OCD IN THE FAMILY: THE BURDEN SHOULDERED BY PARENTSbringing up a child with more-than-mild OCD is always an imposing task. Parents become frustrated that their child cannot be reasoned out of rituals and angry when he or she will not stop them. They blame themselves for their child’s symptoms, assuming they are somehow responsible. They often dread that their child may be developing some sort of a psychotic disorder.The burden is partly lifted when parents find good professional help. They come to realize that OCD is a biological disorder, limited in its severity, and that they are not responsible for it. Further, they are provided much-needed structure for dealing with the disorder at home. But parents never get completely off the hook. Behavior therapy presents its own dilemmas, such as deciding when a child is showing attention-seeking behavior and deciding when to enforce behavioral limits. Furthermore, obsessions and compulsions make children moody and irritable. On top of that, because OCD children are unusually bright, loving, and dependent, patents tend to identify closely with them and to suffer their setbacks with great anguish.In a survey of OCD parents conducted in 1993, the Obsessive-Compulsive Foundation found that more than 80 percent reported significant disruption of family life, particularly the loss of normal closeness in family relationships. Major problems identified in OCD sufferers were depression, lack of motivation, and inconsiderate behavior. Major problems for family members were excessive arguing and being drawn into rituals. Parents’ greatest concerns were the future well-being of the OCDer and how they themselves could get back to enjoying life normally.Parents of OCDers must, indeed, strive to lead a normal life— this is crucial for both parents and the affected child. In order to do this, it is necessary to maintain a rational view of OCD and to avoid becoming overly involved in a child’s symptoms. The OC Foundation has several pamphlets that can be helpful, including, “Learning to Live with OCD,” by Barbara Van Noppen, “Obsessive-Compulsive Disorder in Children and Adolescents,” by Hugh Johnson, and “A Survival Guide for Family,” published by Obsessive Compulsives Anonymous. This last suggests that parents keep reminding themselves, “We didn’t cause our child’s OCD, and we can’t cure our child’s OCD.”*41/338/2*
ALCOHOLISM TREATMENT TECHNIQUES AND APPROACHES: WORKING WITH FAMILIES OF ACTIVE ALCOHOLICSThe most important thing the counselor needs to keep in mind is that the client being treated is the person in the office. In this case it is the family. The big temptation for the counselor may be to try treating the alcoholic in absentia, through the family member. This may be the family member’s wish, too, but it would be futile to attempt it.What does the family need? One important need is for education about alcoholism, the disease, including its impact on the family. Another is aid in sorting out their own behavior to see how it fits into, or even perpetuates the drinking. Also, they need to sort out their feelings, and realistically come to grips with the true dimensions of the problem and the toll being exacted from them. As well, there is the need to examine what their options are for dealing with the problem. Most importantly family members require support to live their own lives despite the alcoholic. Paradoxically, by doing this, the actual chances of short-circuiting the alcoholism are enhanced.Family assessment Just as all alcoholics do not display the identical symptoms or have the same degree of chronicity and extent of impairment, the same is true of family members. In the assessment process many of the same questions the counselor asks in dealing with the alcoholic should be considered. What has Caused the family member to seek help now? What is the family’s understanding of the problem? What supports do they have? What is the economic, social, and family situation like? What coping devices do they use? What are their fears? What do they want from you? Where the counselor goes in working with the family will depend on the answers to these questions. Treatment plans for family members might include individual counseling, support groups, Al-Anon, or other agencies.You will notice that we have been speaking interchangeably about families and family members. Contact with a counselor is typically made by a single individual. Efforts to include other nonalcoholic members of the family (or the alcoholic) usually fall to the counselor. In some cases all it takes is the suggestion. In other cases, the family member may resist. This resistance may be due to a sense of isolation, that no one else in the family cares. It may instead be fear of the other family members’ disapproval for having “spilled the beans” about the family’s secret. Although the ideal might be having the family member approach the others, as the counselor, you (with the client’s permission) can contact other family members to ask them to come in for at least one session. Almost