Overcoming Harm OCD: Mindfulness and CBT Tools for Coping with Unwanted Violent Thoughts

book review by Quentin Dunne

“I feel so awful. I am so awful. I wouldn’t be having these terrible thoughts about wanting to stab my baby girl unless there was something wrong with me!”

Any clinician who has treated a client suffering from harm-themed obsessive compulsive disorder (OCD) has heard some variation of these words. The anguish behind them is real, and the client is right, although not in the way he or she may think. There is “something wrong” with such clients. That something, however, is not a genuine, monstrous urge toward violence, but a painful and baffling mental quirk of repetitive, intrusive thoughts that go against their most deeply held values. Fortunately, Jon Hershfield, MFT, has written an excellent and incisive book, Overcoming Harm OCD, for the purpose of helping clinicians and clients alike.

In Hershfield’s previous books, such as The Mindfulness Workbook for OCD and When a Family Member Has OCD, he provided skillful and sensitive guidance for dealing with OCD in general. This time around, he focuses on the subtype that plagues its sufferers with egodystonic thoughts and images of inflicting violence upon people (often, their loved ones). The author has been candid about his own struggles with OCD, and those experiences lend an authenticity and conviction to his writing. He’s wrestled with the crushing weight of unwanted and disturbing thoughts, sought treatment for them, and come out on the other end, determined to help those lost in the mire of this perplexing condition.

Given that this is Hershfield’s fourth book on the subject of treating OCD, it’s perhaps understandable that the more cynical among us might suspect him (and his publisher) of milking a niche market. Such cynicism, however, quickly fades upon actually reading the book. For one thing, the writing never feels like the formula of an author who’s been there and done that, but rather like the wisdom of someone whose previous books have made him a more seasoned and confident writer. For another, Hershfield’s compassion for OCD sufferers comes through page after page, chapter after chapter. His blend of empathy and expertise allows him to skillfully balance acknowledging the severity of their struggles while also providing genuine, hard-earned hope (as opposed to simplistic reassurance).

Prior to becoming a therapist, Hershfield was a professional actor, and that background may play a role (pardon the pun) in why this book is so engaging. He knows how to communicate information, not merely present it. The chapters contain not only pragmatic clinical tools and techniques – his acronymed H.E.A.L. strategy is particularly helpful – but also vivid anecdotes and metaphors that bring some zip to the material. Similarly, effective touches of humor, wit, and personal experience are peppered throughout. As a result, its 158 pages never seem padded or plodding; indeed, the book has a lively tone and is often even, curiously, rather enjoyable (no small task considering distressing nature of the mental illness at hand).

As a therapist who works extensively with people with OCD, I’m always on the search for books that not only help me practice more successfully, but that are also accessible enough for the clients themselves to read for the sake of their own education and empowerment. Overcoming Harm OCD easily meets the criteria. Therapists looking to sharpen their skills in compassionately treating those with harm-themed OCD would do well to read this book and apply its principles.