Wedding Jitters and Kindergarten Battle Prep

This is a link to the Moth Radio Hour broadcast of December 11, 2016.  The link takes you to the full hour (53 minute) broadcast and the page will allow you to listen to all or just part of the 12/11/16 broadcast.  The Moth is a radio show of stories, told live, to audiences; stories about life, the actual events in the life of the storyteller, and the sense they made of their experiences.

The story I want to direct your attention to starts 28 minutes into the broadcast, and lasts only 7 minutes.  You can fas forward to the story I’m highlighting or listen to the whole broadcast.

The story is of a girl, growing up in a strict family and the role her grandmothers played in helping her, allowing her, encouraging her to rebel from the structure at home, in safe and healthy ways.  The story is told by Aubry Edwards.

Worth a listen…..

OCD and Children

This article was forwarded to me by a colleague.  The best article I have ever read on how OCD works and how parents can work with their children who struggle with OCD.  Take a look!!

OCD and Children                                                                                                                                                                                                  Psychotherapy Networker                                                                                          

It’s a Family Affair                                                                                                                                                                                                         July/August 2016

By Lynn Lyons


Seventeen-year-old David sat in my office and cried. “My friend has a four-year-old sister, and I had the thought that she was cute,” he whispered. “I keep thinking I might be a pedophile. Am I a pedophile?” David had spent hours on the computer researching pedophiles and refused to talk to his friend or parents about why he was so distressed. When his mother looked at his computer, she panicked. Was her son a child molester?

As 12-year-old Jade cleaned her newly pierced ears with hydrogen peroxide, she began to worry that she might pick up the bottle, guzzle it, and kill herself. When she told her mother of her thoughts, her mother hid all the chemicals in the house and slept in her daughter’s room, fearing she was suicidal. Dad was dealing with his own depression, so Mom wondered if her daughter was now following in his footsteps.

Bethany, a friendly and affectionate nine-year-old, suddenly began refusing to have any physical contact with her parents. Her mother became increasingly distraught as Bethany screamed whenever her mother came close or asked for a hug. Mom’s alarm and confusion peaked when she discovered that Bethany was sleeping on her wood floor with no pillow or blanket.

Madeline’s kindergarten teacher noticed a strange behavior emerge a few weeks into the school year: Madeline would lift her chin in the air, take several quick breaths, and repeat this action multiple times. Thinking Madeline was developing asthma or some sort of tic, her parents brought her to the doctor who could find nothing wrong. Madeline finally told her mother that when she saw spots on the sidewalk, she worried the spots meant there wasn’t enough air in the sky, so she needed to take extra breaths to fill up her lungs just in case. Her mother reassured her repeatedly that there was plenty of air, but it made no difference in the behavior.

Each of these children has OCD, and they all finally found their way to my office, where, after months and sometimes years of confusion and family turmoil, the right questions led to an accurate diagnosis, followed by family intervention. David wasn’t a pedophile, nor was Jade at all suicidal. Bethany worried that she was contaminated at school following many discussions in her classroom about the impending flu season; she worried that she’d come home and make her mother sick, and so she’d spend her time at home trying to avoid touching anything that might infect her family, including her bed, her pillows, and her blankets. She wasn’t angry at her mother. The reality was quite the opposite: sweet Bethany was trying to protect her. And little Madeline didn’t have asthma or a tic, but was exhibiting the first signs of childhood OCD, her little brain making a strange connection between spots on the sidewalk and air to breathe—a connection that she couldn’t understand at all.

The Cult Leader

In each of these cases, the diagnosis of OCD was a relief to the family, even though, of course, no family wants to hear that diagnosis. But once I explained how OCD works and assured them the symptom patterns were highly typical of what I see, the fear and confusion they’d been experiencing became more manageable. With families, I usually explain that OCD, like other anxiety disorders, is like a cult leader, demanding acceptance of a skewed view of reality. It shows up and makes an announcement that’s distressing (the obsessive thought): “You looked at the little girl and you were attracted to her!” “You might eat poison by mistake!” “Spots mean the air is running out!” “If you throw out your trash, you might throw something out that you’ll need!”

It then posits a solution to the distress, some action, either internal or external, that offers temporary relief (the compulsion). But the thought inevitably returns, and to get rid of the associated anxiety or fear, the compulsion is repeated. If you don’t obey the cult leader, I tell the families, it becomes furious and even more demanding and irrational. When the cult leader is disobeyed, the price for the child and the rest of the family to pay is more and more worry and fear. So falling in line is the best strategy—except that it doesn’t work.

“It never ends!” said Jade. “Even when I told my mom that I was afraid I’d drink the peroxide and she hid it, I kept thinking that I’d find something else.” Bethany also felt trapped. “No matter how hard I worked to get the germs off me,” she said, “I still thought I’d make my mom sick. And you can’t get all the germs off—they’re everywhere.” David described a long-term pattern of disturbing worries. He was currently wondering about pedophilia, but previously he’d wondered if he was a racist, and when he was much younger, he’d lived in fear for several months that he might impulsively jump out his bedroom window. He’d kept all these scary thoughts to himself, worrying constantly that he’d do something he shouldn’t. Self-doubt ruled him.

When I explain to families how OCD works, I usually see parents recognize this pattern of trying to placate the cult leader not only in themselves, but in their own families of origin. Sometimes one parent can now make sense of the marital struggles in a new way, understanding for the first time the controlling or “crazy” behavior of their spouse that’s made their relationship so challenging. Ideally, the parent acknowledges this recognition, a light bulb goes off, and they can see their own patterns in a new way. But even with their new understanding, the challenge of change can still be daunting.

