Parent Assisted Rituals
As the work towards helping a child or teen fight back against obsessive compulsive disorder (OCD) (or other anxiety disorders where families become involved in making accommodations or exceptions for their child) gets underway, many families start to feel excited that exposure and prevention response (ERP) can help them get their lives back on track. They might even get so excited they decide to speed up progress by stopping all the rituals in which they and other family members might have been previously involved. For example, you decide, “That's it, I’m tired of spending so much money on toilet paper, paper towels and soap. No more Mrs. Nice Guy OCD, I won’t do it anymore!” And you limit the household to 2 rolls a week and 1 bar of soap per month. However, while you’re definitely ready to take this next step, your child might not be ready. Although one of the goals in managing OCD (and other anxiety disorders where accomodation exists) is to stop all the rituals in which you are involved, suddenly stopping them all can be very overwhelming for your child. Fortunately, anxiety experts have determined 2 methods that can work for many families: the all-at-once method or the gradual method.
This method is also known as the “cold turkey” route. This works best for caregiver-assisted rituals that have not been occurring for long or only occur in a few small areas. You can explain to your child that his/her OCD is not only bossing your child around, but also bossing other family members by making the family do things such as washing their own hands frequently, cleaning the house with harsh chemicals, or doing several loads of laundry a day. The family is being held hostage by OCD. Explain that you feel confident you can work together to reduce OCD's power by eliminating family involvement in OCD once and for all.
This method works best for caregiver-assisted rituals that remain a longstanding problem and occur in many ways, or for youth that find the idea of a “cold turkey” approach too hard. You and your child can use the Facing My Fears format to gradually roll back caregiver-assisted rituals in a step-by-step, planned and predictable way by placing examples of how and where caregiver-assisted rituals occur on the Fear Plan. Explain to your child that his/her OCD is bossing the family around but that you feel confident you can work together to use the Fear Plan to get rid of caregiver-assisted rituals gradually.
What to expect: When you begin to reduce caregiver-assisted rituals your child or teen will probably be very anxious. In fact, h/she might become very angry or frustrated and even throw a temper tantrum. This is normal. It is important that if you have decided NOT to do a certain ritual, that you stick with it. Children and teens often get very angry when their parents or caregivers first stop participating in the rituals the way the child has come to expect. In fact, you might consider thinking of these outbursts as the OCD getting angry that the child and parents are no longer behaving in the way OCD has come to expect. Fortunately, if you keep at it, and stick to the plan, your child will be able to manage without you engaging in the ritual, and OCD will start to get the message that the family will not be bossed about anymore. During this early phase it is important that you give your child as much attention and support as possible in other ways. This can help your child when s/he must tolerate your refusal to engage in a ritual when the OCD demands peak. It can also help you to feel more confident about what you are doing if you can recall the fun you had with your child earlier that day, before the OCD returned, making your child name call and throw a massive tantrum.
Tips for Success
To maximize success consider these guidelines:
- Identify the 4-Ws: What, When, Where, and Who: Be clear with your child what OCD caregiver-assisted ritual you are targeting, when you will target it, where, and with whom. For example, “Tom we have agreed that I will not wash your laundry (what) more than twice per week (when), at home (where), and this includes your dad, your sisters, and grandma (who).”
- Get everyone on board: If you plan to stop caregiver-assisted ritual, it is important that everyone in your child’s life agrees: if your child can simply get someone else to do it, then this strategy will not work
- Make sure your child or teen understands and agrees with the plan: When h/she is calm (not experiencing anxiety) explain what the plan is and why you are doing it. Include him/her in designing a My Fear Plan, if you decide to go the gradual method
- Be consistent: If you give in to your child’s demand for participation in a ritual even once, your child’s OCD has learned a powerful lesson: “If I persist and ask enough I’ll get what I want.” This will strengthen the OCD. Be strong- stick to the plan.
- Use rewards: It can be hard for your child or teen to tolerate a reduction and eventual elimination of caregiver-assisted rituals, so providing your child or teen with some extra motivation can help. Review the Rewarding Bravery tool for more ideas