear. 

The Missing Puzzle Piece

With this new understanding, I was halfway there. Then came the next piece of the puzzle. I will never forget the night I was working with a client who exhibited a more classic form of OCD. They would fear they hit someone while driving and would have to circle back around to check. This could be a very time-consuming process for them, which would create work and relationship stress, adding to their anxiety. 

I reasoned to myself that this had to have some type of value knowing that all behavior is purposeful; we would not engage in any type of behavior if there was not some sort of payoff or reinforcement, even if it wasn’t apparent on the surface. After exploring this for a period of time, what the client and I discovered was if we followed out their fears to the ultimate outcome, they would be separated from their spouse due to being incarcerated and they feared their spouse would then leave them. 

Working with Parts

Bingo! Attachment loss is life and death; we will do almost anything in the service of maintaining attachment. We then kept digging to see where this fear originated, which was in their first attachment relationship with their parents. Then an image of a child part of them came into the client’s mind’s eye. We then emotionally processed the feelings associated with the abandonment they felt as a child. Over the next month, we discovered several more wounded parts of the client in need of healing. 

As we addressed the client’s historical wounds, their OCD symptoms continued to decrease until there was a complete termination of them. As I’m writing this, I am feeling a sense of tremendous gratitude for that client due to the fact their experience has helped so many subsequent clients recover from OCD. 

Internal Family Systems

Another thing this client’s case exemplifies is the fact that the underlying causes of OCD can remain latent for years and decades. Some individuals have knowingly struggled with these types of symptoms since childhood in different forms. Contrastingly, others have never encountered symptoms until later in adulthood, such as the case with the client I have referred to in the previous paragraphs. This can make it all the more distressing, confusing, and embarrassing when the person has no experience coping with this problem. 

The final puzzle piece came when I was introduced to a therapeutic model referred to as Internal Family Systems. I had been having good results with other modalities I use, such as EMDR, Brainspotting, and AEDP. However, the framework of IFS is about working with wounded parts known as Exiles and healing them through accessing one’s Core Self. This will then result in the Protective part, The OCD, discontinuing this behavior and taking on a more updated and adaptive role in one’s current life. 

The Key is Integration

This process is much more extensive and complex than I can go into in this article. What I would most like to convey is the utilization of IFS has allowed me to help all of my clients who complete treatment fully recover. Furthermore, everything you need to heal is already within you. I am the facilitator that helps you access your own healing capacities and reset your system. 

If you are struggling with OCD and have been unable to heal, it is not because you are incapable it is due to the fact you have wounded parts (Exiles) who have not yet been integrated. Until this occurs your Protective Parts need to keep engaging in the compulsive behavior in an effort to protect you. 

Myths About OCD

There are many misconceptions about both addiction and OCD. Primary among them are that they stem from a disease or a chemical imbalance. Both of these viewpoints are incorrect and are outdated interpretations no longer supported by neuroscience. However, they were necessary steps to the evolution of how we have arrived at our current understanding. 

In regards to the neurochemical association, I am not an opponent of a client taking medication if their OCD symptoms are at a certain level of severity. However, this will not address the underlying causes. Although I advocate more holistic approaches and experiential therapies to resolve the true origins of my client’s presenting issues, in some cases medication is a necessary aspect of treatment until we can fully address the origins satisfactorily. 

What neuroscience shows us about both of these conditions is they are in essence learning disorders. They utilize the same brain mechanisms as we do in healthy, adaptive learning. Whether it is using drugs, pornography, OCD compulsions, computer programing or making music, your brain gets very good at doing it with repetition. But this can all be changed through neuroplasticity – the brain’s ability to change itself through new experience. 

Unlearning and Learning

After you achieve a sufficient level of neurological integration, you are now free to engage in new healthy behaviors. In the brain, real estate is a hot commodity – use it or lose it. When you no longer engage in the compulsive behavior the network atrophies. The new way gets reinforced the same way the OCD did until it becomes habitual in a good way. 

A final word is an encouraging one. This approach works but not without putting in the work. I am human as well and understand our desire for the quick fix. If we can just take a pill and make it go away, most of us would. However, I have never seen this approach resolve someone’s OCD. You are either left taking medication with no end in sight, while leaving the underlying cause untreated, or battling with periodic bouts of OCD, which the medications will not fully suppress. 

Commit to ending your suffering. It is possible to recover. I would never be so cruel as to give someone false hope. Everyone is capable of healing. Like anything else, it is a very individualized process. No rote formula will work. I have to figure out the specific nuances with each of my clients. Nonetheless, I would also inform you that I have never had a client stay committed to their therapy and not succeed; my client’s and I are undefeated. 

If you would like to learn more about this process or schedule a session, please contact me at 561-468-6464

Boynton Beach Counseling Center
Gateway Counseling Center
1034 Gateway Blvd. #104
Boynton Beach, FL 33426
Phone: (561) 468-6464
Phone: (561) 678-0036

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