Robyn is single, in her 40's, and has a mild intellectual difficulty. Robyn receives a disability allowance and lives on her own in a housing development. She has no family support but works in a sheltered workshop, a position she arranged for herself. She went to her family physician because of the severe dermatitis/skin irritation on her hands. It emerges that Robyn has obsessive thoughts about cleanliness and undertakes compulsive cleaning rituals involving the use of harsh detergents. Robin has