Intensive OCD Program Q&A

The Child Mind Institute Intensive OCD Program, led by Jerry Bubrick, PhD, offers children and their families evidence-based, one-on-one treatment up to five hours a day, five days a week. Using the gold standard treatment for OCD, a form of cognitive behavioral therapy called exposure therapy, the program enables children to make substantial progress within three to six weeks, and teaches parents techniques to help their children practice and get better in between sessions.

Here, Dr. Bubrick answers questions about the program:

What is important and exciting about intensive treatment for OCD?
The research is clear that for most kids with OCD you can get marked improvement in 12 to 15 sessions. You can do that over the course of three or four months or you can do that over the course of two to five weeks. So it is very exciting to think that you can get a whole course of treatment in a really short period of time, and get kids back in control of their lives and able to go to school and do the things they care about.

Who’s right for intensive treatment?
Intensive treatment is particularly helpful for children who have been to a couple of different providers and no one’s been able to make traction with their OCD. It’s also good for kids whose OCD is so severe they urgently need help but would like to avoid hospitalization. Or those who have been hospitalized who then need to transition back their home lives. Because a lot of times hospitals will just discharge and say “Farewell, hope everything goes okay.” But that transition back may be very hard for them and they may need further help.

Why is outpatient intensive treatment better than hospitalization?
It’s less invasive to be in an intensive outpatient setting. You get to stay with your family, or with your parents in a hotel, so after the sessions are over you can enjoy the city, you can go to the park, you can see a movie, you have control over where and when you go. The homework you need to do is connected to being out in the city doing things you normally do. Whereas if you are in a hospital or residential setting, you’re locked into their structure without a lot of control over what you do. You have to earn your way up to have different levels of privileges. It’s very effective for the kids who need it, but we hope to prevent that kind of setting for a lot of kids by giving them this instead.

Why is it important to take the treatment out of the office or hospital into the home or family life?
When you work on symptoms in the hospital or office, to some extent, it may be easier because kids aren’t surrounded by and facing their real, day-to-day triggers. They may be doing great in a structured setting but when they get home to their own bed and bathroom and kitchen, maybe they fear there’s contamination there, and kids tend to regress. In this kind of program, we have people do exposures outside the office, we go out with them into the city, we go home with them, depending on where they live, and do home-based sessions.

How is this program different from other outpatient programs?
Most intensive outpatient programs do a little bit of one-on-one treatment, they do some group treatment, they have some kind of free time where they explore different kinds of things and then they have some self-directed exposure time. The difference with us is that every second the child is here, it is one-on-one CBT. One-on-one exposures.

Why does intensive treatment work?
If you think about it like learning a language, it’s like taking a two-hour class every single day with homework in between. You’re just exposed to it over and over and over, burning it into memory through lots of experience and lots of practice. Similarly, we’re teaching skills more effectively than we can in just one 45-minute session a week. After once-a-week therapy the kid goes home and there’s homework, and there’s playdates and life happens — maybe they did their exposures at home and maybe they didn’t. When they come back a week later, often we have to catch up to where we were the previous session. So progress can be made much more effectively when we have a lot more access to kids, and that raises their compliance and their motivation.

So they’re more likely to do the homework and try hard in the intensive program?
Treatment for OCD works best with high compliance and high motivation. The kids we see are often very symptomatic, they’ve had probably some treatment failures, and their confidence and their motivation can be low. So we work with the family to create an incentive plan that boosts compliance. When we do intensive treatment the kids learn the skills faster and get results faster. They get more and more empowered and motivated because they see it works. And we form a very strong bond with them that gives them confidence. They know we’re dedicated to sticking it out with them.

Some people worry that intensive therapy is too tough on kids. Can you talk about that issue?
It would be understandable for someone who doesn’t really know what exposure is to hear about it and think, “There’s no way my child could handle that.” But they don’t understand how it works. It’s really about slowly and systematically facing the things that prompt anxiety and learning how to overcome those things so they are not to be feared or avoided. Anxiety really does diminish. So, yes, the final session for a kid that’s afraid of a dog may be to have a dog sit on his lap. But the first session might be to draw a picture of a dog.

What will be your role in the care of children in the program?
I will be actively involved in every single case from start to finish. A lot of these programs kind of do a bait and switch. They have a very experienced person as the head of the program, and you see that person once, and then you may get passed off to other people and you may or may not ever see that head of the program again. I want this to be different.

I do the initial screener over phone or Skype to make sure that the program is appropriate for this family and this child. We spend an hour talking about what’s going on, the child’s symptoms, how it interferes with their life, how severe it is.

Once they’re in the program, I’ll finish the evaluation and introduce them to an associate psychologist who’s going to be overseeing the day-to-day functions of the program and a counselor who will work with the child on exposures. I will be discussing the child’s progress with them throughout the course of the week. I’ll come in for 15- or 20-minute blocks to sit in on the exposures, advise on the exposures, participate, answer questions. And I’ll have a weekly session with the parents to talk about what’s going on, what’s working on their end, what’s not working, and helping the family create a plan for staying on track over the weekend. I will be actively involved every week with every child and every family.

What do kids and families say to you after they’ve gone through this?
People come to us in crisis. All parents really want is to get their child back. And they feel helpless. But through the program they learn a tremendous amount about how they can help their kids. We empower the kids by teaching them skills, so their symptoms are reduced, they get better, and more confident, and more motivated over time. But we empower the parents, too. Parents usually leave here not only grateful but much more knowledgeable about how to be advocates for their kids instead of victims of the anxiety.