How to Save the Relationship - 3 Critical Changes to Make Before It's Too Late

First published and edited by Elephant Journal.

“How will I know if he really loves me?”

The late Whitney Houston sings in the background. The couple is looking at the floor, glum and stuck. They’ve been in the same situation of “not knowing” for two years. The relationship is not moving forward and yet neither of them want to break up. The same cycle plays out like a broken record, a relationship punctuated by regular dramas. Each blow up resets it to zero. They have split up and got back together more times than they can remember. It’s a tiring dance that can’t last much longer.

Been in this situation? I have, as have many of the clients I’ve worked with.

The start of the relationship feels like a meeting of kindred spirits. The other person ticks many of the boxes that had been left unticked in the past. They “get” us. They share our values. They care. They understand our quirks. They even have similar quirks. We feel like best friends and lovers. They are interested in us as and not just as a sex object. But the sex is intense. A dream gets ignited. A hope of a happy future with this person is born.

Then, the disharmony starts.

We see parts of them that don’t fit the person we fell in love with. We feel stunned, disenchanted, repelled. So, we walk away and feel unbearably sad. We talk to them in our heads. We miss them when we do new things. We revisit the relationship. That hope or dream is still alive and burning in our hearts.

We try again. And it happens again. And again. And again. Each time, we gather more evidence for why the other person is the “bad guy.” We stockpile this “evidence” to make a case for why we can’t commit to the relationship fully. We say, “If only he/she would sort out their issues then this relationship would improve.” Yet we don’t leave because we still hope, we still dream, and beneath all the disharmony, we still love. The relationship sways back and forth like a swing in a deserted playground.

Smell the coffee.

When we are only willing to commit if the other person changes, then things will never improve. Individuals attach different meanings to the word “commitment,” but essentially, it’s about saying “yes” to the relationship and deciding to step on board with both feet.

We shift from focussing on what they are doing wrong and look at the part we play. As Gestalt therapist Robert Resnick says, “relationships are co-created.” We are 100 percent responsible for our part and how we react to our partner’s “flawed behaviour.” We play our part in the dynamic. We defend, we blame, we withdraw, we meet for coffee, and then we play again. Since a relationship is a system, any small change will inevitably change the entire system.

Snakes and Ladders is a board game, not a relationship.

When we only engage conditionally, then, we keep the relationship suspended and uncertain. These are hardly the right conditions for either of us to take an honest look at ourselves and be open to behaving differently. It’s like a parent telling their child who is struggling at school that if she gets good grades then they will love her. She will most likely become so anxious that she sabotages her own success.

Feeling motivated to do better comes from standing on firm ground. When we are anxious about the security of the relationship and whether the other is “in” or “out,” we don’t feel safe enough to focus on what we bring to the table. But we try nevertheless. Then we stumble and we get told, “There you go, I told you so, you just can’t help your bad character.” 

We start to attack and defend. The pendulum swings. When we are more “in,” the other is more “out.” When the other is more “out,” we are more “in.” We are never on the same page at the same time. With each incidence, we hurtle back down the ladder and start at zero. But still, we stay. And things stay the same. Up and down and a merry-go-round. We are stuck.

Just step in.

Gestalt Therapy theory talks of polarities. Think yin and yang, day and night. Where one behaviour exists, the polarity also exists. Within a shy person, there is an extrovert. Within a compliant person, there is a bossy person. When we don’t acknowledge both polarities, then we behave in an unbalanced way. Relationships also have polarity behaviours. What’s the opposite of staying on the fence? You got it—commitment!

…And commit.

Committing means no more conditions and blame. It means stopping the dance of pursuing, distancing, and showing up naked in the ring in front of the other. It means closing the exits and giving the relationship a chance to thrive. It means seeing disharmony as something to overcome and learn from—not as an excuse to exit.

It means deciding to not play the same old relational record on repeat. It’s tiring, confusing, demoralising, and clearly not working. It means addressing our “madness” and how the other triggers that in us.

Still scared? Deal with it!

