What's the Most Important Thing Missing in OCD Treatment?
A Real Relationship That Sees You From The Start
I was talking to an OCD specialist the other day who blew me away with an insight I hadn’t quite put yet into words.
Everybody is always talking about getting the ‘right OCD treatment,’ and yet they always fail to mention what’s most important that’s glaringly missing in treatment: a real relationship!
And not just any relationship, not even the one you’d find in the gold-standard OCD treatment, it’s one you didn’t even realize you were missing in the first place.
Let me explain. When you are highly sensitive, deeply emotional, and profoundly imaginative like most OCD sufferers are, you struggle with finding a good object to be responsive in the ways you truly need.
Having a good object is crucial because then we internalize that outer relationship and now have a loving, responsive, and tempered internal place to go when we need care and comfort.
What happens when we don’t have that? Instead, we develop a hyperactive obsessional system that attacks and annihilates us instead of providing support. Because it isn’t based on a real person, this internalized object becomes savage, surly, impatient, and unkind.
But before you judge it too harshly, let’s make sure we also give it credit. It is better to have something or someone instead of nothing or no one, and this obsessional companion becomes a second object, a stand-in for what was never there in the first place.
It protects you from that free-falling terror of nothingness and death, from having people who couldn’t really feel, see, and respond to your feelings as a highly sensitive soul. Sound familiar?
Yes, all the obsessional material that forms around these issues have a cast of the fear of this terrorizing nothingness and death, and the obsession becomes our own way of navigating this awful choice.
If I have nobody really there, at least, this obsession will take care of me and I won’t feel so awfully alone.
But it doesn’t have to be this way, and here’s where a good therapeutic or personal relationship can make all the difference.
And here’s what’s missing in OCD treatment right now that I’d like to scream from the rooftops: we need a real relationship.
Not a coach, not techniques, but a real relationship that sees into this deeper and more important storyline.
If we could have at least one person who shows us how to be responsive, generous, curious, and compassionate with all that we feel and think, then we can be with all of these issues from our core.
We wouldn’t have to use our obsessional strategies to manage them, but instead could have the safety and security of the relationship holding us up, keeping us together, and celebrating our wonderful range.
Even better, the best of an early responsive relationship with a good-enough-mother or father (or both) lets you to wonder and wander over anything you feel and think with deep interest and engagement.
No criticism that you think or feel too much. No fears or anxiety about exploring unknown territory together.
Instead, you’d find benevolent, curious, delight. The most responsive caretakers—like the best therapists—allow you room to dream yourself back into reality, or even better, back to a place where dreams and reality co-mingle without any need to explain which is which.
This is the creative center of all human beings.
But what happens when this is missing? The obsessions become a sort of companion and protector at first, but soon enough, they become persecutors and tormenters. We can’t even control them anymore, they take on a kind of overbearing, hypervigilant responsive that tries to keep us away from feelings.
Now, our job isn’t to ignore them or try to ‘kill them off’ either. Our job is to do something very sophisticated that you see very clearly in the trauma literature.
Our job is to say thank you to them for helping to take care of us while we were dreadfully alone. We are to say thank you for protecting us from a too early awareness of death, chaos, and nothingness.
And then we are to say, “But I’d like to develop a new relationship with you based on one that holds, supports, prizes, and champions me in my full sensitivity.” That relationship could come through a therapeutic relationship, a family or romantic relationship, a friendship, or even through a community that really ‘sees’ you.
These relationships are there to help you internalize who you are meant to be and who you have always been.
Along the way, the obsessions will likely try to re-establish control because they are rightfully terrified that you will have to face the unbearable truth of the past.
But you can tell them, it’s ok, I can look death in the eye now because I am no longer alone and I am no longer so young to have to be shielded from it.
You are letting this obsessional second object see that you can carry even more life now that you are being seen for who you really are.
You are giving yourself a true home again, one that is loving, kind, curious, creative, fierce, and passionate.
You are giving back the life to yourself that was stolen long ago, the one that nobody talks about, the one that tries to speak through every obsessional fear and doubt you’ve ever lived.
That’s how important a real relationship is, and I think, it has the rightful power to not only change you, but to change our field.
People with OCD are starving for a real relationship, only they aren’t given the words to say what that is.
Thanks to my wonderful OCD specialist friend, I now have new language to share that with you, and I hope this starts something miraculous in your own OCD recovery.
Please ask questions or share your own responses to this in the comments.
And yes, let’s start telling the OCD community to start taking this relationship seriously.
So many know it in their heart and in their bones, but are easily scared off by the experts suggesting that OCD is just noise.
There certainly is a lot of noise in OCD, but there’s also music in it that’s so worth listening to—and sharing together.