Counseling people who have been diagnosed with OCD can be challenging, and counselors may find it difficult to know how to help them.1See Newcome’s previous article on understanding OCD from a biblical perspective here: https://biblicalcounseling.com/resource-library/articles/gods-faithfulness-experienced-in-obsessive-compulsive-disorder/ In brief, the biblical view of OCD understands that the human heart, filled with sinful desires and motivations, fuels the obsessive and compulsive cycle. Therefore, OCD is a cycle of habituated and engraned or hardened behavior involving one’s thinking and behaving. Oftentimes counselees with OCD struggles are so overwhelmed with the intensity and frequency of their obsessive thoughts and subsequent compulsions that they find it difficult to slow down and digest truth from the Word of God.2Scrupulosity and OCD are used interchangeably in this article. For more, see Brent Osterberg’s booklet on this topic: https://biblicalcounseling.com/product/scrupulosity/?srsltid=AfmBOoop6QIGeWjvgML5GlUtVQfVzuKso6diI65tkcX6iQSdyzzHibn7 Counselees need repetition in learning new ways of responding to their thoughts and denying their urge to engage in compulsions. Progress will begin to take place over time as they make new godly habits of responding to the intrusive thoughts and they are transformed spiritually in how they perceive God, themselves, and their situation. My hope is that sharing some of the homework ideas that I use with such counselees will help you gain confidence in helping others who also suffer in this way.
A Word of Caution for Counselees with Scrupulosity
Be wise and careful with the kind of homework you assign counselees who struggle with scrupulosity so as not to inadvertently feed their compulsions with homework that is too heavy on Bible reading, prayer, and confession. These means of grace are often twisted by a person with scrupulosity and instead of receiving grace from them, they engage in them ritualistically and repetitively (as compulsions) in an attempt to make themselves feel safe. For a time they will need to be re-trained on how to read the Bible and understand it as a whole, to pray honestly and relationally to the Lord, and to confess in a biblical way that ushers in hope and restoration instead of shame and guilt. The end goal is not that they abstain from these disciplines of grace but that they learn to engage them in meaningful and life-giving ways.
Start With the Foundation
I typically assign Psalm 103 as the first homework assignment to get the counselee to focus on the character of God and how He relates to us with mercy, love, and compassion. I highlight how God does not deal with us according to our sins or iniquities (vs 10) which often stands in contrast to their understanding of who God is and how He relates to them. Additionally, we spend time on verses 13 and 14 about God’s compassion for His children and the wonderful promise that He knows and understands who we are and what we struggle with. This helps the counselee to be assured that God is compassionate toward their struggle and knows the frailty of their minds.
Fear
OCD is driven by and rooted in fear. In order to address the fear and distress that resides in the mind and heart of the counselee we go to Psalm 46 together and I have them start by identifying what they learn about God’s character and why He can be trusted. I have them consider His promises from the Psalm and the hope that is given to them. I then ask them based upon God’s Word why they can trust Him instead of trusting themselves or instead of being fearful. With each homework assignment, I ask the counselee how these truths are different from the lies that they are tempted to believe and then ask them how they might think, believe, and act differently based on what they have learned. Psalm 46 is also an excellent chapter for counselees to memorize and meditate on when fear arises so that they can quickly remind themselves that God is their refuge and strength (vs 1) no matter what the future might hold.
Self Sufficiency
Many counselees believe the lie that they are safe only if they keep themselves safe. As the OCD persists, the counselee will become increasingly dependent upon their own evaluations and assessments of their thoughts and come up with all sorts of rituals to alleviate the resulting fear and anxiety (compulsions). They become hyper-focused on themselves, their own system for dealing with the intrusive thoughts, and the distorted beliefs they have about God and self. To enlighten them to what Scripture gives as a remedy for self-sufficiency I assign Matthew 11:28-30 and 2 Corinthians 12:7-10. These passages help them begin to allow God to carry their burdens and know that His grace is sufficient for their every need. Jeremiah 17:5-8 can also be used to show them the contrast between the person who puts their trust in their own flesh versus the one who trusts in the Lord.
Perfectionism
Perfectionism is a common root issue for the counselee and Philippians 3 is an excellent place to assign homework. I use Philippians 3 to draw their attention to how the apostle Paul, as a Jew, sought after a righteousness of his own that was motivated by following the Law. It is important to understand how Paul contrasts his life before and after he came to know Christ, and how what he values now as a Christ follower is not perfection, but knowing Christ more and being conformed to His image. Helping the counselee resist the sin of perfectionism and instead lean into the grace of God and His imputed righteousness (Isaiah 61:10; Philippians 3:9; 2 Corinthians 5:21) will challenge many of the fearful and untrue thoughts and beliefs that they obsess over.
Desire for Certainty and Control
Another persistent idol in the heart of such counselees is their desire for certainty and control. They can be immensely fearful when uncertain about whether they are safe or whether their thoughts are true. The aim of counseling is to help the counselee learn that they cannot find certainty by looking inward but by trusting in the sovereign love and care of God. Likewise, their desire to control their thoughts, feelings, circumstances, and outcomes inevitably increases their anxiety and feeds the obsessive-compulsive cycle. The remedy for control is the same as their desire for certainty. Help your counselee learn that they are safe inside of God’s providential care over their lives. You can use Isaiah 40 as a homework assignment to help them better understand the trustworthy character of God and how He sovereignly oversees their life. Help them learn to surrender their lives to God’s greatness and His power (vs 26) and submit to His plans for their lives.
Grow in Trust
As has already been emphasized, the most important part of the OCD counseling process is to help the counselee learn to trust themselves less and to trust God more. They have made a habit of placing their trust in the interpretation of their thoughts and feelings and they need to daily and moment by moment learn to place their trust in God instead (Proverbs 3:5; Isaiah 12:2). I encourage my counselees to ask themselves when they are stuck in an OCD cycle “how do I need to trust God in this moment”? Encourage and exhort them to consider if they need to trust in His sovereign care (Psalm 121:2), in His wise and loving plans for them (Psalm 33:11), or in His protection over them in response to their fearful thoughts (Psalm 46:1-2). Do they need to apply the gospel to their distressing thoughts at that moment or be reminded of Jesus’ finished work on the cross for them (Romans 8:32)? In the midst of the OCD cycle how can they abide in Him (John 15) and allow Him to carry their burdens instead of trying to do it themselves (Matthew 11:28-30)? As they seek to apply the truths of Scripture to their obsessive thoughts and place their hope and trust in the Lord, instead of their compulsions, they will begin to experience freedom from the obsessive-compulsive cycle.