Nevertheless, in my clinical practice, I consistently find that families with parents open to addressing their generational patterns are more successful in learning how to manage OCD than families with a parent in denial, and research supports my experience. One study, by Abbe Marrs Garcia, published in the Journal of the American Academy of Child and Adolescent Psychiatry in 2010, found that children with a parent and/or sibling with OCD did six times worse in cognitive behavioral therapy than their peers without a family history of OCD. It’s been posited that this is due to the difficulties of supporting a child with OCD when a parent remains trapped by his or her own OCD cult leader.

Recognizing the Rules of OCD

The Howard family illustrates what can occur when the denial in a parent shifts to an embracing of a family perspective. Peter and Cathleen first came to see me six years ago for help with their seven-year-old son, Timothy, who’d been showing significant anxiety for about two years. His fears revolved for the most part, they told me, around the family car. He constantly needed to check the level of fuel in the gas tank, often unbuckling his seat belt to eyeball the dashboard gauge himself. He repeatedly asked for reassurance about the inflation of the tires and the safety of the air bags. “I’ve gotten into the habit of opening the hood of the car before we leave the house and showing him that the windshield wiper fluid is full,” Peter told me. “And even when I stop and get gas with him in the car, he starts asking if we have enough gas within a mile of leaving the station. We just can’t figure out why he feels so scared about the car. Nothing has ever happened. I don’t think we’ve even had a flat tire since he was born.”

Cathleen described how Timothy had demanded she repeat the phrase “You’re safe, you’re fine” three times before she dropped him off at kindergarten, where he’d then spend hours writing his name over and over. The school behaviors disappeared in first grade, but most recently Timothy had created a bedtime ritual that involved taking his pajamas on and off multiple times and getting out of bed repeatedly to look in his closets and his drawers. This ritual could take up to two hours, but when Peter or Cathleen tried to stop him—with reassurances that he was safe and rewards if he stayed in his bed, as well as a fair amount of threatening and yelling—he’d scream and sob.

I explained how Timothy’s behaviors were typical of OCD in children, and that seeing these patterns show up at around five or six years of age is also indicative of a family with a generational pattern of OCD. “Do either of you have OCD?” I asked. “Or do you know of family members that might have it? Your parents maybe?”

“I used to have it a little bit, I think, but I grew out of it,” Peter said, whereupon Cathleen snorted in clear disagreement.

“He vacuums the rug in a certain pattern, and flips out if we walk on it,” she interjected. “Then he has to do it again. That’s just one example. I don’t think you’ve grown out of it, Peter. You just don’t want to talk about it.”

“Keeping the house neat is not a mental illness,” Peter said. “It’s not at all like what Timothy does. Not at all. We need to deal with his issues.”

Cathleen locked eyes with me and shook her head slightly. I held her gaze for an important few seconds, recognizing how deeply stuck she felt. “Timothy definitely needs help understanding this, and you both need some support, too,” I said, knowing I had to tread lightly at this point. “This OCD thing can really take over, so I’m sure you’re both exhausted.” As the session ended, I hoped Peter would begin to make the connection between his patterns and his son’s.

When they returned the following week with Timothy, I explained to him that what he worries about is really of no importance. The content of his worries and the details of his rituals would probably change, just as they’d shifted already. So what we needed to focus on was the process of how to manage his OCD—which, I told him, was like a giant boss who made rules that felt real and important. “I hear your OCD makes rules about what you need to do at bedtime,” I said. “And if you don’t follow the rules, your OCD makes you feel scared or worried that something bad might happen, right?”

Timothy nodded. To help him practice how to respond to the giant boss’s rules, we decided to name it Frank. When we drew a picture of Frank on my white board, he had a green face with bushy eyebrows and yellow teeth. Pretending to be Frank, I demanded that Timothy ask about the gas tank over and over. Then I modeled for Timothy how to roll his eyes and brush off Frank’s bossiness. Together, the four of us talked about how this change in reacting to Frank’s rules might at first feel scary, but coming up with a family plan to ride out the anxious feelings would help it get easier with practice. I stressed that getting rid of the OCD thoughts wasn’t the goal. “Frank won’t give up that easy,” I warned them. “He’ll be mad and bossy when you tell him he’s ridiculous, but I’ll help you learn as a family to respond to Frank in a different way.”

They looked hopeful as they left that session, but a few days later I received an email from Peter thanking me for helping them get started with Timothy and letting me know they weren’t going to return. “I think we can take it from here,” he wrote.

Four years later, Peter left me a message. “I hope you remember us. We need some help. We want to come back.”

When the Howards returned, Timothy was an 11-year-old middle-school student. They also brought along Maisie, their now eight-year-old daughter, whom I hadn’t met before. Timothy no longer obsessed about the car (and laughed when his parents reminded him of these obsessions), but was so concerned with making a mistake on his homework that he was spending hours each night on simple math worksheets. He’d also started a pattern of coming home after school and telling his mother the events of the day, and then returning over and over with more details, worried that if he forgot any detail, he was a liar. Before going to sleep, he wanted to again go through his whole day with Cathleen, afraid that he might have misrepresented something or left out an interaction.

Peter and Cathleen had seen some behaviors in Maisie that were setting off alarm bells. Although they always knew that Maisie liked to keep “treasures” and resisted getting rid of old toys and stuffed animals, they recently found several bags of trash hidden in her closet, as well as piles of old school papers under her bed. When Cathleen told Maisie that she’d cleaned up her room and removed the trash, Maisie “freaked out,” sobbing while she combed through the trash cans in the garage.

Perhaps most significantly, Peter’s obsessions with his neat home, combined with an emotional, downward spiral he’d experienced when he made an error at his job, had put his marriage in jeopardy. Cathleen, seeing the increasing OCD in both her children, was now pushing back against his denial of his own symptoms. More and more, she refused to accommodate his demands for cleanliness and order, and intervened when he became angry with the kids for being messy. She was no longer willing to accept the tyranny of the internalized cult leader that was ruling her husband, her children, and her marriage.

