Therapy for OCPD: How Treatment Actually Works

Let’s imagine that you decide to go to therapy for  OCPD (obsessive-compulsive personality disorder), to deal with your workaholic tendencies, need to control, and utter, uncontrollable frustration with people who are messy and don’t follow the rules. What needs to happen for it to be helpful?

First I’ll speak about what a therapist can do to help that you can’t do for yourself. Then we’ll talk about what you’ll need to do on your end to make your time in therapy effective. Then I’ll give a short example demonstrating how the interaction between the two of you can help.

Your Therapist’s Role in Therapy for OCPD

• Your therapist will help you to explore feelings you usually avoid. They will slow you down and ask you to experience those feelings long enough to see what you need to learn from them.
  • “Did you notice that you just said you were afraid no-one at work likes you, and then you rushed into what you need to do to get that project done? It seems you were avoiding feeling something. What was going on? What’s that fear about, and how do you usually cope with it? Getting stuff done?”

• Your therapist will help you see patterns of thinking, feeling and behaving that you don’t notice because you can’t be objective about them.
  • “Have you noticed that everything you’ve said so far in this session is about planning the future? What’s going on inside right now–in this moment–as you speak with me?”
  • “I’ve noticed that every time you accomplish something you feel it’s not good enough and you rush into a new project to get away from that feeling.”
  • “I know that you care about your sister, but the way you talk to her about what she’s doing wrong probably doesn’t leave her feeling that you care.”

• Your therapist will help you see patterns that you don’t notice because you simply haven’t had the training to recognize them.
  • “I suspect that the way you learned to connect with people when you were young affects how you use the passion and skills that you were naturally born with. If you don’t feel you have a secure connection with people, you might enlist your natural meticulousness to prove that you’re worthy of respect, but you do it in a way that actually pushes people away.”

• Your therapist will model an attitude of patience and realistic acceptance, and help you find ways to break your patterns.
  • “Yes, it’s true that you made a mistake. Welcome to the human race. If you’re perfectionistic and tell yourself that you’re a loser just because you over-reacted, it’s not going to help anyone. Let’s try to understand what happened rather than get into blaming yourself or other people. Next time you’re about to over-react PAUSE. See what you’re feeling and remember what’s really important to you. You might not be able to do this all the time at first, but with our discussions and practice you’ll get better at it.”

• Your therapist will challenge you to think about what’s most important to you.
  • “I know that you want things to be good at home. But what do you really want to happen as a result of criticizing your husband? Do you want to prove you’re right, or to have a family where people are safe, thrive and enjoy being together?”
  • “What did you want to happen by reaching partner at your firm? Now that you’re there, you’re still working like a newby junior associate. I think you’ve forgotten what your real goals in life are.”

 

Your Role in Therapy for OCPD

• Try to allow yourself to feel a full range of emotions, including the layer of emotions beneath anger. You may not be used to this. Say what you feel, not what you think. Emotions serve as a lubricant for a brain that has gotten rusty and rigid.
  • “I just realized that I might seem really angry about what’s going on, but now that I’m sitting with it, I realize I’m actually really sad that there’s nothing I can do about it. I think I’ve been trying to get away from that feeling.”

• Look for your own responsibility, what’s within your control.
  • “He really was being a jerk, but I didn’t have to respond the way I did. I think I was afraid of being blamed and I overreacted. I really like being right but I’m starting to wonder if it’s worth living that way.”

• Figure out why you’ve come to use work or control as a strategy to cope with difficulties.
  • “I remember when my parents said they were getting divorced. I figured it was my fault. I had always been a little perfectionistic, but when that happened I got really controlling, in a bad way. They ended up staying together, but I’ve never stopped being that way.”

• Use the everyday events of your life to identify your patterns such as judging, rushing, controlling, overworking. Connect the dots of the things you get caught in most often. Don’t waste time on behavior that’s just a one-off.
  • “I was in line at the checkout and someone was fumbling with their credit card. I wanted to give them grief for taking so long. Then I realized that there was really no reason for me to be in a hurry. I recognized I always feel urgency whether there is a need to or not. I push myself and other people out of habit.”

• Identify what’s at the root of your compulsive style. What’s really important to you that you want so badly to accomplish?
  • “I noticed how I work long hours so that we’ll have enough money for our daughter to get tutoring and go to a good college. And I get upset with her when she doesn’t get all A’s. But what I really want is to make a home were she feels loved and she feels she can pursue what’s fulfilling to her. I’ve put the cart before the horse.”

All Together Now

This separation of therapist and client roles is somewhat misleading. A major determining factor in therapy is how well the two of you work together, how much real interaction there is between you. For people who are compulsive this offers an opportunity to learn about how they react to people and how they come across to people.

“I ran all the way here. I hate to be late. I thought you’d be angry at me for not taking this seriously.”

“Actually I’m not angry at you at all and the last thing I’d think about you is that you’re not taking this seriously. Do you imagine that with other people too? I suspect that what you imagine people think about you is very different from what they really do. Is it possible that you actually appear to be so serious and pre-occupied with getting everything right that people might see you as indifferent to them?”

What’s harder to put into words about how therapy works is the experience that regular meetings with your therapist fosters. This is not just an intellectual exercise designed to make you behave more reasonably. A consistent and accepting exploration of your feelings cultivates not only awareness, but also increased comfort with who you are as you are, while still leaving room for growth.

Be patient and persist. You’ve been living compulsively for a long time. Don’t expect it to change immediately. If you’re consistent in your attendance, and you use you natural determination to work on yourself, your patterns will change sooner.