How to stop accommodating your loved one with OCD
OCD is a positive-feedback loop and when I say that, I don’t mean it in the way it might be taken colloquially. I don’t mean “Yay POSITIVE feedback,” but instead a self-perpetuating cycle. The more the cycle is engaged with, the worse it becomes. This is NOT what we’re going for in OCD treatment.
Don’t feed the OCD monster!
As part of the gradual worsening of the OCD cycle, most OCD sufferers have to do more and more to appease their OCD and eventually, loved ones and therapists get looped into the cycle too. High quality OCD treatment is all about breaking the OCD cycle in a way that is kind, loving, and compassionate. So guess what… therapists and loved ones have to help break the cycle by withdrawing their participation in it.
Let’s learn about reassurance seeking and accommodations
Reassurance seeking: This happens when an OCD sufferer asks someone around them whether they’re going to be OK in a direct or indirect way in order to soothe their anxiety, with limited practical necessity or effectiveness. In other words, most people would agree that the asker is not going to be getting extremely useful information from the answerer, as a result of the conversation.
Examples (let’s pretend they’re asking me, a therapist):
What do you think of this spot on my hand? (I’m not a dermatologist.)
Would you wash your hands again? Should I? (I’m not an infectious disease expert.)
Would you eat food I handed you right now? (I’m not a food safety expert.)
Do you trust me to babysit your kid? (I mean… I’m pretty desperate for babysitters so you’re not going to get useful information from me on this one.)
Did I just hit someone with my car (when driving and clearly did NOT)?
Accommodations: Accommodations can include providing reassurance but are also much broader and include everything a loved one or therapist would do to make room for the sufferer’s OCD that doesn’t serve an important practical function.
Examples (usually asked of loved ones):
Washing bath towels after every use at the insistence of the OCD sufferer, even if the family historically used them for five days before washing.
Spraying shoes with Lysol each time someone comes home from outside of the house.
High-fiving a child OCD sufferer exactly five times when they arrive home from school at their insistence, with no room for variation.
Allowing a teenager to spend three hours getting ready to leave the house before a family event, even though it will make everybody late and there’s no functional reason for the delay.
One partner tolerating “healthy” meals that they don’t like, at the insistence of an orthorexia OCD sufferer.
Compulsive visits to various physicians, searching for an explanation of symptoms, when reasonable diseases have been ruled out.
Accommodation requests tend to get more elaborate and time consuming as the OCD goes on until things become unworkable on the OCD team.
Let’s contrast the above-listed accommodations with a different thing by a similar name
Reasonable accommodations: These differ quite a bit from OCD accommodations in that they are allowances for normal differences between friends and family members, that support the person as a whole. The difference between OCD accommodations and reasonable accommodations can be subtle so we will have to dig for underlying drivers sometimes. These do NOT make the OCD cycle worse.
Examples:
Making time for an autistic person to stay engaged in a special interest so they can enjoy a state of flow to increase their wellbeing.
Lowering the volume of household activity for a bit while an ADHDer with OCD takes a moment to regulate their overwhelm.
Simplifying transitions between activities to allow for less distress for any neurodivergent person.
Washing towels slightly more often because one household member prefers one thing and another prefers another due to normal differences in cleanliness.
Agreeing to add a vegetable to dinner because one family member is feeling constipated or is craving vegetables.
How do we withdraw accommodations?
Remember that saying, “Don’t hate the player; hate the game?”
It is not the OCD sufferer’s fault that they are asking for accommodations. We need to give them incredible compassion and love, as PEOPLE but we also need to withdraw reassurance and accommodations, in order to force them to tolerate distress and help them get more flexible within their OCD. How do we do that in a kind and compassionate way? We withdraw accommodations slowly and with LOVE. Love, kindness, respect, validation, transparency, and intent are all so important to making this happen in a loving way that supports our OCD sufferer.
Step One: Identify valued boundaries
If you’re a loved one or therapist, you have to reflect on your boundaries with your OCD sufferer. What would you like to be able to loosen up in your relationship with OCD. Or if you are the sufferer, what do you know you’re asking of your loved ones that deep inside, you know isn’t right? How do you want things to be different? Why?
The components of a valued boundary include:
Defining the behavior that is impeding the loved one or therapist
A goal for flexibility with that behavior
An important reason the therapist or loved one wants to set that boundary
Step two: Develop a script for enforcement and try to get buy-in
After sharing these boundaries with the OCD sufferer, the loved one or therapist will either work on a script together with the sufferer or will present a script to them (if they refuse participation) on how to remind them of the boundary in a kind way. This script will have a few components to it:
Gently verbally label (name) the OCD sufferer’s pull for accommodation or reassurance.
Restate the boundary.
Remind them of the value behind it.
Affirm love and compassion for the OCD sufferer.
Ask them how to support without accommodation or reassurance.
Example of boundary setting in action:
I can see that you are looking for reassurance about the cleanliness of your shoes before coming into the house. I know this really bothers you.
I am not going to reassure you about it because I know that it makes the OCD cycle worse and the positive effect of reassurance never lasts.
I’d like to be able to have a relationship with you in which we’re engaging on things of mutual interest and I don’t want to be reassuring you about things I know you know the answers to.
I care about you so much and I want to support you as you try to tolerate the discomfort of not getting the reassurance.
Can I sit with you through this discomfort or otherwise help you manage through the uncertainty without reassuring?
Step three: Enforce consistently and grow boundaries over time
Whatever time, money, or resources loved ones or therapists have given up for their OCD sufferers, it’s time to get those things back (with love) from the OCD that stole it. Tell the OCD sufferer that you want to get back to a workable life for you and that you know it’s important to move slowly and deliberately toward that future. Therefore, you will make these boundaries (refusal to accommodate) grow over time until you, as the loved one, are at a state of “normal for you.” Therapists who specialize in OCD should also verbalize this intent and normalize it as part of the treatment process.
OCD therapy IS uncomfortable but it shouldn’t be sudden or torturous. By clearly stating personal boundaries and expectations as a valued goal, you can work together to pace withdrawal of accommodations in a reasonable way for all parties.
In practice
In at least 75% of my OCD cases, it’s the client actually ASKING for withdrawal of accommodations from their loved ones or general practice therapists (when I’m acting as a consultant). This is truly how it should be - with the OCDer asking for the gradual withdrawal of accommodations in the service of their own treatment. However, there are times where an OCDer does not yet see their requests for accommodations as problematic, and sometimes loved ones have to set boundaries ahead of readiness in the client and this gradual path towards firm valued boundaries is the best way to do it.
Love the person with OCD and be consistent and firm with the OCD.