Although there are many effective psychological treatments for OCD, these treatments do not work for everyone. To make treatments for OCD more effective, there is now an increased emphasis on integrating family members into treatment for OCD. Let's explore how explore how family members are being integrated into behavioral treatment for OCD.
OCD Has an Impact on Families
When a family member has OCD, it often has a significant negative impact on family functioning by disrupting relationships, reducing time for leisure activities and causing financial strain. Not surprisingly, this level of dysfunction causes a great deal of distress, both for the family member with OCD as well as the family itself.
Importantly, not all families (or even family members) react in the same way to OCD symptoms. For example, some families or family members react harshly towards symptoms and criticize or isolate the individual. This often causes the affected person to feel even more stress, which is a well-established trigger of symptoms.
On the other hand, some families or family members may be overly accommodating, especially when the affected person is a child. Accommodation can take on many forms including providing excessive reassurance, participating in rituals, taking over the duties of the family member and turning established family routines upside down to accommodate compulsions or avoidance behavior. Although accommodating symptoms may seem helpful, in the long-run it actually serves to reinforce and perpetuate symptoms as well as increase disability.
Integrating Family Members into Treatment for OCD
Given that family members often have maladaptive reactions to OCD symptoms -- that is, they either react too harshly or are overly accommodating, the integration of family members into therapy focuses on the following:
Education: Integration of family members into therapy begins with education and information about the origins and symptoms of OCD as well as how the treatment process works. This is particularly important for exposure-based therapies as it often requires the affected individual to confront the very things they fear most. This can be very distressing for family members unless they are aware of the underlying principle of the treatment.
Changing Behavior: Families are educated about the potential harm of adopting either an overly harsh or accommodating stance when confronted with OCD symptoms and are given strategies for changing such behavior. For example, the family might sign a contract with the affected member agreeing to limit reassurance or participation in a particular ritual. Once family members are able to perceive the harm their reactions may be having, they are often more motivated to change.
Co-therapy: Entire families or specific family members can be engaged to act as coaches or co-therapists to practice exposure exercises at home. Exposure therapy is most effective when done regularly, so sessions undertaken at home can be very helpful if the person is only able to meet with their therapist weekly or every other week. The therapist should work closely with the family to determine who might be a good candidate to act as a coach or co-therapist.
Integrating Family Members Into Treatment for OCD Improves Outcomes
Although not every study has been in agreement, most research suggests that integrating family members into psychological treatments for OCD improves the effectiveness of such treatments. As well, it tends to decrease the distress level of family members.
However, integrating family members into therapy will not be a good fit for everyone. First and foremost, the person with OCD may not want family members involved in their treatment; particularly if their obsessions and/or compulsions have the potential to be embarrassing. Indeed, people whose obsessions and compulsions relate to themes of sexuality and/or violence may be particularly hesitant to allow family members to participate in therapy.
In addition, family members themselves may be affected by OCD symptoms or other forms of mental illness and may need help for their own symptoms first. And not all therapists may be comfortable with and/or feel that it is productive to integrate family members into therapy (although most will likely be open to it). Finally, the person with OCD may simply not have any close family members to integrate into therapy; indeed, many individuals with OCD -- particularly men -- never marry and live alone.
Renshaw, K.D., Steketee, G., & Chambless, D.L. "Involving family members in the treatment of OCD" Cognitie Behaviour Therapy 2005 34: 164-175.
Steketee, G., & Van Noppen, B. "Family approaches to treatment of obsessive compulsive disorder" Journal of Family Psychotherapy 2003 25: 43-50.