OCD is very lifestyle invasive and in the case of younger clients, family and carers can be very involved in the daily maintenance of OCD. As a therapist, treating children and teenagers with OCD is rewarding but I have observed particular challenges:
1. Children and teenagers have yet to develop an effective ‘penalty-reward system’ based upon their experience so lack the ability to project forward. Adults tend to have a greater understanding of the penalties of not taking action and the rewards of doing so. Hence younger clients will be less motivated to embark upon tough work to manage their OCD.
2. Similarly, children and teenagers often consider that they don’t ‘have to change’. They are unlikely to become homeless, destitute or abandoned. Thankfully they won’t default on their mortgage or child payments or face redundancy but it can affect their engagement in the process and commitment to see therapy through
3. People with OCD are intelligent and so children and teens can be surprisingly resourceful and focused in their efforts to manipulate the people in their environment. Even if their parents set helpful boundaries, it is not unusual for younger clients to redirect their efforts towards grandparents or the wider family. This isn't malicious, it is the OCD.
4. Mental health awareness is improving but has still some way to go, therefore younger clients are loathe to accept their OCD. Mental health issues can be a frightening and alienating concept and may be seen as failure
5. Parents will default to over empathising. As a parent there is a natural and biological urge to rescue your child from emotional and physical discomfort. Adapting their overtly collusive behaviours may not mean they have dealt with the more covert ones, .e.g., reassurance, debating, negotiation and problem-solving
6. It is tough for families to draw the line between unhelpful collusive behaviours and the behaviours of a caring parent. There may also be some inter-family issues between Mum and Dad or parents and grandparents. Parents tend to agonise about ‘what is OCD and what is normal parenting’
7. The family unit may be dispersed, e.g., parents separated or working away from home so a coordinated family approach and shared message may be more tricky to implement
8. OCD rarely exists in isolation from other conditions, e.g., depression, but ‘teenagerness’ the etiology of which isn’t a clinical discipline (!), can have a profound impact upon OCD and therapy
9. Finally, a tough one! The origin of OCD is thought to be genetic hence one or more parents will also have obsessive tendencies. They may be similarly indecisive and anxious. They may overthink regarding their child’s condition, the options for treatment, the treatment itself and their role. Helping parents manage their discomfort may be key to long term change.