To Kathy H and Kathy R

[Guest guest]

Kathy(s):

What do you think about imaginal exposures for Kellen's issues with poop?

My understanding is that when a tape loop or real-life exposures are too

difficult that sometimes sufferers can start habituating to an imaginal

exposure. This can be a way of bringing an exposure that would be too

difficult in real life to an acceptable level on the hierarchy, ie. the

looking at pictures of poop and not touching the pictures that I suggested

earlier. Of course, you'd have to check w/Kellen. She might say it would be

too easy (It's only a 1 on my hierarchy) or " that doesn't seem like it

would help at all. "

Also Kathy R., one very effective way I found to coach Kelsey in bossing

OCD back was to equate it to teasing, a concept that kids this age are

(unfortunately) already familiar with. I'd say, " That bad guy is saying:

'nah, nah, nah, na (you know the sing song teasing voice) I can make you do

it cuz I'm the boss.' But he doesn't get to be in charge of you, does he?

You make the rules! " Then we'd show him who was boss and revel in our

victory over this mean bully! After that, we'd remember when he made all

the rules and how she was bossing him back more and more and how one day

he'd have no more power. And guess what? We're pretty much living that now.

Kathy H: Thanks for the heads up on Kelsey's constipation problem as

possible OCD. I'm happy to report that it wasn't though. One thing about

having a kid who is very literal and incapable of lying...I don't have to

deal with the secrecy issues of OCD. If I ask, she tells! She's been more

than willing to hustle to the bathroom when she needs to go.

Good luck Kathy R with this tough issue.

in San Diego

[Guest guest]

HI Chris:

I think that imaginal exposures are quite helpful as long as the OCDer does

them. This is hard to monitor in a child. Since Kelsey is so open and

literal this may not be a problem for her. The loop tapes are a means to

reinforce and standardize imaginal exposure. Also I have read about people

doing E & RP by writing out their obsessions in glorious technicolor (is this

what King does?).

I have read that imaginal exposure in research studies is not as

consistently effective as real-life exposure. Of course this is in a

research setting and may not prove important for a particular individual.

How I would do imaginal stuff with Steve was quite incidental. Just reading

OCD books to him would start him obsessing and ritualizing and then we would

encourage ritual prevention while continuing the exposure by reading more.

I thought I was working on the cognitive part but it became the behavioral

part for him.

I suspect looking at poop pictures but not touching them would probably be

more along the lines of real-life exposure to poop rather than avoiding

touching poop. That is why I would probably work on the obsession behind

the compulsion and design exposure to the obsession while encouraging ritual

prevention by not bringing poop into it, even just in pictures. Watching

for the spike in anxiety is the important part to clue you in on whether the

E & RP is targeted correctly.

You are so lucky that you can believe all that Kelsey says. Steve would

often say something completely different from what was going on in his body.

It was part of his avoidance. Even his present CBT therapist has told me

that she has to stay on her toes because he uses his quick mind to throw her

off track. So even if he would say that is a 0 or a 1, I would still ask

him to do the E & RP, making sure he really was bored with it. How you talk

with them about the exposure while doing it can also increase the intensity

so a 0/1 becomes something higher just by filling in more details.

I love how you describe the way you and Kelsey formed a team to boss back

the bully, OCD. It is such a strong reminder that they dislike what OCD

does to them even more than we, their parents, do. Kelsey obviously

realizes she is not alone and isolated in her suffering with OCD but has a

loving mother backing her all the way. :-))

Great news on overcoming the bowel difficulties. What a relief to have a

problem that is not OCD for a change! They are generally so much easier to

resolve. Take care, aloha, Kathy (H)

kathyh@...

At 09:27 AM 09/24/1999 -0700, you wrote:

>From: Roman <ChrisRoman@...>

>

>Kathy(s):

>

>What do you think about imaginal exposures for Kellen's issues with poop?

>My understanding is that when a tape loop or real-life exposures are too

>difficult that sometimes sufferers can start habituating to an imaginal

>exposure. This can be a way of bringing an exposure that would be too

>difficult in real life to an acceptable level on the hierarchy, ie. the

>looking at pictures of poop and not touching the pictures that I suggested

>earlier. Of course, you'd have to check w/Kellen. She might say it would be

>too easy (It's only a 1 on my hierarchy) or " that doesn't seem like it

>would help at all. "

>

>Also Kathy R., one very effective way I found to coach Kelsey in bossing

>OCD back was to equate it to teasing, a concept that kids this age are

>(unfortunately) already familiar with. I'd say, " That bad guy is saying:

>'nah, nah, nah, na (you know the sing song teasing voice) I can make you do

>it cuz I'm the boss.' But he doesn't get to be in charge of you, does he?

>You make the rules! " Then we'd show him who was boss and revel in our

>victory over this mean bully! After that, we'd remember when he made all

>the rules and how she was bossing him back more and more and how one day

>he'd have no more power. And guess what? We're pretty much living that now.

>

>Kathy H: Thanks for the heads up on Kelsey's constipation problem as

>possible OCD. I'm happy to report that it wasn't though. One thing about

>having a kid who is very literal and incapable of lying...I don't have to

>deal with the secrecy issues of OCD. If I ask, she tells! She's been more

>than willing to hustle to the bathroom when she needs to go.

>

>Good luck Kathy R with this tough issue.

>

>in San Diego

>