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“Bridget” was my first cognitive behavioral therapy (CBT) case and assigned to me in my second year of doctoral training as part of a clinical practicum. She was a 21-year-old undergraduate student who presented with depression and obsessive-compulsive disorder (OCD), in which the obsessions were religious in nature and the compulsions were rituals of the Catholic religious tradition, such as crossing and praying. Distinguishing between thoughts and behaviors that would be targeted as symptoms and those that would be retained as bona fide religious beliefs — and thus not viewed as a function of Bridget’s OCD — presented unique ethical and technical challenges. In Phase 1 of treatment I used cognitive-behavioral therapy (CBT) methods to target Bridget’s OCD symptoms. After these obsessions and compulsions had been virtually eliminated using the CBT-oriented treatment, Bridget was eager to pursue other difficulties (such as the impact of her interpersonal style on her relationships with men). At this time I had the opportunity to continue therapy with Bridget in conjunction with a psychoanalytic course I was taking that offered a psychodynamic supervisor. I determined that this Phase 2 arrangement would be in Bridget’s therapeutic interests in light of: (a) the issues with which she was dealing; (b) the fact that Bridget and I had established an excellent working relationship during Phase 1 and Bridget easily agreed to continue therapy with me in the new, less structured, psychodynamically oriented format; and (c) the fact that the new, psychodynamic supervisor was open to my integrating psychodynamic concepts into the CBT approach I had employed in Phase 1. Overall, therapy was conducted weekly during 2 ½ academic years (the client generally took the summers off) for a total of 79 sessions. The therapy results across the two phases present evidence that in the context of the above-mentioned facilitating conditions, the two phases worked smoothly together to help Bridget with the variety of problems she presented.

pragmatic case studies in psychotherapy

Targeting Catholic Rituals as Symptoms of Obsessive Compulsive Disorder: A Cognitive-Behavioral and Psychodynamic, Assimilative Integrationist Approach