In our two-hour family session, four years after I’d first seen them, we talked openly about OCD. I explained to the kids how OCD works—Timothy vaguely remembered how he’d named his OCD Frank—and gave them examples of its consistent pattern of offering a disturbing thought or worry, and then requiring they do something to prevent the horrible outcome it threatened. They nodded as I described patterns that hit close to home (a girl Timothy’s age was failing in school because she wouldn’t turn in her “imperfect” homework assignments) and opened their eyes wide as I gave examples that were, to them, “crazy” (a boy arrived in my office crying, having been pestered all day by his OCD worry that he’d eaten his little dog).

For the first time, Peter talked to his children about his own OCD, acknowledging that his desire to keep the house perfect was because of his cult leader, not their laziness. They pointed out to him that he never wanted to play with them when they were visiting their grandparents on the lake because he spent all his time tidying up. In turn, he shared with them how his OCD made him feel like things were never quite right, and how he couldn’t fall asleep at night if he felt that something in the house or at work was out of place.

Together, they began to recognize the OCD patterns in Peter’s mother and aunt. The recognition resulted in laughter, as if they’d finally unlocked the secret of why holidays and visits felt so weird and tense. Cathleen told her kids how she’d tried for years to figure out how to manage all of these OCD rules, and that they needed to work together as a family to rise up against the cult leader, instead of feeling so anxious and mad at each other all the time.

After that, the Howards have come to see me as a family once a month. In one session, Timothy came up with a plan to spend 30 minutes on his math homework, more than enough to complete it when he reminds his OCD that it won’t be perfect. Rather than trying to avoid the anxiety and discomfort that his OCD triggers when he disobeys it, he tells his OCD that he’s supposed to feel anxious as he continues to step away from his compulsions. When he slips and asks his mom for reassurance about something he might’ve done wrong (his worries about lying have at times morphed into other imagined transgressions, like cheating or being mean to friends by mistake), Cathleen says hello to Frank, and reminds Timothy that he’s getting sucked into content by saying something like, “Oh, Frank, really? Are you trying to trick us with that again? Timothy, please let Frank know that we’re onto him.”

A few months after our family meetings began, Peter and Cathleen arrived alone. Now that Peter was willing to discuss his OCD openly, Cathleen needed to talk freely about how hard the early years of the marriage had been. She told Peter how confused she’d been by his constant anger at her. She felt his OCD was another partner in their marriage, and she couldn’t please either one of them, no matter how she tried. Peter talked about his family growing up and the shifts he knew he needed to make in his own parenting. He could finally see the price he’d paid as a child with his mother’s OCD running the family, and he didn’t want to continue to pass on this generational legacy.

Soon after that session, the kids happily reported to me that a picture had fallen off the wall and left a big scratch in the paint. “And Dad is going to leave the picture leaning against the wall, and he’s not going to fix the scratch for now,” they said. To his credit, Peter actually left the “mess” in the hall for a few months, saying he’d fix it when he felt like it, not when OCD demanded it. Walking by the picture propped against the wall and the scratch in the paint, he said, felt like a victory.

Maisie has been the slowest to change in regard to her hoarding patterns. She participates fully in the sessions and is great at pointing out when others are “OCDing,” but she resists cleaning out her room and at times wants to argue about the value of her scraps of paper or bags of trash. Progress is being made, though. She arrived to one session with a small bag of trash. “Why don’t you keep this here until our next session,” she told me. “I’ll see if I miss it or if I’m okay.” She forgot about the bag for several months, and I let her. When I reminded her of its hiding place in my desk, she laughed, and a month later she spontaneously announced, “I’m ready to clean my room.” She’d been watching her father and her brother make changes, and their modeling and successes had been contagious.

Overcoming Denial

Not all families are as open and committed as the Howards were when dealing with the family impact of OCD. Elizabeth, Jack, and their 12-year-old son, Bryan, were more of a challenge, mainly due to Jack’s denial of his own OCD. Unlike Peter’s eventual recognition of his symptoms, Jack was less receptive and as result, the therapy was a bit bumpier.

The run-up to therapy occurred when Bryan’s school guidance counselor recommended some counseling because of his difficulty completing his homework assignments. Elizabeth and Jack knew Bryan could do the work, but night after night he’d procrastinate and then completely melt down. “I can’t do it! I don’t know what to do!” he’d cry. Lately, he’d been refusing to go to school, afraid to get in trouble because his homework wasn’t done. His parents felt trapped.

“He won’t do it, but he won’t let us help. Then he won’t go to school so the teacher can help,” an exasperated Elizabeth told me. When I asked for an example of when Bryan felt really distressed, he described a recent science project that involved illustrations. He completed the writing assignment, but couldn’t get the drawings to look the way he wanted them. So he secretly stayed up much too late, drawing and erasing over and over again. When he went to school the next day, he didn’t turn his work in. The teacher noticed the missing project a few days later and emailed Elizabeth. “We had a huge fight,” said Bryan. “I couldn’t tell Mom why I didn’t turn it in. She was mad, but I just couldn’t give it to my teacher.”

At this point, I explained to Bryan about the bossy rule-maker in his head called OCD. I guessed out loud that it probably felt like there were rules he had to follow, even if they didn’t make much sense. For example, I told him, there was a boy I knew who’s OCD demanded he walk up and down his stairs five times before he left for school in the morning, or else his parents might get a divorce. “What was the rule inside of you that felt so powerful you couldn’t turn in the project?”

Bryan’s answer wasn’t a surprise. “It didn’t look right. I had to keep going until it was done. I couldn’t stop. What if it wasn’t done and I stopped? What if I stopped too soon?” When I asked about more rules and things needing to be just so, the obsessions and rituals came tumbling out. Dressing for school in the morning was agonizing. Bryan needed to ask his mother repeatedly if his outfit was perfect. Recently, a ritual about the temperature outside had emerged: Bryan would ask his mother the weather, she’d tell him, he’d ask two or three more times, and then would have to go the computer to look it up for himself three times. It’s this feeling of doubt—this desire to keep at bay the agonizing feelings of uncertainty—that ties a family dealing with OCD in knots.