We feel cautious. Can we trust the other? What if we go for it and it doesn’t work out? As Gestalt Therapy theory says, “whenever we take the risk of doing things differently we feel anxious.” It can’t be helped. It’s part of life. We can only avoid uncertainty and anxiety if we die.

Stop looking for perfection because you won’t find it. We work on accepting that our partner is a flawed human being, just as we are. Stop looking for your soulmate, because you wouldn’t know them if they were jumping up and down naked in front of you.

Philosopher Alain de Botton, in his refreshing and down-to-earth The Course of Love, discusses the concept of the soulmate, which arose with the romanticism period of European history. Until then, families chose matches that were mutually beneficial. We are supposed to recognise our soulmate instantly. We search high and low for that special person that feels “just right.” But as de Botton says,

“None of this has anything yet to do with a love story. Love stories begin…not when they have every opportunity to run away, but when they have exchanged solemn vows promising to hold us, and be held captive by us, for life.”

Chemistry is for the school science lab.

Dr. Young, who devised Schema Therapy, says that strong chemistry with someone can be a warning sign that we are attracted because they are similar to the parents that wounded us. For example, the woman abandoned by her father who chooses unavailable men. Or the man with the depressed mother who falls in love with a depressive.

The relationship won’t reveal itself like a flower growing in shit. You need to do the work. Rake the shit and prepare the ground.

Here’s how:

1. Stop blaming and criticising.

Psychotherapist Susan Anderson has coined the term “outer child,” which is the part of us that blames and criticises the other. The part that sabotages relationships. Similarly, schema therapy describes the “angry child” mode. We all have one. It directs itself at us as and tells us we are crap. We can start to become aware of it, even track it. We can also monitor the amount of blaming and critical thoughts we have toward our partner, and balance them out by thinking about what we like about our partner.

2. Stop defending.

We can stop defending ourselves so readily. Sometimes, we can’t admit to stuff because we believe (deep down) that to do so makes us a bad person. We will do anything to defend ourselves from the shame, which comes from a negative core belief. We might believe that “making a mistake” or “being imperfect” makes us a bad, defective, and flawed person.

Conversely, if my self-worth is not attached to my behaviour then I can say, “You’re right, I’m sorry for taking out my bad mood on you.” I still feel confident that I’m a good and lovable person. If acknowledging blame means I am now an awful, despicable, condemned person then, of course, I will defend myself like my life depends on it.

Unfortunately, many of us were parented in ways that fostered shame. Gestalt Therapist Robert Lee conducted a study on the internalised shame on marital intimacy. He found that couples with high internalised shame scored low in both marital intimacy and marital satisfaction. So, start challenging those negative core beliefs and believe you are entirely worthy and acceptable.

3. Ditch the ‘”if” and stay with the “now.”

In the heat of the moment when the other triggers us and we feel intense anger, anxiety, jealousy, or whatever else, we can use the mindfulness technique of embracing the feelings without acting on them.

You might need to take some space in order to do so. I don’t mean leave the relationship though! Tara Brach, psychotherapist and mindfulness teacher, has a great technique called the “Yes” meditation. Rather than resisting everything that is “wrong” we embrace it.

If I’ve had a spat with my partner, I distance myself physically, close my eyes, and focus on my feelings and body sensations. Firstly, I notice everything I don’t like. I don’t like what they have said. I don’t like that they have “triggered” me. I don’t like that I have fallen for the trigger. I don’t like that I got angry. I don’t like the whole situation, in fact, I hate it. I’ve had enough! And then I practice saying “yes” to every element I don’t like. I notice there is more space and I uncover a tender spot in my heart. My feelings become less intense and I can reflect in a more balanced way on how I want to respond to the situation.

If you do this, I cannot guarantee that you will live happily ever after. Things happen, life changes, jobs change, kids are born, parents die.

I cannot guarantee you will stay together. But it’s highly likely you will reclaim your broken parts and feel more whole, which is a much better foundation on which to build a love story.

