Obsessive Thinking (3)

Phillipson outlines a behaviour therapy approach to "Pure-O" along these lines: "crazy" thoughts pop into our minds from time to time but some people invest them with such significance that these thoughts are taken to represent action(s). Further, efforts are then made to avoid these thoughts occurring again.

Phillipson's behaviourist approach is based on classical conditioning procedures of "exposure and response prevention" (ERP), of learning to allow the crazy thoughts to occur as much as they want and not trying to run from them but just allow them to be what they are, just random thoughts (that have taken on a meaning far beyond their status). The goal is not to eliminate these thoughts ("spikes") but to practise non-avoidance of the spikes.

One technique mentioned by Phillipson is called the "Spike Hunt" in which the patient/client is instructed to purposely seek out spikes (instead of avoiding them). So a client who has the thought that he may get up in the night and violently assault his wife and child because he has secretly hidden a weapon in the house, is instructed to sleep with a kitchen knife beside his bed!! Phillipson reported that this patient gained 75% relief from this counterintuitive measure.

This particular technique sounds similar to Viktor Frankl's paradoxical intention wherein obsessive patients are asked to do the thing they most fear. Frankl has challenged patients to go to the shop window which they fear to go past because of the thought they have that they will throw a brick through the window. He told them to go there and throw a brick through the window! Of course, it never happens and the spell of the feared thought is broken.

(Frankl's existentialism is quite different from the behaviourism of Phillipson but nevertheless, on this small point of technique they seem agreed even though their rationales are antithetic!)

Obsessive Thinking (2)

Last time mention was made of three types of obsessive-compulsive disorder (OCD) as identified by Steven Phillipson: the common type of OCD which may involve hand-washing because of fear of contamination for example; the second is the "responsibility" type, who fears for the well-being of everyone else he knows and is driven by guilt; and lastly the pure-O type.

To counteract the third "pure-O" type where the person tries to push away the thought by thinking or imaginal means Phillipson proposed three methods that are not very helpful according to him. The first which is saying, Stop! ("thought stopping") or stinging oneself with a rubber band around the wrist, he says, has not been proved to be adequate. The second method is to point out the illogicality of the mental rituals. This approach hasn't proved to be effective either because invariably the sufferer already knows that what he thinks is illogical. Another option is to use analytic interpretations, which assign meaning to the "spike" (the worrying thought) with a view to resolving its power by understanding it. Phillipson believes this approach also to be detrimental because trying to find solutions to the thoughts will only prolong the condition.

Phillipson advises the use of behaviour techniques even questioning whether the addition of cognitive procedures adds anything to the former. We will outline his behavioural rationale and list some of the behaviour techniques he suggests next post.

Obsessive Thinking (1)

When I started counselling I imagined naively that clients would appear with circumscribed complaints that I would then be able to help them with. What I came to realise quickly was that clients will come with fragments of their emotional life, inner acts and outer actions exemplifying different syndromes. For example, obsessive thinking can be a feature of major depression but then it can be part of a borderline personality disorder condition too among other conditions.

Obsessional thinking is a painful, torturing condition and only sufferers can know the full extent of its misery. Sufferer fight against their thoughts but this does not seem to help because they seem too strong for them. Hence, they feel powerless and helpless. At times, they feel like two people with two different sets of thoughts: one sensible and rational, the other destructive and irrational.

They try to divert themselves in various ways by activities or sometimes with self-harming but such deflections work only for so long before the thoughts begin to intrude again. What to do?

Both psychodynamic and behaviour therapy schools offer something for sufferers with the latter probably being more appealing for those who want an "action-based" approach while the former appealing to those wanting to know the "real reason" for their malady. However, David H. Malan who wrote the superb Individual Psychotherapy and the Science of Psychodynamics on brief psychotherapy conceded that sometimes successful dynamic therapy constructs a convincing mechanism for how the obsession got started but fails to cure the patient! That is, one can be given a good reason and it might not help.

Christian psychotherapy should be aware of the spiritual nature of mankind. That is, that clients being made in the image of God, have no existence other than in their relation to God. All their temporal lives are expressions of their spirituality as image of God.

People have inner lives and outer lives. Therefore, claims that humans are just their external behaviour are false. On the other hand, humans are not just made up of a temporal inner and outer life either. Human acts of many kinds emerge out of the supratemporal heart of mankind as thinking-imagining-willing acts. These dimensions are the inward act-life of people and from these acts come external actions.

Having said this is not to say that so-called "behavioural" techniques cannot validly be used by Christians to alleviate pain. Of course they can, as long as we don't allow their use to convince us that our clients are just emitters of behaviours that are elicited by chains of reinforcers.

One of the most sophisticated behavioural presentations I've read on the Internet anyway is that of Steven Phillipson who identified three types of obsessive-compulsive disorder: 1) a "contamination" type leading to repeated cleansing or anxiety leading to checking locks and appliances; 2) a responsibility type leading to a over-worrying about other people; and 3) a "pure-O" type in which the obsession revolves around fear-provoking thoughts (he calls them "spikes"). The person attempts in a mental way to push away the thought, avoid the repetition of the thought (or spike) or tries to solve the question or undo the threat that the thought-spike presents.

Importantly, clients will generally present with aspects of all three types but one will usually predominate. Next time, a closer look at the third type above.