As always, I so appreciate your unique perspective and thoughtful approach to OCD. Would you drill down a bit on this idea of "betraying yourself" by not embracing your sensitive and empathetic self before engaging with ERP? What does this embrace of our whole self look like and how does it clear a path for ERO to work more effectively?
You bet Maria! So, in general, what I mean is that ERP tends to focus on confronting rather than avoiding the anxiety, fear, and discomfort, but it doesn't look at any of the surrounding feelings or any potential message in why OCD is springing up at the moment. It doesn't even pretend to acknowledge one's anxiety could have some interesting feelings and thoughts mixed together worth knowing about and will make it easier to face the anxiety itself.
Also, the notion of ERP is square against being too sensitive. It shows you how to be very alpha and desensitized towards what you are facing. It's like muscling your way past emotions, but it's not engaging them, being curious about them, or giving them any due or curiosity at all.
BUT when the psyche notices you saying to it: "I see, you are trying to communicate something to me that I might be missing and you're raising the volume," it begins to open up like a child that is in a tantrum but just desperately wants to be understood and helped with sorting things out. The psyche isn't just thinking, 'quick, stop my behavior!" It's thinking, 'are you getting some of the message I'm sending you so you can help me regulate better?"
Once that process is engaged, and the psyche feels 'heard,' it's a lot easier and more possible to do ERP (if it's even necessary at that point), just as a child is more likely to 'follow the rules' or 'be more amenable' if it at first feels heard, respected, and witnessed.
ERP doesn't do any witnessing of the emotional backdrop of OCD at all. It even does worse. It says, 'you are not even important enough to merit a conversation. You are in the way of being better."
That's like telling a child, I won't listen to your feelings until you change your behavior first--this might work in the short-run but it doesn't create a real relationship, it creates another mode of fear that needs to be continually performed.
At its best, ERP can help deepen confronting the tricky emotional, cognitive, and behavioral stuff, but at its worst, ERP can actually invalidate the very basis of the person with OCD itself.
I don't have research to support it, but I would hypothesize that a good reason why a number of people either avoid or drop out of ERP treatment is because some part of them sees it as asking them to betray an important part of themselves, i.e. the deeply feeling, sensitive, and intuitive sides of self which is a core of the OCD sufferer.
People with OCD are people pleasers par excellence because they are so tuned in to what other's need and want. Unfortunately, performing for the love and approval of a therapist is no different that performing for the love and approval of a parent--it only changes surface behavior and doesn't get a real emotional or relational change. Even worse, it makes the person feel disconnected and distrustful of their own instincts, needs, and wants.
Hope that helps a little. But if it doesn't, feel free to send me a typical kind of scenario that you've either seen or experienced that I can approach with more detail.
It's a really good question and it's got me thinking even more deeply about this stuff, so thank you!
Thank you, Mike. This clarifies a lot for me. Here's a scenario: a person with OCD is stuck in an obsessive thought loop revolving around an unrequited romantic interest. The rumination and what-iffing is full on, thoughts are circular, there's some compulsion towards seeking reassurance and certainty. If they did ERP, they might repeat the phrase: "X doesn't like/love me and is attracted to someone else. I will never have a romantic partner." They do this until the anxiety is zero. For this person, what would their self talk look like if they were to embrace their inner self/knowing before engaging in the ERP? Does this make sense? I am out of my depth, but intrigued to hear your answer. Thanks!
Interesting scenario! Ok, so, this person can first empathize with themselves about how important love is to us all and how elusive it can be.
As part of that, they might start acknowledging that they are feeling a lot of things, most likely a great deal of ambivalence.
They might feel immensely hopeful and wishing that something will change and this person will return their love. They might even feel a bit frustrated (or secretly) angry that their feelings aren't returned and they can't have their desires. They might feel disappointed or even fearful (or both) about this person not liking them and then spiral into wondering about others. But the most important thing is to embrace the full mix of feelings, which is a kind of exposure itself.