References:

Anderson, S. ‘Taming Your Outer Child: Overcoming Self-Sabotage and Healing from Abandonment’, (2015), New World Library, California.

De Botton, A., ‘The Course of Love’, (2017), Penguin, UK.

Lee, R.G. (1994b). The Effect of Internalised Shame on Marital Intimacy. Unpublished doctoral dissertation, Fielding.

Yes, Our Parents Probably Screwed us Up a Little—Don’t Skip the Therapy.

Edited and first published by Elephant Journal.

“They fuck you up, your mum and dad.
They may not mean to, but they do
They fill you with the faults they had
And add some extra, just for you.”

~ Philip Larkin, “This Be The Verse”

Some clients arrive for their first therapy session skeptical, worried, or downright reluctant to talk about their childhoods.

I assure them I have no interest in getting them to do something they don’t want. Nevertheless, if they are willing, then I am curious—exploring their childhoods helps me to understand their concerns more fully. What they say is often something along the lines of:

“It feels indulgent, like I’m feeling sorry for myself when other people have had it so much worse.”

“That was then and this is now, and I don’t see how dwelling on the past can help me today.”

“I had a very happy childhood, and I don’t want to blame my parents.”

You probably don’t want to talk about your childhood because it fucked you up. And unprocessed childhood stuff can manifest as:

Negative Core Beliefs

The reasons given above are telling in themselves. Deeming oneself as “indulgent” suggests we have a critical inner voice. I could challenge you by asking, “What’s the problem with being ‘indulgent’ in your personal therapy session? What would that mean—to be seen as indulgent?”

Often, if we pursue the line of inquiry, it comes back to a fear of being somehow “wrong” or “unlikeable.” Childhood is often the time when these types of negative core beliefs are picked up.

Emotional Crises

Not wanting to dwell on the past might also mean we want to avoid difficult feelings. However, the fact that we are experiencing mental health issues in the present suggests that these difficult feelings, although avoided, are still around in a different form.

It is also highly likely that we use that same defence mechanism—of minimising our feelings by not dwelling on the past—in the present, too. We get angry but don’t say anything. We feel hurt but keep quiet. We feel scared but put on a brave face. This leads to a car-crash of emotions that pop up in unwieldy ways, such as panic attacks, violent outbursts, or floods of tears at inappropriate moments.

Self-Blame

The phrase, “I had a very happy childhood” coming from a client who is evidently suffering would make any good therapist’s ears prick up. It suggests a black and white, childlike way of categorising experiences as either very happy or very unhappy, with no room for grey areas.

What did you do, as a child, with experiences that didn’t fit into that category of “very happy?” After all, we cannot have been very happy all of the time, even with the best of parents.

Often, we have a strong sense that talking about our parents in a less than flattering way is wrong and makes us a “bad” daughter or son. We feel guilty for criticising our parents. We do not differentiate between our parents who may have had the best of intentions, and their behaviours, which may not always have been helpful, and could have been downright hurtful. We prefer to blame ourselves.

But if we don’t talk about it, we will likely remain fucked up.

According to Dr. Jeffrey Young, who devised Schema Therapy, our parents are responsible for providing: 1) nurturance, including reassurance, attention, affection, warmth, and companionship, 2) empathy,including understanding, interest, self-disclosure, and mutual sharing of feelings, and 3) protection,including strength, direction, and guidance.

Even in a household where the children grew into reasonably functional adults, they may have experienced parenting deficits.

I’ve worked with many clients who are very successful in several areas of life but suffer a highly critical inner voice, lack of self-esteem, high anxiety levels, or relationship black holes.

When exploring their childhoods, they discover that even if their parents meant well, something was missing in the quality of their relationships.

Perhaps nothing less than achieving 100 percent in school was acceptable, and the child would end up feeling “not good enough” if they came home with 95 percent. Maybe either or both parents found it difficult to express their own vulnerability, so the child grew up with no model about how to express emotions.

