If you have experience with cancer treatment, you may already know what is meant when I say, “cut out the margin.” Margin is the edge or border of tissue that is being removed through surgery. Why can’t you just cut out the “bad” part? Why must you go further? Simply, it is only deemed clean when all cancer cells are removed; if you don’t remove the margin, you run the risk for recurrence. Treatment for OCD is not so different. To strengthen your outcomes and run a lower risk of relapse, you’ve ‘gotta catch ‘em all’ (compulsions). Let’s take a look at a therapy insider tip that you might not have gotten elsewhere: cut out the margin.
Why Clients Come To Me
Clients come to me ready to get unstuck. Ready to get their lives back. Ready to leave their house without a ridiculous layer of requirements they must adhere to until their anxiety lets them off the hook. To kiss their spouse without second thoughts of contamination or checking. To wash hands like their peers. To not be tormented by intrusive thoughts. To be less anxious. To be free. And many, many more reasons.
Part of the education process in my delivery of CBT [link when you have an article] from Day One looks at how you can gain as much victory as possible over your OCD- and this naturally involves looking towards the end of treatment- today. It’s important for you to know up front what you’re committing to. Though a client is often ready to move forward with their lives as soon as they see “good enough” progress, don’t settle for that.
Encouragement to Keep Going
It is important that we don’t just stop treatment once you get symptom relief. In fact, it’s important to remember what brought you to therapy in the first place. If you are treating a chronic and/or episodic condition like OCD, research is very clear on the need to take it to the endzone:
“Leaving untreated areas in OCD is problematic because it makes relapse more likely” (Gillihan et al., 2012).
I promise- this is not the same as perfectionism. I promise- this is not to hold you in therapy longer (I’ve got way too much important work to waste either your or my time). I will always try to balance celebrating your wins and working with your real-world limitations (cost, time, motivation, etc.). But I want to be very clear here: your long-term outcomes are directly connected to whether you get rid of all your compulsions or not (when possible). If you leave behind some untreated area of OCD, you are leaving room for the “whack-a-mole” presentation of OCD to grow. Fear always generalizes as it grows; unfortunately, you won’t be able over time to stick with one manifestation without it growing. One door knob you avoid becomes two. One social situation you avoid becomes more. Obsessively mentally checking your moral intentions with one intrusive thought becomes one thousand.
Cut out the margin.
Just as in cancer treatment, get the margin. Go for it. It may seem daunting and scary. Especially if you’ve been trying on your own and/or if you haven’t gained a specialized lens for one of the most debilitating conditions on the face of the planet (medical and mental- a top 10 every year). Your long-term well-being will be better for it.
A Psychotherapists' thoughts on healthy living.
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