Michael A. Tompkins, Ph.D.
Co-Director of the San Francisco Bay Area Center for Cognitive Therapy
Obsessive-compulsive disorder (OCD) is a chronic condition and therefore even following an effective treatment, your client always and will forever face the possibility of relapse. Assisting the client to manage the risk of relapse is an essential part of treatment for the condition. As you taper sessions with the client, use the times between sessions to assist the client to practice the relapse prevention plan you and the client developed. An effective relapse prevention plan includes several features, such as practicing and reinforcing life-style exposures.
Life-style exposures. An effective relapse prevention plan includes opportunities for the client to practice responding adaptively when in the course of everyday life situations trigger his OCD symptoms. The manner with which a client responds to these unplanned exposures can tell you much about whether the client has truly adopted an effective recovery attitude. Brainstorm with the client the life-style exposures he is likely to experience before he next meets with you. Ask him to write these on a monitoring form and add space for him to note other life-style exposures that arose but that you did not include on the form. Develop with the client an appropriate response to a life-style exposure – approach and remain without engaging in any attempt to decrease his anxiety or neutralize the obsession. Develop imaginal exposures to these life-style events and practice in session. In particular, check that the client is responding appropriately to the obsessions and distress triggered through the imaginal exposure. Include on the form space for the client to list new obsessions, compulsions, or triggers and of course, when you meet with him, praise the client for successfully completing life-style exposures.