Treatment Goals for Patients with Obsessive-Compulsive Personality Disorder

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Treatment for clients with Obsessive-Compulsive Personality Disorder (OCPD) will have to address the issue of control. For significant change, these individuals must develop tolerance for:

• their own emotional vulnerability;
• their lack of control over people and situations; and,
• the presence of chance, uncertainty, and impermanence in their lives.

These areas of living cannot be controlled away, defended against, or dissolved in the drug of choice.

Cognitive therapy notes three maladaptive OCPD schemas: perfectionism, the need for certainty, and the belief that there is an absolutely correct solution for problems (Sperry, 1995, p. 141). Treatment goals in relation to these issues would include greater self-acceptance and tolerance for uncertainty and ambiguity. A major treatment goal for individuals with Obsessive-Compulsive Personality Disorder would be to make increments in their capacity and skills to take a more proactive (less reactive) role in dealing with the affairs of their lives (Millon & Davis, Clarkin & Lenzenweger, editors, 1996, p. 338).

Treatment goals must allow for acceptance of OCPD individuals' basic personality style and temperament. While personality can be modified in treatment, it is rarely transformed. Nevertheless, autonomy and realistic self-esteem can be expanded even if OCPD conflicts and defenses remain in place (McWilliams, 1994, p. 148). Oldham (1990, p. 5) maintains that personality styles are nonpathological versions of the personality disorders. Personality style is an individual's organizing principle. It is the orderly arrangement of attributes, thoughts, feelings, attitudes, behaviors, and coping mechanisms. It is the distinctive pattern of how a person thinks, feels, and behaves (Oldham, 1990, p. 15).

For individuals with Obsessive-Compulsive Personality Disorder, a more adaptive shift toward a personality style would result in a reduction of interpersonal strain, symptoms secondary to tension, depression, and dread of the future. Oldham (1990, p. 57) proposes nine traits and behaviors in the conscientious personality style (the non-disordered version of OCPD). These individuals:

• are hard working,
• embrace strong moral principles,
• do things the "right" way,
• are inclined toward perfectionism,
• have a love of detail,
• are orderly,
• are pragmatic, practical, and "no-nonsense" in approach to situations,
• are prudent, thrifty, careful, and cautious, and
• are inclined to accumulate and save possessions.

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Reviewed: 04/2006