Obsessive Compulsive Disorder by Polly Waite Read Free Book Online Page A

It may be possible to deal with different agendas within sessions or it may be necessary to organise separate sessions for family members.
    • Sessions should have a clear structure and agenda.
    • If family members have different agendas, the therapist will need to address this and may need to organise separate sessions.
    The basic tools
    The key tools in CBT are:
    1
    Developing a joint formulation.
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    Creswell and Waite
    2
    Psychoeducation to make sense of the maintaining role of thoughts and behaviours.
    3
    Guided discovery using Socratic questioning.
    4
    Guided discovery using behavioural experiments.
    5
    Relapse prevention.
    Developing a joint formulation
    This describes the process of working with the young person to achieve a shared understanding of what is keeping the problem going. By definition, this formulation needs to be worked out explicitly with the young person: for example, using a large piece of paper or a flip chart and making sure the young person has a pen in their hand throughout so that they are free to write or draw as much as they wish.
    For the young person to feel ownership of this formulation, it needs to be described entirely using their terms: for example, if they or the family have a particular name that is used to refer to OCD, or whether there is a picture image associated with it. Indeed, using pictures to illustrate the formulation can make it both livelier and more meaningful.
    Formulations for OCD must pay specific attention not just to automatic thoughts but also to the meaning of these thoughts and how they then relate to feelings and behaviours. For example, the thought that ‘My Mum could get knocked down crossing a road on her way to work’ may be frightening enough, but may also be associated with other thoughts about what this means; for example, ‘If I don’t do a compulsion, it will be my fault if it happens.’ Even in cases where the presentation appears predominantly behavioural (i.e. compulsions) there are still likely to be associated cognitions that are maintaining the disorder, for example, a belief that they will be overwhelmed by distress if the compulsion is not performed. To elicit these it will be necessary to ask, for example, ‘What would you worry deep down would happen if you didn’t do X?’ or ‘In your worst nightmare, what would happen if you weren’t able to do X?’ Examples of formulations are given in Chapters 4 to 7. Typically, the therapist and young person regularly revisit the formulation in subsequent sessions as they acquire more information through discussion and behavioural experiments.
    • A shared formulation, written down in the young person’s terms, is a way of making sense of the problem.
    • It enables the young person to see how the problem has evolved and why it keeps going.
    Psychoeducation
    In order to help the therapist and young person to develop an idiosyncratic explanation of what is maintaining the symptoms, it is useful to help The use of CBT with children and adolescents
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    them to recognise the role that thoughts and beliefs can play in determining feelings and behaviour. Seeing from the outset that it is perfectly normal for our thoughts to take on this role can help young people (and their families) to view their behaviours as quite understandable, rather than being weird or a sign of madness. This also provides an opportunity to be creative and allow the young person to have fun within the therapeutic environment. Cartoons can be readily employed to illustrate different ways of interpreting scenarios, as can reference to television programmes, for example, soap operas where characters endlessly misinterpret situations and create problems for themselves. Figure 2.1 illustrates one way of playing a family game to demonstrate associations between thoughts, feelings and behaviour. This particular example could be used with a young person who had worries and compulsions that are not around contamination as the point