Re: Therapist choice, sanity check

[Guest guest]

Hi,

It's always good to be concerned and ask questions, and keep asking!

I can tell you our son, 16yrs, is also in CBT and not yet able to do

exposures really, but they are working on the cognitive part,

insight, which is critical for this age group I find. For our son,

even talking about any of it is problematic, so in a sense is a form

of exposure.

I think the bad thought ocd is much trickier to work with in general,

and in therapy. From what I have seen it is challenging the

thinking/thoughts which involves " talk " therapy if you know what I

mean. If your therapist has 20 yrs experience and worked with many

OCD patients you would think she knows what she's doing, but one

never does know... You might ask how she is going to help your son

specifically to try and pin it down. Also, maybe ask for references

from other patients (if you feel bold enough, not afraid you will

offend)

You sound lucky to have found someone so experienced, but I think you

are right to question and confirm!

Barb

>

> Hi,

>

> I was just seeking some affirmation or otherwise about the therapist

> we ended up selecting for my 13 year old sons' mild to moderate OCD.

> My son has bad though OCD and he is obsessed with the thought that

my

> husband or I will get in a car accident and die. His OCD doesn't

> happen during school, as he says he is too distracted to think about

> it. He is a good student with a drive to succeed.

>

> The therapist (psychologist) is an older woman with over 20 years

> experience counseling children with anxiety in my geographic area.

She

> has worked with many OCD patients over the years. She is very

> soft-spoken, but smart, and my son seemed to like her at our first

> meeting, even though they appear to be cut from different cloths. My

> only real hesitancy is that her therapy style is combined CBT and

> talk; she doesn't think my son is ready for any exposure therapy

and I

> got the vibe that she may not even use it at all, although I would

> need to confirm this. Everything that I have read so far indicates

> that exposure therapy is the only way to go with OCD.

>

> Should I be concerned or satisfied?

>

[Guest guest]

Thanks for your thoughts, Barb. I was lucky enough to have 2

different friends that have used this therapist successfully in the

past (she is one of the 'it' therapists in my area), but their kids'

problems were much less severe.

I understand what you mean when you say vocalizing the thoughts are

basically exposures. Our therapist has my son turning his questions

into statements when he can manage it. So, instead of " Are you going

to be here when I get back? " I ask him to state what my answer would

be, with the goal of getting him to say " You are going to be here when

I get back " . The idea is the more times he vocalizes this, the more he

can retrain his thoughts. Its hard for him, but no pain, no gain.

We've only had one session, so I'm sure she is just easing him in

gently. As I write this, I am kind of reassuring myself that she

knows what she is doing.

[Guest guest]

Can you get a sense of how experienced she is with using ERP? Ask her

what she has done specifically for her OCD clients (since she works

with other than just OCD). How does she determine the Dx (with a YBOC

checklist?). Ask her to give examples of devising exposures, esp

regarding OCD possibly like your son's. Does the example include

starting very low on the anxiety intensity hierarchy? I think she

should be able to address these type questions with little

hesitation.

Does she give an explanation why he is not ready? It is true if the

client is not willing exposure cannot take place, only non-

accomodation (i.e family members trying not to accomodate OCD)can

take place. She may be working on building trust or rapport esp if he

is eventully going to be seeing her without you-at 13 might be

appropriate.

My son (10) has shut down with his therapist just over an

explanation of how an exposure would be conducted for his or someone

elses OCD. It seems he cannot bear to think about much less discuss

it or do it (in realm of contamination, but it seems like there are

other concerns not verbalized too). He did complete a YBOC and talk

about the hierarchy. It is not clear what some of his ocd may be

either, if he won't reveal it there is not much the T can do but

build up trust so he'll eventually feel safe to reveal it. So we have

been trying medications to reduce the anxiety, and maintaining a

casual talking type rapport (it is very hard to get him to talk too)

with his T, hoping he comes around to readiness for more active

therapy.

If anyone has suggestions how to overcome this sort of passive non-

participating stage I am open. Motivations/rewards were suggested but

thus far there is nothing he wants enough to motivate him to try

exposures or to even talk more about his ocd, and nothing he won't

just give up, rather than plan any seemingly dreaded exposures (if we

try taking things away-which the only thing we can think of is

computer time). If he goes out with his friend or plays outdoors I

am thrilled. So I try to encourage any outside activities as sort of

natural expoures, or maybe containing some unplanned exposures.

I say 'we' but my dh is very frustrated and complains the therapist

is doing nothing, and I am letting my son get away with his behaviors

and with maintaining his ocd, he also takes it out on my son in anger

at times, which upsets my son very much (very sensitive and

scrupulous in a way, in that he does not ever want to be " bad " ).

All I can do is try not to accomodate, for example if he wanted his

bedding washed I would refuse telling him I will not do what OCD

wants, and he would then not go to sleep, until falling asleep with

his head on the table. So it creates alot of tension. He is also on

homebound tutoring b/c he could do barely more than sit in class or

stand on the playground semi-paralyzed much of the time. He would

just sit over his desk with tears coming down and not move, read or

write, plus developed a very sore back from hunched over posture.

Taking him to school became a forcible procedure that we could not

carry out daily.

nancy grace

, " bostonpies " <wjoltsik@...> wrote:

>

> Hi,

>

> I was just seeking some affirmation or otherwise about the therapist

> we ended up selecting for my 13 year old sons' mild to moderate OCD.

