Working with clients experiencing obsessions and compulsions

Abstract

The above account illustrates how one woman’s life has become increasingly dominated by obsessive-compulsive behaviour. An obsession is a repetitive, intrusive thought, image or impulse which cannot be easily dismissed. It is distressing and often leads to a compulsion, the urge to act in a way that the mind knows to be irrational but which can only be resisted with the greatest effort. In Mrs Armstrong’s case the obsession is the persistent thought of having to ensure something is clean and uncontaminated by her touch, and the compulsion is the actual act of cleaning and washing, in a precise order. If that order is disturbed her personal ‘rules’ are that the ritual has to be started all over again. Compulsive rituals, whether the overt behaviours of washing, cleaning and checking, or more covert strategies such as repeating a ‘bad’ thought twenty times, serve to reduce or neutralize the anxiety caused by the original obsessive thought. When clients seek help because of washing or cleaning excessively they are likely to have developed this behaviour to reduce their fear of ‘contaminants’, such as dirt, germs, blood or disease, harming themselves or others. Compulsive checkers, including the client who risked losing his job due to time spent repeatedly checking that every light, electrical and gas appliance was switched off before leaving the house, typically believe they are responsible for averting illness, death or disaster by their actions.

I must always wash my hands before putting the clothes into the spin dryer. If I can’t remember whether I have done so or not, I think to myself ‘It doesn’t matter, I’ll hang them out to dry anyway’, but it will go on and on in my mind until the clothes are dry and I have to wash them again, this time ensuring I wash my hands first.’

Mrs Armstrong evidently washes all her clothes three times, each time after drying.

‘I must clean something before I touch it, then after I’ve touched it I must wash my hands. Sometimes I don’t realize I’m doing it, but then I know if I didn’t do it, I would never rest. I spend most of my day cleaning clothes and the house. My husband has been very tolerant up to now; he used to try and help by cleaning parts of the house for me, but that was no good, I had to do it myself, I had to make sure it was right.’