I then asked if anyone else in the family had rigid rules or rituals that needed to be followed. Did anyone have weird things they had to do? Elizabeth immediately looked at Jack.

“I don’t think there’s anything wrong with making sure the house is picked up,” he shot back immediately. “If people drop by, I want them to see that we keep a clean house. That’s not a problem, it’s a strength.”

“It’s a problem,” said Bryan without looking up.

With more prodding, Bryan and Elizabeth described how if a blanket on the couch wasn’t folded precisely and draped over the middle of the couch exactly, Jack yelled. If Bryan was drinking something and left his cup to go to the bathroom, it was gone when he returned. Jack was consistently late for the kids’ games or recitals because he couldn’t go straight from work to the event: he had to go home to make sure the house was perfect, not trusting the others to pick up. He didn’t see his rigid habits and expectations as a problem, though. “If they’d follow the rules, we’d have a clean and peaceful house,” he said. “But they won’t. They’re fine with the house being a mess and I don’t get that.”

As I continued to work with Bryan, I used his father’s denial to help Bryan see how his own OCD could negatively impact the relationships in his life if he demanded that everyone follow its rules. I also worked to help him distinguish between what I described as “total cray-cray” and “tidbit-of-truth” symptoms. Now, I can’t take credit for this colorful perception of OCD thinking. I owe its existence to one of my clients, an outgoing and warm 14-year-old named Joseph. One day, he and I were discussing how, when it comes to OCD, many people get stuck in examining the content of the obsessions, looking for some meaning or connection. Parents do it all the time, trying to link the behaviors to some event in hopes of finding the root of the problem. Therapists who take a psychoanalytic approach to OCD can make all sorts of connections and hypotheses as to the meaning of certain thoughts and rituals. But in my approach, I regard the content of OCD as meaningless. Eventually, Joseph and I agreed that it’s important to determine when something is an OCD thought versus a regular “brain thought,” even though differentiating the two can be tricky because OCD sometimes pulls you in by hooking onto something that makes some sense.

“Now I know I have two types of OCD thoughts: ‘total cray-cray’ [meaning crazy, for us old people] and ‘tidbit of truth.’ I’m getting good at catching my total cray-cray thoughts,” Joseph told me. “They’re easy. My OCD comes up with some weird rules that make no sense. Like it says that if I walk on the wrong side of the hall, I’ll lose all my friends. No sense.” Tidbit of truth is harder to recognize, he continued, because there’s some truth to the rule and the consequence. For instance, Joseph was an athlete, so when his OCD demanded he do exactly eight minutes of push-ups every day or he’d lose his athletic edge, this rang true for him. Why shouldn’t he stay in shape? This, explained Joseph, is harder to step away from.

In Bryan’s case, he could see that his father’s OCD was tricky because having a neat house was a good thing—a tidbit of truth. Getting good grades and doing well on school projects? These made sense, too. But since Bryan and I have worked on telling the difference between doing well and OCD, he’s learned to pay attention to the quality of his thoughts and rules, noticing how strongly they make him feel and react, even if there’s some truth in the content. If he gets frustrated because he can’t figure out a math problem or disappointed because his drawing of a fighter jet is off, that’s one thing. But if he stays up all night, convinced he must not go to sleep until he’s checked his homework over and over for errors, panicked that he might miss something, that’s something else. His father serves as a helpful illustration, although we both wish it could be different. While Peter shows his children by example how to be flexible in the face of rigid OCD, Jack is showing Bryan the price of rigidity in a family, and given Jack’s unwillingness to give up his OCD-driven parenting, that’s probably the most useful lesson for Bryan to draw from recognizing his family’s pattern. Jack comes to the sessions when asked, but he’s yet to have the breakthrough that so helped Peter and the Howard family. There’s work to be done, and Jack will show up, but I know it’d move faster if Jack were more engaged.

Working with the Non-OCD Parent

In contrast, sometimes the parent with OCD works hard to change herself and help her children, while it’s the non-OCD parent who refuses to get on board. For example, Mandy, a caring mother with three active boys, came to see me several years ago because she realized her OCD was negatively affecting her parenting. Her father, she told me, also had OCD, as did many other relatives. The family’s various OCD issues were acknowledged as “the Costello way,” with a fair amount of sarcastic acceptance. No one, as far as she knew, ever went for help, even though her father’s need for perfection bordered on being abusive. He’d wake her and her siblings up late at night to clean what he determined were unacceptable messes, and he wouldn’t allow them to leave the house until complete symmetry of light switches, towels, and pillows was achieved. Mandy’s kids were still young, but she recognized that her need to control the environment so that nothing would be out of place was a problem. After a horrible morning, in which her children all left for school crying after one of her “OCD rants,” she decided that things needed to change.

Mandy was the perfect client. She worked hard, held herself accountable, and talked honestly about the successes and struggles she had as she learned to step back from her OCD and let her boys be children. Within a few months, she left therapy equipped with an approach that worked for her. Two years later, however, she called about one of her sons who was showing telltale signs of emerging OCD. It had taken her a while, however, to recognize that his seemingly obstinate behavior was OCD. At first, she’d taken him to the doctor because he had several bouts of constipation and some increasing difficulty at bedtime. The doctor treated the constipation with laxatives and diet changes, but missed the source of the problem: the OCD process that was well under way. When Mandy began to ask the right questions, however, eight-year-old Devon revealed the rules he had about finishing things before he was allowed to stop or interrupt himself. He wasn’t using the bathroom or listening to his body’s signals because he couldn’t allow himself to stop, sometimes refusing to go to the bathroom for hours at a time. The refusal to go to bed also now made sense.