> My son has bad though OCD and he is obsessed with the thought that

my

> husband or I will get in a car accident and die. His OCD doesn't

> happen during school, as he says he is too distracted to think about

> it. He is a good student with a drive to succeed.

>

> The therapist (psychologist) is an older woman with over 20 years

> experience counseling children with anxiety in my geographic area.

She

> has worked with many OCD patients over the years. She is very

> soft-spoken, but smart, and my son seemed to like her at our first

> meeting, even though they appear to be cut from different cloths. My

> only real hesitancy is that her therapy style is combined CBT and

> talk; she doesn't think my son is ready for any exposure therapy

and I

> got the vibe that she may not even use it at all, although I would

> need to confirm this. Everything that I have read so far indicates

> that exposure therapy is the only way to go with OCD.

>

> Should I be concerned or satisfied?

>

[Guest guest]

In my opinion, yes, you should be concerned. Talk therapy doesn't

help with OCD at all. And I know, because we tried it for years, with

many therapists who told us they knew how to treat OCD. The only

thing it accomplished was making them richer and us poorer.

The therapist should also know how to specifically use CBT with OCD.

Just knowing CBT is not enough. They need to know how to apply it to

the OCD thoughts to help your son gain control of them. He will need

those tools for the rest of his life.

He might not be ready for exposure. What do you think? Does he seem

willing to work on his rituals and/or thoughts to get better? Does he

understand it and what is required of him to get better? If he's not

willing or ready, talk therapy will not help him either though.

Exposure therapy is crucial to getting better, but they have to be

willing to work on their rituals, which can cause some anxiety. You

start with the easy stuff, working your way up to the harder stuff.

And with a good therapist, they will allow the child to set the pace,

deciding when to move on, respecting their feelings.

I learned to get to the point with therapists. They used to

intimidate me, but I got over it when I realized I was going to have

to be a little more assertive to get our son the help he needed.

Reading about OCD, gave me the knowledge to know what he needed and

what to ask for, to make sure we were making progress, rather than

throwing money down a black hole.

It sounds like you've done your homework and know what is needed. If

she is not on the same page, you might need to find someone who is.

Or is you think she can work with you, respecting your opinion, you

might talk to her and tell her what you've read and what you think

your son needs, to see if she is willing to do what is needed.

Best of luck to you.

BJ

>

> Hi,

>

> I was just seeking some affirmation or otherwise about the therapist

> we ended up selecting for my 13 year old sons' mild to moderate OCD.

> My son has bad though OCD and he is obsessed with the thought that my

> husband or I will get in a car accident and die. His OCD doesn't

> happen during school, as he says he is too distracted to think about

> it. He is a good student with a drive to succeed.

>

> The therapist (psychologist) is an older woman with over 20 years

> experience counseling children with anxiety in my geographic area. She

> has worked with many OCD patients over the years. She is very

> soft-spoken, but smart, and my son seemed to like her at our first

> meeting, even though they appear to be cut from different cloths. My

> only real hesitancy is that her therapy style is combined CBT and

> talk; she doesn't think my son is ready for any exposure therapy and I

> got the vibe that she may not even use it at all, although I would

> need to confirm this. Everything that I have read so far indicates

> that exposure therapy is the only way to go with OCD.

>

> Should I be concerned or satisfied?

>

[Guest guest]

Hi, what many families do is give it about 5 sessions, sort of

a " trial " to see what the therapist is doing or will soon be doing.

Of course sometimes with insurance limits or paying out of pocket,

etc., it can be good to know after the first session or two if it

will be more than " talk " therapy. But sounds like his therapist has

begun some, as you said he's changing his questions to statements.

I'm sure that's a bit hard for him to do too!

Keep us updated!

>

> Thanks for your thoughts, Barb. I was lucky enough to have 2

> different friends that have used this therapist successfully in the

> past (she is one of the 'it' therapists in my area), but their

kids'

> problems were much less severe.

>

[Guest guest]

To be fair, she said that she couldn't determine a therapy until she

gets to know my son better. Is she supposed to do the OCD diagnostic

test during the first appointent?

Next appointment I will spend the first few minutes alone with her and

ask all these questions. After 2 other bad (there, I said it)

therapists who missed the diagnosis, I don't have any more time to

waste. She really does seem to know what she is doing, and her

questions and suggestions for my son were dead on and he was

responsive to them.

She actually was able to determine, thru talking, that it was the

early darkness that comes with Daylight Savings that is one of the

triggers of his OCD, as he noted that he gets more anxious of us

driving in the dark. Throughout his life I had always noted that he

seemed especially 'off' for half the year and much less challenging

the other half. I would never have made that correlation with the

light, but this makes alot of sense.

I wish I could help the woman (right now I can't remember her ID) with

the 10 year old who has shut down. I am so sorry for your pain and I

hope he starts talking again soon.

[Guest guest]

Although I wouldn't discount that some talk therapy can help a child

vent his frustration, in our experience, it was of little value. CBT

was wonderful. My son was suffering debilitating emotophobia at the

time (3rd grade) and exposure therapy was the charm. He completely

desentisized to that particular fear (although others have arisen to

take its place). However, we use the same techniques with the other

fears and my son feels he has gained power to fight the irrational

thoughts. They are there, but they don't hold the same power. We, too,

met a few therapists who wanted to use a little of this and a little of

that, to treat his OCD but they weren't true specialists. I beliee you

will find that someone who specializes in pediatric or adolescent OCD

will cut right to the chase, and make real progress with your child.

Best of luck to you. Again: don't be afraid of exposure therapy. It

is taken in degrees and your child is in the driver's seat.