Re: Boundaries/consequences

November 30, 2010

There may be too many behaviors you are trying to shape at once.

I know I did that too. Our therapist had me slow way down on

expectations. The first step was the medication.

1) Start with a crumb of a the pill. She takes the pill

she gets the laptop. It is just a crumb. You could take it

too it is not going to have any therapeutic impact. It is just

one small step. If she can't do that she can practice pretending

she is taking it and get a small portion of computer time.

I often gave the crumb to my daughter when I could distract

her quickly. Like give the crumb and then hand her the

laptop. I think ramping up on the medication will help a lot.

2) Tardies: She can earn back the after school activity if she

practices pretending she is taking a crumb of the medication.

It can be an actual crumb. Practices other things to earn points

for the after school activities.

3) Limit the laptop as the reward that is not earned.

4) Break up the tasks. With rewards. Will she let

you supervise? Be calm and not anxious yourself or

anger. You see it is hard. Your intention is to help

her so she is not so distress. But it is just taking to

long so lets work together on some of the morning

routine so it goes faster. You think she might me

anxious about school. Ask her to talk about that too

at night or after school for points.

The mistake I made for years was to set too high

of goals. Make each step smaller so there is less

anxiety. Praise and cheerlead. You know it is hard

and you are proud she is trying.

If the conseq are too aversive they will increase

anxiety.

Pam

>

> I am new to this. HELP! My 14 year old daughter had displayed some mild

germophobe tendencies for the last 4 years. We have only ONE bathroom. So when

her routines ramped up in mid July it became disruptive to the whole family. We

had 3 free sessions with an EAP (employee assistance program) therapist. She

indicated OCD & printed off some online info. Until then, we had been reluctant

to intercede. We started putting restrictions on her time in the bathroom. She

uses a shower pouf to scrub her arms. Her neck looks raw too, although she

claims that she is not using the pouf on her neck. She uses ALL products to

excess shower gel, bar soap, liquid soap, as well as other personal care

products like facial cleanser, foundation & hairspray.

>

> At this point in time, she showers for 25 minutes & doesn't open the bathroom

door for another 35 minutes. I am certain it is only this short because we

advise her every 5 minutes. We shouldn't have to because there is a clock on the

back of the toilet & a waterproof one in the shower, yet she is oblivious to the

passing of time. We can hear water being turned on & off in that extra time.

Keep in mind, during this closed door time she is doing NONE of what she should

do! NOT brushing teeth, washing face, brushing hair, none of that is done until

the door is open. This makes total bathroom time between an hour and 15 minutes

to an hour and a half. Mornings have her in the bathroom after the toilet flush

for over half an hour, again without doing what NEEDS to be done. After her 1st

visit with her own therapist (just under 2 weeks ago) we--my daughter, husband &

myself--sat down & set goals for her morning bathroom prep time and her evening

bathroom time. Although she was a part of setting those times, she has yet to

fall within those parameters. We told her that if she exceeds the time in the

evening, she loses her laptop & cell & if she is tardy for school, she loses

afterschool activities. Last night was the first time we actually enforced the

no cell/laptop punishment. She sobbed for at least half an hour. This morning,

she was tardy. I am torn. Today is auditions for the spring musical & she was

adamant that she would be staying. I told her the only way I would let her stay

is if at her next (2nd) visit with her therapist (Thursday) that she tells her

that she needs meds. I don't know why, but she is VERY opposed to taking meds.

>

> On one hand, I have been doing my reading & know that although this is not

something that she can control, progress can be made with intercession BUT it

should not be heavy handed. On the other hand, everything that I knew (or

thought I knew) about parenting is to set boundaries & consequences. A few weeks

ago my husband wanted to take her to the ER to see a pediatric psychiatrist to

get her on meds immediately. I feel like such extreme action could lead to her

being suicidal. I DON'T KNOW WHAT TO DO!! I feel like every move I make could

trip a mine or make her fall from the tightrope.

>

November 30, 2010

Hi there,

Pam has given you some good input around behaviors and shaping them. I know

others will jump in soon and give lots more too. I will try to give you input

on what I think might be most helpful to consider.

