Early in my training, an adolescent client* came to me with such significant mental health challenges AND strengths, at first it was difficult to identify his obsessive compulsive thoughts. The client was extremely intelligent and engaging in conversation. He had worked through a lot of his early resistance to treatment and was working hard to address some extreme social anxiety and PTSD. The client’s sense of humor and ability to identify and poke fun at his own resistance to change is what nearly masked his obsessive thinking.
In the weeks as he was nearing discharge and getting ready to go to a new school, the client started stating jokingly that he was never leaving. The joking gave way to irritation and anger and eventually, he was repeating his statements about not leaving treatment and started insisted that he was being treated unfairly. We clinicians are trained to validate clients’ thoughts/fears and to support the client to work through them. Week after week passed however, and I found myself having the same conversation with the client. His father reported the client was cycling through the same conversation at home as well.
One day in a session, I had an instinct to be somewhat absurd and change the topic. I stated to the client, “This conversation is starting to feel repetitive to me and today I’d rather talk about something else. What can we talk about – clowns? Monkies? Global warming?” The client didn’t as I feared, get angry at me for not validating him. Instead, he seemed perplexed and laughed. Then he relaxed and engaged in a next conversation. In our final sessions together, the client’s thoughts about leaving continued to come up yet he accepted it when we acknowledged them and then changed the subject. Before I did, he started realizing that he appreciated something about the shift in gears and even thanked me for initiating the shifts.
I ran this situation by a supervisor more recently, and she said that what had happened with that client sounded familiar; she recommended this book I am now reading – Brain Lock. Author Jeffrey Schwartz, a UCLA psychiatrist, explains the brain chemistry behind OCD behavior and describes a four step process where OCD clients benefit from 1. Relabeling thoughts 2. Reattributing the source of the thought 3. Refocusing attention to more constructive thoughts/behaviors and 4. Revaluing obsessive thoughts to give them less value and space in your mind. For anyone challenged by repetitive, ruminating thoughts, this book’s a good read and useful tool.
*Identifying details of clients are changed to protect privacy.