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Strategic systemic approach and hypnosis

      Obsessive compulsive disorder (OCD) affects millions of people today. The treatment, to be effective, requires first defining the type of OCD from which the patient suffers. This article details treatments adapted to OCD without rituals or pathological doubt, the triggering factors, symptoms and treatments using the systemic approach.

      OCD without rituals or pathological doubt

      An interactional reading involves a more personalized understanding of OCD , recognizing that individuals may experience and manifest their symptoms in unique ways. This approach promotes personalization of treatment, with a more in-depth exploration of underlying dynamics which helps to improve therapeutic engagement. While the DSM provides a structured framework for classifying disorders, interactional reading enriches clinical understanding by highlighting the diversity of OCD experiences and informing therapeutic approaches tailored to each individual.

      Determining the nature of OCD

      The treatment will be oriented according to the nature of the OCD observed: OCD with rituals , OCD without rituals or pathological doubt, pathological doubt.

      What is OCD without rituals or pathological doubt?

      In the analysis of obsessive disorder without rituals or pathological doubt , the excessive search for control to the point of loss of control is a central paradox. This disorder, primarily driven by fear of error, results in a paradoxical failure to control thoughts that are supposed to help maintain order and predictability. The person suffering from this disorder frequently engages in excessive planning and pervasive control, characteristic of an obsessive perception-reaction system. This hyper-control manifests itself in a vicious circle where defense against phobic perceptions leads to an increased need for control, culminating in a total loss of it.

      Affected individuals often enter into crisis when confronted with uncontrollable elements, highlighting the limits and fragility of their rigid control system. This disorder can sometimes be accompanied by an “obsessive-paranoid” type perception-reaction, where distrust of others and a rigid perception of the world predominate. To combat intrusive thoughts, the individual may seek distraction, seek comfort or assurance from others, or engage in compulsive behaviors.

      How to identify OCD without rituals or pathological doubt?

      In the therapeutic approach, it is essential to understand whether the individual is using their mind more or performing physical actions to maintain control. It is also crucial to determine whether these actions are preventative or reactive, and whether the mental controls are aimed at avoiding certain thoughts or engaging in rumination. Understanding whether the concerns are focused on oneself, on others, or on broader external elements, allows the intervention to be adapted to the specific situation of the individual.

      Strategic questions make it possible to identify the nature of obsessions and compulsions without rituals or pathological doubt, their impact on the individual's daily life, and the underlying mechanisms that maintain the disorder. Examples of strategic questions that could be asked in such cases include:

      Questioning the nature of obsessions:

      • What is the specific nature of your obsessions?
      • How do these thoughts manifest and how often?

      Question the impact on daily life:

      • How do these obsessions affect your daily life?
      • Are there specific situations or times when they are more intense or disruptive?

      Identify current management strategies:

      • What strategies do you currently use to manage your obsessions?
      • Are these strategies effective or do they provide temporary relief?

      Identify emotional and physical reactions:

      • What emotional and physical reactions do you experience in response to these obsessions?
      • How do these reactions influence your behavior and ability to function 

      Trace the history of the disorder:

      • When did you start noticing these obsessions?
      • Have they evolved or changed over time?

      Understand the influence on relationships and activities:

      • How do these obsessions affect your personal relationships, professional relationships, or other important activities?
      • Are there any avoidances or behavioral changes related to these obsessions?

      Questioning awareness of obsessions:

      • Are you aware of the irrationality or exaggeration of these obsessions?
      • How do you perceive these thoughts and their validity or importance?

      Ask for support and resources:

      • What type of support or resources have you sought or found helpful in the past?
      • Are there any interventions or approaches that you have not yet explored but that interest you?

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      Treatment of OCD without ritual or pathological doubt

      Treatment of OCD without ritual or pathological doubt with the systemic approach : prescriptions

      Prescriptions in obsessive disorder therapy without rituals or pathological doubt are interventions designed to disrupt and reconstruct the patient's excessive and rigid control systems. They aim to facilitate a change in the way the individual perceives and reacts to intrusive thoughts and stressful situations. These prescriptions are adapted according to the specificity of the symptoms and mechanisms of the disorder in each individual.

      For individuals who seek control through actions,

      For individuals who seek control through actions, therapy can encourage the introduction of small imperfections or calculated risks. This approach, known as imperfection introduction, involves asking patients to intentionally make small mistakes or leave certain details imperfect in their daily activities. The goal is to gradually diminish the fear of imperfection and error, thereby reducing the need for excessive and compulsive control.

      For individuals seeking to exert mental control

      For those seeking to exert mental control, such as striving to suppress or drive away intrusive thoughts, or engaging in rumination, ritualization of thoughts is often prescribed. This technique involves allocating specific times of the day to focus intensely on obsessive thoughts, followed by periods where the individual commits to not actively thinking about them. For example, a patient may be asked to think about their worries for 5 minutes every hour and then engage in other activities or thoughts the rest of the time. This aims to reduce the impact and frequency of intrusive thoughts by confining them to specific times.

      For individuals who try not to think or push away intrusive thoughts/images

      For individuals trying not to think or to push away intrusive thoughts/images, particularly when these thoughts are related to physical symptomatology, adding the task of imagining the worst may be beneficial. This technique, known as mental worst-case exposure, encourages patients to consider the most negative scenario and think deeply about it. This can help reduce anxiety associated with uncertainty and decrease the compulsive need to control future events.

      Metaphors and aphorisms

      The use of metaphors and aphorisms such as "In the symbol of the Tao, there is a little black in the white and a little white in the black", "Losing control to better master it", "The survival of the fittest", "What doesn't kill you makes you stronger", and "Riding the waves of change" can help reframe the perception of control and encourage a more nuanced and flexible approach to managing life . These elements aim to encourage an acceptance of uncertainty and change as integral parts of life, thus proposing a reconceptualization of the individual's perception of control and introducing more flexible and adaptive management strategies.

      These prescriptions are adapted and modified according to the patient's individual context, reactions and specific needs. The strategic therapist uses these tools to disrupt the obsessive-compulsive cycle, introducing new dynamics that allow the patient to regain a sense of control and reduce the disruptive influence of compulsions and obsessions on their daily life.

      The systemic and strategic approach is very effective in the treatment of OCD. Obsessive and compulsive disorders are part of the psychopathologies studied in the third year of the LACT course and in the Clinical Master of Giorgio Nardone (CTS) .

      Related Resources and Articles

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      A team of more than
      50 trainers in France
      and abroad

      of our students satisfied with
      their training year at LACT *

      International partnerships

      The quality certification was issued under
      the following category of actions: Training action

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