Treatment of Obsessive Compulsive Personality Disorder Using Gestalt Therapy

To summarize OCPD in the language of Gestalt Therapy: obsessive compulsives replace sensory awareness of the body and world (and actions tied to this sensory awareness) with beliefs and imagination about the body and world (and actions tied to these beliefs and imagination). 

A healthy person looks at a sunset and has a feeling about the sunsett hey are watching. An OC person looks at a sunset and thinks, “The day is almost over. What did I forget to do?” There is no bodily feeling attached to the here and now. There is a distorted awareness of the Outer Zone and preoccupation with the Intermediate Zone.

 

FIGURE 1: Awareness in Healthy Personality

 

FIGURE 2: Awareness in Neurotic Personality

 

FIGURE 3: Awareness in Psychotic Personality.

 

The goal of Gestalt Therapy is to decrease the amount of time I spend in the intermediate zone by increasing the amount of time spent in awareness of the body and environment (Inner and Outer Zones).  This is as easy as noticing your own perceptions as they are occurring right now. Seeing through your eyes. Hearing through your ears.

 

Decreasing time spent in the Intermediate Zone means practicing intentionally letting go of planning, control, and self-manipulation. It means letting go of character/self/personality. Instead of trying to be some particular kind of person I imagine myself to be, I would just respond to situations as they occur. Doing so means waking up to the fact that I am not the person in my imagination. I am just me. Some days that will be remarkable. Other days that will be unremarkable. These tags are irrelevant. 

 

When I am attached to the person I am in my imagination, then I worry whether I will be perceived as this person. I become anxious. I busy myself with work dedicated to cultivating this personality. Perls gives the gist of the situation: “ ‘Will I get applause, or will I get rotten eggs?’ So that’s not an existential choice, just a choice of inconvenience. But to realize that it’s just an inconvenience, that it’s not a catastraophe, but just an unpleasantness, is part of coming into your own, part of waking up” (Perls, 1969, p. 33).

 

This sounds like self-acceptance, but there is no “self” to accept as you’ll recall. The self is a static formulation, but what Perls is describing is existential—that is, situated in existence. It is dynamic, changing based on the situation and Inner – Outer balance.

 

The difficulty is with letting go of the person you hope you will become. “What will happen if I don’t become the superlative person of my imagination??” Instead of a certain future, we find an expanse of nothingness, of uncertainty. OCPD is a solution to the uncertainty.

Perls calls this uncertainty the “fertile void.” It’s fertile because it is full of potential. Anything can take root and grow. In my experience, when I let it, I’m always positively surprised and impressed by what happens when I submit to the fertile void—when I let go and simply am what I am. I trusted the process as a PhD student.

 

I had just successfully pitched my prospectus and was starting to write my dissertation. I had written maybe 40,000 words and ran out of steam. All I wanted to do was watch Netflix on my laptop. “But how will I finish my dissertation if I’m watching hours and hours of Dexter?” I wondered. So what did I do? Well, I didn’t create a work schedule with deadlines to torture myself with, thank God. I watched Dexter until I was confident that I would never complete my PhD. I watched the whole series in about eight days. From sun up to sun down. I became comfortable with my future as a master’s degree holding part-time psychology instructor. And on the ninth day, I wrote. And I wrote and I wrote and I wrote. I finished the whole thing in one month. It took me longer to format than it took me to write.

 

But if I had the courage to continue letting my planning go, then I wouldn’t be writing this now. It is easier for me to make my limited plans for the future than it is to submit to the infinite possibility of the fertile void. (Because what if the possibility is crappy?) I worry that my wants won’t be satisfied were I to let nature run its course, so I take over for nature.

 

I want to be successful. But I’m not sure that is what would happen if I let go and let whatever happens happen. What if I never publish anything again? What if I get steamrolled by administration and wind up teaching ten classes? What if? What if? And so I take nature into my own hands. I will see to it that I continue publishing, even if it kills me.

 

And so on with my marriage, my fitness, my personality. I throw myself at each task, working myself to exhaustion. Ironically, the devoted approach fails on each account:

·      I cut calories to lose vanity weight and soon become undernourished. My metabolism slows and I feel terrible AND gain weight.

·      I exercise compulsively and am afraid to rest. But the lack of rest means no fitness improvements. I become exhausted and wind up less fit than I was when I started.

·      I make a writing schedule and stick to it. I plan what to write about and how to do so. I plan where I will get it published. I make myself want to do it. I end up working on projects that don’t inspire me. My writing is derivative, stale, and uninteresting to readers.

·      I constantly posture and position myself with colleagues in hopes that I will appear more competent and capable than I am—hoping that they will see and recognize my accomplishments. I end up coming off as haughty, selfish, and disrespectful.

·      I’m so focused on pleasing Erica or on appearing to be a good husband that my performances come off as exactly that. 

OCPD is the computer-driven solution to life organization. It’s planning, problem-solving, fixing, and so on. If I feel unsure, then I brainstorm, I compute, I plan, I work. 

[Even as I was writing this, I suddenly had a feeling that I could do more to be a supportive colleague. So I went to Academia.edu and Researchgate.net to follow newer faculty at my school. After I had searched for (and could not find) the few professors I had in mind, I compulsively began updating my own profiles at each location—adding newer materials, updating contact info, etc. I’m not sure how long it took. Even as I was doing it I thought, “This is exactly what I’m trying to stop doing.” But I continued undeterred.]