Treating a Mother's Accommodation Behaviors of Her Adult Son's OCD: The Case of "Brianne" and "Charlie"

Abstract

Obsessive-compulsive disorder (OCD) is an anxiety disturbance in which distress and impairment extend beyond the patient to their immediate family members. Many family members become involved in their loved one’s compulsions by engaging in accommodation behaviors, which ultimately make it easier to perform compulsions or avoid obsession-invoking triggers, frequently exacerbating the severity of the OCD symptoms and decreasing motivation for treatment. Also, accommodation behaviors can indirectly result in negative consequences for the family member engaging in them and for other non-OCD members of the family, reducing their quality-of-life.  The current case study documents and discusses a 3-month, 10-session, cognitive-behavioral treatment designed to help "Brianne," a married Caucasian mother of two in her 40s, reduce her accommodation behaviors with her 19-year-old son, "Charlie," who was unmotivated to accept treatment for his diagnosed OCD and who was living at home. In line with the above, the treatment was premised on the hypothesis that reducing Brianne's accommodation behaviors would  have a positive impact not only on Charlie and Brianne, but also on the other two members of Brianne's nuclear family: her husband "Jack," and her older son "Shane." The therapy focused on (a) providing Brianne with psychoeducation regarding the nature of OCD and the negative impact of accommodation behaviors, (b) developing Brianne's alternative coping behaviors in response to Charlie's rituals, (c) offering Brianne communication training, and (d) promoting Brianne's self-care behaviors. Results indicate that the treatment was effective in reducing Brianne's accommodation and improving her quality of life as well as her husband's and other son's within the household, but that more treatment was likely necessary in order to consolidate therapeutic gains. The treatment did not appear to impact Charlie's OCD treatment-seeking motivation nor his levels of anxiety or aggressive outbursts by the end of therapy. Factors contributing to the results of the treatment are discussed. Overall, the case results suggest that family members living with OCD-diagnosed adults not currently seeking treatment can derive benefit from a brief intervention designed to reduce accommodation behaviors, improve family communication, and promote self-care.