Treatment Provider Guidelines

cont. from

The first rule of treatment for therapists working with Obsessive-Compulsive Personality Disorder (OCPD) clients is ordinary kindness. These individuals are accustomed to being exasperating to others without fully comprehending why (McWilliams, 1994, p. 294). Working with them can be tedious. They are likely to engage in long monologues of self-justification, lofty goals and ambitions, and reasons why family members, intimate others, and subordinates at work need to be rigidly controlled (Stone, 1993, p. 348). The strained, affect-controlled, and detail-oriented speech of individuals with OCPD must be met with patience, tolerance, and the ability to listen without drifting off into personal reveries. Service provider boredom can be managed, to some degree, by listening to the patterns of behavior, attitudes, and beliefs that are consistent through various situations and relationships described by clients with OCPD. It is not beneficial to brush aside, no matter how gently, material that these individuals see as important in an effort to get on with affective issues. Their focus is often more businesslike and problem-focused; they are not as comfortable with an emphasis on emotional support and relationships (Beck & Freeman, 1990, p. 321). Pressure to prematurely focus on and experience emotions is both alien and alienating.

Be watchful of individuals with OCPD becoming conscientious clients, i.e. approaching treatment as a task that must be carefully attended to with hard-work and careful adherence to the ground rules of honest discourse. This may result in inhibited self-disclosure that is determined by what these individuals believe is expected of them. Their studied compliance and lack of genuineness must be addressed directly; treatment is not a set of duties that must be followed without deviation. It is a more naturally unfolding process that emphasizes personal experience and genuine expression of self (McCann, Retzlaff, ed., 1995, p. 149). However, keep in mind that clients with OCPD who bring their dogged persistence and task-orientedness to treatment are often able to stay with the treatment process, develop a good therapeutic alliance, and enjoy a favorable outcome (Stone, 1993, p. 350). The success of the treatment process with these individuals is a matter of managing their inhibitory defenses, utilizing their strengths, supporting their conscientious intentions, and accepting them in spite of their interpersonally problematic behavior. Individuals with OCPD do not generally inspire warmth in the people around them, including service providers. Their arrogant, argumentative, and self-justifying behavior can make them seem to be stronger or tougher than they really are. It is important to remember that their defensive structure covers vulnerability to shame, humiliation, and dread.

Transference and Countertransference Issues

Individuals with OCPD (Obsessive-Compulsive Personality Disorder) tend to be good clients; they are serious, conscientious, honest, motivated, and hard-working. However, they also tend to be consciously compliant and unconsciously oppositional. The combination of excessive conscious submission and powerful unconscious defiance can be maddening and countertransference is usually annoyed impatience. OCPD clients can also emit an atmosphere of veiled criticism that has the potential to undermine the clinician (McWilliams, 1994, p. 294). These individuals can feel genuinely grateful to effective service providers, but underlying their gratitude is a degree of hostility or aggression which can stimulate the service providers own aggression (Richards, 1993, p. 258).

Service providers who have a need to feel emotionally connected to their clients may focus on and become irritated by OCPD defenses -- and fail to recognize the emotional pain underlying these defenses. If service providers become irritated enough, they may try to conceal their anger and irritation by experiencing positive concern for OCPD clients, i.e., using their own defense of reaction formation and mirroring the OCPD defensive pattern. Also, these individuals' compulsive need to be good clients can be joined by the service providers' need to be good clinicians (Kubacki & Smith, Retzlaff, ed., 1995, pp. 174-175).

Because clients with OCPD are often not much fun to work with, particularly if they have passive-aggressive traits, they can evoke the countertransference issues of:

• adopting a routinized uncreative way of relating by the service providers;
• accepting and mirroring the clients' own stereotyped self-presentation;
• irritation, boredom, and fatigue;
• exasperation and a need for greater client dependency; and
• frustration and feeling tortured by these individuals' tendency to repeat topics.

continue: Therapy Techniques

top . pages 1 2 3 4 . send to friend . personality disorders site map

Reviewed: 04/2006