What To Do When Your Loved One has OCD
Hi Everyone,
I hope you’re all doing well. I’ve seen some signs that we may be seeing the end of the pandemic in the not too distant future and that can’t happen soon enough for most of us. I certainly think that the pandemic has contributed significantly to a rise in overall anxiety and especially a rise in OCD around the world. So as the threat of the pandemic decreases I’m hoping we see a corresponding decrease in anxiety/OCD.
The Problem
In this post I thought I’d cover how client’s partners/loved ones/friends can best help with their OCD. Many, if not most, of my clients' partners/loved ones/friends end up getting pulled into participating in my client’s OCD rituals - this is often called “accommodating”. Their intent is to be helpful and they are doing what they think is best, but by participating in the compulsions and/or offering reassurance, they are actually helping to maintain and even perpetuate the OCD. In the same way when my client’s perform their rituals they are feeding the OCD, when anyone else helps perform the ritual or offers reassurance, they are doing the same thing - they are inadvertently feeding the OCD and contributing to the very thing they are trying to stop. It is understandable that others get pulled into the rituals as it is difficult to watch someone we care about struggle, when it appears that we can do something to help. And it often only takes a moment or two to help out so it seems so reasonable to just do (or help with) the ritual and provide some relief. There are at least three ways families/friends accommodate: completely performing the ritual, helping to perform the ritual and offering reassurance.
Some simple examples and typical responses: “Would you mind checking to see if I locked the door properly?” - “Sure!” (helping with the ritual) “Can you wash your hands after touching that doorknob?” - “OK” (helping with the ritual)
Some not so simple examples and typical responses: “Did I have sex with that guy we just passed on the street?” - “Of course you didn’t!” (offering reassurance) “If I’m left alone with the children, I might harm one of them!” - “You would never do that!” (offering reassurance)
As I’ve written about in previous posts, accepting uncertainty is at the heart of managing OCD and the above typical responses are designed to help reassure clients and remove the uncertainty, but OCD’s trump card is always “How can you be sure?” And often asking the question once isn’t sufficient and the same or a similar question is asked over and over in a futile attempt to be sure.
How do Family/Friends Respond?
Use Logic: There are a number of ways families can respond to their loved one performing rituals or asking for reassurance. It is so very tempting to use logic, because often the rituals don’t make any sense and it seems so easy to just explain that they should simply stop the ritual. How can twirling around three times to the right and then three times to the left prevent bad things from happening? Logic virtually never works! It will likely only lead to frustration because the OCD sufferer probably already knows that what they are doing makes no sense, but they still feel compelled to do it anyway (“I know that twirling around like that makes no sense, but on the off chance it may keep my loved ones safe I have to do it anyway…just in case!”).
Get Frustrated: It’s also very easy to get frustrated with the OCD sufferer, especially if the rituals continue over a considerable period of time and if the rituals interfere with the family’s overall functioning - “Why do you keep checking the door locks/stove/hair dryer/coffee pot! You already checked them one this morning. You’re making all of us late for church again!!”
Accommodate: Families can become focused on helping their loved one not get too upset. When prevented from completing rituals, clients can sometimes become quite upset and so to avoid this, families can revolve around keeping “Dad” happy by helping him with the rituals. Sometimes families have become very accustomed to the way their loved one operates and they tell me things like: “That’s just the way dad is. He never touches door knobs with his bare hands, takes hour-long showers and carefully wipes down the seat he uses whenever we go out to eat.”
The Solution
Part of my job is to help not just my client, but also to help my client's family and friends understand how they can best help. The goal is the same as when we’re dealing with the client him/herself…stop doing or participating in the rituals and stop offering reassurance. Once everyone is on board with that goal then the next step is to work out an understanding of just how to get there. A good way to address the problem is to come up with an agreement, which can be as formal as a written contract, working out how to stop the rituals and reassurance. Gradual reduction usually works best. Making a list of exactly what the family/friends do to accommodate the OCD is a good starting point.
Let’s say after noticing and tracking the number of ways family members help perform the rituals or offer reassurance we find that mom usually offers some type of reassurance around 10 times a day. To help with reducing how often mom tries to help, she can be given a book of “coupons” and each time she offers reassurance she must surrender a coupon. Each week the number of coupons is reduced. If the problem is that the OCD sufferer asks for reassurance, then he/she is given the coupon book and must surrender a coupon each time he/she asks for reassurance. If, as often happens, the OCD sufferer keeps asking the same or very similar questions then the answers can be either written down or recorded and then rather than ask the question the written answer or recording is used.
An important element of this technique working is that the OCD sufferer has complete control. Nothing should ever be forced on them. If they aren’t ready to let go of receiving reassurance then they should be given reassurance, but this is also assuming that they have previously agreed during the above mentioned contract negotiation phase that they are committed to reducing/eliminating the amount of reassurance they will receive. So, if in any given situation they may say they “need” the reassurance and get the reassurance, they are still committed to not getting it the next time around.
Here are some books I can recommend on the same topic as this post - here, here and here. If you purchase one of these books through my link, I receive a small portion of the purchase price. And this post is purely for educational purposes only and is not intended to be therapy. If you’re struggling with any of the above, please consult a qualified mental health professional.
That’s all for today. Let me know if you have any topics you’d like me to cover in future posts or if you have any questions.
Stay safe,
Dr Bob
