It is crucial that they do not take on the role of ‘expert’ but develop a collaborative relationship with the young person to work together as a team.
The parents’ role
Exactly how the young person’s family, particularly the parent(s), should be most effectively involved in CBT for OCD has not been clearly defined or evaluated. For example, where family-based CBT has been delivered (e.g.
Barrett et al. , 2004) it has been compared in different formats (group versus individual family members) rather than compared to non-family-based treatments. Certainly in relation to treatment of other anxiety disorders, outcomes of studies which compare individual child treatment to family treatment have been mixed and it is difficult to draw clear-cut conclusions (Creswell and Cartwright-Hatton, 2007). In the absence of studies to guide us, how we work with families must be determined on an individual basis, through formulation of what is serving to maintain the symptoms. For younger children (pre-adolescents), parents are likely to have a greater influence on their child’s developing cognitions (in contrast to adolescents who may be particularly influenced by their peers) (e.g. Rosenberg, 1979), so The use of CBT with children and adolescents 31
greater involvement of parents with younger children may give better results (e.g. Barrett et al. , 1996a; although see Bodden et al. , in press).
CBT with young people across different disorders has involved parents in a number of different ways:
1
As facilitators , in which the parent acts as a coach, helping the young person with homework and maintaining the principles of therapy at home.
2
As co-therapists , in which the parent models adaptive coping with the therapist and takes on the therapist’s role out of sessions; for example, helping the young person to identify thoughts and their meanings, to design experiments and evaluate results.
3
As clients , directly targeting parental behaviours which may be accommodating or maintaining OCD such as performing compulsions for the young person, providing excessive reassurance and helping parents to promote the young person’s autonomy.
Within each role, parents play an essential part in normalising the young person’s experience in order to challenge their fears about what it means to have these thoughts. For this reason, it is essential that parents also receive psychoeducation. Parents need to be able to be open, non-judgemental and not scared of their child’s thoughts, moods and behaviours. This is likely to require investigation with the parents of what their child’s OCD symptoms mean to them and what they would expect their child to feel or act if put in an anxiety-provoking situation (for example ‘My child will not be able to cope’ or ‘They will go mad’). Perhaps most importantly, the therapist may need to help the parent (by modelling, using Socratic questioning or behavioural experiments) to relax and have fun with their child in order to be confident in their parenting.
Whether and how to include a parent in an individual session will depend on what the goals are of that session, whether the parent(s) have a maintaining role in what is being addressed and how the young person feels about parental participation. As mentioned above, the parent must be included in psychoeducation. They must also have the opportunity to understand the formulation, which may well contrast to the seemingly illogical nature of OCD. If the young person is keen to have sessions independently then this could be done through parallel sessions with the parents, telephone contact or allowing parents to watch videos of the sessions or read the handouts from the sessions. Obviously this needs to be negotiated with the young person and their family.
Research is limited on how family involvement affects treatment outcome for OCD but some level of family involvement is likely to be essential in order for parents to, at least, have a
The parents’ role
Exactly how the young person’s family, particularly the parent(s), should be most effectively involved in CBT for OCD has not been clearly defined or evaluated. For example, where family-based CBT has been delivered (e.g.
Barrett et al. , 2004) it has been compared in different formats (group versus individual family members) rather than compared to non-family-based treatments. Certainly in relation to treatment of other anxiety disorders, outcomes of studies which compare individual child treatment to family treatment have been mixed and it is difficult to draw clear-cut conclusions (Creswell and Cartwright-Hatton, 2007). In the absence of studies to guide us, how we work with families must be determined on an individual basis, through formulation of what is serving to maintain the symptoms. For younger children (pre-adolescents), parents are likely to have a greater influence on their child’s developing cognitions (in contrast to adolescents who may be particularly influenced by their peers) (e.g. Rosenberg, 1979), so The use of CBT with children and adolescents 31
greater involvement of parents with younger children may give better results (e.g. Barrett et al. , 1996a; although see Bodden et al. , in press).
CBT with young people across different disorders has involved parents in a number of different ways:
1
As facilitators , in which the parent acts as a coach, helping the young person with homework and maintaining the principles of therapy at home.
2
As co-therapists , in which the parent models adaptive coping with the therapist and takes on the therapist’s role out of sessions; for example, helping the young person to identify thoughts and their meanings, to design experiments and evaluate results.
3
As clients , directly targeting parental behaviours which may be accommodating or maintaining OCD such as performing compulsions for the young person, providing excessive reassurance and helping parents to promote the young person’s autonomy.
Within each role, parents play an essential part in normalising the young person’s experience in order to challenge their fears about what it means to have these thoughts. For this reason, it is essential that parents also receive psychoeducation. Parents need to be able to be open, non-judgemental and not scared of their child’s thoughts, moods and behaviours. This is likely to require investigation with the parents of what their child’s OCD symptoms mean to them and what they would expect their child to feel or act if put in an anxiety-provoking situation (for example ‘My child will not be able to cope’ or ‘They will go mad’). Perhaps most importantly, the therapist may need to help the parent (by modelling, using Socratic questioning or behavioural experiments) to relax and have fun with their child in order to be confident in their parenting.
Whether and how to include a parent in an individual session will depend on what the goals are of that session, whether the parent(s) have a maintaining role in what is being addressed and how the young person feels about parental participation. As mentioned above, the parent must be included in psychoeducation. They must also have the opportunity to understand the formulation, which may well contrast to the seemingly illogical nature of OCD. If the young person is keen to have sessions independently then this could be done through parallel sessions with the parents, telephone contact or allowing parents to watch videos of the sessions or read the handouts from the sessions. Obviously this needs to be negotiated with the young person and their family.
Research is limited on how family involvement affects treatment outcome for OCD but some level of family involvement is likely to be essential in order for parents to, at least, have a
Similar Books
