Treatment-resistant OCD, inflated responsibility, and the therapeutic relationship: two case examples

This paper is about the use of an unconventional intervention for treatment-resistant OCD that we describe as 'Therapist Assumes Responsibility' (TAR). The use of TAR in this paper as a clinical treatment parallels an experimental analysis by Lopatka and Rachman (1995). Two case studies are used to illustrate TAR and the use of the therapist-client relationship in the treatment of OCD. These include learning to trust others and accepting reasonable levels of insecurity. It is proposed that the addition of an interpersonal factor to CBT theories of OCD helps to explain the role of inflated responsibility and how the client-therapist relationship can be used during treatment. It is further proposed that reassurance seeking might also be the result of this same interpersonal factor.