Cognitive Pearl #038 Shevat 7, 5775 January 27, 15

In my previous post I touched on the importance of the cognitive therapist’s presence in the treatment of OCD. Now let’s get back to understanding what needs to be done. 

The most important part of treatment involves ERP or exposure response prevention. ERP, just as it sounds, is a brutal, liberating, and ultimately joyful process of standing up to the terror that fuels the obsession and compulsive behavior. The route to ERP goes through a full understanding of the ‘story’ of the obsession and compulsion. What we are looking to do is to break things down into their components so that ERP procedures are used purposely and accurately.

We do this through listening attentively and compassionately to the story. We understand that clients will inevitably filter what they tell us; perhaps they are embarrassed or they believe that some detail is irrelevant. At this point however we need to hear it all. Reassurance and determination will go a long away to getting everything out on the table.

We are especially interested in the internal dialogue known as ‘self talk’. Human consciousness is characterized by a sound track of internal dialogue, reflection, and consideration between all or many parts of our inner world. Much of this world is known as implicit cognition. The back and forth between self talk and implicit cognition contains much of the story of what evokes the obsessions. By tuning in carefully, through patient and thorough understanding, we’re ready to move the client to the next step.