ABSTRACT
In many instances the course of treatment for OCD proceeds smoothly and without complications. However, rough waters are occasionally encountered. The therapist might have difficulty conceptualizing a particularly complicated symptom presentation; the patient might fail to adhere to treatment instructions; or improvement might be slow despite apparent compliance with all of the therapy procedures. This final chapter addresses common barriers to successful treatment that I have not covered in earlier chapters. By and large, such complications arise from two general sources: (a) patient factors, and (b) factors related to treatment delivery. Obstacles associated with the patient's behavior include rejection of the treatment rationale, adherence difficulties, extreme difficulty refraining from reassurance seeking, and the presence of undetected safety-seeking behavior. Obstacles related to the treatment program itself include contradictory information obtained from outside sources, the inclination to challenge the obsession using cognitive techniques, the misuse of cognitive techniques as reassurance rituals, problems with the planning and implementation of exposure, and therapist trepidation with fully implementing the treatment techniques. Strategies for overcoming these challenges are also presented.