Perhaps one of the parents had a volatile temper so that even if their child felt protected most of the time, at other times they felt petrified around them. It may have been that one or both parents were so preoccupied with their own career that their child felt like an obligation on their to-do list rather than a person who they were genuinely interested to know.

So, here’s the thing: we need to talk about it.

It is only by recognising these relational deficits that we can identify where our negative core beliefs have come from and start to disentangle ourselves from them.

As adults, we now have the intellectual maturity—and perhaps the help of an outside therapist’s perspective—to recognise that just because our parent didn’t spend time with us, that didn’t mean we were unlovable. Just because our parent never seemed happy with anything less than 100 percent, that was their “stuff” and not ours, and did not make us “not good enough.” Just because our parent had a terrible temper and would say horrible stuff to us, that had absolutely nothing to do with us.

It’s about recognising that however we behaved as kids, our parents were the adults who were supposed to protect, nurture, and guide us. They could have loved us dearly and had the best of intentions, but this doesn’t mean we always felt like they were doing their job.

By identifying their behaviours rather than blaming them, and by challenging the negative core beliefs we unthinkingly picked up, we can also learn not to condemn ourselves in the here and now. We have less need to put up a front to others. We can be more open. We are more likely to put ourselves out there and recover more quickly when we fall.

To stop playing unhealthy patterns on repeat.

Sigmund Freud first coined the term “repetition compulsion.”

This refers to doing something over and over again due to an unfinished and subconscious experience from childhood that wants to be completed, or processed.

For example, if as a young child, we experienced feelings of abandonment, grief, loss, shock, and rage when one of our parents left the family home, what happened to these feelings? Let’s say we were under five. We might have cried or behaved differently, maybe stopped talking, become more withdrawn, or started wetting the bed. However, since we weren’t able to articulate our inner state so that an adult could sit down with us and help us to understand our feelings, our only way of coping was to suppress them.

And what if the person who evoked strong, difficult, and overwhelming feelings is also our main caregiver? The sarcastic mother’s cutting words chill her little girl’s heart, who, yearning for love, buries her shame to be her momma’s “good girl.” Children, terrorised by their violent father’s drinking binge, “forget” about their overwhelming powerlessness and helplessness when their dad apologises and says he’ll never do it again.

These feelings need to be processed just as rain drops need to fall, just as a pendulum needs to swing, just as an apple tree needs to grow apples.

This is what Gestalt Therapy theory calls “organismic regulation.” When we keep playing the same old unhealthy patterns, like falling in love with unavailable partners who abandon us, or marrying abusive partners where we feel trapped and powerless, or dating arseholes who treat us badly—those are our buried feelings stomping up and down, waving red-faced and screaming, “Wake the fuck up! Grab this opportunity to heal so you can start doing life differently.”

For this to happen, we need to talk about your childhood.

To feel more at peace in the present:

Coming back to those overwhelmingly difficult childhood feelings that were not processed, what happens when a current situation provokes the same feeling? How can we allow ourselves to feel it if we’ve never learned how? How can we get angry with someone when we’ve never learned how to “do” anger?

Some might reply that they don’t need to feel anger, but anger is a perfectly valid emotion and is as worthy and equal as any other emotion. It’s how we express it that can be problematic, not the emotion itself.

According to Gestalt Therapy theory, the function of emotions is to act as messengers. They let us know what it is we need and want from others and from ourselves. Once we know that, we can do something about it. So, if we do not acknowledge all of our emotions, we have a bit of a problem. It means that we limp through life without getting what we need. Depression and anxiety, among other symptoms, are the consequences of that lack of support.

Say, as a child, we didn’t allow ourselves to feel abandonment rage because it wasn’t acknowledged by anyone. It feels overwhelming and scary, so we bury it.

Then, our abandonment stuff gets triggered by a partner who says he is going on holiday with his family rather than us. The anger is there but we don’t allow ourselves to feel it. We feel anxious instead. Or we start to numb ourselves and withdraw from the relationship. Or we start to make cutting comments and become passive-aggressive.

