The idea of actually getting treatment for POCD can be terrifying, especially when you think your obsession is unspeakable and untreatable. But OCD is OCD. POCD is not some untreatable separate diagnosis that requires some strange outlying treatment approach. The most effective treatment for obsessive compulsive disorder is cognitive behavioral therapy (CBT). Though there are multiple forms and variations on CBT, the ones that are most likely to help with OCD use a combination of cognitive, behavioral, and mindfulness-based interventions.
Cognitive Approaches to POCD
Cognitive approaches to the treatment of POCD focus on teaching you how to recognize when you are making assumptions that are problematic, unhelpful, or plain wrong about your pedophile fears. This might include addressing things like black-and-white thinking (if I have even one intrusive thought about a child, it means I am a pedophile) and magnifying (I noticed my baby’s cute bottom and that means I was leering at it inappropriately). Modifying distorted ways of thinking in this approach doesn’t involve trying to prove your fears are untrue (you’ve already tried that plenty), but instead works on drawing your attention to a more objective assessment of your experience. You can’t argue with the content of an obsession, but you can challenge the way in which you have formed your conclusions.
Behavioral Approaches to POCD
Behavioral approaches for OCD emphasize exposure with response prevention (ERP), which involves gradually training yourself to resist compulsions as you methodically confront your fears. Naturally, this does not involve putting you or any children in risk of any harm, but instead is designed to readjust your responses to the POCD triggers. This may involve resuming your role in challenging activities at home (e.g. bathing your children while not engaging in rituals), resisting the urge to do compulsions serendipitously (e.g. continuing to walk on the same side of the street as a child when you have an urge to avoid), purposely increasing closeness with children (e.g. babysitting your niece and resisting rituals), imaginal exposures (e.g. writing narratives about your pedophile fears potentially being true, reading triggering articles/websites without ritualizing), or any or all of the above.
Mindfulness for POCD
Incorporating mindfulness skills is often an important part of the CBT work, especially for POCD and other manifestations of the disorder that are maintained by mental rituals. Mindfulness skills are those which enable you to observe your thoughts, feelings, and sensations as they happen, without engaging them or judging them. You need to be able to see that you are ritualizing, to see the thought approaching and choose a response (often by not responding) instead of just reacting. By accepting the presence of unwanted thoughts, you are not only doing exposure to your fear of not responding the “right” way, but you also lighten the burden of constantly having to punish yourself. The stuff that goes through your head is just that – stuff that goes through your head. Mindfulness work can teach you to make room for that “stuff” and reduce the power it has over you.
Sure, anything to get out of this living nightmare, but how am I supposed to accept something that is anathema to my values?
You’re not. You’re accepting that you have thoughts, that you have fears, that you are uncomfortable around uncertainty, that you very strongly wish no harm to come to anyone you love. You accept that you care strongly about the kind of moral person you are. You accept these things and learn that responding to these thoughts and fears the way you have been brings you no closer to the things you value and it’s time to identify new behaviors that will. That’s a different kind of acceptance.
Demystifying Cognitive Behavioral Therapy for OCD and POCD: ERP
CBT treatment for POCD is a frightening prospect. You want to stop having thoughts about children that make your stomach churn, and your CBT therapist wants you to have them. Or, more accurately, your CBT therapist wants you to let them come, let them be, and ultimately let them go. It’s dirty work, but there’s a lot at stake. The OCD wants total submission. It wants total control over who you spend time with, what or who you make contact with, where you go, how you raise your children, what you listen to on the radio, what movies or TV to watch… It wants it all.
To the POCD sufferer, the idea of discovering that you are a pedophile means losing it all. Your identity, your legacy. ERP rebels against this oppression. Though you won’t ever have to do something that violates your ethical beliefs or do anything that could harm a child, you are going to have to put yourself in situations that trigger powerfully unpleasant thoughts and feelings. But when you develop mastery over this obsession, each step along the way you get rewarded by more freedom from the OCD. Freedom of movement, freedom to be with whomever you want to spend time with, freedom to watch or listen to whatever show or music you choose, freedom from the tyranny of OCD.
If you don’t have a longstanding history of OCD symptoms, and POCD crept up post-partum or at some other time in your adult life, you may be reeling from the shock of experiencing these frightening thoughts for the first time and not knowing why. If you have always had OCD and just found your fears evolving thematically in this direction, your experience is no less terrifying. However, you may already know how OCD works. If you can think it and it’s awful, then you’re doing to think it. This is not because you are some bad person with a broken moral compass or some closeted deviant wired the wrong way. It’s because this is how OCD works. Mastering your OCD means knowing all its tricks and how to outwit them.
The Trap of Convincing Yourself
Uh huh, freedom from OCD sounds great, but how do I know if I’m a pedophile or not? “Pedophiles are like this and I’m like that.” Looking for something like that to prove I’m not a child molester. I mean, what’s the difference between me and someone who’s a pedophile and is just afraid to act on it? Or maybe doesn’t want to act on it because they know it’s wrong or harmful? I need to know that I’m, not sexually attracted to children, that I’m not even capable of it.
This is an OCD trap. I could write about the diagnostic criteria for pedophilia and the basic premise that some people for some reason are either sexually wired toward children or somehow develop urges that result in preying on children. You could read it and find the thing you think makes you different or the same, but your obsession will persist regardless. It is the problem with certainty and capability. First, attempts to attain certainty suggests that certainty is somehow accessible with harder and deeper thinking. If this were true, you would not find yourself seeking out more information about POCD. You would have thought long and hard about it, figured it out, and moved on. Certainty is an illusion. I’ve managed to go my whole life without molesting anyone, but it doesn’t prove a thing other than saying that the attention I need to give to thoughts about potentially molesting children is probably very low. Certainty is perfect knowledge that something is 100% true. Rather than certainty, what we would be better off seeking is confidence, an internalized belief that something is true. This comes not from trying to prove things, but from accepting uncertainty and living in such a manner that “proof” seems superfluous.
The other problem with the never-ending quest to prove incapability is the implication that being capable of something means we will do something or means we are the kind of person who could do something. It’s a trap because if you have at least one arm, you are capable of punching someone. If you are physically larger and stronger than a child, then you are capable of abusing that child. Capable just means physically able, so being aware of capability is irrelevant when trying to determine likelihood of action. What’s more important than the potentiality is reality. If in the present moment you are having unwanted thoughts about children, then you are whoever you are and are having those thoughts. This doesn’t say anything about you other than what is happening. You could be thinking of anything, but happen to be aware of this obsession.
You Are Not Alone
You’re not alone and you’re not a freak (at least, not because of this). If you struggle with unwanted obsessive thoughts about children, and you live in fear and disgust over the presence of these intrusions, you may have a version of obsessive-compulsive disorder, a common mental health issue that really does respond well to the right treatment. If you can find the language to articulate your experience to a therapist who understands OCD, then you can learn the tools to develop mastery over your unwanted thoughts.
Led by Jon Hershfield, MFT, The Center for OCD and Anxiety is a private pay outpatient center devoted to the treatment of obsessive-compulsive disorder and anxiety disorders.