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Hi Indebt,
It definitely sounds like he has Pure O, obsessive-compulsive intrusive thoughts. I have also had multiple episodes of Pure O in the past and can relate a lot to what he’s going through.
Personally, I’ve never told the exact content of my worse Pure O thoughts to anyone, and I don’t think it’s necessary to tell them for healing. The exact content of the thoughts means nothing. He feels ashamed and embarrassed about the thoughts, but the first thing for him to know is that the thoughts are no indication of him or his character. They are something randomly generated by the mind, thoughts that anyone can have, and the fact that he feels so bad and guilty about them indicates that he would be the last person to even act on such thoughts.
What helped me was starting to say “So what?” to the thoughts. When they would come up, I would say or think “So what?” toward the thought, and just act as if the thought was a random passing cloud that has truly nothing to do with me – because that’s what it truly is, a random passing disturbing cloud. The less attention and importance was given to the thought, the more its grip loosened. He must lose fear of the thoughts and treat them as if they’re nothing and random. It has nothing to do with him, and many people have faced the same thing and overcome it, even with extremely disturbing thoughts.
Sometimes Pure OCD intrusive thoughts can feel as though they’re going to last forever, but I would assure him that they won’t and that he’s going to get past this. My episodes varied, first one lasting 4 years, and the second one lasting 2-3 years.
As far as how to best support him, he’s going to need a lot of love and compassion to remind him of what a great person he is, that the content of the thoughts is irrelevant, and that he will get passed it – he’s not cursed with it forever and it will be gone soon. He’ll have peace of mind again. 🙂
I recommend on Youtube, a channel called Chrissie Hodges / Pure OCD Advocate. Super helpful channel for help, support, and guidance! Wishing all the best luck to both, you will overcome this 🙂