Kathy H.,

[Guest guest]

Hi Kathy,

We're seeing Kelsey's therapist tomorrow so I will bring up paradoxical

therapy and also see what I can find on the Internet. Here's an example for

you to help me with...

Today we bought new silverware and Kelsey can't touch it (much less eat

with it!) because, of course, it might be poisoned. (She won't touch most

new things.) And of course it can't be in the drawer with the old

silverware because it might contaminate the old stuff. So, how could I

reframe that? She has a good sense of humour but has always been very

sensitive about being laughed at so this idea of paradoxical therapy will

be a delicate thing to do. However, I heartily welcome this tool as a way

to diffuse tension. So thanks for your help here!

-

Welcome to the list. It has been a true lifeline to me! On the issue of

insurance paying, we pay for the therapy ourselves for our 7-yr old

daughter. And yes, it sure adds up! I've always been an informed healthcare

consumer though and I feel that it's critical to have the right healthcare

professional. We have good insurance, but they wanted to pay for a

psychiatrist only and then they wanted to send us to whatever behavioral

therapist was on their approved list. While Kelsey would probably have had

diminished OCD symptoms on medication, I wanted to do the cognitive

behavioral therapy that is unique to OCD as it is widely regarded as the

most effective long-term treatment. So, we are self-paying and seeing the

regional expert on OCD in kids. Yes, it's putting a dent in the finances

but she is making big gains. Is there any more important investment you can

make than in the health of your child?

In the meantime, I am crafting a letter to the insurance company asking

them to make an exception and allow Kelsey to see this therapist. I have an

example of a successful letter that the OCSDA faxed to me on how to get

medications/and or therapy approved. If you (or anyone else) would like me

to fax a copy, just e-mail me.

Take care,

in S.D.

[Guest guest]

HI Chris:

Thanks for sending the list the description of paradoxical therapy. It

explained the approach so much better than I did.

Before you even get going with coping with the poisoned silverware you need

to find out where on Kelsey's hierarchy the silverware is. Do you know at

what level her therapist is working on her hierarchy? The problem is that

if you do E & RP at too high a level you can get aversion to CBT. Been

there, done that big time. If you find that the poisoned silverware is

on a par with where she is working on her hierarchy or just slightly above,

then go ahead and try some paradoxical approaches. I suggest you explain

to Kelsey up front that you are trying some new ways to help her deal with

OCD and explain a bit about paradoxical therapy. Then it won't be a

surprise. If our OCDers think we are tricking them all hell can break loose.

BTW this silverware thing is pretty typical of OCDers. It was even in " As

Good As It Gets " . Graduated conventional E & RP might be the best approach,

but if I were to try paradoxical I think I would do something like this.

Set the table very obviously with the new silverware (this is exposure big

time for Kelsey), serve up food that is very hard to eat with you hands and

then make sure everyone in the family eats with their hands, makes a

dreadful mess and avoids the silverware like the plague. At the same time

talk about how incredibly dangerous the silverware is and how brave you all

are to sit at the table with it and eat your food so happily with your

hands. Talk about how ancient peoples ate with their hands and why on

earth did people ever invent silverware which is so dangerous, it has

points on it, could really hurt your mouth if you put the silverware in the

wrong way, etc. etc. etc.

Another approach would be to use very fragile plastic utensils which keep

breaking as you try to eat or use chopsticks for very unsuitable kinds of

foods (slippery with sauce, etc.) and act as if everything is delicious and

wonderful even if you can hardly get the food into your mouths. Talk about

how smart and creative you all are in finding a way to eat without risking

eating with the new silverware which is dangerous, poisonous, too new, etc.

etc. etc. Have fun with this, giggle, be like the emperor with his new

clothes.

Take it to the absurd but make sure the humor is not teasing, by doing the

odd stuff yourself this can really help, the idea is to lighten up about

the " poisoned " silverware. You might want to throw in some traditional

E & RP and ask Kelsey who is the boss, her or OCD, when it comes to dealing

with the silverware if you find the paradoxical approach is not working.

If it does not work that is very likely a sign that you are too high up on

her hierarchy.

Good luck, please let us know how things go. Take care, aloha, Kathy (H)

kathyh@...

At 08:55 PM 5/20/99 -0700, you wrote:

>From: Roman <ChrisRoman@...>

>

>Hi Kathy,

>

>We're seeing Kelsey's therapist tomorrow so I will bring up paradoxical

>therapy and also see what I can find on the Internet. Here's an example for

>you to help me with...

>

>Today we bought new silverware and Kelsey can't touch it (much less eat

>with it!) because, of course, it might be poisoned. (She won't touch most

>new things.) And of course it can't be in the drawer with the old

>silverware because it might contaminate the old stuff. So, how could I

>reframe that? She has a good sense of humour but has always been very

>sensitive about being laughed at so this idea of paradoxical therapy will

>be a delicate thing to do. However, I heartily welcome this tool as a way

>to diffuse tension. So thanks for your help here!

>

>-

>Welcome to the list. It has been a true lifeline to me! On the issue of

>insurance paying, we pay for the therapy ourselves for our 7-yr old

>daughter. And yes, it sure adds up! I've always been an informed healthcare

>consumer though and I feel that it's critical to have the right healthcare

>professional. We have good insurance, but they wanted to pay for a

>psychiatrist only and then they wanted to send us to whatever behavioral

>therapist was on their approved list. While Kelsey would probably have had

>diminished OCD symptoms on medication, I wanted to do the cognitive

>behavioral therapy that is unique to OCD as it is widely regarded as the

>most effective long-term treatment. So, we are self-paying and seeing the

>regional expert on OCD in kids. Yes, it's putting a dent in the finances

>but she is making big gains. Is there any more important investment you can

>make than in the health of your child?

