Obsessive-compulsive disorder will be defined and examined
in relation to psychological approaches: psychodynamic, cognitive-behavioral,
humanistic, and family systems. The
philosophical origins of each approach will be discussed in addition to
identifying the goals of each approach.
The techniques and strategies of each approach will be explained. The affects of the approaches will be
discussed in relation to OCD treatment strategies. Also, the effectiveness of each approach in
relation to OCD, which will be based on treatment outcome research.
Obsessive-Compulsive Disorder
The International OCD Foundation defines OCD as “a disorder
of the brain and behavior. OCD causes severe anxiety in those affected. OCD
involves both obsessions and compulsions that take a lot of time and
get in the way of important activities the person values” (2012). OCD can cause uncontrollable fears which
causes the person difficulty functioning in everyday life. An individual suffering from OCD is
preoccupied with perfection, control, detail, lists, organization, order,
rules, and schedules.
The Psychodynamic Approach
The psychodynamic approach originated from Sigmund Freud’s
work. The psychodynamic approach is
derived from Freud’s psychoanalytic theory.
The approach has since been challenged, broadened, and adapted. The
psychodynamic approach to OCD focuses on the anal developmental stage, which
consists of the tasks learned during toilet-training such as learning
self-control and staying clean (Hansell & Damour, 2008). There are three defense mechanisms, which are
reaction formation, undoing, and isolation of affect. Reaction formation is when an individual
turns a negative impulse into a positive, or more acceptable, reaction. Undoing is when an individual uses behaviors
to counteract his or her inappropriate feelings. Isolation of affect is when the individual
separates his or her thoughts or feelings to distance him or her from negative
emotions.
Freud believed that people with OCD used a defense mechanism
known as fixation, which he defined as a “permanent attachment of the libido
onto an earlier, more primitive stage of development” (as cited by Feist &
Feist, 2009, p. 36). For example, an
individual with a fixation on eating or smoking may have a fixation with the
oral stage of development.
The psychodynamic approach suggests several treatment
options, which are free association (talking openly with therapist), resistance
(using defense mechanisms), transference (how the client feels about the
therapist), countertransference (how the therapist feels about the patient),
interpretation (comments from the therapist about the clients emotional
conflicts), and working through (the clients progressive mastery over feelings
and conflicts from speaking with the therapist) (Hansell & Damour,
2008).
The Cognitive-Behavioral Approach
The cognitive-behavioral approach originated on the
principals of learning and also stems from conditioning research carried out by
Skinner, Watson, Hull, Thorndike, James, Pavlov, among others and academic experimental psychology (Plante,
2011). The cognitive-behavioral approach tends to focus on observable and
non-observable behavior learned through conditioning (Plante, 2011). The goal of the cognitive-behavior approach,
unlike the psychodynamic approach, is to focus more on the present behavior
rather than pats behaviors to understand and treat OCD.
There are several techniques used in the
cognitive-behavioral approach such as contingency management,
counterconditioning, exposure, behavioral contract, participant modeling,
behavioral rehearsal, and thought stopping.
Contingency management is changing the behavior by changing the
consequence of the behavior.
Counterconditioning is developing a healthy response to stimuli. Exposure is when the individual exposes
themselves, either all-at-once or gradually, to what he or she fears. Behavioral contract is a document formed
between therapist and client outlining behavioral consequences. Participant modeling is when the patient
observes others behaving in the desired way.
Behavioral rehearsal is when the patient practices desired behaviors or
reactions until he or she does them automatically. Thought stopping is using behavioral queues
to stop thoughts and insert more positive thoughts in their place.
The Humanistic Approach
The humanistic approach developed in part from the
“reductionistic aspects of early psychodynamic theory, which viewed all
psychological symptoms as derived from sexual conflicts” (Plante, 2011, p.
50). The humanistic approach was also
derived from European philosophy and the work of mental health professionals
such as Frank, Rogers, May, Maslow, and Perls.
The goals of humanistic approach is to “emphasize the importance of
interpersonal connection, human freedom, and personal choice for emotional
well-being” (Hansell & Damour, 2008, p. 49).
Active listening is when the therapist listens intensely to
the patient using reflection, summaries, and paraphrasing, in addition to other
techniques. Empathy conveys to the
patient that he or she is being heard as well as understood. Unconditional positive regard is the full
acceptance of the thoughts and emotions of the patient. Congruence gives the patient the sense that
the therapist is being genuine.
Self-actualization is progression towards one’s fullest potential. Peak experiences are points in time where
self-actualization has been reached.
Visualization is a technique used during therapy where the patient
visualizes an individual in an empty chair to say what they need to say to that
individual.
The Family Systems Approach
The family systems approach attempts to utilize the family
as a whole to treat problematic behavior and emotions. Before the 1950’s the family approach was
foreign as psychologist only working with the patient suffering from OCD or
other mental health disorders. The
family systems approach is rooted in the Bateson Project of the 1950s.
Don Jackson founded the Mental Research Institute alongside another
Virginia Satir, another family therapist, in 1959. During the 1970’s especially, the family
system approach became increasingly popular among mental health
professionals.
The goal of the family systems approach is to improve
communication between family members, and bring attention to the whole family
instead of the problems on one individual within the family. “OCD is clearly a family affair yet many
clinicians may not be attentive to family responses to OCD symptoms, how those
responses facilitate the disorder and family dynamics that may result due to
the impact of OCD on every member of the family” (International OCD foundation,
2012, para. 2). Families tend to
accommodate the rituals of individual’s with OCD, which makes the family
systems approach extremely important to the remission and recovery of the
individual suffering from OCD.
Several techniques are using in the family systems approach
such as reframing, paradoxical intention, joining, enmeshing, and
disengagement. Reframing is changing how
the patient perceives a behavior.
Paradoxical intention is a technique where the patient actually acts out
their problematic behavior in order to feel more comfortable with treatment
options. Joining is when the therapist
becomes involved and apart of the family unit rather than an observer. Enmeshment is when the patient suffering from
OCD becomes over-involved and critical of other family member’s lives. Disengagement is the detachment of a family
member in an attempt to avoid emotional involvement.
Conclusion
Obsessive-compulsive disorder is complex and different for
each individual suffering from the disorder.
Each of the psychological approaches to OCD has pros and cons, which
should be evaluated by the psychologist before beginning treatment. The psychodynamic approach focuses on
childhood development and unconscious causes and effects of the disorder. The cognitive-behavioral approach focuses on
the present behavior displayed and non-displayed by the patient suffering from
OCD to better treat the problematic behaviors.
The humanistic approach assumes that the patient is innately good and
encourages personal-growth and eventually self-actualization. The family systems approach includes the
family as a whole in the observation and treatment process without focusing
directly on the patient suffering from OCD.
All of these treatment approached have good qualities and effective
treatment plans. It is up to the
psychologist as to which one or ones he or she will incorporate in the
patient’s treatment plan.
References
Feist, J., & Feist, G. (2009). Theories of
personality (7th ed.). New York, NY: McGraw Hill.
Hansell, J. & Damour, L. (2008). Abnormal
psychology (2nd ed.). Hoboken, NJ: Wiley.
International ocd foundation. (2012). Retrieved
from http://www.ocfoundation.org/
Plante, T. G. (2011). Contemporary clinical psychology
(3rd ed.). Hoboken, NJ: John Wiley & Sons.
