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Elliott, LPCC, NCC
Elliott, LPCC, NCC, Psychotherapist
Category: Mental Health
Satisfied Customers: 7664
Experience:  35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
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I am fairly certain that my brother,, age 58 has OCPD. He

Customer Question

I am fairly certain that my brother, Chris, age 58 has OCPD. He refuses to seek mental health assistance because no psychologist or psychiatrist would be able to understand his special world view. Plus, he cannot afford it. He has been underemployed (self-employed) for years and supplementing with family and friend financial support. Also, he has struggled in recovering from double hip replacement but refuses to seek state help for disability. This is because he would lose control. He will not compromise his Quixotic quest to live by his own moral ethical standards of being completely honest and authentic at all times. He does not believe he can do a regular job because he would have to "play the political game" and knows that bosses and co-workers would not be able to work with him. So, what is the point of trying. He is headed out to live on the street and refuses to offers to live with me or friends. How can I help him?
Submitted: 4 years ago.
Category: Mental Health
Expert:  Elliott, LPCC, NCC replied 4 years ago.

Seeking expert counseling is a sign of strength. A personal relationship with a caring professional is proven clinically effective.

Dear *****,

Your brother is indeed needing guidance and help. You have said nothing to indicate that he has OCPD rather than Paranoid Personality Disorder or even Delusional Disorder. Having to do everything his way or not at all is a good indication, but he certainly will not have control, orderliness, or perfection out on the street, where he will be at the mercy of strangers, be ordered about and harassed by police, and will lose control of his life.

How will he be able to control his movement out on the street? As a practitioner of the Feldenkrais method he should know that his lack of ability to control his movement will have a direct and negative influence on his emotional and cognitive functions. In fact,
Moshé Feldenkrais stated that: "what I am after is more flexible minds, not just more flexible bodies". I mention these things as TALKING POINTS to influence his mind which still works in a certain (but perverse) logical manner.

If he refuses psychiatric or psych therapeutic help, then your own person influence is all that can be done to keep him from his downhill slide.

Pharmaceutically, the most effective drug to help break this cognitive cycle, if he indeed has OCPD, is Prozac. I am not a big fan of this drug for various reasons, but it has been shown to work, more than other medications.

If has is willing to see a therapist, then the best approach would be Cognitive Analytic Therapy (CAT). You can get an idea about how it works from this article:

I understand that you are grasping for straws. Not having his cooperation makes it so difficult. Let me recommend two books that would be helpful to you and to him if he is willing to look at them (available at and elsewhere):

Too Perfect: When Being in Control Gets Out of Control by Jeannette Dewyze and Allan Mallinger


Present Perfect: A Mindfulness Approach to Letting Go of Perfectionism and the Need for Control by Pavel G. Somov

If the only path for him, despite your best efforts, is to hit rock bottom, I know that you will be there for him. Perhaps a brief period of inpatient commitment might be a circuit breaker and allow him to recover or to receive treatment to control his behavior and thoughts.

I wish the best for your brother and all of your family members who care so much for him.

Warm regards,

Elliott Sewell, LPCC, NCC, CCMHC