Don’t Tell Me What They’re Doing — Tell Me What It’s For

Too often, OCD case presentations in MDTs become catalogues of compulsion detail.

We hear about the soap. The sequence. The time of day.

But we don’t hear what the ritual is doing for the child.

We don’t hear what the mind is avoiding, what the act is preserving, or what grief the repetition is warding off.

This blog calls time on over-describing compulsion content — a defensive habit that masks clinical uncertainty and replaces meaning with minutiae.

I tell trainees:

“Don’t tell me what they’re doing. Tell me what it’s for.”

When clinicians spend five minutes describing the texture of the hand towel but never name the internal object, something has gone wrong.

Rituals are not simply acts.

They are communications. Psychic architectures. Emotional economies.

What We Need to Ask Instead:

• What feeling is the ritual trying to hold down or keep out?

• Is this ritual symbolic, repetitive, or defensive in structure?

• What kind of internal object is being invoked, attacked, or protected?

• What does the ritual prevent the young person from having to feel or know?

Alternative Case Presentation Style

Before:

“The young person washes their hands six times, with blue soap only, and recites a phrase backward to neutralise the fear.”

After:

“The ritual seems to prevent a collapse into guilt. It appears linked to a phantasy of contamination not just of the body but the self. Symbolically, it functions like a moral washing — a defensive attempt to repair something unnamed. It started just after the sibling’s accident.”

Reflective Prompt for Teams:

• Where in your casework are you clinging to the details — instead of feeling the meaning?

• Is your language descriptive… or symbolic?

Let’s move from case summaries that impress — to case summaries that think.

Because the question isn’t just: What are they doing?

The question is: What is this mind trying to do — symbolically, defensively, mournfully — with this act?