Breve strategic Therapy

““With the rotation of the head you don´t solve the problem, but there are perspectives, from which the solution results”

Shortened case study

Katherine, a young woman in her early 30’s, came into the practice. She suffered from a severe obsessive-compulsive disorder. She was married, had a good income as an architect and lived with her husband in a family house on the outskirts of a big city. For a long time, they both wished to have a child, and with the pressure of that desire to have children, came a grave intensity in Katherine’s obsessive-compulsive disorder. Before she left the house in the morning, she would repeatedly have to check that all lights were off, all faucets were actually turned off and all the valuables were still in place, as well as complete. Only then could she leave the house. Even so, sometimes she would have to turn back halfway to her office because she suddenly had doubts that this or that light could burn.

When she came into the practice, she was completely desperate because she was clearly aware of her “absurd” compulsions. In the first sessions, it was necessary to calm her, and to take this extreme pressure from her. I explained to her that she certainly had good reasons to carry out these checks, even though she may not always be aware of the reasons, which might have been buried deeply in her unconscious mind. After that, I gave her permission, to carry out the compulsive acts at any time, but she wasn’t compelled to, leaving that decision to her. Understanding and Permission from a person of authority (the therapist in this case) are of great importance to people suffering from OCD because they themselves cannot understand their behaviour and they feel a great deal of disapproval, even shame.

In other sessions, the so-called paradoxical interventions are applied. Instead of trying to suppress the compulsive acts, as is the case with behavioural therapy methods, the client is instructed to repeat the compulsive act at least ten times should she feel the need to perform an obsessional act. Something like this:

“If you feel the need to check all the lights in your house, you can do that, but if you do, you do it ten times, either you do not control, or you control ten times …”

That demand of performing the compulsions according to a certain pattern

stops the impulse. The own mechanism to suppress the compulsion impulses has been overruled. This creates a sense of liberation and the clients regain control over their behaviour. This is very crucial, because initially, they are powerless to the constraints.

Catherine was not once able to comply with the requests. She described the situation as if she had seen through her constraints for the first time. In a final session, the therapeutic procedure would be explained to her so that she can take good care of herself in the future.