Within a few sessions, Devon was well on his way to understanding and changing his responses to his OCD cult leader, whom we called Sticky. We set up a plan for Devon that rewarded him when he did the opposite of what Sticky wanted, which in large part meant either listening to his body, his mom at bedtime, or the teacher’s schedule. He knew when Sticky was likely to show up and was prepared to tell Sticky to knock it off.

“I find Sticky annoying, don’t you?” I’d ask him. “I mean, really, he’s making up some pretty whacky rules.”

Devon enjoyed pointing out his mom’s OCD, which they called Witchy-Poo. We imagined that Sticky and Witchy-Poo went to the movies together. They changed seats 73 times and complained to the manager about all sorts of things. Also, they hated the movie.

Sadly, this playful, therapeutic momentum was short-lived. After several visits, Mandy told me that, despite her husband Eric’s previous frustration with her own controlling behavior and his acknowledgement of her improvement, he didn’t believe in therapy and wouldn’t support her and Devon’s efforts to address the OCD. He wouldn’t prevent her from coming to get help for her issues, but balked at labeling his son with some mental problem. According to him, Devon needed to learn to change his behavior through more parental discipline, not more therapy sessions. Although Mandy wasn’t the type of person to kowtow to her husband and he didn’t explicitly forbid treatment, the mixed messages at home resulted in confusion and shame for Devon. Maybe he didn’t have OCD, he told me. Maybe he just needed to listen better and stop misbehaving at home. Mandy continued to bring Devon to see me on an as-needed basis when symptoms ramped up or new content emerged. But without her husband’s willingness to work with the program, and given the frequent disagreements they had about it, the sessions dwindled to nothing.

I’m still hopeful that Devon will return to see me, especially now that he’s entering his teens, a time when OCD content often becomes more confusing and difficult, as it grabs on to the prominent social and sexual aspects of development. I worry how his father will handle this. And I kick myself for not sticking to what I know is such a critical component of my approach: family psychoeducation and involvement. My policy when working with anxious children is that both parents must be involved in treatment when at all possible. But because I knew Mandy and saw how well she understood the approach to OCD, I didn’t press her when she repeatedly gave excuses for Eric’s absence at Devon’s sessions. In retrospect, I should’ve insisted that we meet.

While I understand his resistance to having his child labeled with OCD, I believe that Eric would’ve benefited from seeing OCD symptoms demystified and being part of a family plan to deal with them. If I’d been able to make sense of what he’d been observing for years with Mandy and her family and was now seeing in his son in a straightforward, no-nonsense way, the outcome might have been different. Instead, the case served as a solid reminder of why I believe treating OCD in children should always be a family affair.

Of course, it’s true that treating a family together is more cumbersome: the appointments are harder to schedule, and there’s more to manage dynamically in each session. Plus, these days, most parents are interested in quick fixes, like psychotropic drugs, for their children. But treating a family works. In fact, a 2014 study published in JAMA Psychiatry concluded that a family-based OCD treatment model tailored to the developmental and familial needs of early-onset OCD sufferers was remarkably effective, with 72 percent of the children rated as much improved.

Still OCD is a clever opportunist with the ability to pull children, families, schools, and therapists into the dizzying trap of decoding its meaningless content in a misguided effort at getting rid of symptoms, which often masquerade as something valuable. For instance, a physician I treat is admired professionally for his thoroughness, his long hours, and exactitude. His wife and children, however, talk about his paralyzing attention to detail and an inability to manage his time, which keeps him disconnected from his family. Another family told me of their son’s need to shoot 200 foul shots every single day during middle school, something his basketball coach regards as a model of discipline for the rest of the team.

Part of the goal of family treatment is to expand everyone’s view of the long-term emotional and relational cost of OCD, whatever its short-term payoffs in anxiety reduction may be. So I try to use humor and playfulness to help them grasp a larger story of their shared experience, which recasts the role of OCD in their lives and exposes the price family members pay for playing by its rules. When I succeed, that can be a first step toward enhancing the mental health of an entire family for generations to come.


Lynn Lyons, LICSW, has a private practice and speaks internationally on the treatment of anxious children and their parents. She’s the author of Using Hypnosis with Children: Creating and Delivering Effective Interventions and coauthor with Reid Wilson of Anxious Kids, Anxious Parents: 7 Ways to Stop the Worry Cycle and Raise Courageous and Independent Children and the companion book, Playing with Anxiety: Casey’s Guide for Teens and Kids. Contact:


Childhood Fears

Do you remember what it was like for you when you were a kid and scared of the dark, scared there were creatures under your bed that would grab you by the ankles when you got out of bed or monsters in your closet?

You haven’t thought about it lately? Ok, stop, right now and close your eyes and concentrate. Think back to when you were little and scared.  What do you remember?  Do you remember how you felt….being all alone in that room… in the dark…with nothing to keep you safe but your nightlight?

Parents will often bring children to me to address fears, childhood fears; scared of the dark, scared to go to school, scared that mom and dad will die, etc.

Sometimes, it is a childhood fear. Sometimes, it is an emerging phobia.  Sometimes, it is the child getting in touch with the harsh realities of life.

How do I help?

There is a closet in my therapy office that, when you put a rug at the base of the door, It is COMPLETELY dark inside. You literally cannot see you hand in front of your face. So….when I have the opportunity to work with a child who is scared of the dark, we go in there (The parent(s) are present in the office.). I start by letting them be in charge of the light, turning it on and off. Then, we will play cards, talk, tell each other stories in there by, by flashlight, candle light, etc.  In the meantime, I consult with the parents.  Sometimes, they have unwittingly enabled this behavior; there may also be other, outside issues present, playing a role.