Consequences don't work for OCD. They are driven to do what they do, period.

While you absolutely need to have boundaries on acceptable behavior I would

focus on being understanding and empathizing with your daughter first. Then,

ask her what she feels she could work on, right now.

ERP(exposure and response/ritual prevention needs to be done in a gradual way,

and most do best by starting with something small and manageable. But sometimes

they feel they can conquer something big, but it has to be their choice, as they

are the ones that will have to endure the level of anxiety that comes up.

If the OCD is going to be handled, it has to be your daughter leading this.

Taking a hard line as a parent only adds to their stress and increases anxiety.

While it is very frustrating and can take over your household, it is a process

to unravel the pieces to regain some " normal " , and cannot happen that quickly.

But, if you go slowly and within your daughter's ability to change, it actually

can turn around quite quickly. It's all in how it is handled.

Given that there have only been two sessions with this counsellor, it is really

not much, and while your daughter may wish she could make the changes she agreed

to, it's not realistic. So, then she is being punished for something she can't

hope to accomplish.

As Pam mentions, rewards are better than consequences, in terms of the OCD.

Typical parenting does not work, because this disorder has created a non-typical

kid! The OCD is full of rules that they must follow, and they will lie and hide

what they are doing to go around rules and boundaries you might set - as will

teens - but it's different with OCD, they don't get any pleasure out of breaking

these rules, they are just compelled to, usually feel guilty and out of control.

Feeling pressured by others only adds to this guilt and stress.

Medication can be very helpful, particularly if the OCD is severe and affecting

a person's ability to function. This decision is best made in discussion with a

doctor who specializes in OCD and who can help you assess the level of severity.

I, like you, was very hesitant to give our child an anti-depressant. We tried

everything we could for three months, at which point he could no longer

function, medication was needed, and it gave him relief from the anxiety, and

reduced the severity of the OCD. It took time, but eventually he was able to do

the ERP and he got his life back. For most, this is the way out.

These medications can be part of what is needed to give someone their life back,

so I would encourage you to stay open to this as an option, as it might well be

needed.

ERP/CBT is done by a psychologist, and they are generally best able to assess

and help you decide if medication is needed, or if ERP is able to be done

without medication. That really is the crucial thing, if your daughter is able

to expose herself to the things that cause anxiety then she can work this, and

the OCD will reduce. But, if the anxiety is high, and when she tries to do the

exposures it goes so high that she feels unable to continue, then medication

will help dial back the level of anxiety, so she can then do it.

In terms of your daughter's feelings around medication, there could be any

number of reasons, not least of which could be OCD based. Our son was like this

at one point. Again, a skilled doctor can explain what all is going on, how

medication can help, or if it is even needed. When they understand the OCD and

what they need to do, and what is in their control to do it can make all the

difference.

Feeling out of control is very scary, and she will " defend " the OCD, because she

needs to. It can tie into their identity (identity is such a part of being a

teen), and they feel that they " are " the OCD - so it is like you are asking them

to stop " being " who they are.

Which brings me to the final point - being a teen with OCD. We found this to be

one of the hardest parts of it all. Teens are distinct creatures, they are

wanting to be independent, feeling like they know all the answers and don't need

you - and yet they need you desperately, etc, etc. It can be a tricky balancing

act, managing the teen stuff and all the OCD stuff, and never sure where one

ends and the other begins. Know that there are many here who will understand!!!

We dealt with some really difficult behavior with our son, 15 at severe onset of

OCD. We learned the hard way what worked and what didn't... it takes time,

patience, a lot of tears, outbursts.... Just keep trying to connect with your

daughter so she feels you are on her side, she already has a terrorist in her

head to fight(my son's analogy), so she is short on energy to " fight " her

parents.

Having a therapist on board who can help you develop a process for managing the

OCD and doing the ERP can make all the difference, but it can take some time.

Warmly,

Barb

Canada

Son, 19, OCD, LDplus - doing well over 2 years