Helping or Enabling...A Fine Line When Dealing with OCD
Parenting for me has often involved following my instincts and using good common sense. Whether it was telling my fifteen year old daughter that she could not go to the co-ed sleepover, or encouraging my shy child to invite a friend over, I seemed to have a pretty good handle on things. But when OCD joined our family and I continued to follow my instincts, all bets were off.
OCD is an insidious disorder that is capable of tricking and deceiving not only the sufferer, but his or her entire family as well. When my son Dan returned home from his freshman year of college, he was dealing with severe OCD. He was home for about a month before heading off to a world-renowned residential treatment program, and during his time with us I just wanted to keep his anxiety levels down and make everything all right. That was my "mother's instinct." If Dan wanted to sit in a certain seat or eat only peanut butter and jelly sandwiches at midnight, I let him. If he needed to walk around the outside of the house multiple times before coming inside, I allowed it. Why not? What harm could it do?
Turns out...plenty. Family accommodation, for those who have not dealt with OCD directly, is when a family member participates or assists in the rituals of their relative with OCD. In short, they enable the OCD sufferer. Some common examples of family accommodation include reassuring (continually answering questions like, "Will I be okay if I do this or don't do that?"), altering a family's plans or routine, and giving in to your loved one's OCD related requests. By accommodating in these ways, we are basically adding fuel to the fire. While we may help reduce our loved one's anxiety in the short-term, we are, in the long-term, prolonging the vicious cycle of OCD. Some studies conclude that more family accommodation leads to more severe cases of OCD, and more distress among families. By accommodating Dan, I was inadvertently validating his irrational thoughts, lowering my expectations of him, and giving him no incentive whatsoever to fight his OCD.
When my husband spent an afternoon shouting basketball scores to Dan in another room because our son could not look at the television, even I knew that was wrong. It was at this point that we realized it was time to go against our instincts. "You want to know the score, Dan? Then come watch the game!" was the beginning of our conscious attempt not to accommodate him.
Oh, how I wish we had known the right thing to do sooner. At this point in time, Dan had already seen two therapists and a psychiatrist. Though I had also met with two of the three doctors, neither of them ever spoke with me about family accommodation.
Yet even when we understood the negative effects of accommodating Dan, it wasn't always easy to stop. For one thing, we were making things worse for Dan in the moment, by creating more anxiety for him. This is a tough thing for a parent to do, even when you know "it's for the best." Additionally, it was often hard to know whether we were, in fact, accommodating him in any given situation. When Dan insisted on doing errands at 1:00 PM instead of 11:00 AM, was it really because he was busy, or was that just what his OCD was dictating at the time? Did the bookstore that was farther from our house really have a better selection, or was his OCD in control? We'll probably never know how much we unknowingly accommodated him, but it wasn't a problem for too long. Once Dan began his intensive ERP Therapy and understood more what needed to be done to free himself of OCD's grip, he let us know if we were enabling him.
But it gets more complicated. After spending nine weeks at the residential program I previously mentioned, Dan was ready to give sophomore year a try. He and I met with the Academic Services Coordinator at his college, and now all of a sudden, "accommodation" became our friend, not foe. Sure, if Dan's OCD prevented him from using his computer, his professors would provide printouts for him. If it was too anxiety provoking to enter the library, his teachers could bring the required books to class for him. This would allow Dan to at least be able to continue his studies.
But wait. What about enabling? What about not letting OCD call the shots? As I said before, OCD is an insidious disorder, and the path to recovery is not always clear. Should Dan have stayed at the residential program until no accommodations were needed, or was it more important for him to continue on with his life as best he could while also continuing his therapy? There are no easy answers, and not all experts (or parents) agree on this subject. As it turned out, Dan never took advantage of the accommodations that were offered to him.
There is a fine line between helping and enabling our loved ones with OCD. In my opinion, the best way to help and not enable is to learn everything we can about the disorder and the proper way to respond to it. We also need to remember that it's okay to feel angry, annoyed, frustrated, and overwhelmed, as long as these feelings are directed toward the OCD and not the person we care about. OCD sufferers need the understanding, acceptance, and love of their families, and they deserve no less than that.