I have OCD. I am also the founder of OCDFirstAid, a London-based OCD treatment centre. My OCD began as I entered my teens in the late 80’s/90's. I had no idea that there was a name for the strange stuff in my head, let alone treatment. Doing everything 4 times (or multiples thereof), associating bar codes with death, avoiding the colour red, amongst 100’s of other wierd symptoms. After hobbling along for 10 years I tripped over CBT in my early 20’s and adapted it to my own OCD, courtesy of a kindly therapist who freely admitted she knew little about the condition. The lack of knowledge, help and support for people and families of people with OCD was all-pervasive. OCD treatment was a rare and elusive thing.
After working in finance and PR, I gave up my career for lack of interest and a growing sense of something more meaningful. I volunteered for an anxiety charity whilst studying and establishing my own OCD treatment protocol. I found myself inundated with OCD enquiries on the helpline. The gold standard for treatment at the time was Seroxat. Being medication averse (common in OCD) my interest was peaked and I was determined to find a medication-free solution. So after some applied learning via the charity, I started my journey with a Masters in CBT. Soon after qualifying I established the OCDCentre, which later became OCDFirstAid. Over the last 15 years I have split my time between New York and London, observing the cultural and professional differences in mental health care and OCD treatment. From the barely disguised psychoanalytical options in New York, to the barely functioning NHS CBT-based offering in the UK, there still exists an international need for highly specialist treatment for OCD. One that is based upon efficacy rather than medication, ineffectual protocols or a bureaucratic squeeze following another budget-serving whitepaper. My goal was to establish a gold standard for OCD treatment: the optimum combination of education, anxiety management and psycho-therapeutically robust techniques. It has been a lonely road. In the US they admire entrepreneurship & private practice but medication is king. In the UK, medication is met with open suspicion and the more socially-minded are known to spit on private practice. Any association between mental health and entrepreneurship is considered at best, unethical, at worst, illegal. Thank you NHS. The cumulative result of which is often life-threatening procrastination, low levels of self-responsibility and an unhelpful sense of entitlement against a continuing background of poor NHS provision. It’s a lose/lose.
Sadly that hasn’t changed. But many other things have!
The world is a dramatically different place relative to 2003 when I first practiced and ordinarily, in the case of other conditions, technological and medical innovations would be the only independent variables, but this isn’t necessarily the case with OCD — and for reasons you might least suspect. Who would have thought that one of the variables would be cultural or social? I have always conceptualised OCD as emotional hypersensitivity so that (thanks to Dr Jeffery Schwartz) I realised that people with OCD over-respond to emotional triggers across the board, and not just those with anxiety-provoking implications. People with OCD feel the full gamut of the emotional spectrum more acutely — anger, disappointment, rejection, you name it! I believe that the outcome of this biological anomaly is that people with OCD are highly sensitised to their environment (and its changes), much more so than other mental health conditions. This can be witnessed in response to ‘new’ OCD obsessions fuelled by the media, e.g., the media’s concentration on paedophilia cases and the current media fascination with all things celebrity and most significantly, their relationships. These trends have coincided with an increased presentation of clients with responsibility paedophile concerns and also relationship neuroses. Hence, OCD evolves according to social and cultural emphases.
The other aspect of our modern existence that has affected OCD is the dominance of the ‘self’, i.e., ‘selfies’, ‘self-awareness’, ‘self-marketing’, ‘self-absorption’, ‘self-analysis’, ‘self-diagnosis’….need I go on? It isn’t all bad. Who wouldn’t welcome the opportunity for people to take advantage of access to information so that they can make more informed decisions regarding their mental and physical healthcare? Obviously this is a huge step forward from the days of relying on the lucky dip of a single medical opinion from one’s local GP, who is often under pressure to meet timelines and patient quotas. Nevertheless, the OCD hours spent researching online, reading forums and just ‘thinking’ (I have clients that set aside days from work to ‘think’) are not conducive to recovery. Researching online is now in our ‘Top 10’ of compulsions across all sub-types.
Which brings me to what else lurks online and this is the proliferation of treatments and interventions for OCD. Some of course, are helpful, but many aren’t and so online marketing rather than therapeutic skills, credentials and experience is king. Anyone with online marketing skills can present themselves as a viable therapeutic option, especially to those who are vulnerable and desperate for help. It is possible that options such as Chinese medicine, herbal remedies or hypnotherapy may have complementary benefits but it still remains that the only evidence-based intervention for OCD is cognitive behavioural therapy (CBT) and even then, we firmly believe that a sub-set of CBT, namely Rational Emotive Behaviour Therapy (REBT), is a much more robust intervention for OCD. We adjunct this with other approaches but REBT is an integral component of our protocol.
In my own early search for help with OCD I fell foul of a lack of information and now, as a practitioner on the ‘other side’, I believe people are deluged with a confusing excess which detracts from finding effective therapy. All therapists run the gauntlet of others thinking this an easy commercial opportunity and so access to information can be risky!! Therapy can seem nebulous at the best of times but therapy for OCD requires a particular type of acuity. People with OCD are, by default, articulate and perspicacious so countering their complex, highly developed yet irrational obsessions requires sharp wits and proficiency. Hopefully in time, the quality and composition of OCD therapy will become standardised.
Finally, our collective preoccupation with all things ‘comfortable’ including the categories of convenience, quick-fix and control. This is the big variable and it’s gathering speed and size. As a society we have moved further away from our grandparent’s notion that ‘life is difficult’ and closer towards the idea that ‘life needn’t be difficult for me if I can just find a way to get round it…….’, supported by the media and advertising industries who naturally know we are seduced by comfort and are in the business of selling us ideas, services and goods we want but are not necessarily good for us. I often think that Scott M Peck’s ‘The Road Less Travelled’ was a last ditch attempt in the 80’s to halt the downslide! And everyone bought it….but gave up anyway because life was just too hard!
It isn’t rocket science that my single parent clients relapse less often than my teenage clients who have loving and very obliging parents. The former has to get better and the latter doesn’t — well, not yet anyway. It’s a sad reflection of something but what we stand to lose is far more motivating. Concerned parents should always know that their child will only get better if they see the benefits of changing, or the penalties of not changing or both. If neither, then they aren’t ready to change.
In summary, the world in many ways is working against people with OCD so that we therapists are often playing catch up. We, and society, like to believe we are proactive but instead we are reactive — to environmental stressors and influences outside our control. The idea of control, certainty, comfort — so integral to the core issues of OCD. I am aware that I deal with a condition that runs, nay sprints, towards these three ideals in a constantly changing, uncertain, chaotic world that lies to my clients. It tells them that the impossible is possible, their irrationality is rational and what’s more, loads of others would agree. I’m a therapist but really, I’m a dealer in answers and sometimes I have to limit these to no more than 5 per session………….
The big answer of course, is acceptance and the road less traveled, which is the cornerstone of what we do. Encouraging and supporting our clients to do the stuff of their nightmares. The basic premise isn’t rocket science — but shaping their detailed and complicated non-acceptance into acceptance requires conviction and guts! As I said, it’s a lonely road. Then, when they recover, there they are, ‘newly rational’, realising that the rest of the world is nuts. Ha! Join me on that road, I say.