OCD & Strategic Pressure: Working with Treatment Resistant Children & Adult Children Living at Home

As therapists we have all experienced the painful difficulty of seeing sufferers in extreme distress and having difficulty functioning, who are refusing to follow through with treatment at any level. When confronted with a treatment refusing child, the stakes seem even higher because we know that with each passing year of dysfunction, the odds that child will recover begin to decrease. Sending the treatment refusing child to an intensive OCD inpatient program may seem like a viable solution, but such programs can be defeated by the treatment refusing child, because legally, they can’t force anyone to do treatment. We consider Strategic Pressure to be the treatment of last resort, when all else has failed. 

Strategic Pressure is a treatment approach that can be used by therapists to work with the parents of treatment refusing children to pressure them into treatment. It takes into account the difficulty the parents have had with enabling and focuses as much upon helping them to gradually change their behaviors as much as the child’s. It can be used for any dependent child living at home, whether 4 or 36. 

The presentation will discuss identifying clients for whom Strategic Pressure is suitable and how to educate your partners who are the parents of the treatment resistant/refusing child, in their new role. The steps to institute Strategic Pressure will be presented and illustrated with case illustrations. There are a number of phases in treatment from initial presentation to the gradual transition of the treatment refuser to a treatment user. This presentation will help therapists to navigate all of the pitfalls for each of these.

Learning Objectives: 
a. Be able to identify patients for whom Strategic Pressure is suitable. 
b. Be able to design and implement a program of Strategic Pressure. 
c. Be able to identify potential treatment pitfalls and to implement strategies to overcome them. 

Audience level: Intermediate/Advanced