The support model for Parents of teens and young adults with OCD
If you’re a parent of a teen or young adult living at home with OCD or anxiety, you’re likely no stranger to the push-pull dynamic of wanting to reduce your person’s distress while also worrying you’re making things worse.
You may have found yourself doing things like checking, reassuring, avoiding certain topics, or helping your person complete a compulsion just to "get through the day." On the one hand they may be asking you to do less, not more in a lot of areas of their life; but when OCD strikes, they may seem like a younger version of themselves, or ask for things that feel outside your role.
The SPACE model offers well researched and organized approach to supporting young people with OCD, panic and severe anxiety. I’ve found SPACE to be a sound foundation from which to build tools when trying to help your family member recover from OCD. We’ll walk that tightrope together - encouraging independence and competence while staying connected and supporting with emotional regulation.
How OCD impacts teens and young adults
A basic understanding of OCD is crucial so that you can begin to separate it out as a process your person does, rather than an aspect of who they are. OCD is a predictable sequence designed for protection. So it’s helpful to think about what is being protected, and why your child may be so vulnerable that they believe they need this extreme form of protection. I recommend before reading further to take a look at my OCD page, which I update periodically.
Here are some examples of what teens and young adults may be protecting themselves from:
Distress and overwhelm that feel too big
Rejection, isolation, abandonment
fear of perpetual suffering, or feeling “trapped”
Feeling responsible for the thoughts and feelings of others
Grief and sadness
Now let’s discuss some vulnerabilities that could lead a person to believe they need an extreme protection strategy.
History of social exclusion or rejection, or social acceptance that seems partial or contingent on performance
High levels of sensitivity and intelligence
Difficulty determining and understanding internal physical experiences, or difficulty communicating these experiences
Intense felt and expressed emotions
Tendency to disconnect from emotions or intellectualize; ability to deeply fantasize
Experiences of intense overwhelming emotions followed by separation, rejection, admonishment, helplessness, or another person’s horror, overwhelm, or collapse
What is an extreme protective strategy? It’s an inflexible approach that is so energy intensive, aversive, or complicated that it is unsustainable and negatively impacts quality of life and development. Constant rumination, re-doing tasks, second guessing (and third, fourth, fifth guessing…), avoiding food or social events, counting before acting, and school refusal are all examples of ways that people may try to protect themselves, and these methods can cause significant damage and exhaustion. The hallmark of a protective strategy is its inflexiblity. Thus, even when the consequences are mild, the behavior has a sense of altered logic that may be confusing. Enough of these strategies, even when small on their own, can lead a young person to feel distant from themselves and their values.
Corrective experiences and skills
Recovering from OCD requires two main interventions:
the skill gaps be addressed (usually these relate to the vulnerabilities); and
corrective experiences.
Building skills is a component of building competence, reaching developmental milestones, accommodating for neurodivergence, or navigating the internal landscape of feelings and sensations. Building skills can help a person become more confident and more able to address some of their vulnerabilities. General skills (such as problem-solving, regulating emotions, appraising risk, making decisions) are needed, as well as skills for navigating OCD when it arises.
New experiences can help rewire the brain by disrupting beliefs and expectations formed in distress, so that people can let go of their more extreme strategies.
Parents of teens and young adults can be big influencers in both these areas, even as they recognize that some of this work has to be done independently and with a professional.
A Definition of Support
Dr. Eli Lebowitz, a psychologist at Yale, developed a research-backed approach called SPACE (Supportive Parenting for Anxious Childhood Emotions). It teaches parents how to support their child without feeding anxiety.
SPACE defines “support” with two key ingredients:
Acceptance of your person’s emotions (without needing to solve them)
Confidence in your person’s ability to handle those emotions
This formula came from awareness of how parents inadvertently reinforce OCD in two main ways:
Intolerance or pressure: engaging in a struggle with the legitimacy of the feeling, pressuring them to feel or be different than they are, or reacting adversely to feelings
Accommodation: caving to the anxious demands even when they aren’t helpful, hovering or checking proactively if the young person is ok when no material threat is present.
Intolerance conveys that a person isn’t OK and their sensed reality is false - they need to change who they are; Accommodation conveys that anxiety is too much for them (and maybe for you!) and that everyone has to do whatever they can to make it go away. Both messages reinforce the key ingredients of OCD: The person shouldn’t trust their reality and should do whatever it takes to get away from intense experiences.
Support on the other hand, validates that a person’s senses are giving them information, and that they are capable of solving problems and regulating their experience without extreme measures.
