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Hi all,

I have another long thread explaining my daughters symptoms which are based around her inability to touch certain things that she needs to use for everyday activities. 

Plates, cups, bowls, knives, forks, spoons

anything touched by certain other people like beds, clothes, seats etc. 

Her compulsion is to simply avoid all these things to the point where she struggles to eat, drink, sleep anywhere but the floor, wear any clothes that have to be washed (basically leaving only brand new clothes which she won’t then take off). Everyday basic human needs really. It is extremely complex  

We have been seeing clinical psychologists and psychiatrists for past year and their assessment is that is is very hard to understand her exact symptoms but they believe they are a combination of OCD, anxiety around separation, emotional behaviour issues. They believe this makes it hard to define a clear treatment plan and have to play it by ear so to speak.

They want us initially to work on the circle of security (COS) and then CBT  

i don’t think this is a bad plan at all but I am concerned on the proposed strategy  

the plan is to to work 95% with the parents only teaching us how to do this with her. That is important but they don’t plan on working directly with her on a weekly basis with a set CBT course.

i would expect to see some cognitive therapy with her where they help her understand ocd, how it works and what the process to recovery is. We can obviously do this too, and are, but I think it has more credibility coming from a specialist also so we all speak the same language . The therapist said to me that for an 8 year old it’s more like BT only as the C part of CBT is not useful for an 8 year old As too young to benefit or fully understand. I disagree and feel they are missing out on a crucial component that will help her understand why we will do certain things with her when helping her face her fears. Getting an 8 year old to participate in ERP is hard enough but more so if they don’t understand why they are doing it this way  

it would also mean that if they don’t work one on one directly with her themselves we will have to do all the exposure response prevention activities. I realise we would do this on an ongoing basis but surely the therapist should be doing this with her too to build up her confidence, gain trust and explain it all to her.

is it normal that when treating an 8 year old for OCD with CBT that they only teach the parents what to do and don’t work directly with the child doing it too?

what are others experience with a therapist doing CBT with young children or just getting parents to do it after teaching us the methods?

surely it needs both?

 

 

 

 

 

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Hi MH,

I've no idea what's normal procedure for CBT with an 8 year old, but I totally agree with you that they should be doing some CBT work with her as well as with the parents. If anything I'd have expected them to start the cognitive side and delegate much of the behavioural side to parents under guidance, not to brush off the cognitive side completely. To suggest an 8 year old can't do cognitive therapy is beyond crazy - everything we teach in school is 'cognitive', everything a parent teaches before the child even reaches school age is 'cognitive'!

It sounds to me as if the therapist simply isn't experienced at doing therapy with children.  :unsure: Quite possibly the training of therapists doesn't equip them with the understanding of how to go about it, or the confidence to try. I'd ask the therapist if she has children of her own and if she has experience of explaining everyday complicated stuff to them at an age appropriate level they can take on board. If her therapy training is lacking, hopefully her personal parental skills won't be and she can apply her parenting communication skills instead of thinking of it in terms of doing 'cognitive intervention'. 

Failing that, you may have to take a deep breath and ensure that whatever behavioural exercises your daughter is given that you, her parents, at least explain the reasoning behind it to her as best you can. But cognitive therapy is more than that, it's about helping the child understand their interpretation of the world isn't how things actually work. Maybe you could approach it like a science lesson, teaching her the way things do work the same as you'd explain how gravity works or how rainbows are made. I'm sure we'll find a way! But I can clearly remember how much insight I had at 9 and it was a lot - I just didn't have the language or communication skills to explain it back to the adults. And I also recall how frustrating it was to be treated as if I couldn't possibly understand so no attempt was made to explain things to my face while adults whispered over my head like I was deaf... :dry: 

Have a chat with the therapist and explain your concerns. See where it gets you. Fingers crossed(again!) 

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Thanks SB,

I’ve asked the therapist the question before about having her own children and she doesn’t.

she has also spent a lot of time in the US where I hear they are not as enthusiastic about cognitive therapy as some other countries. maybe she is working off those beliefs and background. 

Im therefore trying hard to work with my daughter on teaching her the cognitive side also so she understands better when we are having to not accommodate her compulsion of avoidance. It’s so hard as she doesn’t like talking about it for long and then when we are having to be strong and not get sucked into her circle of anxiety she just feels we are being cruel and mean by not helping her. 

Its almost a race to get her to understand the way ocd works and how it’s best treated and why we do what we do, whilst at the same time actually doing some levels of ERP with her before she fully understands the theory but having to try and move forward. Getting dressed for school is a huge issue but we obviously can’t wait to address that as it’s so important. However that’s near the top of her anxiety ladder so struggling to proceed at a gentle pace with some easier ones first.

i have found a couple of great books aimed at explaining ocd and CBT to a child that I would totally recommend to other parents of kids under 12 who want to explain it to their children in a great way.

The challenge is getting their attention and understanding but also their willingness to learn about it so they recognise when the ERP part is started that they get why it’s being done that way and that we are only doing it to make them get better. Without doubt the hardest part of having kids with ocd - getting their understanding and buy in to CBT

 

The books I really like and would recommend to other parents with children with OCD -

‘Can I tell you about my OCD’ - Amita Jassi (short but perfect to explain ocd to child sufferers and their family, teachers, doctors)

‘What to do when you’re brain gets stuck’ - Dawn Heubner (a kids guide to overcoming OCD with great practical examples)

’Breaking free from OCD’ - Jo Diersley, Isobel Heyman, Sarah Robinson and Cynthia Turner (CBT guide for young people and their families)

 

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For a country that prides itself on being a world leader the attitude of American psychiatrists towards cognitive therapy has always shocked and puzzled me. They are literally decades behind when it comes to CBT. Anyway, your therapist is in Aussie now and ideas there are much closer those of therapy in the UK. :)

The rest all seems very positive. And it sounds like you're on top of it. (Though you may not feel that way just yet!)

Thank you for recommending the books - very helpful for other parents. :) 

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Must admit I do wonder about CBT. Our 13 year old is about to see CAMHS and I have no doubt they'll consider the CBT route.

Son is already seeing a counsellor and doing CBT stuff. Problem is, and I can well believe it, is that counsellor reports that son just won't engage or try, or take on board any suggestions. Pretty sure it will be a complete waste of time for him because he just wont bother.

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1 hour ago, paulfoel said:

Must admit I do wonder about CBT. Our 13 year old is about to see CAMHS and I have no doubt they'll consider the CBT route.

Son is already seeing a counsellor and doing CBT stuff. Problem is, and I can well believe it, is that counsellor reports that son just won't engage or try, or take on board any suggestions. Pretty sure it will be a complete waste of time for him because he just wont bother.

And there in lies the skill of a good therapist. One who knows how to engage and build trust with the child and talk in a language that they understand so they feel heard and want to help themselves. 

I hope that can happen for him ...

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1 hour ago, MHinAus said:

And there in lies the skill of a good therapist. One who knows how to engage and build trust with the child and talk in a language that they understand so they feel heard and want to help themselves. 

I hope that can happen for him ...

So do I but I think they have a job on their hands.....

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