I had the pleasure of meeting Dr. Ted Witzig at the recent International OCD Foundation meeting in Los Angeles, and he kindly agreed to permit me to record a telephone conversation in which I would ask him several of the questions that Protestant OCD sufferers with scrupulosity concerns have asked me over the years. Dr. Witzig brings unique experience both a minister and a clinical psychologist with an expertise in OCD. You listen to our conversation below, and you can also find the complete transcript of our talk below. Dr. Witzig also wanted Christian scrupulosity suffers to be aware of a great deal of useful information he has gathered on his outstanding website.
– Lee Baer, Ph.D.
Play audio here:
Ted Witzig, Jr., Ph.D.
Director of Clinical Services
Apostolic Christian Counseling and Family Services
515 E. Highland St., Morton, IL 61550
LEE BAER, Ph.D. (LB): You’re in a great position by being a psychologist and expert in OCD and also a pastoral authority. One issue is that Protestantism is the greatest range of denominations. If someone who identifies as a Protestant and has scrupulosity, would you suggest that they start by looking for pastoral counseling first?
TED WITZIG, Ph.D. (TW): Well, it’s really interesting because it’s not that different from other religious groups. The experience that pastors or ministers have with treating people with mental health issues and scrupulosity specifically, varies really widely. The good news is that over time they are becoming more aware that repetitive confessions and people who can’t feel forgiven and feel stuck means that there’s more going on than just a spiritual issue. I really encourage people to have a pastoral person that comes alongside them, but at the same time if that person isn’t familiar with OCD – that’s part of the place that I’m trying to step into is trying to help pastors become educated about OCD and how to work with people. What I’m working on now is in essence a scrupulosity treatment manual from three perspectives so that a client with scrupulosity, a pastoral figure or family member, or a mental health practitioner can all look at this through the lenses of OCD and the person’s faith so that they can reach successful treatment. I find that pastors really need to hear from the mental health practitioners that they’re doing the treatment to improve the person’s faith, not to harm it. I think that historically, particularly in more conservative protestant denominations, there’s been quite a gap between mental health practitioners and clergy, and some suspicion between the two. I try to stand in that bridge, and in many ways it’s just being bilingual and being able to translate those things. Pastors just want to see the person to be well spiritually and emotionally and mental health practitioners want the same. We just need to help them get aligned.
LB: You say that a person should have a pastoral person along with the team to ensure that there’s no treatment that would go against the church teachings.
TW: More than anything, I look at the protestant scrupulosity about being around the core of uncertainty, particularly uncertainty about the purity of thoughts, of doubts, of feelings of peace. Oftentimes, they interpret things like uncertainty or doubt as being so spiritually unsafe that it’s a great thing to have a pastoral person be able to look at that person and say “yes, you need to push through that uncertainty.” Having that oomph behind it reinforces the direction of therapy, even if it’s not about getting a specific exposure done, being able to say yes it is the right thing, you need to push through that. It ends up being “moving through the uncertainty is part of your treatment, but it’s also part of faith in general.”
LB: When you tell a patient something like “God understands what’s in your mind and what’s in your heart, and understands that you have a problem” so that if you have a thought that you don’t want to have, God understand that that is caused by the illness – that can be a reassurance, and not helpful. What’s your thought about that?
TW: This is where there sometimes is a departure with people that are schooled in CBT where they want to push “thoughts mean nothing, thoughts of all kinds mean nothing.” Well the problem is that in a lot of Christian circles thoughts can have meaning and do have meaning. So there’s that tension there. What we’re really trying to help people do, is instead of becoming hyper vigilant about thoughts and analyzing thoughts, using thought suppression, all those things, we’re trying to help them learn that the best way to deal with many kinds of thoughts is to let them float and to deal with the uncertainty about that. For example, whether it’s a sexual thought, whether it’s just a regular sexual thought that would happen to anybody, or one that’s intrusive or distressing, I’m going to encourage people to push through those the same way by not spending the time giving the thought meaning and not trying to figure it out. It’s very common for Christians with scrupulosity to try and analyze: was this my flesh, was this a temptation, was this a sin, was this an obsession, and I look at them and say “your job is to not figure it out and to go on.” Ultimately, regardless of what it is, you’re not served by analyzing it. I commonly give an example to people because they’re very doubtful about “did I sin, or did I do this” and a lot of their thoughts are about “what if I, what if I.” They have this sense that they’re going to accidentally miss it. That there’s this gross sin that they’re going to be responsible for that they accidentally missed. And I tell them “If you punched me in the nose right now, gave me a bloody nose, cussed at me, slammed the door and walked out (that’s a horrific scene for the scripture), how long would it be before you realized you’d done something wrong?” and they say “I’d know immediately.” “How about who you needed to apologize?” “Well I’d know immediately.” In that case, you know exactly what you did wrong and who you did wrong to. The issue is that scrupulosity says “well I might have, or what if.” And I tell people that they need to start treating their “what ifs” as obsessions. If you punch me in the nose or if you robbed a bank at gunpoint, you’d know you did something wrong and there wouldn’t be any question. If there’s any question, you need to move on. This whole thing about God knowing our thoughts, I believe it’s true. I think the problem is that people analyzing whether it was a true thought, an obsession, a temptation, that itself becomes a micro obsession. I really encourage people that regardless of what generated the thought they need to not figure it out and go on, and that becomes an exposure.
