Are We Responsible for the Success of Our Therapy?

[deValentin]

If we think we’re responsible for the success of our therapy, and it’s our fault if we don’t get the desired results, this adds that much more anxiety to a mind that’s already laden with a lot of anxiety and undermines the chances of success of a therapy that’s meant to reduce anxiety. However, if we don’t hold ourselves responsible for the success of our therapy, how can we be motivated to make efforts that could make our therapy successful? A possible answer to that dilemma may be found in Metacognition Therapy or MCT. MCT asserts that a ruminating type of thinking is mainly at the root of OCD and that two main beliefs feed ruminations: the belief that they are partly justified and the belief that they are uncontrollable. If we leave our unwanted thoughts alone, they’ll leave us reasonably alone, and our mind will eventually self-regulate (see video “How To Live More And Think Less: Dr. Pia Callesen On Metacognitive Approaches To A Happier Life”).

The difficult question is to determine to what extent our ruminations are voluntary and to what extent they happen to us. My understanding of ERP is that it considered our ruminations compulsive, fueled by anxiety, and that with habituation, we can reduce anxiety and therefore regain some freedom of choice. On the other hand, MCT claims that we often aren’t mere passive observers of our intrusive thoughts. We actively feed them because of the two beliefs mentioned earlier, even if we aren’t fully aware of it, and that fosters our anxiety.

For instance, if I’m caught in a traffic jam and late for an appointment, I may experience a lot of stress and believe it’s partly justified and beyond my control. However, upon reflection, I may realize that I’m actually feeding my stress by holding those two beliefs. I’m not just a passive spectator of an automatic reaction. What inclines me to agree with that view and to believe that ruminations or over-the-top reactions depend partly upon my intentions is that, during a ruminating or overreaction episode, if an acquaintance who is unaware of my dysfunctional behavior drops by for a visit, I’m able to interrupt it. As for the ambivalence about the validity of our ruminations (they may appear partly justified in our eyes at certain times), if our sole therapeutic task is to be a “lazy” observer of our unwanted thoughts, it might be easier to perform it with full conviction.

So, according to MCT, our responsibility is clear and limited: we're not responsible for making our therapy successful. We only need to ensure we’re a fully passive or “lazy” observer of our unwanted thoughts or feelings, so that, whatever the results of our therapy, we have nothing to reproach ourselves with. We didn't add to them in any way, shape, or form. This perspective offers a legitimate source of comfort that can paradoxically contribute to the success of our therapy.

Are MCT and ERP similar at some level? Yes, because, with MCT, triggering situations are not to be avoided (exposure) and ruminations that fuel our compulsions are not to be entertained (response prevention).

What do you think? Did anybody try MCT, also known as detached mindfulness?