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Key points
- People with obsessive compulsiveness seek reassurance knowing its limitations.
- Therapy doesn't make people independent, rather dependent in healthier ways.
- To reduce debilitating self-doubt, rational thinking needs to be coupled with experience.
Obsessive-compulsive disorder entails a wave of self-doubt, which washes over all certitudes.
This wave is so powerful that, like nature's drowning victim in the sea, its captive grasps for whatever safety he can. This tendency manifests in a chronic need for reassurance, which, for the other involved, frequently feels as though responsibility is being offloaded onto them, or at the very least shared. Fearing punishment, whether from a cosmic or more corporeal source, the burden of responsibility may feel as though one is beginning to lose her footing as she treads deeper into the ocean, without knowing how to swim.
Every decision feels life-altering. And the compulsion creates a craving for a degree of certainty that it eventually and paradoxically annihilates.
Patients often wonder why they're preoccupied with acquiring reassurance when its provision is akin to a loose band-aid, essentially asking how they can allow themselves to act so irrationally. Thus, they're often surprised to discover their ambivalence. In reality, they're of two minds. On the one hand, they know that any form of reassurance fades almost instantly—the reason being, that idealizing the reassuring individual is unsustainable (for example, she isn't omniscient, therefore can be wrong). And, on the other, knowing that her mind is going to wash away all the dopamine and serotonin associated with achieving certainty once she starts to think about it, she still secretly hopes for a miracle; a magic act that will silence her inner critic. She chases something she knows can't exist, as a child chases the soothing comfort of a parent.
Ultimately, many of us struggle with taking responsibility for our lives. We may have an enlarged sense of self-importance, believing that our decisions matter more so than they do. We may catastrophize, worrying that each one will engender a horrible outcome. We may consider ourselves incompetent, and incapable of even basic self-care. And, we may idealize those who don't deserve to have been placed in their fragile positions. In the end, when the luster fades, we're left almost only with ourselves, for some time at least.
The misconception about cognitive behavior therapy is that it helps you eliminate or greatly reduce negative emotions. In reality, it helps you ride their waves as they naturally subside through experience, whereas, without those tools, you would just automatically swim to shore. With obsessive compulsiveness, in particular, individuals swim to the harbors of their loved ones, or their therapists, when the tides start to feel unmanageable. Someone asked me, "But, why is it so bad that I need the therapist to reframe my thoughts? Aren't they the expert?" In some sense, yes; in another, no. I responded, "I pretty much would have the same evidence as you, at least at some point." Our patients, to truly challenge their thoughts, need to experience the consequences of their choices, without seeking reassurance.
Making better use of dependence
We don't ask our patients to become independent; on the contrary, we ask them to make better use of their dependence. On this theme, psychoanalyst Nancy McWilliams wrote, “The myth of human independence exists even though all people need each other. Psychotherapy does not make dependent people independent; it makes them able to more effectively use their natural dependence.” Thus, according to her, in our work, we help them accept and work with their existential, human, limitations; they'll never not need others.
Instead of asking your partner to reassure you, a request which you both know is, mainly, fruitless, you may instead ask your partner to help you cope with the consequences of your bad decisions, which are inevitable. Rather than reassurance, which splits or helps evade responsibility, seeking comfort and constructive feedback after the fact helps our partners and friends feel less burdened and makes us better swimmers. You may share responsibility with your partner for some things, but, with small steps, begin to venture on your own, knowing your harbor remains accessible and intact as you labor through the tempestuous sea of doubt.
We all need each other, but how we use one another matters. The work here entails trust, so you'll have to believe that your partner, friend, or therapist won't chastise you for a bad decision. You'll have to decide who's worthy to participate in your experiments. But, as the small victories stack up, the effort exerted to become a better swimmer will have been worth it. This, in a nutshell, is the process of therapy.