In the case of social phobias (an increasing frequent issue), I examine the child’s and family’s socialization patterns, spent in front of “screens”, family history of anxiety struggles and parenting.

The same with children struggling with accepting harsh realities in life; parents and grandparents dying, parents divorcing, friends moving away, etc.  The first step I take here is to have as frank a discussion as I can with the child about the reality with which they are struggling. I find kids are much more willing to discuss such fears when they sense the adult with them are taking their worries seriously.

Child/Parent Problems

A classic situation in my practice…a parent calls me, asking for therapy for a 16 year old child, who is “acting out”.  In session, I learn the adolescent is yelling at their parents, coming in consistently after their curfew, looked at porn or called a girl a “bitch” on Facebook, perhaps was caught drinking at a party, is endlessly provoking their younger siblings, and is very irritable despite parent spending a lot of money on their car or prom dress.

I further learn, that while the parents reach out to their son/daughter, i.e., “How was your day?”, “How did you do on that math test?”; they also text their child multiple times when they are out, asking what they are doing, what they will do next, when will they be home. I learn the parent’s are constantly checking their kid’s grades on the school’s website and going over missing assignments, questioning/urging/threatening them for not turning in homework.

How do I see this? First, I assess the kid’s involvement in the drinking/drug and porn use.  If it seems to me to be the typical adolescent experimentation/exploration of such and that proper consequences were put in place, I then approach both the parents and adolescent as a developmental issue….meaning the adolescent is in the process of becoming an adult and the parents, ready or not, are in the process of letting go (A process that takes much time, effort, attempts and failures with occasional successes, on the part of BOTH, the parent and adolescent.).

I praise the parents for providing a good home and reaching out to their child but tell them to back-off on the texts. Praise their monitor grades and homework but tell them to stop hounding the kid about such. Make it clear you expect them to pass with good grades but that school their responsibility and if they fail, they will have to take the class/grade over. Explain your values (without drama) about such things as porn use or drinking/drug use and give them consequences when they violated such but also empathize with them about how powerfully alluring these things are. Take their “screens” when they are antagonizing, again, without drama, tone or sarcasm.

With the child, I empathize with the “hit” their self-esteem takes when the parents constantly checks on them but challenge them to understand they will always have a boss in their life, in one form or another and learning to work with such people is essential. I’d remind them that their spending money may still come from parents and if they have been a pain (in the a**), do you think mummy and daddy will be willing to give them money for them to waste. I’d talk about how unfair their parents SEEM to be and then relate ways life seems unfair to me at times and how blessed I am at other times.

ADD/ADHD (Attention Deficit-Hyperactive Disorder)

“I get so frustrated with him.  We spent three hours doing that paper last night, the one that was assigned 2 weeks ago and today, HE FORGETS TO TURN IT IN!”

What do you say to this (understandably) irate parent?

I start by showing them my phone and the 6 different reminder lists in it (aside from my calendar).  I explain why I have scrap paper on the end-table by my chair (there for notes I write to myself for when I get home. I also show them the notes I have written myself that day that I will read and do when I get home tonight. I also explain the notes I write for myself at home for the office, where I put them so I won’t forget them in the morning when I go to work.).  I show the parent the drawer in the end-table, what is in it and why I keep extra progress notes in the closet versus the drawer.

I explain how my desk is organized and how long I have had this desk. I explain that I have scrap paper in my therapy office, my assistance’s office and my personal office….and on the counter by the refrigerator at my home. I explain I must write down plans I make when I am talking to anyone on the phone (or I will forget them) and that my office assistant and I have this running joke about me losing my pen and how tricky numbers are, at least when I add and subtract them! I explain why I have kept shoe laces in my underwear drawer in my dresser for the past 30 years and that I am 55 years old.

What is my point?

I have some ADD (Ask my office assistant! On second thought, no, don’t.). It has taken me YEARS to figure out how to keep myself on track.  After 30 + years of counseling people, I have come to the conclusion that it takes years to help kids with ADD/ADHD to learn how to control their behavior and keep themselves on track.

These kids CAN learn to control themselves AND you will play a big role in this….by suggesting ideas, praising effort and success, encouraging and reminding.  You will not help by getting mad and yelling. It is not the child’s fault they are ADD/ADHD. It is the fault of the parent that passed it on to them (ADD/ADHD is a biological condition that is passed on genetically.). BUT, it is the child’s responsibility to learn how to control themselves and kids tend to work harder if they feel accepted and encouraged, rather than rejected.

MEDICATIONS PLAY A ROLE. If you are against medications, I urge you to examine your reservations with someone who knows about these meds.  If you still are against the idea, it will just take longer for the kids to master this.

Oppositional Defiant Disorder (“ODD”)

When I was a little kid, I remember, on the very rare occasion, my mother would say that I was throwing a “temper tantrum” (Actually, my brother threw A LOT more tantrums than I. Just saying….).  Anyway, I never really knew what a temper tantrum was but I knew I was bad for throwing it and I would then begin to hope Mom didn’t tell Dad when he got home from work.

What, you may be wondering, has this got to do with ODD. The connection is that I NOW understand what a tantrum is or was. I was being oppositionally defiant. I had ODD (My brother had it worse, much worse!).

What is it? ODD is just as the title suggest; a child being oppositional or defiant…breaking the rules, talking back, refusing to do as told, doing the opposite of what they are told. These children often lose their temper, are touchy or easily annoyed, often resentful. They argue with authority figures, blame others for their mistakes and can be spiteful or vindictive.

I know what you are thinking…This is my teenage daughter or son! Yes and no. While adolescence is characterized by these behaviors (This doesn’t mean that adolescence is a mental illness!), this can occur in younger children also. Further, the reason a child acts in such ways is also important here.

ODD has become much more “popular” over the past 10-15 years, I believe due to a variety of factors, not the least of which is social media.