We do anything rather than allow ourselves to feel anger, as that just feels way too risky. Thus, we don’t get to say, “I feel annoyed that you’re going on holiday with your family. It makes me think I’m not that important to you.”

Being able to say this could open up dialogue to find some kind of compromise or at least be assured that you are important to your partner. Taking the risk of expressing anger and having it well received gives you the new experience that expressing anger is okay. By not expressing it, you are playing by the old rules that you learned as a child—that getting angry got you nowhere, it was futile, and it tended to boomerang back onto you.

This goes for other feelings too. For example, and without wanting to oversimplify, buried shame can lead to perfectionism and being hyper-critical. Buried fear might manifest as obsessive compulsive disorder and controlling behaviour. Suppressed grief is often linked to depression.

The idea of allowing these feelings is scary because they were scary when we were children. However, taking the risk of allowing them in the present leads to feeling all the other “child-like” feelings that might have also been suppressed. such as joy, excitement, courage, and a sense of empowerment.

“Man hands on misery to man.
It deepens like a coastal shelf.
Get out as early as you can”

So, like Philip Larkin, I suggest you get the hell out of misery as early as you can and to do that, let’s sit down and talk!
~

 
Author: Alexandra Schlotterbeck
Image: simpleinsomnia/Flickr; Xavier Sotomayor/Unsplash
Editor: Catherine Monkman
Copy Editor: Travis May
Social Editor: Callie Rushton

What if I’m going crazy? What if it's contaminated? What if I lose her? - How to Be Free of OCD

OCD refers to obsessive compulsive thoughts and behaviour. These can include obsessive thoughts around four types of vulnerabilities which are: 1) health and illness, 2) danger, 3) poverty and 4) losing control.  Specifically, we can think obsessively about sex, death, relationships and contamination, amongst others. We may behave compulsively by cleaning, checking and double-checking or repeatedly asking our partner the same question. We also tend to avoid certain situations which make us feel particularly anxious. On a physical level, it is common to experience a tightness in our chests, shallow breathing, sweaty palms, palpitations, dizziness or brain fog when in the grips of obsessive and compulsive thoughts and behaviours. We may also generally feel low in mood, lonely, empty and tired because of our condition. 

What If?

Underlying the specific nature of the thoughts and behavour is the ‘what if’ question. For example, ‘what if I didn’t lock the door on my way out?’ Or, ‘what if the food I am eating is contaminated?’ Or, ‘what if I picked up the knife and tried to stab someone else (or myself) and what if this means that I am going crazy? In his highly acclaimed book, ‘Freedom from Obsessive-Compulsive Disorder: A Personalised Recovery Program for Living with Uncertainty, Dr Jonathan Grayson explains that regardless of what the specific nature of the OCD is, the bottom line is the difficulty living with uncertainty. He goes on to say that whilst we all struggle with uncertainty to an extent, particularly around the existential uncertainties in life such as birth, death, life changes etc., those with OCD find uncertainty and the resulting anxiety, particularly difficult to manage. This is at the core of the disorder, regardless of the specific thoughts and behaviours. Indeed, it is common for the nature of the OCD to change over a lifetime. One might start with obsessive thoughts about killing oneself or another and then move on to obsessive thoughts about whether we really love our partner. It is common for OCD symptoms to disappear for months to years or to at least subside and feel more manageable and then to reappear or worsen at life transitions such as graduation, changing profession, getting married, having children or retiring. We can imagine the present subject or subjects of our OCD as the current actors on the stage whilst the difficulty with uncertainty, the backdrop to the scene, remains the same. The scenes and the actors come and go but it is the backdrop, the difficultly with uncertainty which does not change. I use this metaphor because in terms of treatment it can feel tempting to want to ‘talk out’ the OCD. Often this might lead to feeling better temporarily, however since the underlying issue is around uncertainty and no therapist can give us 100% assurance on a ‘what if’ question, it is far more fruitful initially to focus on the difficulty with uncertainty.

Why do some individuals find uncertainty so difficult?

