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Family involvement in Treatment – Katie d’Ath Ocd presentation-katie-d ath
- 1. Supporting your loved one not their OCD Family Involvement in OCD OCD Action Conference February 2010 Katie d’Ath www.katiedath.com
- 2. Can I fix it? (Can I be fixed?) No. But you can help. The OCD sufferer plays the most important role in their recovery but they need your support, encouragement and understanding Katie d’Ath Feb 2010
- 3. Supporting your loved on not their OCD • • • • Effects of OCD on family members Understanding how we often respond to OCD Finding better ways of responding to OCD Building resilience: agreeing goals and moving forward • Shifting the focus from OCD • Questions and Answers Katie d’Ath Feb 2010
- 4. How does OCD affect you? Depression Sadness Shame Hurt Anger Guil t Frustratio Anxiety n Concern Resentme Exhaustio nt n Katie d’Ath Feb 2010
- 5. Introducing the OCD snake QuickTime™ and a decompressor are needed to see this picture. Katie d’Ath Feb 2010
- 6. CBT: Exposure & Response Prevention - Deliberate exposures to the feared event or stimuli - then NOT engaging in the ritual (including reassurance seeking!) This promotes HABITUATION Katie d’Ath Feb 2010
- 7. WHAT WOULD YOU DO IF THERE WAS A SNAKE IN YOUR HOUSE? Katie d’Ath Feb 2010
- 8. Why do we accommodate the OCD? • Counter-Intuitive: it’s normal to reassure someone or help them when they feel bad • Quicker: Short term gain (long term pain) • Easier: Short term gain (long term pain) • Less distressing: In the short term Katie d’Ath Feb 2010
- 9. HOW DO WE ACCOMMODATE THE OCD SNAKE? Katie d’Ath Feb 2010
- 10. Accommodation Traps • • • • • • • REASSURANCE – “everything will be ok” AVOIDANCE – avoiding doing things for fear of triggering OCD RITUALS – participating in OCD rituals ASSISTANCE WITH DECISIONS AND SIMPLE TASKS MODIFYING WORK, FAMILY OR SOCIAL ROUTINES ASSUMING LOVED ONES RESPONSIBILITIES TOLERATING ABNORMAL BEHAVIOURS OR CONDITIONS Katie d’Ath Feb 2010
- 11. Why doesn’t accommodation work? • Inadvertently sends message it’s okay or necessary to respond to OCD in this way • Gives OCD respect it doesn’t merit • By stepping in you are modeling belief that they can’t cope and need to be protected • Unwittingly Sending the message that they are weak/vulnerable • ALL OF THESE THINGS HELP MAINTAIN THE OCD Katie d’Ath Feb 2010
- 12. Aims of standing up to the OCD Snake 1.To promote HABITUATION – i.e allow sufferer to feel the fear and not do anything to make it better 2.To encourage RISK TAKING – fighting against the need for certainty 3.To STARVE the OCD Snake of attention Katie d’Ath Feb 2010
- 14. Resisting the OCD QuickTime™ and a decompressor are needed to see this picture. Katie d’Ath Feb 2010
- 15. Standing up to the OCD Snake • Contract: agree what you’re working on • Help by being consistently unaccommodating • Alert to OCD’s cunning • Reward your loved one for sticking with it • Manage expectations (change rarely happens overnight, but persistence pays off) Katie d’Ath Feb 2010
- 16. Obstacles to Standing up to the OCD Snake Katie d’Ath Feb 2010
- 17. How do I know if it’s the OCD or a different concern? • 99% of anxiety experienced by the sufferer is a result of their OCD. • Magic question: Ask if they’d feel anxious if you didn’t help them. If yes: it’s an OCD thing and needs to be treated as such If no: suggest experimenting to test this out You’ll soon learn to play the OCD snake at it’s own game. Katie d’Ath Feb 2010
- 18. RULE OF THUMB If, in the short term, the actions: • help the sufferer to feel better • relieve anxiety • provide comfort WORK TOWARDS NOT DOING IT It’s food for the OCD Snake! Katie d’Ath Feb 2010
- 19. What can you do when it’s not working? TROUBLESHOOT - did you negotiate the contract according to the rules? If not renegotiate. DON’T TAKE IT PERSONALLY - it’s not your fault! DON’T JUDGE - they are trying their best. ACCEPT - if your loved one is not ready to change you can’t force them to but you can change how you respond to the OCD’s demands. STICK to the contract even if your loved one is not fulfilling their part - it’s not IF you’ll stop feeding the OCD it’s WHEN
- 20. WHY DON’T YOU? QuickTime™ and a decompressor are needed to see this picture. Katie d’Ath Feb 2010
- 21. More accommodation leads to: -More severe OCD -Greater level of family dysfunction -More negative attitude towards sufferer Reduction in accommodation leads to: -OCD sufferer does better in treatment -More functional family life -Better family relationships
- 22. “Life shrinks or expands in accordance with one’s courage” - Anais Nin www.katiedath.com
Editor's Notes
- Introduce Self: Katie d’Ath – cognitive behavioural therapist – specialize in working with people suffering from OCD and families etc Different stages – try and make it as relevant as possible Format – not talk at you – interactive – questions. Firstly, let’s have a show of hands – who came along today to learn how to fix their loved one’s OCD? OK – and anyone with OCD who came along to get their loved ones to learn how to fix them? If lots: Alright, well, I’m afraid you’re going to be disappointed because unfortunately I’m not going to tell you how to get someone better – why do you think that is? (Invite answers)
- That’s right – you can’t cure someone’s OCD – or indeed have someone cure your OCD – even the best therapist in the world can’t cure OCD. Certainly you can help and the right therapy can help, but ultimately it’s the person suffering from OCD who plays the most important role in curing themselves. So if we’re not going to learn how to cure OCD what are we going to do today?
