While discussing the treatment of obsessive–compulsive disorder, one should become familiar with some basic points, concerning the symptoms and causes of the disorder.
As it was mentioned in a case background, Madam Y was diagnosed with “obsessive behaviors of checking things and obsessive thoughts.” OCD is characterized by intrusive thoughts as well as by repetitive behaviors. It is well-known that people who suffer from OCD frequently perform certain tasks to seek relief from an anxiety.
Thus, according to a case background, Madam Y “would makeup over and over until she felt satisfied, she was tired during the process but she couldn’t stop her behavior.” The citation is considered to be another example which confirms the diagnosis.
Thus, people who suffer from OCD must do certain compulsive rituals to prevent unpleasant event from taking place. At least, they believe that their actions will help them to avoid the situations they are afraid of. Thus, certain rituals are considered to be the so-called escape from the obsessional brooding.
The most widespread obsessive thoughts include fear of germs, fear to cause pain or harm, some violent thoughts, focus on moral ideas, fear of losing some things, etc. Madam Y’s obsessions are in the category fear of losing some things: “She is insecure and anxiety, she is always keeping a handbag in her hands even sleep, because she worried she would lost the money or stolen by others.”
The most widespread compulsive behaviors are double-checking of things, doing senseless things to be satisfied with smth, washing or cleaning all the time, arranging things, etc. Madam Y’s compulsives are in the category doing senseless things to be satisfied with smth: “she won’t switch on the light and close the windows to avoid touching with all kinds of lights in order to keep white.”
The causes of the disorder are also to be taken into consideration. While choosing the treatment, one is to analyze both psychological and biological factors which influence the disorder appearance. Madam Y’s OCD is based on psychological factor.
For instance, it is said that Madam Y’s father “was easy to get hot temper and would blaming and shouted to Madam Y.” The dominant character of the Madam Y’ father as well as his brute actions and coarse words gave rise to Madam Y’ complexes development, including “low self-esteem and lack of self-confidence”, as it was mentioned in a case background.
So, time is ripe for treatment. There are several ways to treat Madam Y’s obsessive behaviors. On the one hand, it is a behavioral treatment which is to be used. Thus, exposure and response prevention is recognized to be of great importance as a therapeutic effect is based on the fears confronting.
The second way is called person-centered psychotherapy and considered to be more appropriate method to treat OCD. M. Cooper says that “person-centered therapy is actualizing its potential in creative and original growth, forging new pathways and understanding.” (WAPCEPT, 2007) PCT is considered to be a talk-psychotherapy which appeared in the early forties.
The founder of the PCT is an American psychologist Carl Ransom Rogers.
Taking into account the psychological factors which caused Madam Y’s OCD, the therapist’s task is to provide Madam Y’s with non-judgmental environment to show empathy towards her personality. Thus, it is only a non-directive approach which may help Madam Y to solve her internal conflicts.
Of course, there are many contradictions concerning the therapy. On the one hand, some behaviorists and psychoanalysts suppose that PCT can’t be effective because of its conditional relationship; however, numerous investigations showed that the form of talk-psychotherapy is considered to be a vastly effective way of treatment.
So, let’s consider some points from the log. The actions are listed in consecutive order:
To help Madam Y, the therapist must rely on the following basic steps: therapist-client psychological contact. Taking into account Madam Y’s complexes (low self-esteem/lack of self-confidence) the therapist is to show the personality importance.
Thus, Madam Y is to be convinced of the therapist’s good intentions. The next core concept is vulnerability. Thus, the contradictions Madam Y feels all the time (her internal conflicts) lead to the contradictions between her experience and awareness. The interdependence of Madam Y’s anxieties and internal conflicts impacts on her ability to think reasonably.
Genuineness means the relationship facilitating
Unconditional positive regard is also one of the most important ways which is to be used to help Madam Y. Thus, her actions, words, ideas, thoughts should not be approved or disapproved. On the contrary, Madam Y must realize the uniqueness and utility of her own ideas for herself.
As far as Madam Y’s father attempts to psych out his daughter seemed to work, Madam Y’s low self-esteem was formed over the pressure. Madam Y’s self-regard must be increased through her ideas acceptance.
Therapist Empathic understanding allows creating fiduciary relations. Thus, it is accurate empathic understanding which plays the most important role in Madam Y’s treatment. Due to empathic accuracy, Madam Y is able to get a social support to adapt to certain conditions.
Perception is considered to be the last core concept of PCT which combines the empathic understanding and unconditional positive regard.
According to a case background Madam Y was diagnosed with OCD in 2009. ‘After the medical treatment for half year, Madam Y was feeling recovered and default treatment’. As far as the treatment was not completed, a little bit later the symptoms appeared again.