Childhood Behavior

Do you remember when you first mastered tying your shoes or whistling?

These are what I call “Original Learning Experiences”, learning something for the very first time.

Most people can’t remember many (if any) of their original leaning experiences. I can remember trying to tie my shoes, but not mastering it….when I finally “got it” (I never learned to whistle.).

I see a lot of kids (who are still learning things for the first time) with parents that are frustrated because “He just doesn’t seem to be “getting it”!, “She is so slow at times!” or “He’s just doing this to frustrate me!”.

Now, every situation is different but I have noticed in a fair amount of these cases that the problem is that the parent has forgotten that there is a time when you learn something for the very first time. If you are still having a problem with this concept, think back to the time you first understood what sex is all about….You recall that “Ah ha” moment. That was your original learning experience in that area.  Children have them ALL THE TIME and sadly, many parents don’t realize this and/or have forgotten having them themselves.

What other original learning experiences are there for children?…riding a bike, getting dressed, making breakfast for yourself, making breakfast for one of your parents, going “potty”, taking a bath by yourself, understanding death (through the loss of a close pet or a grandparent, brother, sister, friend or parent), the first time you stole something, the first time you lied, the first time you felt guilty, etc.

It is easy to forget these things.  It is important to remember them….for the sake of your children and your parenting.

I remember a father in my office that was so frustrated at his son.  He’d asked him to help him rake the yard.  The father was in the front and the boy, about 7, was in the back.  After a while by himself, the father checked on him son and found the boy trying to knock leaves (the yellow and red ones) out of the tree with his rake. The boy was earnest in his efforts to help.  The father was angry.  I told the father a story about myself.  For the longest time, perhaps until I was 7, I always thought of the season of “Spring” as a time when a big spring would bounce around the earth, skewering people and taking them to heaven (Yeah, I was a little morbid as a kid!).

Divorced Parents…..don’t do this….continued

7.  Making kids feel guilty for spending time with their other parent.  If you and your ex have joint custody, then your kids inevitably will be spending time with their other parent on a regular basis as well as during some holidays.  Galamba says that parents need to remember that although they divorced their spouses, their children didn’t.  “Don’t tell the kids how lonely you’ll be when they’re with the other parent or that you’re sorry they have to spend time with him,” she says.  “Instead, tell them to have fun and consider their time away as ‘court-ordered’ relaxation.”

8.  Justifying your bad behavior.  P.J. whose parents divorced when she was a kid, says that her dad’s defense of his affair made the split harder on her and her sister, “I asked him years later if he was sorry for what he did and he defiantly said, ‘No, and I’d do it again,'” she says.  “Where was the father who taught me right from wrong?  He damaged his credibility with me.”  Pescolido says that affairs are strictly parents’ business – knowing the truth can damage your relationship with your children and cause them to have trust issues within their future relationships, she says.

9.  Putting your kids in the middle.  Jessa recalls delivering child support checks from her father to her mother until she was 20 years old, which she says was humiliating.  Kids simply shouldn’t be a go-between, Dr. Orbuch says.  “If their mother or father wants a message relayed to the other parent, or they need to make a decision together, they should talk to each other,” she says.  “And, this should go without saying, but never grill your child for details on the other parent’s life.”

10.  Making everyone feel your unhappiness.  The pain of divorce can last a long time, but don’t transfer it onto your children.  Lindsay’s mother still vocalizes her bitterness about her split.  “It hurts me when she says, ‘The past 30 years have been a waste,'” she admits.  “I feel like I’ve been a hassle.”  Galamba says that no child constantly wants to hear how her parent was wronged.  “The ‘woe is me’ game can be a self-fulfilling prophecy.  Many adult children start showing a preference for the parent who was portrayed as ‘blameworthy.'”

Divorced Parents…don’t do this!

My internet homepage is MSN and like yours, everyday, MSN has a number of different circulating front-page stories.  I give these stories a quick glance as I run through them and rarely actually click on and read through them.  A few weeks ago, a story entitled, “10 Things Children of Divorce Wish Their Parents Wouldn’t Do”.  I read it and was pleasantly surprised. Right on the mark. So, I decided to share.

“Marriages come and go but divorce is forever, to quote the late, great Nora Ephron.  While you may be able to move on to another man/woman, your children will always be tied to you and your ex-and any drama from that relationship.  With this in mind, adult children of divorce share what bothered them as kids and still irks them today about their parents’ post-split behavior.  Plus, experts weigh in on what divorced parents should do instead.

1. Bad mouthing the other parent. Stacey’s parents divorced when she was 18 and they disparaged each other for years.  The destruction of the family was painful enough without being involved in the parents’ marital strife,” she says. Negative  talk damages children’s self-esteem, adds Susan Saper Galamba, a divorce and family attorney in Overland Park, KS. “Whether it’s genetics or environment, a child’s bound to have attributes of both parents.  When one parent repeatedly speaks negatively about the other, and then tells a child that she sounds just like the other parent, the child receives the message that she’s bad. too.”

2. Discouraging kids from talking about their other parent. “Kids want to talk about their lives, including their other parent, without feeling,” says Dominique, whose parents divorced when she was younger.  Psychologist Terri Orbuch, PhD, a relationsip expert for adds, “Even if an adult child speaks negatively about the other parent, she doesn’t want the parent who’s listening to add to that negativity.”  Instead, help her identify solutions to the problem at hand.

3. Divulging the dirty details of the divorce. Stacey began to resent her father after her mother offered uncomfortable information about the split.  Sparing kids details makes divorce easier on them, says Allison Pescosolido, founder of the Dibvorce Detox Program.  “When you need consoling about how horribly their dad treated you, get actionable advice from a professional; don’t look to your kids she adds.  Also, avoid mentionaing particulars like child support says Sheila Blagg, CEO of Divorce, an online network for separated and divorced individuals.  A child should never know if a particular parent isn’t paying,” she says.  “It may make her feel that her dad or mom doesn’t love her enough to support her.

