Treatment Techniques for Obsessive-Compulsive Personality Disorder

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Zimmerman (1994, pp. 113-115) suggests the following questions in the assessment of individuals with Obsessive-Compulsive Personality Disorder (OCPD):

  • Have you ever been told that you spend too much time making lists and schedules? Do you think you do?
  • When you have something that needs to be done, do you spend so much time getting organized that you have trouble getting it finished on time?
  • Have you been so involved in the small details of what you were doing that you lost sight of the main thing you were involved in?
  • Would you describe yourself as perfectionistic? Would others?
  • Have you ever failed to complete a project on time because of your high standards for that project?
  • Would you call yourself a workaholic? Would others? If so, do you spend so much time working that you have little time for family, friends, or entertainment?
  • Do you have difficulty taking time off of work because you worry about getting behind?
  • How many hours a week do you work?
  • Would you work the same number of hours if you could get the same pay for fewer hours?
  • Do you have a strong sense of moral or ethical values? Do you think you are more concerned about ethics or values than other people?
  • Do you worry that you have done something immoral or unethical?
  • Do you find it difficult to throw things away even if they are old and worn out?
  • Has anyone ever complained about all the things you save?
  • Do you do jobs yourself because no one else will do them to your satisfaction?
  • Do you take over other people's responsibilities to make sure things are done right?
  • How is it for you to spend money on yourself? On others?
  • Do you save as much as you can for future problems?
  • Do people describe you as stubborn?

In treatment, clients with OCPD are most comfortable when the interaction is organized, detail oriented and unemotional (Turkat, 1990, p. 85). These individuals will have difficulty in treatment exploring emotional issues and their link to behavior. They are more likely to be responsive to self-control or affective management training. They will diligently follow instructions if enhanced control of emotional distress is a possibility. They will value training that allows them to recognize early stages of emotional distress and how to implement strategies to avoid sudden and extreme loss of emotional control (Donat, Retzlaff, ed., 1995, p. 54).

Short-term treatment can be beneficial in assisting clients with Obsessive-Compulsive Personality Disorder in crisis. Specific, focused goals to help these individuals to accommodate to change can be done in a limited number of sessions. Validation of feelings will help clients with OCPD to be relieved of guilt, self-doubt, and fear. Confrontation of OCPD defenses may be more effectively accomplished in group treatment. These clients may get in power struggles within individual sessions [their preoccupation with details and need for control can lead to an endless conflict over words, issues, and who is in charge (Sperry, 1995, p. 144)]. Group can diffuse this inclination. The group process also allows clients with OCPD to develop trust in several people (McCullough & Maltsberger, Gabbard & Atkinson, editors, 1996, p. 1000).

OCPD treatment is organized around three basic considerations: 1) attention to defenses; 2) softening and modification of superego rigidity; and 3) identification and working through of unconscious conflicts that generate symptoms (McCullough & Maltsberger, Gabbard & Atkinson, editors, 1996, p. 1001). Treatment must find a way to counter Obsessive-Compulsive Personality Disorder indecisiveness, ruminations, and suppression of emotion. Problem-solving methods will be useful (Stone, 1993, p. 349).

Clients with OCPD may not do well in family therapy. They are inclined to ally themselves with the treatment providers and experience difficulty entering the client role. They also experience extreme anxiety if forced to relinquish their defenses and expose their feelings to significant others (Millon, 1981, p. 243). McWilliams (1994, p. 297) actually suggests that clients with OCPD, with encouragement, can go beyond identification of affect to actually enjoying the experience of their feelings.

Interpersonal treatment of obsessive-compulsive personality disorder focuses on building the ego strength that is needed to recognize situations that set off regressive patterns. Five categories of therapeutic response in the interpersonal model are: facilitating collaboration, helping individuals learn about regressive behavioral patterns, teaching them to block maladaptive patterns, enabling the will to change, and teaching new patterns (Benjamin, 1993, p. 132). Benjamin (Clarkin & Lenzenweger, editors, 1996, p. 210) goes on to suggest that clients with OCPD should be assisted to:

  • reconsider their self-definition;
  • explore connections of current problem patterns and early learning;
  • watch for potential violence or abuse;
  • differentiate from abusive parents (by altering self-talk and learning constructive alternative responses); and,
  • learn softer alternatives to responding to others.

continue: Goals for Therapy

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Reviewed: 04/2006