Thus, one is to make a conclusion that PCT can’t be considered to be the only method to help Madam Y as she feels “a negative emotion that involves feeling nervous, scared, afraid, or worried.” (Association for Behavioral and Cognitive Therapies, 2010) In my opinion, PCT is to be combined with cognitive behavioral therapy (CBT) to consolidate the effect.
Madam Y’s treatment defaulting gives us some misgivings concerning PCT reliability as the only mode of treatment, when Paul Salkovskis says that “CBT encompasses most areas of human behaviour and experience, and represents many different research methods, from randomized controlled trials to detailed case studies.” (Behavioural and Cognitive Psychotherapy, 2011)
Cognitive behavioral therapy is based on the methodology of Albert Ellis. Thus, Madam Y is to become familiar with Ellis’ model ABC. She must learn to analyze her obsessive behaviors through the scheme ABC. A means activating events Madam Y experiences, B means her thoughts, ideas and beliefs about A, C is considered to be an emotional consequence based on her thoughts only.
Thus, Madam Y’s obsessive/repetitive behaviors are based on her irrational beliefs (which are considered to be B) which upset her all the time and she is unable to confront them (depression is considered to be C, e.g. a consequence which is caused by irrational beliefs). There are three core philosophies Ellis defined. Madam Y’s case is based on the third type.
It was rather easy to define what type Madam Y belongs to, as her psychological complexes (low self-esteem and lack of self-confidence) gives us a prompt: I can’t ever enjoy myself at all (as my complexes prevent me to succeed). The belief causes the negative consequences, including discomfort, inaction and avoidance. So, the practice of REBT is considered to be effective, as it was empirically proved.
Providing a life-acceptance philosophy is one of the most important tasks REBT uses. Thus, Madam Y is to achieve mental wellness. REBT task is to show Madam Y that her obsessive behaviors needlessly upset her all the time.
Generally, cognitive behavioral therapy is related to the above-mentioned discussion, namely exposure and response prevention combined with cognitive therapy itself. Exposure and response prevention was listed before to show the importance of different methods combining.
Madam Y’s treatment must be accompanied with special home assignments. For instance, to speed up Madam Y’s recovery, the following steps are to be taken: relabel – Madam Y must train herself. For instance: I am at home, there is no danger, and nobody can take my money; reattribute – Madam Y must imagine that there are two I – the first I is Madam Y who is real; the second I is Madam Y’s OCD.
Thus, when obsessive thoughts appear, Madam Y is to say: It is not Me. It is OCD ; refocus – when obsessive thoughts appear, Madam Y is to concentrate on some other things, for instance, she is to concentrate on her hobbies or the things she is interested in/fond of; revalue – Madam Y is to convince herself of the thoughts meaningless.
The most important techniques Madam Y must use at home are her attention refocusing and reflections her thoughts on paper. Thus, when obsessive thoughts come, she is to write them down. The technique will help her to realize the frequency of the thoughts appearance.
So, Madam Y can see how repetitive her ideas and thoughts are. Madam Y’s obsessive thoughts/ideas are to be said aloud – she is to repeat them a lot of times to be able to neglect them in future. Madam Y is to create a mental picture to be sure that her actions were already performed before. “Creating an OCD worry period” is also to be taken into account.” (HELPGUIDE. Org, 2011)
Thus, Madam Y is to think about negative thoughts for ten minutes only. Interval choosing is up to her. When obsessive thought appears, Madam Y is to repeat it until she feels irritation. Mindful meditations and various relaxation techniques are of primary importance too. Madam Y is to keep her emotional balance and get enough sleep. Social isolation is contra-indicated.
Healthy eating habits mustn’t be omitted while coping with OCD. Madam Y is to communicate with people she likes. Aerobic activity or any other kind of regularly exercises is considered to be a good way to cope with OCD.
New methods of “computerized cognitive behavioural therapy” can be also used to treat Madam Y’s OCD. (National Institute for Health and Clinical Excellence, 2011)
Association for Behavioral and Cognitive Therapies. (2010). What is Anxiety? Retrieved December 08, 2011, from http://effectivechildtherapy.com/sccap/?m=sPublic&fa=pub_Anxiety
Cooper, M. (2007). Person-centered therapy. Retrieved December 08, 2011, from http://www.pce-world.org/about-pce/articles.html
HELPGUIDE. Org. (2011). Obsessive-Compulsive Disorder. Retrieved December 08, 2011, from http://helpguide.org/mental/obsessive_compulsive_disorder_ocd.htm
National Institute for Health and Clinical Excellence. (2011). Depression and Anxiety – Computerized Cognitive Behavioural Therapy (CCBT). Retrieved December 08, 2011, from http://www.nice.org.uk/guidance/TA97
Salkovskis, P. (2011). Behavioural and Cognitive Psychotherapy. Retrieved December 08, 2011, from http://journals.cambridge.org/action/displayJournal?jid=BCP