4. Keeping kids completely in the dark. Still, some key information is worth sharing, depending on the situation and your children’s ages, say Pescosolido. For instance, Anna felt deceived after her parents kept the reason for their divorce secret from her for a year.  “My parents split because my dad’s gay,” she says. “It’s better to be open then trying to ignore an issue because you’re embarrassed.”

5. Skipping family events because your ex will be there.  Unless there are extenuating circumstances, like abuse, you’ll likely need to attend some of the same events.  Salamoa says that adult children of divorce often dread coordinating special occasions with their parents. “Blending families when someone remarries is hard enough, but dealing with one or both parents refusing to attend gatherings can be near impossible,” she says.  “If parents aren’t careful, they may not get invited at all.”.

6. Making the situation all about you. If you agree to go somewhere your ex will be, handle the encounter gracefully.  Frankee, whose parents have been divorced since she was eight, says her mother’s anguish over being near her father ruined big moments.  When I graduated from college, my mom wouldn’t hug me until I’d said goodbye to my dad,” she says.  Blagg recommends ex-spouses ignore each other, rather than cause a scene, which only mortifies children.  “Choose your seats wisely,” she advises. “You don’t have to greet one another but remember that your going to be dealing with this individual for years to come.”


More to come…..

10 Signs That Your Child is Spoiled

I have MSN as my homepage and today they posted an article….10 Signs that your Child is Spoiled.  I read it.  It was pretty good.  Thought I’d share it and observations at the end if you see your child in this light.

10 Signs Your Child is Spoiled.

1. She throws tantrums, often. The surest sign of a spoiled child is one who frequently throws temper tantrums, both in public and at home.

2. He’s never satisfied.  Spoiled children often can’t express satisfaction with what they have.  If they see someone else with something, they will want that instead.

3. She isn’t helpful. No child likes to clean up but once the toddler years have passed, he should be willing to help with smaller tasks, such as cleaning up her toys or putting her shoes away.

4. She tries to control adults.  Spoiled children often don’t delineate between their peers and adults, expecting both to listen to them all the time.

5. She frequently embarrasses you in public. A slip-up here and there is normal but that is different from a tot purposely embarrasses her parents in public for the sake of attention.

6. He won’t share.  Sharing is a difficult concept for little ones to master, but once a child reaches the age of 4, he should be more willing to share toys, snacks, etc., with friends and sibs.

7. You have to beg her.  A parent or caretaker is an authority figure and should be obeyed when a request is made.  You should not need to beg your child to have a task completed.

8. She ignores you.  No child likes to hear the word, “No” but she shouldn’t ignore you when you speak to him.

9. He won’t play alone.  By the age of 4, a child should be willing (and able) to play on her own for a stretch of time.  Always needing a parent or playmate to play with demonstrates an unrealistic need for attention.

10. You have to bribe her. Parents should not have to bribe their little ones with money, toys, treats or the like to get them to do routine tasks.


Now….in case your child is spoiled, what do you do.  A few tips:

1. Recognize sometimes children become spoiled because parents are doing too much of a good thing, i.e., praising for doing things. Some parents praise children for EVERYTHING they are asked or expected to do and eventually, the child expects and demands this or refuses to do what is asked if praising is withheld. With children under 4, praise every time.  With children over 4, praise sporadically and begin asking the child how they feel when they have cleaned their room or picked up their toys/shoes.  Emphasize the good feeling they feel inside and explain this is what motivates most people as they get older….that good feeling inside for a job well done.  This teaches the child to start praising themselves for their own hard work.

2. In regards to temper tantrums, taking into account whether the child is tired, hungry, maxed out their ability to be patient in relation to the age they are, my first response is to IGNORE….ignore and carry on with what you are doing (i.e., the child in the shopping cart who is throwing a fit and mom is pushing the cart and ignoring the fit) or if you can’t continue doing what you were, wait but do not give in (i.e., the child is now on the floor of the store, kicking and screaming.  You calmly stand there and watch but do not give in or become emotional yourself.). Once the fit is over, focus on continuing your task and later, when calm, address the child and his/her fit.  The same for home.

3. Don’t expect your child or you to be perfect.  In today’s world, the unspoken rule is that if you are not a perfect parent, you are a bad parent.  With the thousands and thousands of books on parenting today, I have met parents that were afraid to say “no” to their child or let their child be a child (and lose it) for fear that they would be labeled a “bad parent”.  My mother never seemed to fear this!!!!! LOL.  Seriously, I recall many times she said “no” (and rightfully so), and I turned out fine.  When I encounter this, I encourage the parent to set the books aside and ask themselves what they think is reasonable to expect of the child or what they think is reasonable to do in the situation and most of the time, the parent comes up with fine responses for the child.

4. Bribing.  Ok, let’s face it, it is quick and easy and we have all used this in the past.  BUT, children quickly learn what you are doing and can/will  quickly turn it around on you.  I am working with a couple right now that have fallen into this trap.  What I am having them do is: 1, clarify with the child what they want him to do, 2, Explain there will be consequences if he doesn’t comply, 3, walk away if he throws a fit or refuses, 4, impose the consequences after a reasonable amount of time for the task to be accomplished, 5, follow-through with the consequences and use each other to support the other when following through with the consequences, 6, ignore his threats to retaliate, 7, again, re-present the request task, 8, clarify consequences, walk away,….you get the picture.  This is don’t without becoming emotional, without yelling, without threatening, etc.  They have come a long way…..they have a long way yet to go….and they will get there.


If you thing your child is spoiled, stop blaming yourself, consider what I have shared above and if you need further assistance, call me, Ed Esselman, Esselman Counseling, 217-224-5273.


More later…