Meaning and Pragmatism in OCD Treatment

Abstract

This response to the commentaries of Mandala (2008) and of Deacon and Nelson (2008) focuses on the utility of treatments nested within different theoretical schools of thought. Here I concentrate on the use of self as clinical tool, and the need to define variables and concepts in treatment so that they can be methodically utilized. I also choose to focus on the use of functional analysis to sharpen the accuracy of exposure treatment, and on the relative value of the use of cognitive therapy in obsessive-compulsive disorder (OCD) treatment. Finally, I describe a 5-year follow-up conversation with Bridget along with Bridget’s repeat of standardized ratings to illustrate the struggle in differentiating scrupulosity and religious observance as it is experienced by the scrupulous OCD patient.