Raúl Segura: the treatment of OCD from Brief Strategic Therapy

We interviewed Raúl Segura, an expert in the treatment of OCD using Brief Strategic Therapy.

Among all types of psychotherapy, there is one that places great emphasis on the need to focus on the present in order to obtain results as soon as possible, and to enhance the effectiveness of the psychologist's intervention. This is is the case of Brief Strategic Therapy (BST), developed from the work of the psychologist.developed from the work of Paul Watzlawick and Giorgio Nardone.

The TBE creates intervention protocols adapted to each type of harmful psychological alteration so that the person stops feeding the problem unconsciously and begins to live from healthier habits and away from the disorder. To understand how it works in the treatment of Obsessive-Compulsive Disorder, we talked to a Canarian psychologist specialized in this type of therapy: Raúl Segura Díaz..

Interview with Raúl Segura: helping people with OCD from Brief Strategic Therapy

Raúl Segura Díaz is an official psychologist of the Brief Strategic Therapy Center of Arezzo (directed by Giorgio Nardone himself), and works in his office in Las Palmas de Gran Canaria. On this occasion, this professional talks to us about his experience treating patients with Obsessive-Compulsive Disorder, a psychological disorder known to be related to the need to perform repetitive "ritual" patterns of behavior.

Is it possible for a psychological disorder that has been troubling a patient for years to disappear in just a few months of therapy?

Just because a disorder is disabling and has been affecting a person for many years does not mean that the solutions to make it disappear have to be of the same magnitude. If the right treatment protocol is found, most problems are solved in a few months.

It is true that the most important thing is to unblock the disorder in the first sessions so that the patient stops suffering and then gradually work with appropriate strategies to eliminate it completely. This is how it is done in the case in question, in Obsessive Compulsive Disorder (OCD), which must be completely eliminated, small improvements are not enough, if it is not completely eliminated then it will be reproduced again. We could say that it behaves like a virus.

In the case of Obsessive Compulsive Disorder, is the treatment complicated?

I would say that it is a complex disorder that cannot be solved with ordinary logic. We must understand how it works and apply the appropriate treatment. It is necessary to know how the problem is structured in the patient's mind, to know the type of rituals and whether the OCD is based on fear or pleasure. For example, an OCD based on fear would be the implementation of rituals to avoid contamination, and one based on pleasure would be pulling out one's hair, which is called trichotillomania. We must be very clear about what the patient does to reduce his fear or not to give in to pleasure.

Most patients with this disorder start rituals or compulsions that reassure them at the time and gradually become more frequent until they completely disable them. Other strategies used by patients is to avoid what they fear, for example not to go to places where they can be contaminated, and also to involve the family to help them.

At first it may seem that all this calms the OCD sufferer, but then it becomes part of the problem, as the disorder progressively demands more rituals, more attention from family members, more avoidance. We must use specific protocols, as is done in Brief Strategic Therapy (BST), to dismantle all this that the patient has built and thus free him/her from the trap of the disorder.

Since your specialty is Brief Strategic Therapy, what would you say are its distinctive aspects, and what distinguishes it from other psychological interventions?

One of the fundamental aspects is that Brief Strategic Therapy is focused on change, not on learning like others. Let me explain: in other therapies there is a dialogue with the patient so that he/she knows his/her problem, so that he/she understands it through reason and this leads him/her to act differently.

In Brief Strategic Therapy, on the other hand, the dialogue is focused on making the patient perceive and feel his problem from another perspective. The aim is to make the patient put into practice prescriptions, which sometimes may seem original, but are based on efficiency. This helps to overcome the resistance to change that any structured disorder has.

In EBT we make the patient relate differently to his problem, which causes him to have a different perception of it. He begins to realize that he can stop doing certain rituals, thus breaking the rigid structure of the disorder.

In the sessions we use persuasive language that fits the patient and his problem. A communication oriented to discover for himself how the disorder works and how it is that what he has done so far to solve it maintains it or even worsens it. All this makes EBT one of the most effective treatments for OCD.

How does one begin to notice that compulsions cease to have their power over the person?

Compulsions stop dominating the patient's life when the patient can stop doing them, when it is no longer inevitable to carry them out. The patient realizes that more and more often he/she dominates the situation instead of the disorder. This can be achieved in a short time if with the appropriate stratagems we take hold of the symptom so that it ceases to be something irrepressible.

The patient observes that he can, for example, stop washing his hands, or that he can stop checking a document twenty times before sending it, or that he can stop reciting the mental formulas that the disorder used to impose on him.

Can we all become structured, suffer from OCD?

If we take into account that OCD is based on reasonable things taken to the extreme, we could say that anyone could suffer from it. Washing your hands is good to avoid contamination, but it's not good to wash them twenty times. It is a good thing taken to the extreme. Being tidy and clean is fine, but if this leads us to spend most of the day involved in tasks to tidy and clean we go from something that is fine to a disorder.

The logic is not wrong, what is wrong is to take it to the extreme. For example, having a hobby to bring us luck before playing a soccer match is not harmful at all, but it is harmful if that hobby requires more and more time, if we have to repeat it first ten, then twenty, thirty times?

Would you recommend the use of Brief Strategic Therapy to most psychologists?

I would recommend EBT to those psychologists who want to solve psychological problems efficiently.

We should keep in mind that Strategic BPT has specific protocols for different psychological disorders that have been tested on hundreds of patients. Not only that, but at the Center for Strategic Brief Therapy in Arezzo, which is directed by Professor Giorgio Nardone, continuous research is carried out to on the one hand adapt and improve existing protocols and, on the other hand, develop new protocols for pathologies that arise as a consequence of the constant change in our society.