Friday Counseling Issues: A Ramble

I’ve worked two full weeks now since the end of my Christmas break.  It’s amazing how fast the time is going. Christmas was such a great time, having all nine of my grandkids together.  It just went too fast.

Anyway, today I’m thinking about a couple of things that some of my clients are dealing with. Both are difficult to manage, for the client and for the therapist.

OCD is a combination of two things:  Obsession is what goes on in the brain, and compulsion is the resulting behavior.


Some obsessions have their roots in actual events, usually somewhat traumatic. For instance, someone who gets caught in a stalled elevator may develop obsessive thoughts and fears of any small, enclosed place.  Those fears could result in compulsive behaviors such as never going into a building that has elevators; avoiding any enclosed place such as a public bathroom stall; or avoiding any room that has no windows. The person who suffers from this type of obsession may be compelled to check at least three times (pick any number) before entering a building, to make sure there are stairs, windows, and more than one door.

Veterans who come home from active duty having suffered, perhaps, traumatic brain injuries in an IED blast could very well have Post-Traumatic Stress as well. Any loud noise triggers a startle response. They may go into immediate defensive mode if they hear a car backfire, or even a balloon popping nearby. The obsession is the blast noise; the compulsion can become as serious as refusing to ever leave their house or even their own bedroom.  No TV, no music, no loud talking. If there are children in the home, they learn very quickly to play quietly.

Obsessions that are rooted in actual events are easier to treat than obsessions that have no apparent connection to reality. Take, for instance, a young man who is obsessed with the idea that he is too thin, and is unappealing to girls.  His obsession with his weight compels him to strip down several times a day, leaving his clothes in another room, making sure that he is touching nothing when he steps on the scale to make sure his weight hasn’t dropped below, say, 175 pounds.  If it should drop below that arbitrary number, he immediately begins to eat the most fattening foods he can find, and then he worries about getting a flabby belly so he does 100 crunches.  His whole day can be taken up with these obsessive-compulsive behaviors. He can’t keep a job.  He has no social life. Yet, the truth is that he is a fairly good-looking man with a normal body weight.  He is pleasant and kind, but he’s convinced that he’s a freak.

People who have OCD are often perfectionistic, which of course only makes their problem worse. There was a beautiful young woman who came to see me because her boss was threatening to fire her.  The problem?  She was too slow.  She had to type every document three times;  each document had to be proofread three times; if something was to be mailed, she had to fold it three times, put it in the envelope three times, check the address three times, position the stamp three times before gluing it down. As you can imagine,  she took three times as long as all the other girls in the secretarial pool.

What was her obsession?  She believed that if she did not take these precautions, she would make a mistake that would close down the multi-billion dollar company she worked for and collapse the economy of the whole USA.  Seriously.   She really believed that.

How do we help people who suffer?  And believe me, suffer is not an overstatement.

This is one of the few problems in which I insist my client see the doctor and get some good anti-anxiety medication. Once that is established, we begin working with Cognitive Behavioral Therapy, which addresses the obsession head on. Once the obsession begins to lose its power, the compulsions also begin to fade.

I’ve made it sound so easy.  It isn’t. Obsessive thought patterns are well-established and very difficult to remove.  It takes great strength of character to kick obsessions to the curb.

If you know someone who struggles, please don’t make fun of him; don’t tell him to just get a grip.  He wants to, he’s tried to numerous times.  He’d give anything to live your normal life, without all the fears and time-consuming rituals he feels compelled to perform.

So, not really a ramble after all.  I’m done.  And I’m not feeling terrific, so I think I’m going to go gargle some cider vinegar and maybe go back to bed.