Clinical research shows that there can be neurological differences in some OCD sufferers. To simplify greatly, this means that there are some neural pathways going from the orbital frontal cortex to the cingulate gyrus, to the thalamus and back to the orbital frontal cortexwhich act as a negative feedback loop. See this explanation from the BBC http://www.bbc.co.uk/science/humanbody/mind/articles/disorders/causesofocd.shtml

These parts of the brain are responsible for OCD like behaviour. When one of these parts is not working properly then we can have OCD symptoms. Other research suggests that OCD is linked to a  low level of serotonin. For this reason it is worthwhile considering the option of taking an SSRI or anti-anxiety medication, particularly if therapy alone does not help or if there is also low mood, dysthymia or depression. In my experience, clients are often wary of becoming reliant or medication or think that they should be able to ’sort their problems out on their own’. I suggest that taking medication should be discussed with a psychiatrist but can been viewed as an additional support. Sometimes we feel too overwhelmed with our OCD symptoms to be able to engage in therapy. In these cases, medication can help take the edge off, particularly since starting therapy can sometimes temporarily increase our anxiety and worsen our symptoms. However in my clinical experience, whilst medication can improve symptoms, it is not enough to stop them and this is why therapy is also necessary.

What is the treatment for OCD? 

Exploration of Adverse Childhood Experiences

Whilst some argue that OCD is purely a biological matter, I have found that all OCD clients have experienced significant circumstances in their childhood where there was a backdrop of uncertainty and a feeling of not being in control. Sometimes it takes bit of exploration to identify this. Many of us feel very protective of our parents. We might feel guilty exploring childhood difficulties with a therapist, as if we are betraying our parents. It is also fairly common not to remember too much about our childhood or to emphasise how we were so lucky and had such a good childhood. The fact is that however good our childhood was, we all experienced some hurts, upsets, minor traumas or full-blown trauma along the way. This is simply because our parents are human and no human is perfect. Even the most well -meaning parents may have unintentionally negatively impacted their child or children. Whether it is because they parented in the same way as they were parented so thought that their behaviour was normal. Or because they were not fully available to their child due to overworking, depression, alcoholism or OCD, amongst others. In fact it is common for an OCD sufferer to have a parent who also struggles. Sometimes the parental wounding can simply be because you have different temperaments. For example, an outgoing mother with a shy introverted child might unintentionally wound the child when she insists that they sing in front of the whole family at every family gathering. 

Schema Therapy

A common theme in childhood experience of OCD sufferers is having felt ‘not good enough’ or insignificant. Perhaps there was conflict in the marital home and the child was not given the attention they needed. Perhaps one had to compete with other siblings who demanded more of our parents’ attention due to special needs. Maybe we were bullied at school and didn’t tell anyone so didn’t get the support we needed. Perhaps we had a parent with a volatile temper and felt as if we were constantly living on egg shells. We might at times have felt alone, insignificant and lacking the reassurance and empathy we needed from one of our key care givers. Dr Jeffrey Young created Schema Therapy which is an effective tool for uncovering childhood situations which have left an unhealthy mark on our psyche. Schema Therapy also provides a treatment model for how to heal these schema. Schema is the name coined to refer tothe particular type of difficult childhood circumstances we experienced that still impact us in an unhelpful way today. These do not need to be ‘ Big T’ traumas. Often ongoing and seemly low-grade traumas such as a parent being preoccupied with depression can have just as damaging an effect.  There are around 18 different schema and the one which relates to OCD is the Vulnerability to Harm and Illness schema.

