16 year old daughter with ocd not responding to cbt - any ideas?

[Guest swinkertint]

I've had some useful advice on this forum before, and hope some suggestions might be forthcoming on this occasion, as I am at the end of my tether. My daughter has had cbt at CAMHS since February this year, but has not made any progress towards beating her ocd. She seems to be stuck, and reluctant to try the techniques that were suggested to her by her therapist, always saying 'they don't work'. CAMHS have now said that there is no point in her coming to sessions, and they have made an appointment for her to see a psychiatrist in a few weeks with a view to her getting medication. CAMHS view was that for some reason, she was holding on to her ocd. Anybody have any similar experiences, any ideas about how to move forward? Reluctant to go down the drugs route, but things are getting worse.

[Em24]

Sorry to hear that your daughter isn't getting on well with her CBT. It's weird but sometimes OCD gets so far its almost like the compulsions are a safety blanket and kind of comforting if that makes any sense?! So people can be reluctant to give treatment a proper go.

She needs to be in the state of mind that 100% she wants it gone, that she can live without her compulsive behavior and get on with her life. But sometimes people aren't ready to make that step.

Hopefully she will see in time that the real and only way to beat OCD is through herself. CBT is the best thing to help her, although saying that I'm practising CBT and am on a small dose of anti anxiety medication. They normally advise meds alongside CBT, you may find with the meds taking the edge off of her anxiety levels and mood she may be more inclined to give the CBT another go.

Hope it works out ok for you all

[Guest jellybean1234]

Hello Im going through a similar thing to your daughter right now. I dont know what type of OCD she has but I would advise she trys to face her worst fears, it helps alot, expose herself to things/situations shes most afraid of doing/being in. I was in a similar state of mind she was in where you think as long as its bearable its fine, and that there is no hope because even if your having a good day you ruin it by feeling hopeless, and ignoring the efforts through the day of the people trying to cheer you up, getting depressed for no reason. I personally had to realize that I was being half-hearted at trying to get better, and needed to take time out of my day to try and help myself by exposing myself to the things i feared the most, and by that realize how irrational these fears were, slowly letting go of compulsions.

I hope this helps

[Gemma7]

Hi, I would consider looking into a different therapist. It may be that another therapist may use different techniques to help her engage with therapy or maybe her and her therapist just didn't have as good a trusting relationship as is needed to face your problems.

[Guest swinkertint]

Thank you all for your suggestions, very helpful. I wonder if anybody has any experience of hypnotherapy, but perhaps I'll post that in a new thread.

[Guest BeavenT]

As a parent you are naturally reluctant to see your child on meds...I was in the same position, but having seen with my son they really do help...They help,to suppress the anxiety a little in order when they are not in that state of fight or flight they are more able to take on board the CBT.. There is light at the end of the tunnel, but it is a long haul...I was lucky enough to be able to pay for CBT as and when needed, because the 12 week slots offered on the NHS are no where near long enough,

[Guest swinkertint]

Thank you for your comment BeavenT. Do you mind if I ask you how old your son was when he started on the meds, and can you tell me what they are? I know that most of these drugs are not designed for youngsters, and I do worry about side effects. Have you had any problem with these?

[Guest BeavenT]

hI he takes Sertiraline it's a drug that helps the natural seratonin levels in the brain release at a slower rate...he is now 21 and has battled with OCD since he was 17 ..we have a fab Gp who explained all the pros of taking meds....at first is was a very scary though, but honestly is has helped....my son is now living independently and is very successful at uni..,he has a CBT therapies privately that he can call whenever he feels,the need...he still takes the meds, and has had no side effects at all...beacaise of the OCD the first week of taking them heightened his anxiety, but this was due to fear, of what the meds would do, but he soon realised that this drug didn',t alter his persona or make him a zombie, just enabled him to clarify the thought processes going on in his head,,,keep talking, to the counsellors and professionals, My sons OCD has not gone completely , but he is now in control, not it controlling him...

[Guest swinkertint]

Thank you BeavenT, very useful info, it gives me heart!

[PolarBear]

You asked about hypnotherapy. There is no evidence whatsoever that hypnotherapy has any impact on OCD. It can be used to help teach people how to relax, which can be beneficial, but it doesn't positively affect obsessions and compulsions. Hypnosis has been raised on the forum many times; I have as yet to hear from one person for whom it worked.

