deal with the problem.
2
In many ways the young person is the ‘expert’ because they are the one who knows how their OCD works on a day-to-day basis. It can be helpful to emphasise that one of their jobs is to teach everyone else about the problem so everyone understands how it currently works.
3
It is helpful if the young person understands that CBT is an active treatment where they will have to try out different and new ways of dealing with the problem. This can be achieved by asking the young person what problems they anticipate if the sessions just involved talking about the OCD and not trying out anything new.
4
The importance of trying out tasks outside the sessions needs to be highlighted and again it can be helpful to get the young person to think about the purpose of these tasks to build motivation and encourage the young person to ‘own’ them. Tasks between sessions are not just for the young person and there may be times when it is appropriate for the therapist or family members to try things out to get extra information and model tackling the problem.
5
The therapist should inform the young person that each session will start by setting an agenda so that they can plan and prioritise what they are going to talk about during the session. The young person and family members should be encouraged to add items to the agenda and be involved in deciding what the most important things to be covered are.
• When planning the first session, the therapist needs to think about who will be in the room for sessions.
• At the beginning of the first session, the therapist needs to provide information about the nature and process of CBT.
• The young person needs to understand that CBT is an active Planning and carrying out treatment
55
treatment that involves trying out different and new ways of dealing with the problem.
• Sessions start by setting an agenda to plan and prioritise what they are going to talk about during the session.
The young person’s understanding of OCD
At the beginning of therapy, the therapist will aim to explore the young person’s understanding of OCD, and specifically what they think obsessions and compulsions are and how they relate to each other. There may be some words that the young person feels uncomfortable with, for example, some young people prefer not to use the word ‘ritual’ as for them it conjures up ideas of witchcraft. Consequently, this discussion should also involve finding out what the young person already calls or would prefer to call obsessions (e.g. ‘worries’ or ‘thoughts’), compulsions (e.g. ‘habits’, ‘rituals’, ‘jobs’) and the OCD generally (e.g. ‘OCD’, ‘the worry monster’). This also helps to externalise the OCD and reinforce the idea that it is the OCD that is the problem, not the young person.
Making sense of the problem
Once this is established and the young person can clearly identify the difference between obsessions and compulsions, the focus of the first treatment session is to gain a greater understanding of the problem. The young person and the therapist begin to build a picture of how the problem is working. It can be helpful to begin by asking the young person to think of a recent time where OCD was a problem. They should try to recall a time that is fairly fresh in their memory and that is typical of how the problem often arises.
Once they have identified a time, the therapist encourages them to tell them more about the situation in order to prime their memory. This includes when it was, where they were, whether anyone else was present and what happened just before. It is important to remember that the trigger to an episode of OCD can be external (e.g. seeing something on television) or internal (e.g.
remembering something bad that has happened in the day). Once this has been established, the therapist moves on to help the young person identify what was going through their mind, what they made of the thought
2
In many ways the young person is the ‘expert’ because they are the one who knows how their OCD works on a day-to-day basis. It can be helpful to emphasise that one of their jobs is to teach everyone else about the problem so everyone understands how it currently works.
3
It is helpful if the young person understands that CBT is an active treatment where they will have to try out different and new ways of dealing with the problem. This can be achieved by asking the young person what problems they anticipate if the sessions just involved talking about the OCD and not trying out anything new.
4
The importance of trying out tasks outside the sessions needs to be highlighted and again it can be helpful to get the young person to think about the purpose of these tasks to build motivation and encourage the young person to ‘own’ them. Tasks between sessions are not just for the young person and there may be times when it is appropriate for the therapist or family members to try things out to get extra information and model tackling the problem.
5
The therapist should inform the young person that each session will start by setting an agenda so that they can plan and prioritise what they are going to talk about during the session. The young person and family members should be encouraged to add items to the agenda and be involved in deciding what the most important things to be covered are.
• When planning the first session, the therapist needs to think about who will be in the room for sessions.
• At the beginning of the first session, the therapist needs to provide information about the nature and process of CBT.
• The young person needs to understand that CBT is an active Planning and carrying out treatment
55
treatment that involves trying out different and new ways of dealing with the problem.
• Sessions start by setting an agenda to plan and prioritise what they are going to talk about during the session.
The young person’s understanding of OCD
At the beginning of therapy, the therapist will aim to explore the young person’s understanding of OCD, and specifically what they think obsessions and compulsions are and how they relate to each other. There may be some words that the young person feels uncomfortable with, for example, some young people prefer not to use the word ‘ritual’ as for them it conjures up ideas of witchcraft. Consequently, this discussion should also involve finding out what the young person already calls or would prefer to call obsessions (e.g. ‘worries’ or ‘thoughts’), compulsions (e.g. ‘habits’, ‘rituals’, ‘jobs’) and the OCD generally (e.g. ‘OCD’, ‘the worry monster’). This also helps to externalise the OCD and reinforce the idea that it is the OCD that is the problem, not the young person.
Making sense of the problem
Once this is established and the young person can clearly identify the difference between obsessions and compulsions, the focus of the first treatment session is to gain a greater understanding of the problem. The young person and the therapist begin to build a picture of how the problem is working. It can be helpful to begin by asking the young person to think of a recent time where OCD was a problem. They should try to recall a time that is fairly fresh in their memory and that is typical of how the problem often arises.
Once they have identified a time, the therapist encourages them to tell them more about the situation in order to prime their memory. This includes when it was, where they were, whether anyone else was present and what happened just before. It is important to remember that the trigger to an episode of OCD can be external (e.g. seeing something on television) or internal (e.g.
remembering something bad that has happened in the day). Once this has been established, the therapist moves on to help the young person identify what was going through their mind, what they made of the thought
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