LB: When you’re saying that, is it as a psychologist or as a pastor? For example, a psychologist wouldn’t say “no, that’s not a sin.” But as a pastor would you say “that’s not a sin” or would you say “that’s OCD.”
TW: When it comes down to whether someone isn’t sure it’s sin, my advice would be that they have to treat it as an obsession. Here’s my pastoral side: I don’t believe that God made a scenario where “there’s one thing, and if you did it you’re done for. But I’m not going to tell you what it is.” What kind of father would I be if I told my daughter “there’s one thing you could do that would cause me to write you out of my will and treat you as dead. I’m not going to tell you what it is, but don’t do it.” And that’s how people with OCD relate to God around their OCD. Particularly with obsessive doubts. The intrusive stuff – thoughts of blasphemy, intrusive sexual thoughts – I find that much easier to deal with than the people who are the chronic ruminators about doubt. If someone comes in with blasphemy, the Holy Spirit, and unpardonable sin, I say let’s get to business. Those chronic ruminators, that’s double heart. It’s doable, but it’s double heart.
LB: A major problem is people worrying that they haven’t prayed properly – they didn’t pray long enough, didn’t have the right concentration, didn’t have the right feelings in their heart, – what advice do you give to them?
TW: I try to figure out what they’re doing lengthwise. One thing I’ve had to do is help people shorten up their prayers because they’re getting to work late and stuff like that. I don’t do what some have done, say “you’re forbidden to pray.” We find an acceptable time range that they need to stay in. In essence, we want them to become functional and within normal limits. If it was 10-15 minutes versus two hours, it’s hard for someone with scrupulosity to say “ten minutes is okay when I was doing two hours?” The other thing is that a lot of people with OCD are searching for that special click. As they play it over in their mind, their mind is searching for that mental coat hook. But they don’t have that coat hook. So I use the imagery of laying the coat down, which means that the purpose of prayer is not about a feeling. I have to work with people about moving their faith away from feelings. And prayer is a big one in that way because they hear people talk about prayer is a time of intimacy, a time where they’re so connected. They end up using prayer as a major checking session or analysis. In Protestantism, repetitions of prayer is not used so it’s pretty easy to say: if you think you said it wrong you’ve got to keep going. Someone who thinks they’re going to pray to Satan might say “In Jesus’ name, in Jesus’ name, in Jesus’ name…” So we use that concept of: what are the things that are normative in the faith community? It’s creating a sense of normalcy. The biggest thing is helping people to detach their emotions and emotional checking from the prayer. That means that prayer may or may not feel right to them. I like to give them “God, help me to accept and move on from obsessions, and help me to fight doing my compulsions.” That’s not the whole prayer, but it’s one of those things that we move it into. Ultimately, it’s about actually getting people to do it, move through it, tolerate that they may not have done it right, and keep going.
LB: What would be an indication for a Protestant with scrupulosity that their treatment isn’t going in the right direction?
TW: One lady at the OC foundation, she came out of a room and she was so panic stricken. She was in a panel talking about exposure. She had thoughts of blasphemy about God – she was saying “F God.” But then her exposure was to sit in church saying “F God” and to eventually being sitting in the front row of church, looking at the pastor, and saying “F God.” Some people would say that’s a great exposure and if she can do that, that’s great. She said to me: “If that’s what I have to do to get better, I will suffer with this my entire life. I will not do that.” And I said to her: “Ok. First of all, you do need to do some exposure. How about you construct a loop tape that would say something like this: ‘Oh no, I’m sitting in church, and what if I curse God?’” She looks at me, she was pensive for a moment, and said “I could do that. It would be scary.” And I said, “It would be scary, and you need to do that.” There’s not protestant pastor, particularly on the conservative side that’s going to say “Yes, you should sit in the front of church saying F God in your head while I’m doing my sermon.” The same thing is true with sexual intrusive thoughts. I am amazed at how often pornography is prescribed. I was at a behavior therapy event at the OC Foundation and the suggestion for treating gay thoughts was masturbating to gay porn. You think you’re going to find a conservative protestant preacher who’s going to say that’s a great idea? This kind of stuff creates violations through the person, and they’ll suffer as they do that treatment. I tell people over and over: you have to learn to tolerate uncertainty. You need to be able to come to that place where you don’t have the equations in your head that faith equals uncertainty. But you don’t have to do an exposure where you have to do something that within your faith community would be sinful.
`
One of the most common things that people hear – especially if the pastor doesn’t understand that there’s a mental health condition going on – they’ll hear that they have to do it harder. They have to pray harder, they have to read harder, they have to confess harder. If what is being prescribed spiritually gets in that pattern of OCD where you go confess and feel better for a while but feel worse again because you wonder “did I really say the whole thing?” Those kinds of things are definitely something to watch out for. Also, one of the big splits that happens is that pastors tend to see the world through spiritual eyes. Psychiatrists are going to look through biological eyes, some emotional. I tell people that they need to take a bio-psycho-social-spiritual view of their condition. There’s oftentimes this “or” mentality – even among professionals. Pastors and parishioners will hear: “I’m either diligent in my faith or I’m going to take medication. Or because faith didn’t work I’m going to do CBT.” I encourage people to acknowledge the “and” because that’s how God built us. Doing one thing doesn’t diminish the importance of the other.
[subscribe2]