"Functional," Sub-Clinical Obsessive-Compulsive Symptoms and Their Challenges: The Case of "Angela"

Abstract

Complex behavior patterns may underlie symptoms of obsessive-compulsive disorder (OCD), which, in turn, seem to contribute to the maintenance of symptoms, hinder its management, and interfere with the client’s compliance with treatment. Although the evidence-based choice for treating OCD is cognitive-behavior therapy (CBT), such treatment might prove ineffective if it is not accompanied by a careful and thorough investigation of the contingencies involved in the onset and maintenance of symptoms; and this  might take longer than predicted by treatment manuals. We present a case study of the treatment of "Angela," a client with OCD who suffered from sub-clinical symptoms for 20 years and did not obtain relief with antidepressant medication. Angela underwent cognitive-behavioral therapy for three and a half years and was treated by the first author in weekly sessions. The difficult management of symptoms, the contingencies involved in them, and the development of the therapeutic relationship are discussed. Treatment results indicated a significant decrease in symptoms, anxiety, and discomfort. We believe this case illustrates limitations associated with a strict, manual-driven treatment with a pre-determined number of sessions.