>

>In the meantime, I am crafting a letter to the insurance company asking

>them to make an exception and allow Kelsey to see this therapist. I have an

>example of a successful letter that the OCSDA faxed to me on how to get

>medications/and or therapy approved. If you (or anyone else) would like me

>to fax a copy, just e-mail me.

>

>Take care,

>

>in S.D.

>

>

>

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>

[Guest guest]

Hi Kathy,

Oh you are so creative! Can I hire you on a consulting basis?

You surely could go into the therapist business with all your skills and

knowledge one of these days, don't you think?

As wonderful as your idea is, it is probably too high on Kelsey's

hierarchy. (We use a 1 to 10 scale, but she is fond of rating things in the

thousands and millions!) I'd never even thought about the " aversion " apsect

to CBT, which makes perfect sense, so I REALLY appreciate you mentioning it.

We're kind of all over the place on her hierarchy. We've been working on

the things that most interfere in daily life: clothing, erasing letters,

going new places. He said it doesn't matter if it's at the top of the

hierarchy as long as we break it down into manageable steps. So if going to

the video store is a 10, we spend 7 days driving there and standing in

front of it briefly so it's just a 2 or a 3. I'm sure the people in the

store think we're stalkers! (Just imagine the tediousness of working on

this kind of exposure! I'll be glad when " new places " get better.)

I talked to her therapist about paradoxical therapy. He was familiar with

it but doesn't seem to use it. He said we have to be careful not to

reinforce an obsession by using it, which was my initial thought too. Has

this ever happenned to you? Or do you find that the sheer ludicrousness of

how you approach it makes that impossible?

Thanks for your thoughts,

Chris

[Guest guest]

Hi Chris:

Thanks for the compliments - actually we need to learn this stuff to

reinforce what our kid's CBT therapist is doing.

By breaking down the top of the hierarchy items into steps you are creating

lower hierarchy items. Dr. Hatton's manual that was on sale at the OCSDA

conference has a good description of this. I know what you mean about how

things can be very slow but that is the best way. It took months and

months for Steve to get over one contaminated village 30 miles from here.

His therapist would keep driving closer and closer to it. After some

months they were out of the car and walking down the street. I am sure no

one looking at him would realize his achievement.

We started using paradoxical therapy with Steve after he was already

familiar with CBT for about eight months. I have never found that it

reinforced his obsessions. It is effective precisely because it switches

his focus to help him question his obsession much more effectively than us

saying " that is your OCD " " please try to boss it back " or something similar.

One important way that paradoxical therapy helped was with me. It helped

me stop taking the OCD so terribly seriously and to approach fighting it

with a determination less grim but more whimsical. When we use humor we

make OCD less scary and less powerful. Kids respond to this particularly

well. I think that is why monsters are often portrayed as a bit silly or

odd in a way that we can giggle at. So we can think about monsters but not

be completely scared by them. For me that is an important part of the

power of paradoxical techniques.

The things that reinforce obsessions are compulsions, parents participating

in rituals, avoidance behaviors and the OCD sufferer's struggle to

recognize that their obsessions are OCD thoughts, ideas or images or to try

to drive them from their mind. I think the paradoxical stuff shifts their

perspective and gets them to realize things are OCD. It could be seen as

participating in the ritual but personally I think our OCDers are smart

enough to tell by the ridiculousness (which must be kept fun and not

teasing) that their obsession is faulty.

What I noticed about Steve at first was that he did not always realize that

something was OCD. It was clear to me it was but his insight was limited.

Paradoxical therapy helps to develop his insight. Of course it is not a

cure all but for us it has been a very useful technique for OCD and non-OCD

family members alike.

It sounds like Kelsey is making wonderful progress, you must be so proud of

her. It took several tries before Steve really got going so you are lucky

with this early start. Good luck, take care, warmest aloha, Kathy

At 07:50 AM 5/22/99 -0700, you wrote:

>From: Roman <ChrisRoman@...>

>

>Hi Kathy,

>

>Oh you are so creative! Can I hire you on a consulting basis?

>You surely could go into the therapist business with all your skills and

>knowledge one of these days, don't you think?

>

>As wonderful as your idea is, it is probably too high on Kelsey's

>hierarchy. (We use a 1 to 10 scale, but she is fond of rating things in the

>thousands and millions!) I'd never even thought about the " aversion " apsect

>to CBT, which makes perfect sense, so I REALLY appreciate you mentioning it.

>

>We're kind of all over the place on her hierarchy. We've been working on

>the things that most interfere in daily life: clothing, erasing letters,

>going new places. He said it doesn't matter if it's at the top of the

>hierarchy as long as we break it down into manageable steps. So if going to

>the video store is a 10, we spend 7 days driving there and standing in

>front of it briefly so it's just a 2 or a 3. I'm sure the people in the

>store think we're stalkers! (Just imagine the tediousness of working on

>this kind of exposure! I'll be glad when " new places " get better.)

>

>I talked to her therapist about paradoxical therapy. He was familiar with

>it but doesn't seem to use it. He said we have to be careful not to

>reinforce an obsession by using it, which was my initial thought too. Has

>this ever happenned to you? Or do you find that the sheer ludicrousness of

>how you approach it makes that impossible?

>

>Thanks for your thoughts,

>

>Chris

>