A Case of Severe Obsessive–Compulsive Behaviour Treated by Nurse Therapists in an In-Patient Unit

Abstract

The patient was an 18-year-old girl with a 2-year history of incapacitating Obsessive–compulsive avoidance behaviour for a severe germ phobia. Previous in-patient admissions had failed to produce any improvement. There were no staff in the hospital where she was admitted with any expertise in behaviour therapy so the author was called in as an outside consultant to advise on possible treatment.A full assessment was made of the patient and the basic behavioural ideas of “modelling”, “flooding” and “avoidance behaviours” were introduced to the entire ward staff. It was decided to employ the ward sisters as the main therapists who were to act as “models”. Target behaviours for change were selected with the patient and baselines obtained before active treatment commenced. Target behaviours were handwashing, time spent in toilet, amount of toilet paper used, rituals before, during, and after showering. In addition, a “germ contamination” hierarchy was constructed. By the 18th week of in-patient treatment, all target behaviours, except going to the toilet to defecate, were under control. This latter behaviour eventually responded well several months later when she was no longer an in-patient. At 2-year follow-up, this girl was entirely free of all “germ” phobias and the associated obsessional avoidance and decontamination rituals.