Teenager with Social Phobia

This chapter illustrates the work of reducing family accommodation as a stand-alone and independent treatment, without concurrent child-based treatment. The chapter presents the case of Derek, a 16-year-old boy who was coping with Social Phobia and who refused to meet with the therapist for evaluation or treatment. The chapter first introduces the case and provides the rationale for working only with parents rather than focusing on attempting to work directly with Derek. Next the chapter reviews the course of treatment and demonstrates tools for overcoming the challenges inherent in working with parents without a child’s or adolescent’s engagement in the treatment process.

Reducing Accommodation to Treat Child Anxiety

This chapter discusses reducing family accommodation as a means of treating childhood anxiety. The chapter covers both reducing family accommodation as a stand-alone treatment and reducing family accommodation as part of a broader treatment strategy that also includes direct child-based therapy. Research supporting the efficacy of reducing family accommodation to treat child anxiety is reviewed, and practical considerations such as when to introduce the topic of family accommodation and how to optimize the sequence of child and parent work are discussed. Additional benefits of reducing family accommodation, including improved family functioning, positive impact on siblings, and improved parent–child relationship are also discussed.

Extreme Accommodation of a Child with OCD and Coercive Behaviors

This chapter illustrates the work of reducing family accommodation of obsessive-compulsive disorder (OCD) in a case of extreme family accommodation with a high level of resistance and coercive behaviors in the child. The chapter presents the case of Cora, a 12-year-old girl with OCD. The chapter introduces the case and the rationale for working only with Cora’s mother. Next the chapter reviews the course of treatment. The chapter exemplifies the challenges of working with the single parent of a highly aggressive adolescent who forcibly demands extreme levels of family accommodation and reacts with aggression to changes in the parental behavior. Transcripts from sessions and email correspondence with the therapist illustrate both the level of difficulty faced in this case as well as the power of a supportive and knowledgeable therapist to guide the parent in overcoming these challenges. The case demonstrates the ability of parent-based treatment to achieve change in an otherwise highly intractable case.

Teenager with Generalized Anxiety Disorder

This chapter illustrates the work of reducing family accommodation as part of a larger treatment strategy that also includes working directly with the anxious child. The chapter presents the case of Heather, a 14-year-old girl who suffered from generalized anxiety disorder. The chapter first introduces the case, including a detailed description and history. Next, the chapter describes the course of treatment with a focus on the work with parents and the ways it was integrated into Heather’s treatment. The chapter includes transcripts from treatment sessions with parents and child and exemplifies some of the problems and solutions in working with families of anxious children.

Planning How Parents Will Reduce Accommodation

Effectively helping parents to reduce family accommodation of childhood anxiety requires careful and thoughtful planning. This chapter provides guidance on formulating effective and realistic plans for changes in parental behavior aimed at reducing family accommodation of child anxiety symptoms. A well-crafted plan will be focused, specific, and pragmatic. It will also avoid the common pitfalls that can hinder implementation, which are discussed in the next chapter. This chapter also provides guidelines and examples for communicating the plan to the child and maintaining a supportive parental attitude. Clinical anecdotes and sample texts enrich the chapter and bring the content to life.

Addressing Accommodation

This chapter provides rich tools and helpful strategies for beginning the practical implementation of reducing family accommodation in clinical work. The chapter covers the psychoeducational component of treatment and includes several useful metaphors that can be used to convey both to parents and to children the rationale for reducing family accommodation. The chapter also offers guidance and suggestions for educating parents on the role of family accommodation in maintaining child anxiety. The chapter also covers tools and tips for more detailed mapping and monitoring of family accommodation and guidelines for choosing domains of accommodation to focus on in the subsequent steps.

Assessing Family Accommodation

Addressing family accommodation begins with assessing the extent and form of accommodations being provided. Assessing family accommodation should be part of the broader assessment plan when evaluating childhood anxiety and obsessive-compulsive disorder. This chapter provides guidelines and tools for the initial assessment of family accommodation. Methods of assessing family accommodation include clinical interviewing and structured rating scales. The chapter provides many examples and suggestions for ways to broach the topic of family accommodation with parents in an empathic and nonjudgmental manner. The chapter also provides detailed information on the currently available rating scales for measuring family accommodation and the relative advantages of each tool.

Why Parents Accommodate

This chapter reviews common reasons and motives that maintain the high levels of family accommodation commonly reported by parents of anxious children. Among these reasons are to reduce child distress, the belief that anxiety is harmful to children, the need to promote short-term child or family functioning, to protect a child’s social status, the parent’s own anxiety, and aggressive behaviors of anxious children that promote family accommodation. This chapter discusses each of these reasons, beliefs, and motivational factors and addresses the challenges they present to clinicians working to reduce family accommodation in the treatment of childhood anxiety disorders. An empathic understanding of the factors contributing to family accommodation is critical to effective intervention by the therapist.

Parental Support

This chapter introduces the concept of supportive parental responses to childhood anxiety symptoms, a key concept in addressing family accommodation. Supportive responses are defined as parental responses that convey to the child two messages: a message of acceptance and validation of the child’s anxiety, and a message of confidence in the child’s ability to cope with and to tolerate anxiety-related distress. When parents combine both acceptance and confidence they are being supportive of the child’s anxiety. The chapter includes several examples, clinical anecdotes, suggested texts for explaining the concept of support to parents, and tools for practicing formulating supportive statements that parents can use with their child.

Child with Separation Anxiety Disorder

This chapter illustrates the work of reducing family accommodation as part of a larger treatment strategy that also includes working directly with the anxious child. The chapter presents the case of Yuki, a 7-year-old boy with separation anxiety disorder. The chapter first introduces Yuki’s case including a detailed description and history. Next, the chapter describes the course of treatment with a focus on the work with his mother and the ways it was integrated alongside Yuki’s treatment. The chapter includes excerpts of transcripts from treatment sessions that illustrate how the therapist dealt with challenges that arose during the clinical work.