Obsessive Compulsive Disorder (OCD): A Case History
Should we be treating more than the compulsions and obsessions?
by Daniel Kronenberg PG Cert (Clin Hyp), BSCH (Assoc)
The following is a case history of a client with OCD. Full permission from the client has been given to publish her story.
Jane (not her real name) came to see me concerning her obsessive checking behaviour which she’d carried out for the past 7 years. She was now 27 years old, held a very responsible position within a hospital and had a generally positive outlook on life. Jane told me she had been to see her GP about her behaviour and had been sent to group and one-to-one Cognitive Behavioural Therapy (CBT) / Counselling for support where she had learnt some coping skills and strategies which helped on some days but not when she was experiencing high levels of stress. The CBT sessions had lasted for 12 months.
When Jane came to see me, she still checked every single electrical item, all the light switches, the windows and taps in every room of her flat. The checking was not a simple matter of a quick look and then leaving the flat; Jane would check a room, move onto the others but then at the end of all the checking she would doubt herself and begin the process again. This could be as much as checking each room 5 times before she forced herself to leave the flat. Even when she was out at work, or elsewhere, she would have some background anxiety plaguing her as to whether she had really checked thoroughly. Jane would also check other places where she had to leave such as holiday accommodation. Jane’s OCD would be classed as of moderate severity as it occupied one to three hours of her day.
OCD is described by the NHS as:
“A mental health condition where a person has obsessive thoughts and compulsive activity. An obsession is an unwanted and unpleasant thought, image or urge that repeatedly enters a person's mind, causing feelings of anxiety, disgust or unease. A compulsion is a repetitive behaviour or mental act that someone feels they need to carry out to try to temporarily relieve the unpleasant feelings brought on by the obsessive thought.” (1)
Even with this definition, it is hard for those of us who don’t experience OCD to fully imagine the emotional impact that such a condition has upon the sufferer’s mind. This includes a constant sense of self-doubt, anxiety and a sense of wasted time – always seeking satisfaction and comfort from the obsessive behaviour but never finding peace. When I asked Jane to tell me what would happen if she didn’t check her flat before leaving, she looked mildly anxious and said that the desire was so strong and overwhelming that she would have a panic attack. She said that even though she knew logically that leaving a single item on was not a high risk, she still had a worrying feeling that if she didn’t check everything something bad would happen.
Jane’s goal for therapy was to be able to trust herself more so that she could stop checking everything or at least check only once before leaving home.
During the initial consultation, I asked Jane when the OCD had begun and what had been happening at the time. She had a very clear memory of this and described her time of living in a shared flat at university with a very unbalanced young man who caused a great deal of emotional stress for others in the flat. He also had a habit of leaving the cooker on - “He tried to burn us down three times,” Jane said. She still showed signs of heightened emotions and was agitated when talking about him. The checking behaviour had begun during this time.
I instantly felt that if this initial event, which still appeared to carry a strong emotional charge, could be processed then Jane could possibly have some relief from what could be a key emotional component of her condition. During this session, I applied the Rewind Technique (2), targeting the memories connected to her flatmate.
Jane reported at her next session (two weeks later) that she was no longer concerned about her flatmate and the memories now felt distant and no longer so important in her life. More importantly, two days after her last visit, she found that the number of checking times had dropped down from 5 to once or twice. She also reported that the sense of self doubt was not so strong, she felt calmer and more rational and the anxiety around the issue had disappeared when she was not at home. She had also been away on holiday for a week and had not thought about her flat the whole time. She commented that this had been the best she had felt around the issue since it had begun.
The second session of hypnotherapy focused on helping Jane develop a better sense of gaining more awareness of the reality of when she had checked and trusting her own perceptions of the world around her. I also used the Rewind Technique again, in another context, so that Jane could feel more comfortable with the possibility of not checking.
A week later, Jane told me that the day after her last session she had left something on charge at home and had gone out knowingly without concern. A day after that, she had gone out without checking most items in the flat and had no stress or anxiety about this when she was out. On the day she came for her third session, she told me she hadn’t checked anything and wasn’t stressed at all. I asked her if she had forced herself in any way. She said it had been easy and even though she had been stressed in a personal relationship and had not slept well, it had been fine to just leave the flat to come and see me.
Jane came to see me 2 more times to make sure we had completed the necessary work together and even though she had experienced very distressing personal news a couple of weeks after the OCD behaviour had ceased, which initially raised concerns in me, the checking and associated anxiety did not return.
As to the question, "should we be treating more than the compulsions and obsessions?" – very little of the therapy actually focused directly on the obsessions or compulsions and yet Jane feels she has moved on from her OCD successfully. Sometimes it is helpful to target the underlying trauma, which initiated the behaviour, to produce a positive result for the OCD sufferer as well as manipulating the process of the compulsive behaviour within hypnosis. In Jane’s case, it appeared that this approach gave her the necessary input to be able to detach herself from the hold that the OCD had previously had on her life.
Daniel's website is: http://www.dkhypnotherapy.co.uk tel: 07472 134 824
1. From NHS Choices website http://www.nhs.uk/conditions/Obsessive-compulsive-disorder/Pages/Introduction.aspx
2. For more about The Rewind Technique http://dkhypnotherapy.co.uk/the-rewind-technique.php