OCD Treatment: Squaring Up ‘Interest’ and ‘Willingness’

By Jonathan Hoffman, PhD, ABPP

‘Interest’ and ‘willingness’ might be used interchangeably in everyday speech. However, in the context of OCD treatment, not so much. ‘Interest’ implies being motivated by curiosity about or inclination towards getting treatment for OCD – not unlike “just looking” in a store. On the other hand, ‘willingness’ connotes that a person is motivated to, well, ‘do’ OCD treatment.  

The table below illustrates four ways that ‘interest’ and ‘willingness’ may square up with OCD treatment-relevant considerations: 

A. Top Left Square 

 When interest and willingness are both high, it is ‘all systems go’ for OCD treatment – blasting off with psychoeducation and proceeding to evidence-supported treatment (EST), which in most cases means facing one’s fears in exposure and response prevention (ERP). There is a catch: The presence of high interest and high willingness in no way negates how other variables affecting progress throughout OCD treatment might be in play. These include the presence of co-occurring conditions, challenging personality factors, learning difficulties, logistical issues in accessing treatment, or family over-accommodation of OCD symptoms.  

B. Bottom Left Square 

This square depicts ‘interest’ in OCD treatment being high, while ‘willingness’ to engage in it is low. It pertains to individuals who are ambivalent about OCD treatment, as well as those who ‘talk the talk’ but do not ‘walk the walk.’ Either way, focusing on how to transform readiness for OCD treatment from the contemplation stage into the action stage is job one. One effective therapeutic technique that may be applied to OCD and prevent fruitless power struggles about

engagement in treatment is called Motivational Interviewing (MI). In MI, a clinician has a collaborative conversation with an individual impacted by OCD but ambivalent about treatment to help them identify and enact personally compelling ‘willingness’-related reason(s) to do the OCD treatment ‘walk.’  

C. Top Right Square 

 What does it mean to have low ‘interest’ in and high ‘willingness’ for OCD treatment? Yes, these two states of mind do not necessarily go together. Some people recovering from substance abuse are not interested in sobriety but live it nonetheless because they can see the bigger picture. The capacity to do what needs to be done to improve functioning and quality of life regardless of ‘interest’ is a fantastic (and underestimated) skill. Moreover, as time goes by, ‘interest’ in OCD treatment can quickly wane, especially after a period of lessened symptoms. Accordingly, well-designed OCD treatment protocols strive to prepare individuals for this eventuality in the relapse prevention (RP) phase of treatment, for example, by asking people to self-monitor their level of ‘interest,’ and when it is at its lowest, make a particular effort to undertake challenging self-guided exposures. Regarding the potential to benefit from OCD treatment, people in this square are often the proverbial ‘diamonds in the rough.’ 

D.  Bottom Right Square  

There are many explanations for having low ‘interest’ in and low ‘willingness’ for OCD treatment, including being in denial or having poor insight into OCD symptoms, falsely believing that OCD is their ally, being more frightened of OCD treatment than of OCD, or excessive accommodation of OCD symptoms. Whatever the reason, when interest and willingness are both low, the person is unlikely to engage in OCD treatment. In some very extreme cases of OCD with loved ones in the picture, there may be a solid rationale for utilizing ‘strategic pressure’ as a final attempt to leverage the person in a crisis into OCD treatment. However, the pros and cons of such drastic measures must be carefully weighed before implementation.  

For parents and family: When a loved one’s ‘interest’ and ‘willingness’ for needed OCD treatment are both low or a mismatch for one’s own, it may be wise to avoid power struggles with them and change the focus to getting support for yourself from a clinician that has specialized knowledge in these matters, either on an individual basis, through parent/family guidance, and/or via an OCD support group.   

Hopefully, this exploration of the relationship between ‘interest’ and ‘willingness’ will assist anyone that OCD impacts in exploring how these two states of mind might square up for treatment, whether it is for themselves or a loved one.  

And, no matter where you stand in this process, it never hurts to ask yourself: just ‘interested’ or ‘willing?’