Many people wonder how to “get” a friend or family member into treatment. Unhappily, the answer is, you can't, really. That said, there are ways you can encourage a reluctant family member to at least try CBT or medication.

Certainly, staying calm, offering gentle encouragement, and employing a lot of patience is one way. It is the classic way. Therapists disagree about the effectiveness of the second way, which is to bring more pressure to bear. While you can't force an otherwise competent adult into treatment, nor are “intervention”-style tactics recommended, we can tell you that there's a case to be made for keeping up a steady pressure, rooted in loving concern. One caveat, however: Don't expect immediate success. This technique works in the same way as brainwashing: Your friend already knows she has a problem. Over time, with you to point out to her how it is affecting her life and the lives of those around her, she may come to realize that trying almost any kind of proven treatment may be worth it, and that she has nothing to lose.

Keep in mind also that mild paranoia can often be a symptom of OCD. Unfortunately, that means that fears about getting treatment will only be magnified. This is to be expected.

Once Again

Another reminder for you, the family member or friend: Patience is your watchword. Most likely, the person with OCD is resisting your efforts because she feels afraid. Remember to take time away from the person if you need to (and you probably will). Look for support from other friends and family members of people who have OCD (but not necessarily friends or family members you share; your goal should not be to embarrass the person). This can't be overestimated. The OC Foundation has local branches, and information on its Web site (www.OCfoundation.org). Other support groups can be found online and perhaps in your community. You may even be able to find groups that include, or are geared specifically toward, spouses and significant others.

What Else Can You Do?

In addition to urging your friend to get good help, you will want to support without enabling. Just what is “enabling,” anyway? This term comes from the twelve-step movement, which originated with Alcoholics Anonymous (AA).

AA's highly successful model encouraged people to band together to battle an addiction that seemed, at times, stronger than the individual members themselves. Some of the jargon that came out of twelve-step programs remains with us. One such term is “enabling,” used to describe an unhealthy relationship wherein the “enabler” believes he is helping the sufferer but, in actual fact, is just helping him to perpetuate his self-destructive behavior. In the case of OCD, enabling would refer to giving the person reassurance, checking for him, or allowing him to spend too much time doing these things.

Unfortunately, enabling usually does not help the person who is being enabled. Neither does it help the one doing the enabling. In fact, what usually happens is, it ends up working against everyone concerned.

A therapist might counsel family members to tell the OCD sufferer firmly, “We're ready to leave now, and will go without you rather than wait for you to check the stove knobs and door locks again.”

Refusing to “help” the person who has OCD, even if it is done kindly (and we hope it will be) may feel cruel to you. You may see that you are causing genuine anguish. None of us likes to see people we love in distress. That said, it is sometimes kinder to allow the person to suffer in the short term, in order to benefit in the long term.

An Extreme Example

Think of it as you would chemotherapy, for instance: No reasonable person wants to see a family member or friend go through chemo. It causes physical suffering. The patient becomes weak, anemic, thin from loss of appetite. It's distressing for all concerned. Yet, you would never advise someone you cared about to skip the chemo because it was certain to make her feel uncomfortable! You would almost certainly say, “This is going to be tough. But it will eventually make you better.” That is what we hope you will say to your friend about refusing to enable her OC behaviors.

One Caveat

At first, it will probably be difficult. You might not necessarily recognize when or realize how often you end up getting roped into helping your OC friend. Or you may not have the emotional strength to cause your child or spouse to suffer.

Some therapists advise going “cold turkey” — that is, refusing to participate in any enabling behaviors at all. Others will recommend a more gradual approach, starting slowly by saying things like, “I will reassure you one more time, but after that, we have to let it go. I don't want to enable your behaviors. I want you to get well.” We recommend this second approach, although, of course, we defer to the advice of your own or your family's therapist.

One other thing to keep in mind: Even if the OCD sufferer in your life does not get better once you stop “helping,” chances are you will enjoy your own life more when you are no longer spending so much of your time essentially caring for someone else.