Engaging the Ambivalent OCD Client
by Reid Wilson
Working with therapeutic resistance is often discussed in psychotherapy training, but the ambivalent OCD client poses a unique challenge for clinicians. Here, anxiety expert Reid Wilson demonstrates a counterintuitive cognitive-behavioral approach to confronting safety-seeking behaviors that can help these clients maintain commitment to recovery.

Part of the 6-video series: Strategic Treatment of Anxiety Disorders
Kathleen struggles with anxiety about two main issues: accidentally setting her house on fire, and getting vulnerable relatives sick from her germs. Compelled by pervasive self-doubt, she repeatedly checks to make sure her stove is turned off and washes her hands up to 30 times a day to ward off contamination. This need for absolute certainty also extends to checking her door locks and kitchen faucets, which robs her of valuable time. She tells Wilson this behavior is distressing and time-consuming, yet her belief in the persuasive content of her fears requires Wilson to skillfully manage her ambivalence.

In two live sessions with Kathleen, Wilson shows us how a pragmatic assessment, clear protocols for exposure experiments, and a thorough briefing about the insidious nature of OCD can alleviate, rather than validate, the need for reassurance that drives anxiety. With humor and clarity, he passionately encourages Kathleen to rise above the content of her obsessive thoughts and practice moving towards that which she fears, supporting her in learning to tolerate uncertainty. With practice and patience, Kathleen’s checking behavior decreases significantly.

If you’re looking for a fresh understanding of OCD and effective ways to treat its self-reinforcing nature, you’ll find it in Wilson’s engaging, lively approach.

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What therapists are saying…

"There is nothing more satisfying than watching a master use his skills, and Dr. Wilson does that wonderfully in this video. While other therapists may become exasperated with their clients who appear unmotivated to change, Dr. Wilson brings that to the forefront of the session, challenging where he can, and also knowing where to pick his battles. Listening to Dr. Wilson give the reasons why he has made the choices he has made allows for the viewer to get an insight on how to manage a difficult client and still get results in just two sessions. This is a must watch video for anyone wanting to work with OCD patients."

-- Patrick B. McGrath, PhD, Director, Alexian Brothers Center for Anxiety and Obsessive Compulsive Disorders
"Wilson masterfully illustrates how to work with clients with strong convictions in the beliefs that generate therapeutic ambivalence. He introduces clear, insightful approaches to helping clients externalize their OCD-related thoughts and accept distress and uncertainty. Easy to follow and informative, this video is a highly valuable tool for supporting the clients we can find difficult to engage in treatment."

-- Fugen Neziroglu, PhD, ABPP, Clinical Director of the Bio-Behavioral Institute, Great Neck, NY; Author of numerous books on OCD, including Overcoming Body Dysmorphic Disorder
"The video and instructor’s manual showcase Wilson’s informed approach to treating ambivalent clients and provide an excellent resource for therapists familiar with ERP. The most valuable tool is watching Wilson working with a client. This demonstration and commentary help to make Wilson’s techniques more accessible to developing and experienced therapists. Overall, Engaging the Ambivalent OCD Client presents a valuable, user-friendly guide for therapists."

-- Melanie VanDyke, PhD, reviewed in American Psychological Association PsyCRITIQUES
In Depth
CE Test
Given Kathleen’s belief in the content of her obsessive thinking around safety and cleanliness, she’s to be commended for her strides with the therapeutic exposure practices Wilson offers. Many of Kathleen’s obsessions are grounded in reasonable concerns we all deal with; but OCD’s ability to exaggerate these concerns makes treatment a challenge for therapists and clients alike. Over two sessions, Wilson proposes several tailored modifications intended to support Kathleen in “moving toward” the anxiety that drives her compulsive behaviors, helping her more fully engage with her recovery and see real change.

By watching this video, you will:
  • Learn the core concepts of Wilson’s approach to treating the ambivalent OCD client.
  • Understand how to conduct a highly focused assessment.
  • Identify tools for helping clients increase their tolerance of uncertainty and discomfort.

Length of video: 03:02:13

Number of Discs: 1

English subtitles available on: Stream

This DVD plays in All Regions

Individual ISBN-10 #: 1-60124-362-6

Group ISBN-10 #: 1-60124-363-4

R. Reid Wilson, PhD is a licensed psychologist who directs the Anxiety Disorders Treatment Center in Chapel Hill and Durham, North Carolina. He is also Clinical Associate Professor of Psychiatry at the University of North Carolina School of Medicine. Wilson specializes in the treatment of anxiety disorders and is the author of Don’t Panic: Taking Control of Anxiety Attacks (Harper Perennial, 1996), Facing Panic: Self-Help for People with Panic Attacks (Anxiety Disorders Association of America, 2003), and is co-author with Edna Foa of Stop Obsessing! How to Overcome Your Obsessions and Compulsions (Bantam, 2001). Wilson served on the Board of Directors of the Anxiety Disorders Association of America for twelve years and was Program Chair of the National Conferences on Anxiety Disorders from 1988-1991. In 2014 The Anxiety and Depression Association of America honored Wilson for a lifetime of service in treating anxiety disorders, awarding him the Jerilyn Ross Clinician Advocate Award at its annual conference in Chicago.

See all Reid Wilson videos.

CE credits: 4.5

Learning Objectives:

  • Learn the core concepts of Wilson’s approach to treating the ambivalent OCD client.
  • Understand how to conduct a highly focused assessment.
  • Identify tools for helping clients increase their tolerance of uncertainty and discomfort.
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