Your client reads that exposure and response prevention (ERP) is the gold standard for treatment of OCD. She tells you, “I’m willing to try ERP, but I’m only willing to do some exposures and not others!”
Ambivalence—and a great deal of it—is a typical feature of hoarding disorder. Even clients who seek treatment for this debilitating condition bring considerable ambivalence to the goals and tasks of the treatment. Before you can work with a client’s ambivalence, you must first know what it looks like. Here are typical signs of ambivalence you may encounter when working with people who hoard.
The evolution of treatment for obsessive compulsive disorder (OCD) began with traditional strategies for managing mental illness; before the practice of psychotherapy was really developed, disorders like OCD were viewed as spiritual or moral issues, with the problem being the thoughts themselves, rather than the sufferer’s relationship to them. Then, following the emergence of the psychoanalytic model, talk therapy became the new standard of treatment for coping with obsessions and compulsions: in it, they were treated as symbolic manifestations of subconscious problems.