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The Power of Metaphor in OCD Treatment

Breaking the talk therapy taboo when treating obsessive-compulsive disorder.

Key points

  • Reassurance is a big taboo in OCD treatment.
  • Talk therapy has unique benefits that enhance standard OCD treatment.
  • A metaphorical approach can add more dimension to understanding particular obsessions.
Steve Johnson/Pexels
Source: Steve Johnson/Pexels

Beth agonized over whether her boyfriend was the right partner. Was he reliable, smart, kind, strong? You name the adjective, and it made it onto her ever-shifting list, boiled down to one question: Was he enough?

Relationship OCD is the relentless recurrence of doubts and fears over a romantic partner:

Are they the right one for me?

Am I attracted to them? Wait, wasn't I checking out that other person, and doesn't that mean that I'm not?

I should end the relationship now because it's just become clear. Wait, maybe I'm wrong, and I'm making the biggest mistake of my life.

Beth went into standard OCD treatment and found something curious. Whenever she wanted to explore why she fretted about her relationship, her therapist said they wouldn't be doing that here. Reassurance is a big taboo in OCD treatment, a form of collusion sure to help the OCD sufferer continue to breathe life into their own Frankenstein. Nothing helpful or worthy about that.

I take a different stance and view talk therapy as essential to OCD. When Beth started treatment with me anew, we talked about relationship concerns. Not just on a literal level but on a symbolic level, too. Perhaps her fears over her boyfriend had some interesting associations and meanings that nobody ever talked about. That's just what we found.

Beth's relationship obsessions about her partner echoed the massive emotional unreliability in her family of origin. Nearly impossible to pin down who her parents were and if they'd be emotionally available from one moment to the next, her psyche found an ingenious way of taking matters into her own hands. In a twist of irony, the unreliability of her own thoughts and feelings was the best way for her psyche to show just how severely others shapeshifted for her. Without proper decoding, this tormented her.

CBT for OCD takes a highly literal, behavioral approach. Relationship fears are trying to get you to bite, so you'll continue obsessing and ritualizing over them; the best way to get them to leave you alone is to stop fishing. This is why, according to CBT, talk therapy for OCD is hurtful.

A metaphorical approach can add more dimension to the understanding of your particular OCD. And it isn't as complicated as it sounds. Metaphorical just means that our psyche is capable of associating and connecting to a variety of different feelings and thoughts. Like a good poem, there are more potential meanings and registers to what we are experiencing, and that's just part of being fully human.

It's no defect. It's how the psyche manages and negotiates the wide variety of feelings we have, especially those connected to attachment. Just as Dr. Sue Johnson showed how attachment is the fundamental basis of couples' issues, it is also a primary motivator and driver of obsessional behavior as well. And what more sensible way for this to show up than in relationship concerns?

Robert Frost once said:

"Unless you are at home in the metaphor, unless you have had your proper poetical education in the metaphor, you are not safe anywhere."

Beth was determined to understand why relationship obsessions gnawed at her, and she was right; there was a lot more to the story. Most other therapists missed crucial and valuable clues as to the fuller metaphorical picture of this story. No wonder so many with OCD feel unsafe anywhere—without a metaphorical understanding, they are walking blindly.

More from Michael Alcee Ph.D.
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