What Is A Parent’s Role in Their Child's OCD Treatment?
Impact on the Family System
The OCD sufferer is not the only one who feels the weight of this illness. Parents often find their once well operating family system is now strained. OCD changes the power and roles within the family hierarchy, shifting parenting and complicating sibling relationships. While OCD takes over running the household, parents can feel like a guest in their own home. Try your best to keep previously established rules and routines in place. OCD can be sneaky and ruthless, once you begin accommodating a behavior, OCD will quickly look for more. Keep open dialogue between you and your spouse about how you each are handling your child’s distress. Avoid playing the roles of good and bad cop at home. A united front keeps the hierarchy strong and messages clear to your child. While OCD is running the household you may fall into the trap of focusing your parental energy solely on your child with the illness. Schedule special outings with your other children, they've been impacted more than they are showing.
Enabling Fears
Nobody wants to see the ones they love in distress, especially when the person in distress is your child. OCD can cause public breakdowns, missed meals, late school arrivals and explosive arguments. It is no surprise that parents begin patterns of accommodation out of love and the need to survive. What appears to be harmless, unknowingly strengthens the exact behaviors you are trying to extinguish. When you rescue your child from their obsessional fears, their anxiety becomes reinforced through the cycle of avoidance.
What does accommodation look like?
Doing excessive amounts of laundry
Making alternative meals
Providing recurring reassurance
“You are ok, nothing bad is going to happen”
“You are not going to throw up”
“Don’t worry my hands are clean”
“God is not mad at you”
Walking on eggshells in your own home
Buying extra supplies of hygiene products
Supporting the avoidance of triggering places
As a team, with the guidance of the therapist, accommodations will systematically be decreased. Be patient, it is normal to want to accelerate the pace of treatment. Removing accommodation too quickly can negatively impact trust. Anticipate some resistance during this process. Afterall now your child is facing their anxiety rather than avoiding it. Model the behaviors you want them to show. Stay calm and collected, regardless of the intensity of their distress.
As you deny accommodations, choose to support your child by externalizing their OCD and share “boss back” statements like “that is just your OCD, don’t let it scare you” or “you are stronger than your OCD. It is just tricking you”. Externalization can be an effective tool in reducing stigma, shame and hopelessness around your child’s behaviors. Placing blame on “the OCD” and not your loved ones shows them you are on their team and together you will not listen to OCD.
Response Prevention and Home Practice
The key to freedom from OCD is ritual prevention. It is necessary for exposures to exist outside of the therapist’s office. There is no magic wand in a 45 minute weekly therapy session. True recovery happens when response prevention occurs everyday, all day. Depending on age and treatment motivation, parents may need to be an active coach in guaranteeing the completion of home practice exposures. Finding time between your child’s academic, social and extracurricular activities can be challenging, but it is necessary to model that home practice is a critical piece of their treatment journey. Consider a reward system calendar on your fridge to track progress and entice compliance.
Finally, remember rituals are our last option to de-escalate. Each ritual tightens OCD grasp and response prevention is the goal. The objective is to learn to lean into anxiety instead of away. Anxiety will fade and scary thoughts are just thoughts. Support your child to first explore their toolkit before choosing a ritual.
Ignore thoughts/urges
Boss back/self soothing statements “That’s just a worry trick” “I don’t have to listen to you”
Coping skills (going for a walk, drawing, playing with a pet, listening to music, talking to a friend, technology)
Be careful coping skills can also look like another avoidance ritual. Only use when necessary. Goal is to make thought/feeling more tolerable, not completely remove feeling of distress.
Final step, try to delay, change or modify the ritual to not fully satisfy OCD.
You are not alone on this journey. There are many resources and avenues of support for parents of children with OCD. Start at The International OCD Foundation to find support groups, resources and qualified therapists to help!
Looking for treatment for your child with OCD? Get connected with Kelsi below.