Gestalt Therapy 

Gestalt therapy posits that anxiety is the feeling of excitement when we are not allowing ourselves to fully breathe. The Gestalt definition of excitement refers to the whole range of outward going and forceful e-motions including not only excitement but all types of anger from feeling irked, irritated, annoyed, frustrated, angry, enraged, hateful, spiteful, malicious, vindictive and murderous, to name but a few. In my experience, clients with OCD often have a difficult relationship with anger. They believe that anger is a ‘bad’ emotion and that it is unhealthy. They may try to bypass their anger. Either we don't feel anger at all or we bottle it up or get angry with ‘the world’, current affairs or  public transport services, for example. We find it difficult to own and express anger assertively and directly to another, usually a significant other. We might be passive-aggressive or deflect our anger by getting irate with the shopkeeper who short-changed us rather than our partner who pissed us off. We fear that expressing anger directly is risky and that we may end up losing the person we love if we do so. We have normally learned early in our childhood that getting angry is risky. We may instead internalise our angry feelings and become angry with ourselves. A common denominator in all OCD clients I have worked with is the very critical inner voice. Often clients are accompanied by a constant narrative about just how terrible, incompetent or ridiculous they are for having OCD symptoms. They blame and get frustrated with themselves. This then causes us to feel even worse about ourselves and never resolves our OCD. Therefore an important part of therapy is exploring how we learned that expressing anger was risky, how we can learn to express it appropriately, and how we can develop a more compassionate voice to ourselves.  Often this  includes experiential work where we look at where the misplaced anger really belongs and where we fight back against the original person who made us feel bad as a child.

CBT

This is clinically proven to be effective in the treatment of OCD. It is premised on the idea that our thoughts affect our feelings which then affect our behaviours. For example a thought such as ‘what if I were to pick up that knife and cut my wrists?’ leads to a feeling of anxiety and a behaviour of eliminating all knives from the house. If we can challenge our thought and replace it with something more helpful then we don’t feel anxious and we are ok with knives in the house. Challenging the thoughts and beliefs entails firstly logging them to see what kind of unhelpful inner talk we have, and then analysing them for cognitive distortions such as catastrophic thinking, ‘black and white thinking’, fortune telling, amongst others. See this link for a full list and explanation of thinking errors. We also look for the evidence to suggest our thought has significance. For example is there any evidence which supports the idea I might cut my wrists? Have I ever done that before? Probably not. The second part of CBT is the behavioural part where we start to expose ourselves to situations and thoughts that are difficult for us until they no longer affect us. For example we tolerate eating with a fork that might be contaminated and when we do it enough times, we realise we can handle the uncertainty and the anxiety that accompanies it and it is no longer a big deal for us.

Mindfulness

To oversimplify, this is holding the knowing that all our experiences are temporary and often momentary. By reframing how we view our symptoms, we give them less power. For example, think about how different it feels to say to yourself, ‘In this moment I am feeling anxious’ or ‘right now i am having a thought that the spoon may be contaminated’ rather than simply focussing on how anxious you feel or how dirty the spoon might be. Mindfulness Based Cognitive Therapy (MBCT) has also been clinically proven to be effective for working with mental health disorders including depression and OCD. A great resource to learn more about mindfulness is Tara Brach's website.

Sensorimotor Therapy

Dr Pat Ogden, co-author of Sensorimotor Therapy offers an alternative to the CBT approach. The idea is that we can alter the faulty neural pathways that lead to OCD and anxiety by introducing somatic interventions. Dr Ogden describes the building blocks of experience which include 1)our thoughts, 2)emotions, 3)body sensations, 4) movements and 5) remembered images, smells or sounds that may come to mind as we focus on these. If we can change one of the building blocks in our well-trodden neural path then we can break the path and behave differently.  This might mean having the ‘what if’ thought but not allowing it to take hold. One of the ways we can break the old pattern is by working directly with our bodies. For example making the opposite movement that our body wants to make when we are feeling anxious such as lowering our shoulders and standing straight rather than raising our shoulders and hunching over. Somatic interventions are also offered for the client to try which help to reduce anxiety. Learning techniques to master anxiety gives us a sense of mastery and can give us the confidence to engage in the next steps of therapy.

I believe that having expertise of all these approaches means that the client and I have a highly equipped tool box for tackling OCD. Some clients are ready to get started with CBT straight away and others find this more difficult in which case we may start with exploring key schema, mindfulness and anxiety management techniques until they feel ready to start CBT. Others respond well to the benefits of a containing and nurturing therapeutic relationship and a Gestalt Therapy approach.