- We’ll also briefly discuss the treatment for OCD, so that everyone understands a couple of very important principles before moving on to family involvement. We’ll look at how OCD affects you as family and loved ones when you live with OCD around you and introduce ways of coping both so that your life is less dominated by OCD and help you maintain a healthy constructive relationship with your loved one suffering from OCD. Then we will of course look at how you can help? What can you do – (or perhaps more importantly stop doing,) to enhance treatment and help with recovery.
- NORMALISE!!!!!! How does OCD affect relationship with sufferer? How do you feel? Perhaps here – talk about what it’s like to live with OCD – get an idea of how people cope, what they do etc. How do these feelings affect your relationship with your loved one? Compassion towards selves for having these feelings. Working with OCD sufferers I encourage them to create an image of their OCD as an animal or a monster of some kind – something that helps them to remember that it is the OCD that’s driving them rather than themselves. Does anyone here have a way that they’ve characterised their OCD? I give the very same advice to the families and carers of OCD sufferers. Help you to be angry and resentful of the OCD rather than the OCD sufferer. So I wanted to introduce you to my image of OCD….
- On white board. Why might I characterize OCD as a snake do you think? Slimey, slippery, unpleasant, cunning, quick – difficult to get hold of, scary, unpredictably etc tenatious. 1st reason for characterising the OCD as a snake is so that you can separate the OCD from your loved one and feel angry resentful etc towards the OCD rather than your loved one. SO how is it going to help you and your relationship if you can separate the OCD from your loved one? What other reasons might we have for seeing it as a snake? Who can tell us what the main principles are in treating OCD (from therapy pov) (So that you’re denying things to the OCD snake rather than to the OCD sufferer) OCD vs Intuition OCD is distressing for the sufferer right? What’s our natural response when we see our loved one suffering or they ask for help if someone falls over and hurts themselves – what’s the first thing you do – go to them and check they’re ok – you try and provide them with comfort. If you have a friend who’s worrying about an exam – what do you do? You try and reassure them that it will be OK – so it’s intuitive to do these things, which is why it’s so easy to fall into OCDs traps. Can you remember what the main treatment for OCD is? Deliberate exposures to the feared event or stimuli then NOT engaging in the ritual - especially REASSURANCE. So dealing with OCD is counter-intuitive. BUT if you see it as a snake (or a …) then it makes much more sense.
- Would you get a broom and try and shoo it away? Would you call someone to come and get rid of it? You probably wouldn’t say ‘oh hello snake how can I help you? Is there anything I can do to help you or make you more comfortable? – would you like something to eat? Perhaps a nice big bite of REASSURANCE PIE?
- Easier = no battle Don’t have to watch your loved one struggling if you give in to the ocd.
- Because we confuse the OCD with our loved one we are WAY TOO ACCOMMODATING! Can anyone think of ways in which they may unwittingly be inviting and accommodating to the OCD snake? Invite people to share stories of what they do…. Give examples to start them off if necessary. If you can see the OCD as a snake how would that change the way you deal with it? Take over locking up house? Not have certain things in their house? Extra washing of themselves - Do you reassure your loved one when they’re anxious…
- Go through and get examples from people of each of the traps. Tricky – some of these things work in the short term – especially reassurance – also modifying your life to make it easier – (i.e if you just have to get out the door to get somewhere you’ll take over the responsibility for checking so that you can leave on time – short term helpful – long term maintains the OCD. The more disrupted your life becomes, the more resentful (understandably) you are likely to feel about your loved one with OCD – the more resented they feel the more upset and anxious they get the greater the OCD. At the back of your hand out you’ll find a sheet called ‘Recognising and changing accommodation traps’ …. Remember what the treatment is for OCD? Deliberate exposures to the feared event or stimuli then NOT engaging in the ritual (which is usually designed to alleviate distress) – HABITUATION –i.e getting used to the fear so that it gradually decreases.
- So let’s recap: We know what OCD is We know what the treatment for OCD is – ERP We’ve talked about how it affects us and We know how the OCD traps us into feeding it So – what can we do now to start standing up to the OCD? Shea Khan doesn’t take any of the OCD snake’s rubbish Shea Khan is suspicious and doesn’t give in to Kaa easiliy Kaa is good at tricking Shea Khan It takes both you - the carer and the suferer to help beat the OCD snake at it’s whiley game. Watch more snake so they can see that even when you try and resist the snake is very whiley and he tries to convince you he’s on your side…. So both carers and sufferers have to be on their guard!
- (Who remembers learning to drive? How did you feel the first time you got behind the wheel? Nervous. How do you feel when you drive now? Both learning that you can do it -you can cope and getting used to it) Do interactive bit here: CONTRACT: But remember: when you learned to drive you did it gradually – you didn’t start in a formula one car on a busy motor way – you started small and worked up – the first time you drove you may have just gone around the block…. So that’s why when people say to people suffering from OCD, just do it – it’s just not that simple – in fact that is nigh on impossible. Imagine if you’d never been in a car and then someone sat you in it and said take part in the grand prix – do you think you’d be able to do it, or do you think you’d be completely overwhelmed and refuse or quit? Talk about Sufferer needing to be in CONTROL of TREATMENT - can’t force them into things but you can take a very strong stance: see sheet at back. Contract - timelines. Contract: Challenging but not overwhelming principle – in line with therapy (if in therapy) - think about when you tried to do something difficult. HELP: Consistently unaccomodating - ask audience what might happen to stop them from being accomodating etc…what stops us from sticking to our guns? ALERT: In what ways is OCD cunning - again ask for examples. Reward: Agree rewards (never to do with being more accommodating though!!)
- Seeing your loved one distressed OCD sufferer threats Worries: Am I doing the right thing?