Mclean Hospital

Assessing Without Obsessing: Ways to Check In on Your OCD

By Brittany Mathes and Marie-Christine Andre

May 8, 2015

If you have ever been in treatment, you probably noticed that most sessions started with a review of the previous week. Did you complete your homework? Did you resist your rituals? Did you use your skills? This information is discussed each week in an effort to objectively assess the thoughts, feelings and behaviors that may be influencing treatment progress in order to inform treatment decisions. For instance, if you did not use your skills in the past week, the current therapy session might focus on reviewing those skills, and your homework for the week might consist of actively practicing those skills.

The assessment process is meant to keep clients on track throughout treatment, but it can sometimes become problematic, particularly for individuals with OCD who may obsess about the process itself. For example, some clients start to ruminate about their perceived lack of progress, regardless of whether their perception is in line with reality. One way in which to elucidate the differences between perception and reality is to engage in an objective assessment, in which the individual uses data (e.g., check-in questions) to draw conclusions about treatment, rather than trying to subjectively perceive progress. Additionally, some clients can become overly focused on tracking progress in one specific area (e.g., symptom reduction), rather than looking at overall progress. Though symptom reduction is an integral part of treatment, it’s important to consider changes in other areas (e.g., mood, distress tolerance) that may be contributing to changes in symptom reduction and overall quality of life.

In an effort to promote and enhance the use of assessment throughout treatment, the OCDI Office of Clinical Assessment and Research started a weekly treatment group, called “Tracking Your Progress,” in which clients learn how to effectively and independently use self-assessment skills to track progress. During this group, clients engage in discussions about the advantages and challenges of assessment and how to objectively evaluate progress. In addition to group discussions, clients complete self-report questionnaires that are communicated in weekly reports to treatment teams. The data presented in these reports help to facilitate conversations between clients and treatment providers regarding treatment progress and decisions.

Treatment at McLean

The assessment process can seem straightforward, but it is often deceptively difficult. It’s important for clients, family members and clinicians to be aware of the challenges that assessment can bring to ensure that the process is helping, and not hurting, overall progress.

In an effort to facilitate a discussion about these issues, we will be presenting a workshop about assessment this summer at the 22nd Annual International Obsessive Compulsive Disorder Foundation Conference in Boston. We will be discussing the difficulties that can arise during the assessment process, particularly with individuals with OCD, and how to tailor this process to your/your family member’s/your client’s needs. We look forward to seeing you there!

Brittany Mathes and Marie-Christine Andre are staff at McLean’s OCD Institute.