Managing family accommodation of OCD

Managing family accommodation of OCD

What was the aim of this research?

Family accommodation refers to the ways in which family members (e.g., parents, siblings) take part in the rituals of a child with Obsessive Compulsive Disorder (OCD), including assisting with the performance of compulsions, facilitating avoidance of anxiety-provoking situations and modifying family activities because of the child’s OCD. Although families usually accommodate OCD in an attempt to reduce or avoid causing the child distress, it actually tends to increase the severity of OCD in the long-run. When children with OCD engage in compulsions or avoid anxiety-provoking situations, they are unable to learn that they can tolerate the situation and that their feared outcome is unlikely to occur. Although family accommodation is usually targeted in family-based treatment of OCD, there are cases where children and teenagers refuse to participate in treatment for their OCD. This paper demonstrates how parent-only treatment can be implemented in these situations to reduce family accommodation, without any direct involvement of the child.

How did we do it?

This paper describes the treatment of Gemma (not her real name) to illustrate how clinicians and parents can work together to reduce family accommodation and improve OCD symptoms, when children refuse to participate in treatment.

What did we find?

Working in collaboration with a therapist, Gemma’s parents were able to gradually reduce their accommodation of her OCD, and Gemma was increasingly required to confront anxiety-provoking situations while options to use compulsions were reduced. Although she initially showed distress and resistance, over time her OCD symptoms improved, as did her relationship with her parents. During treatment it was important to work with Gemma’s parents to implement boundaries while still being empathic, utilise rewards and logical consequences, and consider risk-management plans.

What does this mean in practice?

It is possible to implement treatment for OCD (at least to some extent) even when youth refuse to participate. Parents can play an important role in making changes within the home and family environment that can be pivotal in improving their child’s OCD symptoms.


This article is available to the public online as a result of an open-access publication grant from Macquarie University Faculty of Human Sciences

Johnco, C. (2016). Managing Family Accommodation of OCD in the Context of Adolescent Treatment Refusal: A Case Example. Journal of Clinical Psychology, 72(11), 1129-1138. doi:10.1002/jclp.22393

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