I’ve had many clients and spouses state at the beginning of their exposure therapy that they are practicing ‘paradoxes’ to prove to themselves how ridiculous their OCD is. I’m all for seeing OCD as ridiculous– however, OCD is not treated by insight-oriented approaches (psychodynamic, general psychotherapy- i.e., “talk,”).
Paradoxical interventions work like the following example:
Your child wishes to avoid vegetables altogether, so you fix a tasty dish with yummy veggies and tell them it’s ‘adult food’ or ‘you probably won’t like it’ or ‘you probably need to be a big kid to enjoy this. The child’s curiosity is piqued, and they start to cajole you into sharing. (Trust me, it doesn’t always work.)
Purpose and Techniques of Paradoxical Interventions
The purpose of these interventions is to help the person see more clearly, or gain insight, into their role in maintaining a problem.
The techniques are multi-fold and applied variously, but include:
- Prescribing the symptom they want to change.
- Especially if a patient believes the behavior/symptom is involuntary, you are trying to help them see what control they may or may not have over it (Howes, 2010).
- Recommend keeping things the same despite the client stating they want change.
- Attempt to reason that all changes they would make would be worse than where they are (Foreman, 1990).
These attempts can help some people. By and large, paradoxical interventions aren’t a fit for OCD treatment. They are meant to address poor insight, and not as a first resort. Most people in OCD know their behavior and/or thoughts are not typical- at least at some level. Most sufferers want to change how they approach their thoughts and behaviors. To even be diagnosed OCD, obsessions are defined as “intrusive, unwanted.”
This Is How We Do It
Cue Montel Williams’ This Is How We Do It. If you’re a clinician, unless you have a severe case where a client has lost insight and have reasonably considered first line methods, paradoxical approaches are not a fit. If you’re a client, remind yourself of what you’re doing in Exposure and Response Prevention for Obsessive Compulsive Disorder:
Exposure therapy helps clients to systematically confront fearful stimuli along with changing fearful responses. This relearning increases confidence and decreases disruption in life. Over time, discomfort and fear typically decreases through active engagement rather than avoidance, suppression, neutralization, or ritualization.
The Real Real
Navigating OCD is incorporates new learning based on facing fears, intentionally living life, and non-engagement with rituals. This is done over time, with client buy-in. Expecting to “see the light” once and forever be changed by some stroke of insight is a fool’s errand. It doesn’t work that way. Okay, fine, maybe 1 in a million. But I’m not going to hang my hat on getting lucky. Are you?
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