Purpose 🎯

Identify mental rituals and subtle compulsions that may be missed during assessment or treatment planning.

Let’s Talk About It 🗣️

Explore whether the client:

• Reviews memories
• Repeats phrases internally
• Checks feelings or intentions
• Compares options or sensations
• Reassures themselves
• Tries to replace or cancel thoughts
• Mentally argues with OCD
• Searches for the “right” answer
• Replays conversations

End by identifying one subtle compulsion that could become an ERP target.

Ask:

• What do you do in your mind to feel more certain?
• What mental process feels hard to stop?
• What are you hoping the mental ritual will prove or prevent?

If the Conversation Gets Stuck 💡

• Do you replay events to check whether you did something wrong?
• Do you check whether you feel the “right” feeling?
• Do you try to cancel, replace, or neutralize thoughts?

Telehealth / Whiteboard Version ⚖️

Create a detective board of possible hidden compulsions. Circle the ones that show up most often and identify one possible response-prevention practice.

Why This Works 🌱

Hidden compulsions can maintain OCD even when visible rituals decrease. Identifying them helps create more accurate and effective ERP targets.

Clinical Pearl 🧠

Mental rituals often feel like problem-solving, but they may function as attempts to gain certainty or reduce distress.

Documentation Language 📝

Therapist utilized a hidden compulsion identification intervention to assist client in recognizing mental rituals, reassurance patterns, checking behaviors, and potential ERP response-prevention targets.

Clinical Focus: Mental Compulsions, Assessment, ERP Target Identification