They might even wonder about why this is affecting them so much right now. Perhaps the person was someone they finally felt could appreciate them in a way that felt special and so this now feels, like a sense of themselves, is gone. So much of this depends on the person's full story and backstory, so my tips are only general here, but I hope it gives a 'feel.'
The core of most forms of OCD is the fear of loss and the desire for connection, and the challenge with holding the fact that both of these things coexist. People with OCD are exquisitely aware of these feelings and thoughts, and without proper mirroring that these feelings are natural and important parts of being fully human, they begin to run away in compulsive defenses to control them and 'make believe' they aren't there.
I think there's a zen balance of noticing and witnessing them without losing your sense of self that's so hugely important for OCD. Let me know if this answers the question a bit and if it opens other questions, keep writing, and I'll respond.
Anybody else out there with questions, feel free to write and I'll respond. :-)
Great questions Maria! It's such an art working with these things, but I think it gets really creative and interesting when you approach OCD in this way.
I appreciate your post. I do think ERP is often administered in a heavy-handed way that neglects other important parts of the individual with OCD. While ERP has been super helpful for me, it never would have been effective if I used it in isolation.
Yes, I don't think ERP is completely bad or problematic at all. But I DO think without engaging more feeling and relationship, it can easily become heavy-handed, cold, and self-sabotaging.
I wish the OCD researchers would go a little less overboard on ERP--which they claim is the only true active ingredient in OCD treatment--and start to examine what other ingredients might make a tremendous impact on change and growth.
Yes, I do. I don’t just work with OCD but as you can tell, I’m very interested in it and think the field is missing so much in understanding it. Feel free to email me at drmichaelalcee@gmail.com if I can be of any further help.
ERP--while incredibly effective--is also excruciatingly challenging, especially for those suffering from taboo themes such as POCD or Harm-related obsessions. The mere idea of accepting the presence of those thoughts is so distressing that ERP can be unobtainable for some. Combining treatment with others, such as Acceptance and Commitment Therapy (ACT) or medication, can make a significant difference.
As always, I so appreciate your unique perspective and thoughtful approach to OCD. Would you drill down a bit on this idea of "betraying yourself" by not embracing your sensitive and empathetic self before engaging with ERP? What does this embrace of our whole self look like and how does it clear a path for ERO to work more effectively?
You bet Maria! So, in general, what I mean is that ERP tends to focus on confronting rather than avoiding the anxiety, fear, and discomfort, but it doesn't look at any of the surrounding feelings or any potential message in why OCD is springing up at the moment. It doesn't even pretend to acknowledge one's anxiety could have some interesting feelings and thoughts mixed together worth knowing about and will make it easier to face the anxiety itself.
Also, the notion of ERP is square against being too sensitive. It shows you how to be very alpha and desensitized towards what you are facing. It's like muscling your way past emotions, but it's not engaging them, being curious about them, or giving them any due or curiosity at all.
BUT when the psyche notices you saying to it: "I see, you are trying to communicate something to me that I might be missing and you're raising the volume," it begins to open up like a child that is in a tantrum but just desperately wants to be understood and helped with sorting things out. The psyche isn't just thinking, 'quick, stop my behavior!" It's thinking, 'are you getting some of the message I'm sending you so you can help me regulate better?"
Once that process is engaged, and the psyche feels 'heard,' it's a lot easier and more possible to do ERP (if it's even necessary at that point), just as a child is more likely to 'follow the rules' or 'be more amenable' if it at first feels heard, respected, and witnessed.
ERP doesn't do any witnessing of the emotional backdrop of OCD at all. It even does worse. It says, 'you are not even important enough to merit a conversation. You are in the way of being better."
That's like telling a child, I won't listen to your feelings until you change your behavior first--this might work in the short-run but it doesn't create a real relationship, it creates another mode of fear that needs to be continually performed.
At its best, ERP can help deepen confronting the tricky emotional, cognitive, and behavioral stuff, but at its worst, ERP can actually invalidate the very basis of the person with OCD itself.
