ASK THE THERAPIST

I believe that my 14-year-old daughter has OCD. She is scheduled for an intake with a therapist in a month, but for now I feel stuck about how to cope with her struggles. My daughter is caring and social. She is reliable and smart. Over the last year she has been dwelling on obsessive thoughts and acting compulsively. I believe that her kind heart and her high level of spirituality feed into her OCD the most. She suffers tremendously if she feels she may have hurt a classmate’s feelings. She will discuss it with me and replay the scenario over and over again and is unable to relax until she apologizes to her classmate. She is anxious about davening and will constantly ask me if she ate a kezais and is required to bentch.  I wonder about my part in her struggles because I too struggle with some obsessive thoughts related to religion. I have always shoved them under the rug and never received help. How do I help my daughter until she begins therapy and learns the skills to help herself?

I would like to commend you for writing such a caring question. I appreciate your honesty about your own struggles. I feel that it’s important for you not to blame yourself.  However, I’d like to start off by encouraging you to find help for your own struggles as untreated OCD can be an incredibly anxiety provoking. It would be  helpful for you and your daughter to receive help simultaneously. This is because there will be nothing more inspiring and healing for your daughter than to watch your healing process. 

When you parent an anxious child, your instinct will be to try to reassure her as she experiences stressors. However, when you try to reassure this child, you are inadvertently accommodating the diagnosis. This will allow the OCD symptoms to take over your child’s life as well as your family life. When your daughter begins therapy, you as a parent will be identified as the co-therapist. Therefore, it is  important that you begin your training now. In your home environment it will be your role to create exposures to help your daughter face her anxieties. You will also engage in response prevention to inhibit your daughter from engaging in rituals to reduce her level of anxiety. 

I believe that the most important role you can engage in now is to remain neutral when your daughter discusses her triggers with you. Avoid offering any reassurance, although you have the urge to be supportive. Providing reassurance is labeled as “family accommodation,” which will further feed into your daughter’s unhealthy cycle. Do not accommodate your daughter’s anxieties by avoiding natural discussions you would normally have with your family. In your case, continue to have daily conversations related to interpersonal relationships and topics of religious interest.  That said, it is important that you validate your daughter by stressing how difficult the obsessiveness must be for her. Empower her by highlighting how brave she is to have to cope with this colossal struggle.

Teach your daughter to be the boss of her anxiety as opposed to any family members taking on that role. Quite literally, this means that you should encourage your daughter to name her anxiety. Then tell her to command the anxiety to lay low. For example, she can say things such as, “I’m in control, Bob. I’ll get back to you at my convenience.” Although this might sound ludicrous, naming the anxiety and obsessiveness and commanding it, will empower your daughter. Last but not least, begin entertaining the idea of medication. When paired with therapy, psychopharmacology has been proven to be the most successful in helping individuals manage symptoms of OCD. Although exposure and response therapy as well as other CBT techniques have been empirically tested, they often need to be jumpstarted with the usage of medication.

I wish you lots of luck as you face this difficult journey but commend you for seeking help. Remember, and remind your daughter, that she will always be the greatest expert of her life.