Session 5: Continued Problem-Solving/Modeling Healthy Responses to Anxiety

This chapter provides a guide to continued family problem solving. It begins with a review of skills learned earlier in treatment as well as progress with the initial family issues they have begun to address. It provides a strategy for picking the next family problem to target, with an emphasis on giving the family more independence during problem solving exercises. The chapter discusses the parents’ inadvertent potential to reinforce OCD behavior in their behaviors and in their speech. Parents who are particularly anxious may have difficulty managing their emotions in the moment, even though they understand the concept of modeling. The chapter provides strategies for helping these parents navigate OCD-related situations that may trigger their anxiety. Focus of the chapter continues to skills training in emotion regulation, including in-session practice exercises and discussion of the importance of modelling healthy responses to anxiety.

Session 4: Addressing Barriers to Treatment Success

This chapter describes how to assist families as they apply skills learned in earlier treatment sessions to work on specific problems at home. It begins with a review of their progress with the first family problem, and, if appropriate, guides the therapist in helping families pick a new issue to address. The therapist reviews treatment progress and discusses potential barriers to change, including secondary gain, low motivation, and noncompliance. It is important that the therapist monitors and reframes blame that may arise during these discussions. The therapist should make it clear that OCD symptoms/behaviors are not done on purpose, even if there are aspects that appear to work to the child’s advantage. Strategies for addressing these obstacles are discussed and additional interventions applied as necessary.

Session 6: Consolidating Treatment Gains and Looking Ahead/Relapse Prevention

This chapter focuses on a review of the skills learned during treatment, with an emphasis on how they have been applied successfully to address challenges at home. It guides the therapist in processing treatment gains and highlighting changes that all family members have made. It outlines additional in-session skills practice, including exposure tasks, praise, and self-soothing exercises. It emphasizes that total mastery of these skills following a short course of family therapy is not expected. Rather, the goal is to keep practicing and refining these skills at home. It concludes with psychoeducation about relapse prevention as well as an opportunity to process family feelings about termination.

Session 1: Getting Started in Family Treatment

This chapter provides an overview of the first family therapy session. It describes how to introduce families to the PFIT program and to develop a collaborative environment for establishing treatment goals. It describes psychoeducation about the role of the family in child OCD treatment, including family responses and expectations that may undermine success. It places particular emphasis on helping families to understand patterns of symptom accommodation that may be a barrier to treatment success, and it describes broader family dynamics that may interfere with efforts to change accommodation. The chapter also outlines steps for assessing current family functioning, including strengths and weakness, and for evaluating the family’s current strategies for managing OCD. Initial skills training begins with exercises designed to promote positivity in the home environment.

Session 3: Problem Solving Around OCD

This chapter describes the third session of treatment, wherein families begin to identify specific problems on which they’d like to work. Using their initial treatment skills (praise, emotion monitoring, and self-soothing), they work together to identify shared goals to achieve and to prioritize them. The chapter describes strategies for teaching families to use functional analysis to understand their target problems, along with steps for practicing family problem solving in session. Scaffolding and making changes gradually is emphasized.

Session 2: Managing Emotions Related to OCD

This chapter describes the second session of treatment, during which families begin to work on recognizing and managing their emotional responses to OCD. The therapist provides psychoeducation about the range of emotional responses to childhood OCD, including feelings of frustration, manipulation, resentment, and disappointment, and begins to process and normalize the family’s experiences. Emotion monitoring is introduced as a prerequisite skill for managing challenging feelings, and families practice using a thermometer rating system to track their emotions that is based on the use of the feelings thermometer. Initial strategies for responding to difficult emotions are also presented, including self-soothing exercises and initial practice with disengaging from highly charged situations. The chapter concludes with a description of informing the OCD child about how his parents will respond to him at home.