[Guest swinkertint]

Thank you Polar Bear. I had a browse on here after posting that comment and could see that there was no support for the idea.

[Guest Sally44]

I get very annoyed when mental health professionals want to discharge someone because they are not responding to treatment. If that is happening they need to re-evaluate the therapy, make targets the child/adult can achieve, or refer onto a service with more expertise.

It is true that often medication and CBT together is more effective. But medication on it's own is not going to get rid of the OCD.

What does your daughter say about it? OCD feels like an all powerful monster in their lives. It isn't easy to challenge the OCD. Maybe the targets are too difficult. Success breeds success.

There is the maudsley hospital in London that specialises in OCD. You could ask to be referred to them. There is also Exposure Therapy that can help make the child/adult more resilient to anxiety provoking situations. Those can be OCD related or not.

Is your daughter still in school.

[Guest swinkertint]

Hi Sally. Yes my daughter has just started at 6th form, studying for A levels. Since the therapist (who is a mental health nurse, not a psychiatrist) agreed with my daughter that the CBT was not being effective, she has seen no-one but was given an appointment for us all to meet with the psychiatrist so that she can be assessed for drugs (8 week wait for that appointment! not yet seen him). In this gap in between appointments the OCD has completely taken over and we don't know what to do. Unfortunately the Maudsley is in London and we are in the west of the country - how feasible would it be to ask to be referred there? Unfortunately, because the ocd only presents itself at night, there was never an opportunity to try exposure therapy in the sessions, and nobody ever came to the house to try it with her here. It's difficult to know if that's what should be happening?

[Guest Primrose]

My son is aged 17 years and has just started on 25mg of sertratine. Like your daughter CBT did not work at all. I am praying this medication will help.

[snowbear]

Hi swinkertint,

The reason CBT sometimes fails is because the therapy offered is far too heavily weighted towards the behavioural side while the cognitive side is insufficiently addressed. This makes it feel extremely threatening (even life-threatening) and for many people simply un-doable, even when they genuinely, desperately want it to be free of their OCD.

I no longer believe there are people for whom CBT doesn't work.

It's simply a matter of doing much more cognitive work before attempting the behavioural part. Anyone who seems stuck may need to spend a considerable amount of time working on their 'core beliefs' and thinking processes before any kind of behavioural treatment can (or should) even begin.

My advice would be to find a therapist who understands this cognitive stage cannot be rushed and be prepared to stick with it as long as necessary. The end result will be worth it. The good news is behaviour 'improves' on its own as a result of the cognitive work with a reduction in the need for rituals rather than forcibly trying to reduce them. It's approaching the problem from a different angle and enables the sufferer to take control instead of feeling press-ganged into walking the plank. (People who get 'stuck' simply feel so overwhelmed by their anxiety they dare not give up the tiny bit of control OCD provides, however painful it is to hold onto it. Behavioral therapy makes a 'stuck' person more anxious, unconsciously dig their heels in and paradoxically they rely even more on the OCD as a way to cope with the CBT 'threat'.)

CBT is hugely threatening if the cognitive work hasn't been adequately addressed. Little wonder a significant number of sufferers find the challenge of behavioural therapy too daunting to engage with it. Being unable to do so is a genuine inability and does not reflect an unwillingness to change.

If your daughter is holding onto her OCD it's likely meds won't have any benefit whatsoever. The core beliefs making her hold on are what need to be tackled.

Thankfully many therapists seem to be realising it's about finding the balance of 'C' and 'B' in therapy and tailoring it to the individual instead of offering a 'one size fits all' solution and claiming it hasn't worked after x weeks of application.

Timing of therapy is also important. Tackling something as big as your core beliefs takes a lot of mental effort. Immediately after you've experienced a big life change (like entering the open study approach of 6th form after the security of structured teaching at school) may not be the best time to begin. It's likely a life change such as this may temporarily increase the OCD symptoms until she finds her feet and settles in, just as every student needs a settling in period and deals with it in their own way.

Consider not making any big decisions (like going on meds or retrying CBT) for a few more weeks of term. Therapy on top of mastering self-guided study, making new friends etc. is asking a lot of anyone. After Christmas things may have settled a little spontaneously and then it's a chance to start work on the cognitive side.

Just my twopence worth.

[Guest swinkertint]

Dear Snowbear, many thanks for your really full comment, which I think is very useful and has given me a lot to think about. I shall certainly bear it in mind when we see the psychiatrist next week.