Stop Focusing on the Compulsion

He touches the doorframe seven times.”

“She asks me if the water’s safe.”

“He chews his sleeve until it frays.”**

And we write it down.

Seven times. Water. Sleeve.

We document the detail, archive the behaviour.

We become symptom historians.

But somewhere along the way, we forget to ask:

What’s being communicated here—if anything still is?

Clinicians Are Getting Stuck in Compulsion Detail

It’s understandable. Compulsions are visible. Trackable.

They give us something to hold onto in a field full of fog.

But too often, our case formulations sound like behaviour catalogues:

• “Washes five times after touching metal”

• “Checks her notes after every sentence”

• “Needs reassurance that he’s not ‘a bad person’”

We archive the act.

We forget the why.

Compulsions Are Not the Thing. They Are a Strategy to Survive the Thing.

Let me say that again:

Compulsions are not the problem—they’re the solution.

They’re the psyche’s attempt to manage something that can’t yet be thought, spoken, or held.

When we fixate on the ritual:

• We become co-ritualisers

• We design ERP plans for structures we haven’t understood

• We miss symbolic collapse in real time

What Should We Be Listening For Instead?

1. Symbolic Texture

What does the ritual feel like in the room? Is it hollow? Angry? Desperate?

2. Repetition Without Relief

Is the act offering containment—or has it become a sealed system?

3. Therapist Countertransference

Do you feel blank, frantic, irrelevant, or hypnotised?

That’s the symptom speaking through you.

4. Symbolic Readiness

Is the young person able to talk about the compulsion—or only through it?

Can they name the feeling? Or just perform it?

Symbolic readiness isn’t abstract. It shows up when a young person says, “I hate that I have to do this,” instead of just doing it.

You Don’t Need to Know If It’s Seven or Eight.

You need to know what breaks if they don’t.

That’s the work.

That’s what holds symbolic weight.

Final Thought

When we obsess over the detail, we mirror the child’s obsession.

We manage our anxiety by clinging to what’s visible.

But if we stop…

If we look underneath the act,

We might finally hear the structure calling out for help.

If we don’t listen for structure, we treat symptoms forever