Obsessive Compulsive Disorder by Polly Waite Read Free Book Online

the young person . The therapist is not ‘the expert’ but all the different parties are bringing together their particular areas of expertise to overcome the problem. This approach is crucial when working with young people with difficulties including depression, anxiety and specifically OCD, where cognitions are commonly characterised by self-doubt. For this reason therapy needs to be delivered in a way that promotes the young person’s self-efficacy and perceived control . This approach is also essential from a practical point of view. Due to the resource limitations that face services it is essential that therapy promotes the development of skills that can continue to be used over time, independently from the therapist and enable the young person to deal effectively with any future setbacks that may occur once therapy has come to an end.
    There are a number of key features in delivering CBT that meet these theoretical and practical demands, which will be reviewed briefly below.
    First, however, we should acknowledge that when working with young people, in contrast to adults, it is extremely unlikely that the young person will be the one who has sought help. In most cases it will be a parent or carer, or in some cases a teacher or other adult. For treatment to work, the young person needs to play their part and so it is important to consider their motivation to change right from the start. A common method in helping the young person is to identify the pros and cons of having OCD and the pros and cons of changing how things are. Young people may need prompting to consider longer term considerations. Even when long-term factors have been taken into account, particularly for pre-adolescents, they may not be weighed as heavily as immediate or short-term factors. For this reason it is necessary to make sure that the current environment promotes change and this may involve working with parents to ensure that they are reinforcing the young person to take risks and be brave in order to overcome their problem.
    Equally, motivation to change and engagement in therapy should be regularly reviewed as the young person is unlikely to complain during the therapy sessions, but instead will simply refuse to come back. This can be addressed The use of CBT with children and adolescents 23
    directly with the young person but also signs of withdrawal from the therapist or the therapy process should be picked up and discussed openly at the earliest opportunity. Allowing the young person to express both the things they like and dislike will allow the therapist and young person to consider ways of making the therapy more acceptable. For example, should the sessions be shorter? Should they take place somewhere else? Should someone else attend too?
    • CBT should be delivered in a collaborative way that promotes the young person’s sense of self-efficacy and control.
    • It is crucial to consider the young person’s motivation to change right from the start and therapy may need to address this in order to be successful.
    • It is important that the environment is set up to promote change and this is likely to involve working with family members.
    Structure of sessions
    A basic but often neglected starting point is making sure that sessions have a clear structure and a set agenda. This is crucial from a practical point of view as the number of sessions that are available will generally be time-limited. The young person will also feel more in control of the content of sessions if they are predictable in structure and everyone’s items are set on the agenda for discussion. Agendas need to be set so that they are not overly ambitious and allow for repetition and practice of ideas. If the young person does not have items to actually add, at the very least they can dictate where the session should start. At times, family members may have different agendas, which the therapist will need to address without losing sight of the young person’s needs.