Obsessive-Compulsive Spectrum Disorders
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Family Therapy

Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C. E. Zupanick, Psy.D.

People with obsessive-compulsive and related disorders (OCRDs) are not the only ones affected by their disorder. These disorders can be very painful and distressing for their family members as well. For example, marriages and other significant relationships may end because of hoarding. Children can be removed and placed into foster care due to unsafe or unsanitary living conditions. Parents of children with OCD may argue with each other and their children about the best way to handle compulsions. Frankly, it is difficult to imagine how these disorders could not affect families.

upset parent and teenStudies have shown when parents of children with OCD are unable to effectively cope with their child's disorder, it leads to significant marital discord. This in turn increases family tension. This family tension affects all members of the household. Adults with OCD and their families experience similar challenges. In one study of 225 adults with OCD, 80% of the respondents reported their illness was disruptive to another family member's personal life (Cooper, 1996). These findings highlight the importance of family involvement in treatment.

When someone with an OCRD enters treatment, family members usually experience great relief. However, what they may not realize is that family dynamics have a significant impact on treatment outcomes. In some cases, well-intentioned family members unknowingly do things that impede the recovering person's progress. Therefore, family therapy may be very beneficial.

Researchers investigating OCRDs are beginning to understand the powerful impact of family variables in determining treatment outcomes (see Steketee & Van Noppen, 2003 for a review of literature). One such family variable is the family's response to the symptoms of an OCRD. This research suggests that family members of people with obsessive-compulsive disorder (OCD) tend to respond in either antagonistic or overly-accommodating ways.

Both of these extreme approaches are not particularly helpful. Common antagonistic behaviors include harshly criticizing or yelling at their family member for engaging in OCD rituals. At the opposite end of the spectrum are overly-accommodating family members. These family members over-extend themselves by allowing the person with OCD to comfortably engage in his/her rituals. This often means direct or indirect participation in the rituals. For instance, a family member directly participates in a ritual when they wash or bleach items repeatedly so the person-in-recovery feels they are clean enough. They may also participate in less direct ways, such as buying anti-bacterial wipes.

Family therapy helps families to achieve a more balanced response; i.e., somewhere between these two extremes of overt hostility and compliant participation. This consists of a loving and understanding family environment, but with clear boundaries. Family members recognize that OCRDs are painful and challenging. Notwithstanding, they set clear limits so that they do not become directly involved in the rituals.

Although family members should refrain from participation in OCD rituals, they can certainly participate in other positive ways. Families offer a valuable source of historical information. They can help the therapist understand the familial context of the therapy participant. In addition, while therapists usually spend a just few hours each week with a therapy participant, family members are able to provide daily support. As such, family members are in a better position to help the recovering person apply and practice new knowledge and skills, much more often than a therapist could alone.

Another family variable that is important to consider is the presence of a psychiatric disorder in the parent of a child-in-recovery. Research indicates that OCRDs tend to run in families. Therefore, it is not surprising to find a parent, or other family member, with the same or similar disorder as the child. (Yaryura-Tobias, Grunes, Walz, & Neziroglu, 2000). However, these other family members may not have begun their own recovery yet. Clearly, this could compromise their ability to play the role of a co-therapist/coach outside of therapy sessions. Obviously, family education and involvement would be highly beneficial.

In summary, family therapy offers many benefits in the treatment of obsessive-compulsive and related disorders. Family therapy educates family members about these disorders. It helps families to learn the most helpful ways to respond to these disorders. In fact, some family members may serve as co-therapists by helping their family member practice therapeutic exercises. Family therapy also supports and strengthens families, thereby reducing the stress and strain on relationships. Family participation may also lead to the identification of other family members in need of their own treatment.



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