When providing supervision to clinicians, I always ask if they make it a point to include family members in their sessions. The answer is usually, “it depends”. It depends on the age of their client and the diagnosis they are treating.  I share that I find it difficult to see the entire picture of my client’s life without including people that they live with. I also find it crucial to teach members of the client’s family and friend system how to coach them through anxiety so that they have more opportunities for success outside of our sessions.

A young woman with severe OCD came to see me. She was so overwhelmed by the anxiety caused by harming thoughts that she was unable to function in most areas of her life. I asked her to bring whomever she could to the next session so that I could teach them language that would help her as she faced her fears with exposure and response prevention. She brought her mother, her fiancé, and her best friend. I educated all of them on what was happening in her brain and taught her family and friends how to help her into uncomfortable situations while supporting her as she tolerated the accompanying anxiety.  We immediately became a team and they were all in, wanting desperately to help the person they loved so much. Throughout her therapy, each of them kept in close communication, asking questions to better understand their roles and celebrating the success she had along the way.

So what did I teach them that was so helpful? A few important skills are necessary to help a loved one successfully beat OCD. First and foremost, they have to learn not to reassure their loved one which means not saying anything that will make them feel better. This is completely contradictory to what comes natural to each of us (even us therapists).  Instead they have to learn to validate their loved one’s feelings while allowing them to be in the discomfort of the anxiety. Instead of saying, “you’ll be fine” they have to say, “I can see you are really struggling with your anxiety right now. I wonder if you can stay with it, ride it out and not do anything to feel better. I’ll check in with you in 15 min. Even though this may feel impossible, I know you can do it!”.   I also teach them how to set up a good exposure and challenge their loved one to do more. Finally, we discuss how to be playful with triggers because fear and anger only empower OCD.  Once family members learn these skills, they become my co therapists, often giving me insights and feedback about exposures being done at home that help me to set my client up to be more successful.

Involving family members can make the difference between an anxious client having success inside your office and a client generalizing that success outside your office to their life at home and work.

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To download a handout that provides you and family members a template for how to coach a loved one through anxiety and OCD,  go to https://anxietytraining.com/supplemental-material/
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