Building Treatment Readiness in Kids with OCD
We move through four phases when treating individuals with Obsessive Compulsive Disorder (OCD). These phases are…
1. Assessment
2. Building Treatment Readiness
3. Gradual Exposure with Response Prevention (ERP)
4. Relapse Prevention
In this article we will discuss Phase 2, building treatment readiness. Once your child has completed the assessment phase of treatment and it has been determined your child has OCD you may desire a quick fix or an immediate transfer of skills to “cure” your child and strained family system. But try to slow down, treatment is a process and there are no overnight fixes. It is vital your family builds a sense of readiness prior to engaging in the gold standard treatment of OCD, Exposure and Response Prevention treatment.
Before transitioning to Phase 2 your child will have a foundational understanding of OCD and what thoughts and behaviors we are addressing in treatment. As we shift into Phase 2, the main objectives are stabilization, psychoeducation on OCD and Exposure Response Prevention Treatment, and building motivation and optimism around the possibility of change.
Stabilization looks different for each family system. Core concepts addressed in this stage focus on setting the groundwork for thinking differently about OCD. Your therapist may spend time focusing on removing the guilt and shame felt by the OCD sufferer and their caregivers for the family unit's current level of dysfunction. It is vital to shift the blame off of the individuals and onto OCD. Research suggests that OCD can be caused by a combination of factors including a genetic predisposition, neurobiology, learned behaviors, and environmental factors including trauma. OCD is not disrupting your home because of several misinformed decisions but rather a combination of complex interwoven factors.
Through psychoeducation the family will learn how OCD works, including key components of OCD, labeling worries as “false alarms” or “worry tricks”, and that the more you do what OCD tells you to do (rituals/safety behaviors, avoidance, neutralizing) the worse it gets. The child will begin to learn they in fact do have the power to change their behaviors and to gain back control of their life. Kids need clear understanding that they do not need to repetitively listen to OCD, that thoughts are just thoughts, and the more they do not listen to OCD not only will it get smaller but it will become easier to ignore. Parents will receive critical education on their role in treatment of reducing OCD accommodations and shift to supporting their child to be brave instead of fearful.
The final component of the treatment readiness stage is building motivation to engage in ERP treatment. Although exposure therapy is highly effective and widely recognized as the gold standard treatment for OCD it can make you feel highly uncomfortable. The core objective of ERP treatment is ritual prevention which removes the exact behaviors your children have been using to feel safe and calm. Increasing a child’s motivation to feel uncomfortable “on purpose” and resist safety behaviors is vital for treatment success. Building hope and optimism around change will support your child in living an exposure lifestyle rather than white knuckling through exposure therapy with built in avoidance rituals (ie. using fingertips to toss a used paper towel in the trash can versus grabbing paper towel fully and pushing open trash can with no barriers). The therapist will pursue discussions around how OCD impacts their life including what they are being made to do against what they would rather be doing. Investigating what values bring joy to their lives and how OCD gets in the way. Children will also explore how OCD is affecting their family system and other social supports. Therapists will reiterate psychoeducation on the vicious cycle of avoidance, on how rituals provide temporary relief from discomfort, while an exposure lifestyle supplies lasting relief. Lastly, therapists may review how the gradual nature of exposure therapy places some control in their hands as they can dictate where treatment will begin.
You are not alone on this journey. There are many resources and avenues of support for families dealing with Obsessive Compulsive Disorder. 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.