The acceptance + confidence model might sound like:
“I know this is so intense, and I believe you can get through it.”
“I understand you’re anxious right now, and I trust that you’re getting stronger from practice being with these feelings.”“I get why you want me to check on that for you. I can see you are really distressed. Let’s try a different approach, because I know this feeling will pass like it has before.”
Support is neither a protective nor reactive response. It is holding steady in the storm.
It is rare for a parent of a person with OCD to not have either their own predisposition to anxiety (after all, sensitivities and OCD tend to run in families) or have developed anxiety due to the toll OCD takes on the system. The support model is also a way for parents to manage their own anxiety, but they may wish to seek out their own additional skills and support. Pressuring change or accommodating anxiety are both anxious behaviors themselves.
Accommodations: what are they and why do we do them?
When kids are anxious, families often adjust around the anxiety to reduce conflict and distress. These behaviors are called accommodations — and they’re common. Accommodation of anxiety should not be confused with other accommodations that I frequently discuss on my blog, such as the adaptations families make to help people with disabilities access what they need.
Accommodations for anxiety might include:
Answering repeated reassurance questions
Avoiding certain words, numbers, or people
Helping your child complete rituals
Changing family routines to prevent triggering anxiety
While well-intentioned, accommodations reinforce the idea that anxiety is dangerous and unmanageable. OCD, when done as designed, has no natural end point. It relies on a cognitive process of obsessive doubt, which, by its nature, breeds more doubt. Therefore, accommodations might “work” one day to relieve anxiety, but over time the person will need more and more accommodation to feel their anxiety diminish. For example, one day it may be enough to wash hands twice, just checking to be sure by doing it over again. But once a person responds to their doubt by checking, they can get caught at the sink for long stretches checking and re-checking, never feeling “sure” that they washed their hands enough. This kind of certainty is not forthcoming. There is always more possibility, always more doubt that can be generated. If the response is always let’s just play it safe and check, then there’s no real limit (short of living an extremely small, controlled life) of how much checking and playing it safe that can be done.
OCD is a trance
It’s important for parents to know that OCD can lead a person into an altered state of sorts. You may already be aware of this - your person gets this glazed look in their eyes and you know that they’ve gone deep into their imagination. Their clenched posture indicates that this is not a pleasant fantasy playing out in their mind. While doing compulsions, they may move in a pressured, desperate way that isn’t how they usually move. You may hear logic out of their mouths that wouldn’t usually be used in other areas of life.
OCD transports a person via a doubt sequence into an imaginal reality where everything that could possibly go wrong gets played out, and where an oppressive series of unsolvable mental math unfolds in front of them. In treatment, they can learn strategies to recognize this state in themselves and bring themselves back to the present moment. And they may welcome your support when they are new at this skill, because it is in my opinion the hardest skill to master.
I recommend that parents and their teens talk about what kind of support is welcomed and helpful for these states. Each young person has their own preferred language around what is happening to them, and their own way they like to socialize and engage with parents. Some people may want you to get assertive and tell them to “snap out of it,” while others would find that overbearing or mean. Some people might welcome a 5-senses meditation. Others might do well with an engaging distraction. A curious question like, “Where did you go just now?” might do the trick. Although teens and young adults mainly bristle when you tell them to “use their skills,” some people do need and welcome a reminder, like to take a deep breath, get out their response prevention plan, or for you to ask if a doubt just came up for them.
Teaming with your teen or young adult
Every family has ways that they like to collaborate together and address unsolved problems. If your family needs help with communication and problem solving in general, then I usually recommend family therapy or coaching to support collaboration in general before addressing OCD specifically.
In a collaborative system, families can identify unsolved problems without blaming or shaming one another. They can tolerate different perspectives and use them to get a fuller picture of the problem, especially the function of any behaviors that are causing issues.
When OCD is in the family, it is possible for all family members to build a shared understanding of OCD that they can talk about. This is not easy to do if the problem is defined as a person in the family, or if there are misunderstanding about why OCD is emerging.
With a shared understanding of OCD, family members can identify different roles in support. The SPACE program focuses specifically on reducing accommodations and generally applying support. You may find other ways to help, such as talk through a dilemma, validate emotions, express and regulate your own emotions, increase structure where it’s needed, help your person access new corrective experiences out in the world, and rally school supports and other stakeholders to respond in informed ways.
Supporting a person with OCD is rarely a small job or a straightforward process. Many OCD therapists are well trained to support with families and caregivers. If you’d like to schedule a consultation with me, you can sign up here.
