Impulse control and scrupulosity

You report that your patient is acting on her sexual feelings by "watching" and "learning about" the objects of her interest; yet, she reports wanting to be rid of the very thoughts she is acting out. I would start with an exploration of her apparent mixed motivation (ambivalence). Perhaps, using techniques of Motivational Interviewing will help her clarify her goals and, if she chooses, abstain from the pleasure-seeking behaviors that are reinforcing her fixation.

There also appears to be an element of scrupulosity, one manifestation of OCD. I highly recommend the work of Joseph Ciarrochi. His book, The Doubting Disease, is helpful for both clinicians and patients. I believe he describes a case of male client with unwanted sexual fantasies and his successful use of a mindfulness exercise in reducing the frequency and dysphoria associated with these thoughts.

Sometimes, a consultation with a psychologically savvy clergy person can be helpful with these scrupulosity patients.

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