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

is to pick something that is unrelated to the young person’s OCD. This example can engage young people as it is quite silly and different reactions appear odd when people do not know what is written on each other’s cards.
    Commonly in OCD, it is the meanings attributed to intrusive thoughts that are critical to the emergence and maintenance of anxiety and avoidant and compulsive behaviours. Consequently, providing information about the frequency and content of intrusive thoughts in the general population serves an essential normalising function. In addition, imagery, metaphor and nar-ratives can all be used to illustrate other key concepts, for example, the repetition of behaviours as attempts to prevent harm. This will be discussed in greater detail in following chapters.
    Figure 2.1
    Thoughts, feelings and behaviour game
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    Creswell and Waite
    • Psychoeducation is crucial in starting to generate a different way of making sense of the problem.
    • With OCD in particular, information about how common intrusive thoughts are in the normal population is an essential part of therapy.
    Guided discovery
    Guided discovery refers to the process of helping a young person to consider other points of view and put alternative thoughts or beliefs to the test.
    A variety of techniques can be used to achieve this goal and these need not be limited to techniques traditionally associated with cognitive therapy as long as the choice of strategy is based on the case formulation and the goals of the particular session. Socratic questioning and behavioural experiments are, however, central to cognitive therapy so will be reviewed briefly here.
    Socratic questioning
    Socratic questioning is a way of asking questions to explore beliefs and assumptions, to uncover issues and problems and to work through the logical implications of beliefs. Rather than directly challenging a young person’s interpretations and thoughts, the therapist works with the young person asking questions to examine thoughts, test their validity and utility and examine alternatives. Typical questions that are used with adults can also be used with young people and some examples are given in Figure 2.2.
    Figure 2.2
    Examples of Socratic questioning
    The use of CBT with children and adolescents
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    As the young person answers the questions, the therapist listens and reflects, summarises what they have heard and asks the young person further questions to think about the new information in relation to their original belief. The young person is more likely to believe a new way of thinking if it is based on information they have provided rather than information provided by the therapist.
    The tone in which these questions are asked is the key to their success. If a young person feels as if they are being asked a question to which the therapist has a ‘right’ answer in mind, they will feel like they are being tested or are somehow wrong or silly to think as they do. Instead the questions must be asked genuinely out of curiosity with no desired outcome in mind.
    The purpose of the questioning is to help the young person to consider different ways of thinking.
    When considering the evidence for particular beliefs, it is helpful to ask the young person to consider whether they have had any experiences that have showed that their belief is not true or when they are not feeling anxious whether they think about it in a different way. In our experience, young people often find it helpful to consider different ways of thinking when it is in reference to a different person doing the thinking, for example, ‘What would your friend X think if this happened to them?’ With younger children, the use of characters from stories or television programmes may help them to be able to consider a different perspective (see Figure 2.3).
    It may be necessary to use prompts or make tentative suggestions to help a young person to answer these questions. At times, however, the young person may