We are what we (continually) commit to do

When my clients ask me, following an intensive treatment, how much time they should spend working on their OCD, I give them a scale. At one end of the commitment scale, there are recovering alcoholics who have usually undergone a 6 week detox/rehab followed by a half-way house, plus a commitment to 365 AA meetings in their first year (some of those meetings are hours long), supported by therapy, checking in with their sponsor every day and completing their 12 steps. At the other end of the scale there is zero. Every client is different but my answer is that they need to pitch themselves somewhere along this scale and the further away they are from zero, the more functional their lives will be. The key message is that therapy for OCD isn’t a quick fix. The same is true for most mental health disorders. You’d be surprised, after so much suffering followed by treatment, how many clients walk away with no intention of keeping the work up. The reasons are intrinsic and extrinsic:

• The default setting of our mammalian brains to avoid discomfort

• The mistaken idea that they are fixed (rarely promoted by the therapist)

• The experience of having OCD is so traumatic that any future reminders must be avoided

• The shame of having OCD or a mental health condition

• A dramatic change in circumstances, e.g., a new relationship, job, graduation, travel or move

• A lack of personal responsibility for their mental health

• The absence of an incentive to manage their OCD or the absence of penalties should they not manage their OCD

• A change in physical health

• Continued collusion by carers, families or friends

• The existence of a co-morbid disorder such as an addiction, eating disorder or depression (which impacts upon a person’s motivation to manage their OCD

Managing OCD, like love or physical fitness, is most certainly a verb and a commitment to do something, day-in and day-out. I don’t believe the AA or 12 steps treatment model is appropriate for OCD but some of the philosophies are complementary, particularly the idea that managing life-span conditions with high rates of relapse depend largely upon self-responsibility and commitment in the long term. The AA emphases upon personal responsibility, service and daily support/checking in plus sharing wouldn’t be out of place in a comprehensive OCD treatment model. Our programme includes a whole section on personal responsibility and we have encouraged sharing in the past but we are a rarity. OCD therapy tends to be a solitary, nebulous process where clients have little to no idea of the therapeutic approaches involved, evidence of the therapist’s efficacy and few opportunities for interaction with clients managing their OCD.

Over the years, we have sought to build a community but during this lockdown year, it has been our main focus. Our bi-monthly intensive follow up groups in person were out of the question. Therefore, since the announcement of lockdown in March 2020, we have run a free weekly online Zoom with WhatsApp group which has sprouted legs and become its own entity. We wanted it to be supportive, solution-focused and boundaried but it has become so much more than that. The members contact each other, text & share progress updates, anecdotes, support and inspirational messages during a time when isolation is the norm rather than the exception. From this nucleus, online events such as quizzes, escape rooms have developed and something much more than that. For us, it has been both a model and a source of evidence that people with OCD require ongoing support more akin to the AA model of recovery and staying well. The habitual component and high relapse rates associated with OCD aren’t easily managed in the long term without accompanying support. Bearing in mind the average term of therapy in the United States can be 5 to 10 years, here in the UK, differing mindsets towards therapy and financial constraints render that model less feasible. Weekly support sessions for 5 to 10 years are outside the capability of many clients but support in the guise of a weekly peer group plus social media has proved remarkably effective assuming that correct boundaries are in place. It offers a viable solution to the dilemma of social connection being essential to most aspects of health and well-being plus a clinical requisite for solution-based support.

It can’t be any secret that a major part of the success of the AA model lies in peer support by experience and the availability of a support group at any hour of the day or night in major cities of the world. Our weekly group has moved us closer to that model and hence, I would like to add a final bullet point to those above:

• Lack of consistent, solution focused, non-judgemental, accessible peer support

Bearing in mind our new Instagram account with daily updates for all plus live interviews with our clients, this has been our year of sharing. We may have been impelled by circumstance but we are now fully signed up. This is, above all, relapse prevention at work. ‘They’ say, that it takes 10,000 hours to become an expert at any given skill and it takes AA members 7 years of being sober to achieve their Bronze Sobriety Chip so we hope we are helping our clients to accept the tricky notion that relapse prevention is the holy grail of OCD wellness. Becoming their own expert doesn’t happen overnight and more importantly, learning the violin or Spanish is one thing, but not managing OCD is quite another.

Merry Christmas and love to you all.

This blog post is dedicated to the awesome group members for their ongoing commitment to themselves & others.

Photo credit Kazuo ota