A Family Culture of Discipline
The successful practice of OCD exposures at home goes hand in hand with an equally strong commitment to a family culture of discipline. Tamar E. Chansky, Ph.D., gives parents the golden rule for disciplining a child with OCD. “Safety and respect first,” Chansky reminds parents, citing the need to establish this basic premise as an unbreakable household code, with the all-important corollary, “No excuses,” as an adjunct.
This commitment to assuring that everyone in your family gets the same level of physical and emotional safety means a zero tolerance for verbal or physical assaults to or from anyone in the family. As any parent of a child with OCD knows, each day presents occasions when conflict can break out between the affected child and his siblings. This golden rule can be usefully applied to tamp down or avert any threats to family members' physical safety or sense of emotional well-being.
An Interrupted Ritual
One of the most common explosive situations with OCD in the family results from the interruption of the child's OCD-related ritual, often by a sibling. What follows is a step-by-step example of how best to handle such a situation.
When twelve-year-old Sarah was interrupted by her younger brother Sammy as she counted tiles in the hallway, he stopped her from doing something her brain told her she had to do immediately for her own safety. Whether intentionally interrupting Sarah's ritual or not, Sammy's remark made Sarah lose her count. Sarah's frustration at being stopped mid-ritual then turned into rage, name-calling, and hitting.
Sarah and Sammy's Mom heard the commotion from a floor away as it escalated into yells, shoving, and crying. How should she respond to this dispute between Sarah and Sammy? Sarah verbally and physically attacked her brother, so it was she who had to be immediately disciplined. Mom separated her children, making sure Sammy was okay, and then let Sarah know she faced a consequence for her behavior.
Mom allowed Sarah to calm down before attempting to talk with her about what had just happened. If Sarah had protested, saying, “It's not my fault, it's my OCD,” her mother would have recognized her daughter's frustrations, but also let Sarah know there was no excuse for breaking the safety and respect first rule. In this way, she would validate Sarah's feelings but also set a limit, communicating to Sarah that the specific actions and words she used against her little brother were inappropriate.
Mom then encouraged Sarah to disengage from the situation by taking a “time-out.” For her time-out, Sarah went into her room to be alone for several minutes. Upon Sarah's timely return, Mom let her know what consequences would result from her earlier misbehavior, and she gave the consequence to Sarah without debate. Mom explained that Sarah would lose her computer privileges that evening. At this point it was also appropriate for Mom and Sarah to discuss how Sarah might make amends to her brother. Sarah opted to make a simple verbal apology to Sammy.
After their discussion about the consequences of Sarah's actions and how Sarah was going to make amends to Sammy, Mom encouraged Sarah to talk about her feelings leading up to, during, and after the incident with her brother. The goal of this exchange was to make Sarah more aware of her own triggers and help her problem solve around ways to avoid or confront them. For example, should interruptions of her counting ritual be put on the top of Sarah's exposure exercise priority list? Perhaps, or Sarah might decide to put it second or third from the top. The important thing was getting it on Sarah's priority list. Mom knew that if she and Sammy heard Sarah say she was committed to putting her response to ritual interruptions on her priority exposure list, they and everyone else in the family would feel more optimistic and secure.
In situations where a child with OCD misbehaves in a minor way, for example, chattering in an attempt to drown out the conversation of other family members, the child can be simply ignored, thus depriving her of the negative attention she seeks by acting up. But in more serious situations, such as Sarah's physical and verbal attacks on her younger brother, there should be a more substantial consequence, such as a longer time-out, or a loss of computer time in order to reinforce Sarah's boundary-setting lesson.
What are “natural consequences” and how are they used to discipline a child with OCD?
Natural consequences refer to what happens naturally after the child with OCD takes an action. If she's late for school, her teacher marks her tardy, and after three time tardy she gets detention. If she stays up all night worrying, she'll be tired the next day. Within the limits of reason and safety, natural consequences take the parent out of the equation and bring the child face to face with the outcomes of her own actions.
How to Avoid Problems
When conflicts for a child with OCD can be anticipated and averted, it's sometimes best to do so. For example, the child's struggle to cope with the frustration he feels at the end of a school day is often overwhelming, leaving him highly susceptible to conflicts with anyone around him. To deal with this regularly occurring situation, a parent can arrange a half-hour cooling off period every day after school. The child is given a healthy snack and permitted to watch TV, shoot basketball hoops, or otherwise decompress without any interruptions or requests made of him.
Other avertable situations may include trips to public spaces or a visit to a friend's house. In these cases, potentially difficult moments (waiting in line, speaking to strangers) can be rehearsed. Instead of going to a friend's home, the friend can be invited to yours.
The flip side to anticipating and averting difficult situations is going too far in protecting your child from her OCD and unintentionally enabling it. If, for example, you continue to make alternative meals to accommodate her OCD-related food issues, let her use “private” utensils, check the stove one more time before leaving the house because she asks you to, or otherwise participate in her rituals, you are hurting, not helping, her.
Here are some disciplinary dos and don'ts for handling the child with OCD:
Don't give up your authority.
Don't bargain with your child.
Don't discipline until you are calm and without anger.
Don't show your anxiety or fears when disciplining.
Don't expect a “thank you.”
Do model vulnerability and an ability to recover from your mistakes.
Do set clear limits.
Do make simple, clear statements.
Do emphasize the positive.
It can be a difficult balancing act for a parent to play the disciplinarian and still strike a positive tone, but remember that in setting boundaries and minding them, you are giving your child an essential lesson. Eventually she will feel relieved and empowered by her own ability to resist flying into a rage, and will avoid the isolation that comes from such antisocial behavior.