provoking to see if it comes true, e.g. the therapist’s hair turning blue. Once they are comfortable with this, they could then be encouraged to begin to think thoughts that are more anxiety provoking and more related to OCD to see if they work in the same way.
• Behavioural experiments are an essential component of CBT for young people with OCD.
• The purpose of experiments is the test the validity of the young person’s existing beliefs and to construct and test out new alternative beliefs.
• Behavioural experiments need to have a clear rationale and, where possible, the young person should be encouraged to take the leading role in designing them.
Relapse prevention
Many young people report that their symptoms increase in times of stress or illness and so it is possible that events such as coming up to exams, moving house or school or changes to friendship groups can reactivate symptoms.
As a result, towards the end of treatment it is helpful to introduce this so that the young person is prepared and able to deal with it. Most relapse plans incorporate a review of what was helpful in treatment, consideration of what events could trigger further symptoms, further goals to work towards and then a plan for dealing with setbacks. It can also be helpful to teach the young person to deal with stress and other life difficulties. Towards the end of treatment, increasing the length of time between sessions and offering booster or follow-up sessions can also be helpful.
A relapse plan involves a review of what was helpful in treatment, consideration of what events could trigger further symptoms, further goals to work towards and a plan for dealing with setbacks.
The therapist’s role
The therapist’s role is that of an active listener who frequently summarises the material they have heard to check their understanding, and is able to respond to different situations in a flexible way. Together the therapist and young person create a formulation of how the current problems are being maintained; for example, how coping behaviours are inadvertently reinforcing thoughts and their meaning. Throughout therapy the therapist acts as a guide to help the young person investigate and discover new ways of thinking and behaving. Crucially, the therapist asks questions to identify thoughts and assumptions in order to open up new possibilities, rather than 30
Creswell and Waite
giving concrete advice. In CBT it is not all talk, however; experiencing is also an essential part of learning new ways of thinking and acting. The therapist prompts the young person to devise experiments to test out assumptions where the existing evidence is unclear or unconvincing.
Taking a non-expert position also allows the therapist to act as a model for the young person. For example, if the therapist and young person have worked out that the way to find out if touching the toilet bowl will cause a fatal disease is to go ahead and touch it, then the therapist should be prepared to do this first, both to encourage the young person to do the same and as an initial test of the hypothesis. From the therapist’s point of view, taking on this role gives greater insight into the discomfort that the young person is likely to be experiencing and a clear realisation of what the young person is being encouraged to do. Recognising the discomfort that will result from behavioural experiments promotes therapist empathy and compassion, both of which are essential to the therapeutic alliance. It might come as a relief to many of us that modelling fallibility can also be extremely useful for clients who set themselves high standards for success. Equally, the non-expert position leaves the therapist free to use personal examples where this is appropriate and there is a clear rationale, for example, normalising intrusive thoughts.
• The therapist is an active listener who acts as a guide to help the young person investigate and discover new ways of thinking.
•
• Behavioural experiments are an essential component of CBT for young people with OCD.
• The purpose of experiments is the test the validity of the young person’s existing beliefs and to construct and test out new alternative beliefs.
• Behavioural experiments need to have a clear rationale and, where possible, the young person should be encouraged to take the leading role in designing them.
Relapse prevention
Many young people report that their symptoms increase in times of stress or illness and so it is possible that events such as coming up to exams, moving house or school or changes to friendship groups can reactivate symptoms.
As a result, towards the end of treatment it is helpful to introduce this so that the young person is prepared and able to deal with it. Most relapse plans incorporate a review of what was helpful in treatment, consideration of what events could trigger further symptoms, further goals to work towards and then a plan for dealing with setbacks. It can also be helpful to teach the young person to deal with stress and other life difficulties. Towards the end of treatment, increasing the length of time between sessions and offering booster or follow-up sessions can also be helpful.
A relapse plan involves a review of what was helpful in treatment, consideration of what events could trigger further symptoms, further goals to work towards and a plan for dealing with setbacks.
The therapist’s role
The therapist’s role is that of an active listener who frequently summarises the material they have heard to check their understanding, and is able to respond to different situations in a flexible way. Together the therapist and young person create a formulation of how the current problems are being maintained; for example, how coping behaviours are inadvertently reinforcing thoughts and their meaning. Throughout therapy the therapist acts as a guide to help the young person investigate and discover new ways of thinking and behaving. Crucially, the therapist asks questions to identify thoughts and assumptions in order to open up new possibilities, rather than 30
Creswell and Waite
giving concrete advice. In CBT it is not all talk, however; experiencing is also an essential part of learning new ways of thinking and acting. The therapist prompts the young person to devise experiments to test out assumptions where the existing evidence is unclear or unconvincing.
Taking a non-expert position also allows the therapist to act as a model for the young person. For example, if the therapist and young person have worked out that the way to find out if touching the toilet bowl will cause a fatal disease is to go ahead and touch it, then the therapist should be prepared to do this first, both to encourage the young person to do the same and as an initial test of the hypothesis. From the therapist’s point of view, taking on this role gives greater insight into the discomfort that the young person is likely to be experiencing and a clear realisation of what the young person is being encouraged to do. Recognising the discomfort that will result from behavioural experiments promotes therapist empathy and compassion, both of which are essential to the therapeutic alliance. It might come as a relief to many of us that modelling fallibility can also be extremely useful for clients who set themselves high standards for success. Equally, the non-expert position leaves the therapist free to use personal examples where this is appropriate and there is a clear rationale, for example, normalising intrusive thoughts.
• The therapist is an active listener who acts as a guide to help the young person investigate and discover new ways of thinking.
•
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