Therapist's experience

[Guest guest]

Dear list,

Thank you so much for all the responses. Many of them have given me both hope

and support.

Evan's current dose of Zoloft is 50 mg/day. He was on 25 mg/day for the first

week and has only ben on the 50 for a week. DId you mean that 10 -12 weeks is

needed at one level to see a change or would that be overall time to adjust

the dosage? I know there's no t definate time answer, but i'd like to have a

feel for when I should see something or ask to try a different med.

We have been seeing a pyschologist who is very experienced working with kids,

esp. ADHD, and learning disabilities. I feel very comfortable with him. Evan

is still not willing to talk about his bad thoughts there, but they have been

playing games and discussing making choices. Today we set up a situation to

frustrate him and give him techniques to deal with frustration and anger,

besides leaving, throwing etc - none of which he does there, just at home. I

always participate, he is not yet willing to be there alone- is this typical?

My concern is that he doesn't have specific experience with e & rp or even very

much with oCD. He said he is seeing more of it and that Evan is the youngest

OCD patient he has. He said he knows March and plans to call him. He was

very familiar with the books Brain Lock and Shadow Syndromes, also lent me

one called It's No One's Fault. How do I know if he can do this

therapy?Provided we can get Evan to cooperate?

Separate questions - wher can I get info about the videos mentioned/ Are they

any books on tape for kids? Evan is a strong auditory learner and book and a

Walkman have been a lifesaver sometimes.

Thanks again.

Terri

[Guest guest]

Terri:

I think your therapist sounds great. He is willing to admit he is not an

expert, and the fact that he is going to call Dr. March is fantastic.

Also, the fact that you are comfortable with him is VERY important, as is

his willingness to learn. He has recommended some great books to you. I

would suggest you return the favor by having him get OCD in Children and

Adolescents by March and Mulle. It explains in very precise

terms how a therapist should do E & RP.

As to books on tape, I don't know that any kids books on OCD are available

in that format, but you could easily make them yourself. One of the drug

companies puts out a booklet by Connie called Kids Like Me that you

could read aloud to him and tape. Also, within the past several weeks

someone on the list posted a story about OC Flea that my 11 yo son really

enjoyed. I will send it to you off list as it is very long.

Jule in Cleveland

[Guest guest]

HI Terri:

Every person is different. For my son Steve it took 12 weeks at 60 mg of

Paxil, and more weeks before then titrating up to 60 mg, to see any effect.

In fact we were about to take him up to 70 mg to see if we could get a

response. ly it happened at the same time as I started to do flooding

(not recommended by me now, I was desperate then) exposures and he started

to learn that he could survive the anxiety and meltdowns. So I am never

really sure how much it helps his OCD but it has proved a life saver for

his MDD.

Dr. Fred Penzel gave a talk I attended and he mentioned a typical med

problem is working with a Type A doc who jumps from med to med too soon

before trying it for long enough and at a high enough dosage. Kids have

rapid metabolism and take the same dosages as adults and some docs balk at

this. Dr. Penzel also mentioned that some med problems he sees are

patients being kept on the same med too long without it working for them

and other avenues being explored. All in all we have to be vigilant.

Being comfortable with Evan's doc is very important, but more important is

Evan's comfort level with the doc (my opinion). The most important thing

is, is progress being made against OCD. Dr. Penzel advised me not to take

Steve to the same doc more than five times if no progress was happening in

his learning to control OCD. I wish I had gotten this advice in the

beginning it would have saved us so much money and time, and especially

pain for Steve.

I really like that book your doc recommended, " It's Nobody's Fault " by Dr.

Koplewicz. Brain Lock is available on audio tape, it is an abridged

version of the book. The OCF has video tapes about children and OCD as

does the AFOCD (Awareness Foundation for OCD).

What I learned to do in checking on whether a doc knew their stuff about

OCD and its treatment was to ask open-ended questions like: " What is your

philosophy/approach to OCD in children, particularly when it is travelling

with other comorbid disorders? " , " What treatment goals can be established,

and how will we measure accomplishment of these goals? " , " What do you see

as the role of family members in the recovery of their relative with OCD? "

I learned to avoid questions like, " Do you treat people/children with

OCD? " , " How successful has this treatment been for your previous

patients? " , " Can you help us? " because I found these did not produce

reliable answers consistently. The OCF web site has an article on

selecting a treatment provider.

Evan's doc certainly sounds interested in OCD, is willing to consult with

Dr. March who is a top expert in the field, and has been honest about his

inexperience in treating OCD. What worked for us in getting Steve treated

by a therapist inexperienced with E & RP for OCD was to find someone willing

to learn and willing to invest the time to learn. Sometimes docs would say

they were interested but they never found the time to learn. His CBT

therapist welcomed the challenge and was very good at keeping the focus on

E & RP and not getting side tracked by other issues and applying non-E & RP

kinds of therapy until the OCD started to come under Steve's control. What

seemed a good indicators for us were a high level of curiosity, willingness

to take on a tough, treatment refractory case, and regular consultations

with Steve's psychologist who helped to train his CBT therapist who lives

nearby.

Good luck, take care, aloha, Kathy (H)

kathyh@...

At 10:47 PM 03/08/2000 -0500, you wrote:

>From: twmom@...

>

>Dear list,

>Thank you so much for all the responses. Many of them have given me both

hope

>and support.

>

>Evan's current dose of Zoloft is 50 mg/day. He was on 25 mg/day for the

first

>week and has only ben on the 50 for a week. DId you mean that 10 -12 weeks

is

>needed at one level to see a change or would that be overall time to adjust

>the dosage? I know there's no t definate time answer, but i'd like to have a

>feel for when I should see something or ask to try a different med.

>

>We have been seeing a pyschologist who is very experienced working with

kids,

>esp. ADHD, and learning disabilities. I feel very comfortable with him.

Evan

>is still not willing to talk about his bad thoughts there, but they have

been

>playing games and discussing making choices. Today we set up a situation to

>frustrate him and give him techniques to deal with frustration and anger,

>besides leaving, throwing etc - none of which he does there, just at home. I

>always participate, he is not yet willing to be there alone- is this typical?

>

>My concern is that he doesn't have specific experience with e & rp or even

very

>much with oCD. He said he is seeing more of it and that Evan is the youngest

>OCD patient he has. He said he knows March and plans to call him. He

was

>very familiar with the books Brain Lock and Shadow Syndromes, also lent me

>one called It's No One's Fault. How do I know if he can do this

>therapy?Provided we can get Evan to cooperate?

>

>Separate questions - wher can I get info about the videos mentioned/ Are

they

>any books on tape for kids? Evan is a strong auditory learner and book and a

>Walkman have been a lifesaver sometimes.

>

>

>

>Thanks again.

>Terri