universally others will come in at least once (and this includes the alcoholic), if you tell them you are interested in their views of what is happening.Family intervention. The initial focus has to be working with the family or family members on their own problems. Nonetheless, the indisputable fact is that the alcoholism is a central problem and that the family would like to see the alcoholic receive help. It is important to recognize that, ineffective as their efforts may have been, still much of a family’s energy has gone into “helping.” Now, as a result of education about the disease, plus assistance in sorting out their own situation, they in essence have become equipped to act more effectively in relation to the alcoholic. At the very least the family has been helped to abandon its protective, manipulative, enabling behavior. However, more is possible. A very successful technique, developed by the Johnson Institute in Minneapolis, consists of an intervention that involves the family and can be used to help move the alcoholic into treatment. This intervention technique and the rationale underpinning it was first described in I’ll Quit Tomorrow.The intervention process involves a meeting of family, other concerned persons, and the alcoholic, conducted under the direction of a counselor. Each individual, in turn, provides the alcoholic with a list of specific incidents related to drinking that have caused concern. These facts must be conveyed in an atmosphere of genuine concern for the alcoholic. In so doing, the alcoholic is helped to see both the true nature of the problem and the need to seek assistance. Each person also expresses the hope that the alcoholic will seek treatment. By cutting through the denial, by providing the painful details, the intervention process can be thought of as precipitating a crisis for the alcoholic.The counselor who is involved in family work is well advised to become skilled in conducting interventions, either by attending workshops or by “apprenticing” to someone trained in this technique. We should be clear that conducting an intervention is not something you do on the spur of the moment. It is not something to be done impromptu, just because you happen to have the family together. Nor is it something you describe to the family and suggest they do on their own after supper some evening!The effectiveness of intervention depends on the participants’ ability to voice a genuine concern and describe incidents that have caused concern in an objective, straightforward manner. This takes briefing and preparatory work. Typically, this will entail several meetings with the family. The family members must become knowledgeable about the disease of alcoholism, so that the behaviors that previously were seen as designed to “get them” can be seen for what they are, symptoms. The preparation will usually involve a rehearsal during which each of the participants goes through the things that they would like to convey to the alcoholic. The participants also need to discuss what treatment options are to be presented, and the actions they will take if the alcoholic does not seek help. Is the spouse ready to ask for a separation? Is the grown daughter ready to say she will not be comfortable allowing Mom to babysit for the grandchildren anymore. Beyond preparing the participants, a successful intervention also requires that the counselor be supportive to all present, equally, and deflect the alcoholic’s anxiety and fears, which may surface as anger.*128\331\2*
PROPHYLACTIC MEDICATIONS FOR ALLERGIC NOSES: CROMOLYN SODIUM NASAL SPRAYCromolyn sodium, manufactured by Fisons Corporation and available in the United States as Nasalcrom Nasal Solution since the early 1970s, was the first allergy prophylactic medication developed and marketed worldwide. A prophylactic medication is defined as one that acts as a preventative against disease. Cromolyn sodium functions as a prophylactic medication because it prevents the allergic process from developing. No process, no symptoms. This is in contrast to the other medications for allergic rhinitis-antihistamines, decongestants, corticosteroids, and ipratropium bromide – which act to relieve the symptoms, caused by the allergic process, but do not alter the process itself.Since the early ’70s, much has been learned about this remarkable medication. Its list of actions currently includes the following:- Preventing the release of mediators from mast cells- Preventing the accumulation of inflammatory cells in the lining of the nose- Blocking both early and late allergic reactions- Inhibiting the action of cells that cause inflammationIt is the chemical mediators released during allergic reactions that cause the persistent inflammation characteristic of chronic rhinitis. Because of its ability to prevent the release of these chemicals into the nasal tissue, cromolyn sodium is widely prescribed by physicians as an allergy “blocking” drug. Of note is that cromolyn sodium is not an antihistamine, a decongestant, or a steroid.*49/322/5*