Hypnotherapy & NLP for OCD: when CBT alone just isn't enough!
Richard had been diagnosed some years ago with a debilitating condition called Obsessive Compulsive Disorder (OCD). He had been wanting to try hypnotherapy for some time and the opportunity arose when his mother picked up a leaflet about a talk I was giving at the local library. He plucked up the courage to come along and approached me with an abundance of enthusiasm and optimism for hypnotherapy and how it could be the key to overcoming his paralyzing condition.
Richard had lived hopelessly for decades with his condition which got significantly worse after having his 2 children. During this time he had received help from countless therapists all using Cognitive Behaviour Therapy (CBT) type approaches to attempt to conquer his symptoms by challenging his irrational thoughts and fears.
He would gain some ground but nothing significant and was still very dependent on his wife. He couldn't leave the house alone, had never had a family holiday, even a day trip, could not enter his parent's house, had stopped driving, and was becoming estranged from his children, and his skin was becoming excruciatingly painful from all the scrubbing!
His last relationship with his CBT counsellor broke down after he felt rapport was lost when 2 things happened. First, she was trying to encourage him to approach a Geiger counter beneath the stairs which Richard believed was significant to why his condition started. He couldn't go near it, and he wouldn't willingly let others go near it either. However, the therapist touched it in an attempt to show how innocuous it was.
He said his anxiety went through the roof and she had to leave. For the next appointment, the therapist suggested he attend to see her instead at her office. He said after sitting anxiously in the therapy chair for only a few minutes, he had to leave. In his mind, the therapist had now become contaminated, and so had her office. It was the last time they saw each other and he wasn't keen on seeing any other therapist using these kinds of approaches with him.
So he attended his first session with me eager to get started. He didn't expect a miracle cure and was very realistic about how we might work together. Having heard his stories, I already had a good idea of the things that wouldn't work with him. I knew from his descriptions of previous therapy he had, that the therapists had led too soon and lost his trust. So work needed to start slow in building a good rapport between us, and in his confidence to put his trust in me.
I knew I had to challenge his beliefs along the way and even in the first session used effective CBT-type questioning to understand Richard's trigger scenarios, physical symptoms, emotions and focus of attention when in those situations. I learnt all about his family, support systems, hobbies and interests and hopes and dreams for how he would like to be free from the condition. During this first session I elicited his automatic, intermediate and core beliefs but because of co-morbid depressive symptoms wasn't able to access resources during this session. It was far too early for all that!
Richard was unable to handle/touch anything if handled by others and not wiped down first. What was particularly disturbing for him was the effect his behaviour was having on his children. He just wanted to be a normal dad, doing normal things with his kids.
Richard returned for his second session with a little apprehension but also excitement about what we would do together. We talked about his expectations of hypnotherapy and continued our rapport & trust building, especially talking more about his children, before I induced a trance. Here I used simple progressive relaxation, breathing techniques, eye fixation and various deepeners. He managed to relax really quickly and we talked throughout so he could share his experiences with me.
All this was reinforced through ego-strengthening hypnotic suggestions. As he relaxed, he gained the confidence to close his eyes and went into a relatively deep trance. As he did I could observe more closely the rawness of his skin caused by routine scrubbing and the deep relaxed feelings he was experiencing being free, albeit temporarily, from the anxiety. We anchored this deep relaxation, so he had a positive resource state he could use away from the session to start to self-manage his anxiety.
In the third session, Richard reported feeling much better about things. We used guided imagery and deep breathing and practised letting go of his anxiety using symbolic imagery with the red balloon technique. We stacked another positive resource state of having let go of the anxiety and feeling positive and relaxed in the hypnotic therapy chair. Direct ego strengthening posthypnotic suggestions (PHS) was given for using his new resource state away from the session as a thought-stopping technique, in his anxiety-provoking situations.
In session four, we accessed his favourite place to induce trance, this took a little time because we had to go back sometime in history to find it. We were able to stack another resource state here on the good feelings he got from being there. We now had an awesome powerful positive resource state consisting of a set of really good examples of times when he was relaxed and positive, and we could start to collapse a few negative unresourceful states.
Richard brought to mind a recent time when he was in his living room and unable to touch his CDs because his children had been holding them and thus had 'contaminated' them. We used refractionation to open his eyes, and I passed him a CD which he took from me without flinching.
I got him to hold it and pass it from hand to hand, before doing an arm drop deepener to deepen the trance and test his fear of direct touch. Richard experienced no anxiety during this time. We did more ego-strengthening PHSs for good progress and feeling enabled to overcome any challenges he faced with ease, especially around the children.
We future-paced to the next time he was at home and the kids handed him something or used a door handle before him. He raised some anxiety here and we collapsed this unresourceful state using his resource anchor. We set a couple of behavioural experiments before the next session.
The first was around playing with children and being able to remain calm without having to take a shower or wash his hands. The second was to instruct everyone in the house to shut the doors behind them so he had to practice using his own resources of keeping calm without washing his hands or asking for help when opening the doors. We future paced this first in the safety of the therapy space so, in his mind, he'd already done it! And if it didn't go to plan in his imagination, he would know what to do to manage it okay by himself!
In session five, Richard reported feeling much more confident and in control of himself in managing his anxiety in feared situations, and recalled how he was feeling much less dependent on his wife for help. He was washing significantly fewer times a day, and his behavioural experiments went well in that he realised he could cope and nothing terrible would happen.
He reported how he drove himself to his parent's house but could only stay with them for a short while, and as soon as the perceived 'criticism' from his parents started he made his exit. He even found this good work generalising out to other things that he couldn't touch after they had been touched but not washed e.g., dirty laundry.
In this session we collapsed more serious unresourceful states in a trance of him being in situations where he felt he was going to get contaminated i.e., touching the Geiger counter under the stairs and going to his parent's house. We used the Fast Phobia and Swish techniques on these most feared scenarios where he felt paralyzed by his anxiety and fear.
In session six we were able to use age regression interventions using the TV Timeline back through some of the Initial Sensitising Events (ISEs). There were a few to explore, but one stood out as being the worse and most significant for Richard. He remembered playing around in his father's workplace at the back of his parent's house, incidentally where they still live. This is where he came across the dysfunctional Geiger counter for the first time.
He remembered how his father had chastised him as a boy for playing there and touching things he shouldn't be touching. Here we were able to explore and resolve many of these early anxieties and Richard gained insight into where his problems may have started. He hadn't been able to recall any of this before and had never expressed to anyone how he felt at the time.
In trance, he was able to make peace with his father, and gain an understanding of how unsafe it was for him to be playing in his father's workshop, and how his father had his best interests at heart even if he might have overreacted at the time. After some further ego-strengthening PHSs, we set another behavioural experiment that Richard now felt ready for.
Whilst still in trance, Richard agreed to face what had been his worst fear. We future-paced removing the Geiger counter from the cupboard under the stairs. He felt totally relaxed and confident throughout. he knew his resource anchor was there should he need it, but cared not to use it!
Richard arrived at his next session happy to report that he had arranged a day trip away with his family. He had also been over to have dinner with his parents at their house during the week and although he didn't always like what they said, he was able to stay and not feel anxious about it.
He reported passing objects, such as plates, between family members with no problems. He was still concerned about laundry care and needing to eventually still wash hands after touching an old dishcloth but realised his wife and kids do this too! His skin had significantly improved and the itching and soreness had gone. He was now very confident with self-management and significantly more independent from his wife’s interventions.
He was now driving his children to school by himself. And not only had he rekindled his love for working on the old 'banger' i.e., the carcass of a car that had been lying dormant on the front driveway for the past few years, but he was doing it with his father!