* Published December 2022
A central component of RF-ERP is challenging the ways in which a person justifies ruminating. In order to argue effectively against a justification, one must first fully understand it. This entails helping the patient to formulate exactly why they think it is important to ruminate.
Patients are usually able to identify their justification for ruminating with the help of a few guiding questions (1). However, sometimes they have difficulty doing so or the therapist has difficulty understanding how the justification makes sense. When this is the case, the patient and therapist may be struggling with a ‘causal’ justification. The purpose of this article is to explain what a causal justification is, identify four different types of causal justifications, provide examples of each one, and provide some ways to challenge such justifications.
Often, a person ruminates in an effort to figure out whether something is true. At other times, however, a person may ruminate in an effort to prevent something from happening.
Four Types of Causal Justifications
The causal justifications that I’ve encountered aim to prevent one of four things:
- Believing an untruth
For each of these, I’ll provide a quick description and then two examples – one of someone with OCD about being gay, the other of someone with OCD about religious faith.
1. Staining (2)
“If I allow myself to think or feel that, I will never be able to take it back.”
Sometimes a person ruminates as a way of undoing an unacceptable thought or feeling, so that they don’t ruin their record or contaminate something pure.
- If I allow myself to feel attracted or think I’m attracted to a person of the same sex (without neutralizing that thought or feeling via rumination), I will never again be able to say that I have never been attracted to someone of the same sex. (Or: If I allow myself to question my heterosexuality, I will never again be able to say that I have never questioned it.)(3)
- If I allow myself to doubt my religious beliefs (without neutralizing that thought or feeling via rumination), I will no longer be someone who has never had a doubt.
“If I allow myself to think or feel that, it will permanently change what I think or feel.”
Sometimes a person ruminates as a way of undoing an unacceptable thought or feeling because they’re afraid that if they allow themselves to think or feel (or not feel) something, this will permanently change them. Sometimes they are afraid that if they don’t control some thought or feeling, they will lose control of it, or lose control altogether.
- If I allow myself to feel attracted or think I’m attracted to a person of the same sex (without neutralizing that thought or feeling via rumination), I will become attracted to people of the same sex (3). (Author’s note: That’s not how it works.)
- If I allow myself to have a religious doubt (without neutralizing that thought or feeling via rumination), I will permanently lose my faith.
Believing an Untruth
“I don’t believe it’s true (whatever it might be), but I’m afraid that if I allow myself to think or feel that, I’ll end up thinking it’s true.”
Sometimes even though a person has no doubt about whether something is true, they ruminate (as a way of undoing an unacceptable thought or feeling), because they’re afraid that otherwise they’ll come to believe it is true.
- I know I’m not gay, but if I allow myself to feel attracted/think I’m attracted to a person of the same sex (without neutralizing that thought or feeling via rumination), I will cause myself to believe that I’m gay.
- I know my religious beliefs are true, but if I allow myself to doubt them (without neutralizing that thought or feeling via rumination), I will cause myself to believe they are false.
“I don’t want to know.”
Sometimes a person ruminates (as a way of undoing an unacceptable thought or feeling), because they’re afraid that if they allow themselves to think or feel (or not feel) something, they will discover something that they don’t want to know.
- If I allow myself to feel attracted/think I’m attracted to a person of the same sex (without neutralizing that thought or feeling via rumination), I may realize that I am gay, and if I am gay I do not want to know.
- If I allow myself to doubt my religious beliefs (without neutralizing that thought or feeling via rumination), I may realize that my religious beliefs are false, and if they are false I do not want to know.
Please note that many people with OCD will think this example is referring to them (“Is that my problem? Do I just not want to know?”), and it’s not. Everyone with ‘Pure O’ has times when they believe their worst fears are true, and that they just aren’t brave enough to accept what they fear is the truth. And that is not what I’m describing here. If there were a blood test that could tell a person whether their worst fear were true, the vast majority of people with OCD would take it, get the results whatever they might be, and plan their lives accordingly. In contrast, here I am describing the rare case of someone who would actually rather not take the blood test.
I also want to be clear that just because the person doesn’t want to find out if X is true doesn’t mean that it is true. For example, just because a person says that if they’re gay they don’t want to know, doesn’t mean they are in fact gay.
In the rare case that the person is clear that they don’t want to know, though a therapist may help a patient sort through their ambivalence, I believe that they should ultimately respect the patient’s wishes. The patient should understand, though, that they won’t be able to let go of their symptoms through ERP if they are ambivalent about doing so. None of this precludes other types of therapeutic intervention, though.
Arguments Against Causal Justifications
The following are several arguments that can be helpful in challenging causal justifications. None is relevant to every case or every justification.
- You can’t figure out what’s real if you keep neutralizing your experiences. If your goal is to know what’s true, you have to allow yourself to acknowledge your internal experiences without trying to think your way out of them.
- It happened. You felt what you felt or thought what you thought – whatever it was, whether you know what it was or not, whether you know what it means or not. Trying to think your way out of it doesn’t change the fact that it happened.
- You are holding yourself to an impossible standard by not allowing yourself to think or feel certain things. Moreover, trying to block yourself from having certain thoughts or feelings is a recipe for distress.
- These thoughts and feelings are normal, and all other humans have them too. You don’t get to be an exception, and trying to be an exception is making you sick.
- That’s just not how that works. You don’t make yourself gay, or stop loving someone, or go crazy, or lose control by allowing yourself to have or not have certain thoughts or feelings without reining them in.
- The only way to find out is to let go, as terrifying as that might be. Otherwise you could spend your whole life holding on because you never let yourself find out that you didn’t have to.
- If you like metaphors, here are a bunch for the latter two causal justifications: Just because you let yourself like dessert doesn’t mean you’ll never eat a salad again; You’re afraid if you don’t extinguish the fire it’ll get out of control, but really it’ll just burn out; If you never let the dog off the leash, you’ll never find out that they don’t run away; etc.
A Few Notes on the Above
- When I say one must allow thoughts, I mean thoughts occurring to you, not ruminating. For example, acknowledging that you wondered whether some element of your religious belief is realistic, without then analyzing whether or not it is true.
- Acknowledging internal experiences doesn’t mean jumping to conclusions about them. For example, acknowledging that you noticed an attractive person of the same sex doesn’t mean jumping to the conclusion that you’re attracted to them, or if you are attracted to them, that that necessarily means you’re gay. It means acknowledging that experience, while potentially tolerating not knowing, as you allow yourself to acknowledge progressively more internal experiences over the course of time, and allows a clearer bigger picture to eventually emerge.
- Acknowledging internal experiences also doesn’t mean forcing yourself to have them; it just means refraining from undoing them when they happen naturally. What this means, practically, is that when the thought or feeling happens, rather than trying to do something about it such as ruminating, you refrain from engaging with it at all.
1. E.g., What are you trying to figure out? What are you afraid will happen if you don’t figure this out? How would figuring this out prevent that from happening?
2. This concept is also relevant to people who feel that they have to share every thought and feeling they have with the people closest to them, and that not doing so constitutes keeping secrets or lying (in psychoanalytic terms, that they are not allowed to have separate mental space). When you feel like you have to share every thought and feeling you have, you have to be very careful about what you allow yourself to think and feel…
3. This example doesn’t indicate that the feeling is or is not attraction, just that the person is neutralizing something they are afraid is an experience of attraction.