OCD and the family

tree peonies by fenceFamily members of people with OCD are frequently puzzled and distressed because they don’t know how to help.

Those who feel most powerless are often the parents or partners of adults who refuse to get treatment.  Their own lives may be severely disrupted.  They may not realize that help is available.  Dr Alec Pollard has created a “Family Recovery” treatment which I use with families.

I begin by asking the family about the symptoms the person who may have OCD is displaying.  (Some people already have a diagnosis of OCD which is known to family members, but others do not.)  Of course I cannot accurately diagnose the person through reports alone, but I can get some idea of what is happening and whether there are any additional acute  concerns (such as severe depression and suicidal statements/gestures).  If there are such concerns, we focus on those first.

Let’s take the example of parents with a son who doesn’t work, contributes no money to the household, and plays video games most of the  day.  He has certain rituals that he insists the family participate in.  For example, everyone may have to change their clothes immediately upon returning home, and all clothes worn outside the home have to be left on an unheated enclosed porch where there is no space to store them.  The son owns a car which he rarely uses, and the parents are making payments and paying the insurance so he can go to an interview if he gets one.

I would ask the parents to list all the effects on their own lives.  In this example, the mother may have stopped having dinner with her friends and going to  her book club, because of the difficulty in keeping any of her clothes looking neat.  She irons an outfit on the front porch every day before work. She is exhausted and sad, and  but believes her son can’t help his behavior and she would be a “bad” mother if she didn’t do what he says.   The father, who works in construction, also participates in the ritual because of the mother’s urging.  He is extremely angry and believes that his son could change if he wanted to.  He missed going out to the movies with his wife, and he’s angry that he can’t replace his old truck, because they have been covering their son’s car payments and insurance since his unemployment ran out.  The parents’ marriage, which used to be good, is severely strained by their arguing about what to do about their son. ( In this example, it is the mother who is more insistent on accommodating, but it is often the father instead.)

I ask each parent to list their accommodations – both the things they do and the things they have given up doing because of their son’s OCD.  Both have given up social activities and managing their own clothes.  The father has given up getting the truck he needs.

Next we make a plan for the parents to recover their own lives.  It’s important to note that at this point they are NOT trying to force their son to get treatment.  They are simply reclaiming their own freedom of action.  Both parents must agree on the plan.  They don’t talk to their son about it or implement any changes until they have worked out the details and agreed on a time frame.

The  plan for this family has to be something the parents can agree on.   Education for the parents may be necessary to help them avoid expecting too little and taking on their son’s  responsibilities, or expecting too much – that he could just chose to stop having the problem.  The plan may include wearing whatever clothing they chose, and keeping it where they choose.  They might agree to stop paying for the car and insurance, and let their son take the responsibility of deciding whether to sell the car or let it be repossessed.

Once the plan is in place the parents set up  a time with their son to discuss the it.  They present it as something they are doing for themselves and try to keep the tone as light as possible.  They don’t talk about their son getting into treatment.  They set a time frame of several days or more so their son has an opportunity to get used to the idea of the change before it actually happens.

It’s important before the meeting to address potential “sabotage behaviors”.  Their son may threaten to hurt himself, them, or their belongings.  These issues have to be thought about beforehand.  If he makes comments that imply self-harm they should contact the police and request that they do a “safety check”.  Similarly, if he threatens them or damages property they should call the police.  In both cases, they can stress that their son has a mental illness and needs to be assessed at the emergency room.   This is usually the hardest thing for the parents to do.  It may help them to talk about whether it is helping their son for them to accommodate his illness.  They need to agree on what to do about sabotage behaviors before the meeting.

Once the parents stop accommodating and get their own lives back , we can begin to talk about how they can make changes that may directly motivate their son to get into treatment, such as using incentives.  However, they also may need to think about how to plan to  help their son if he continues to refuse any treatment.  OCD is a qualifying diagnosis for Department of Mental Health services in Massachusetts.  He may need to apply for Social Security or SSDI (which would require that he be assessed).  The National Association for the Mentally Ill has chapter meeting that offer support for parents with adult children with chronic mental illness.

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