I don't have research to support it, but I would hypothesize that a good reason why a number of people either avoid or drop out of ERP treatment is because some part of them sees it as asking them to betray an important part of themselves, i.e. the deeply feeling, sensitive, and intuitive sides of self which is a core of the OCD sufferer.
People with OCD are people pleasers par excellence because they are so tuned in to what other's need and want. Unfortunately, performing for the love and approval of a therapist is no different that performing for the love and approval of a parent--it only changes surface behavior and doesn't get a real emotional or relational change. Even worse, it makes the person feel disconnected and distrustful of their own instincts, needs, and wants.
Hope that helps a little. But if it doesn't, feel free to send me a typical kind of scenario that you've either seen or experienced that I can approach with more detail.
It's a really good question and it's got me thinking even more deeply about this stuff, so thank you!
Thank you, Mike. This clarifies a lot for me. Here's a scenario: a person with OCD is stuck in an obsessive thought loop revolving around an unrequited romantic interest. The rumination and what-iffing is full on, thoughts are circular, there's some compulsion towards seeking reassurance and certainty. If they did ERP, they might repeat the phrase: "X doesn't like/love me and is attracted to someone else. I will never have a romantic partner." They do this until the anxiety is zero. For this person, what would their self talk look like if they were to embrace their inner self/knowing before engaging in the ERP? Does this make sense? I am out of my depth, but intrigued to hear your answer. Thanks!
Interesting scenario! Ok, so, this person can first empathize with themselves about how important love is to us all and how elusive it can be.
As part of that, they might start acknowledging that they are feeling a lot of things, most likely a great deal of ambivalence.
They might feel immensely hopeful and wishing that something will change and this person will return their love. They might even feel a bit frustrated (or secretly) angry that their feelings aren't returned and they can't have their desires. They might feel disappointed or even fearful (or both) about this person not liking them and then spiral into wondering about others. But the most important thing is to embrace the full mix of feelings, which is a kind of exposure itself.
They might even wonder about why this is affecting them so much right now. Perhaps the person was someone they finally felt could appreciate them in a way that felt special and so this now feels, like a sense of themselves, is gone. So much of this depends on the person's full story and backstory, so my tips are only general here, but I hope it gives a 'feel.'
The core of most forms of OCD is the fear of loss and the desire for connection, and the challenge with holding the fact that both of these things coexist. People with OCD are exquisitely aware of these feelings and thoughts, and without proper mirroring that these feelings are natural and important parts of being fully human, they begin to run away in compulsive defenses to control them and 'make believe' they aren't there.
I think there's a zen balance of noticing and witnessing them without losing your sense of self that's so hugely important for OCD. Let me know if this answers the question a bit and if it opens other questions, keep writing, and I'll respond.
Anybody else out there with questions, feel free to write and I'll respond. :-)
Great questions Maria! It's such an art working with these things, but I think it gets really creative and interesting when you approach OCD in this way.
I appreciate your post. I do think ERP is often administered in a heavy-handed way that neglects other important parts of the individual with OCD. While ERP has been super helpful for me, it never would have been effective if I used it in isolation.
Yes, I don't think ERP is completely bad or problematic at all. But I DO think without engaging more feeling and relationship, it can easily become heavy-handed, cold, and self-sabotaging.
I wish the OCD researchers would go a little less overboard on ERP--which they claim is the only true active ingredient in OCD treatment--and start to examine what other ingredients might make a tremendous impact on change and growth.
Do you offer therapy?
Yes, I do. I don’t just work with OCD but as you can tell, I’m very interested in it and think the field is missing so much in understanding it. Feel free to email me at drmichaelalcee@gmail.com if I can be of any further help.
Such an insightful post.
ERP--while incredibly effective--is also excruciatingly challenging, especially for those suffering from taboo themes such as POCD or Harm-related obsessions. The mere idea of accepting the presence of those thoughts is so distressing that ERP can be unobtainable for some. Combining treatment with others, such as Acceptance and Commitment Therapy (ACT) or medication, can make a significant difference.