“Desperately banging on the door”: High-Intensity Therapist’s Experience of Delivering Cognitive Behavioural Therapy to Individuals with Obsessive Compulsive Disorder: A Thematic Analysis

Abstract

Cognitive behavioural therapy (CBT) has been shown to be an effective therapeutic approach for individuals experiencing obsessive-compulsive disorder (OCD). However, significant challenges regarding client dropout from treatment have been identified within the literature. Qualitative research exploring the experiences of the clinicians delivering this form of therapy to those with OCD is lacking. This research study aimed to address this gap in the current literature base, thereby offering an opportunity for the identification of the ways in which treatment delivery may be improved in an effort to enhance client engagement. Eleven qualified high-intensity CBT therapists holding a British Association for Behavioural and Cognitive Psychotherapies (BABCP) registration, working within the National Health Service (NHS) or private practice, participated in an audio-recorded semi-structured interview focusing on exploring their subjective experiences of delivering high-intensity CBT to individuals with a diagnosis of OCD. The collected data was analysed using thematic analysis. Four major themes were identified in the participants’ accounts. These themes were labelled ‘Drowning in the Complexity’; ‘Boxed In and Shut Out’; ‘Desperately Seeking Control’ and ‘Frustrated Practice’. Findings suggest that participants frequently felt a sense of being lost in therapy with clients, owing to the varying nature of the clients’ reported intrusions and compulsions in combination with the presence of other co-morbid mental health problems. Contextual constraints, particularly within the NHS environment, in addition to the occurrence of client resistance to therapeutic techniques, appeared to result in therapists attempting to regain control of the therapeutic endeavour by adopting an overly didactic and directive approach. Such a stance appeared to have an impact on the therapeutic relationship between the therapist and client. The implications of the findings for future clinical practice regarding CBT for OCD are considered and the relevance of these findings to counselling psychology is explored. A critical review of the study is presented along with suggestions for future research.