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Children, Families, and the Management of OCD

Reducing shame and increasing cooperation can transform OCD.

Key points

  • Early detection of OCD in children is crucial for effective management.
  • Families should modify expectations and avoid comparisons to ease stress.
  • Indirect therapy focuses on family dynamics to avoid singling out the child.

Clinically we can see that Obsessive-Compulsive Disorder (OCD) in children can deeply affect family dynamics, often disrupting routines and creating a need for accommodation that impacts all family members. Understanding and managing these challenges is crucial for maintaining a supportive environment conducive to the child's treatment and recovery.

Following are some practical strategies families can employ to handle OCD within the family context. Early detection of OCD symptoms can significantly aid in managing the disorder more effectively. Family members are encouraged to identify and respond to early warning signs, which may include increased isolation, repetitive behaviours, excessive reassurance-seeking, and significant changes in eating or sleeping patterns (Gibson, 2021., 2022; American Psychological Association, 2021). Recognizing these as symptoms rather than personality traits can help in addressing them constructively without increasing the child's stress or shame.

Modifying Expectations and Communication

Adjusting expectations during periods of change and avoiding comparisons are essential in supporting a child with OCD. Stress, which can exacerbate OCD symptoms, often rises during transitions or when unrealistic standards are set (Gibson, 2021; Nardone and Portelli, 2013; American Psychological Association, 2021). Families should strive for supportive communication that avoids complex rationalizations, as these can increase the child's anxiety. Keeping explanations simple and focusing on reassurance rather than logic can be more effective in reducing the child's distress.

Encouraging Independence and Setting Boundaries

It is vital to foster a balance between support and independence, allowing the child space to manage their symptoms while ensuring they do not feel isolated. Setting clear and reasonable boundaries related to OCD behaviors, while maintaining normal family routines as much as possible, can prevent the disorder from dominating family life (American Psychological Association, 2021). This includes being firm yet compassionate about not participating in rituals or compulsions, thus reinforcing the child's efforts to resist these behaviours.

The Role of Indirect Therapy

Indirect therapy, which does not directly require attendance by the child is conducted to avoid pathologising or having them feel blamed. It's a helpful and strategic intervention (Gibson, 2021), involves family members primarily, and can be pivotal. This approach leverages family dynamics as a resource for change, reducing the child's sense of being singled out and preventing the disorder from defining their identity (Gibson 2021; Nardone & Salvini, 2007). By focusing on modifying parental behaviours and responses, indirect therapy aims to disrupt dysfunctional family patterns that perpetuate the child's symptoms.

Developing Family Consistency

A strategic approach involves seeking family and parental agreement and this can align all members towards common goals in managing OCD in children and young people and can reduce significant conflicts and misunderstandings. This method helps in setting realistic expectations and responsibilities, which can be particularly effective when combined with professional guidance (Nardone & Salvini, 2007). Clear communication and shared goals can significantly enhance the effectiveness of home-based strategies and ensure that the child's progress whether before or during therapy is supported at home. Managing a child's OCD requires an approach that involves the entire family context. By recognizing symptoms early, adjusting expectations, maintaining clear communication, fostering independence, and potentially utilizing indirect therapy techniques, families can create a supportive environment that encourages solutions. It is also essential to consult with healthcare professionals to tailor these strategies to individual family needs, ensuring that each child receives the support necessary for managing their OCD effectively.



American Psychological Association. (2021). Guideline for the management of OCD in children and adolescents. APA.

Gibson, P. (2021). Escaping The Anxiety Trap. Strategic Science Books.

Nardone, G., & Salvini, A. (2007). The strategic dialogue: Rendering the diagnostic interview a real therapeutic intervention. Jason Aronson.

Nardone, G., & Portelli, C. (Year). Ossessioni compulsioni manie: Capirle e sconfiggerle in tempi brevi. Ponte Alle Grazie.

Vitry, G., Pakrosnis, R., Brosseau, O. G., & Duriez, N. (2021). Effectiveness and efficiency of strategic and systemic therapy in naturalistic settings: Preliminary results from a systemic practice research network(SYPRENE). Journal of Family Therapy,43(4).

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