371 | OCD Behaviors in Children: What We're Really Treating in CCPT

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You're listening to the Play Therapy Podcast with Dr. Brenna Hicks,

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your source for centered and focused play therapy coaching.

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Hi,

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I'm Dr. Brenna Hicks,

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The Kid Counselor.

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This is the Play Therapy Podcast where you get

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a master class in child-centered play therapy

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and practical support and application for your

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work with children and their families.

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In today's episode,

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we are covering

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a one-off topic.

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So we've finished the Game Changer series.

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And I typically call this a palate cleanse.

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So,

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we're just doing

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a one-off,

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not related to any series,

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and we're gonna talk about

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behaviors

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in children that

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mirror OCD.

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And how to understand what's going on,

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how to work with that in the playroom.

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I get a lot of questions about OCD behaviors lately,

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and we talk about it in coaching,

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and I've never talked about it on a podcast.

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So,

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I want to do that.

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Before we dive into that,

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a couple of shoutouts,

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huge shout out to Core Wellness

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and Katie and Joseph for

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an incredible event.

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I just want y'all to know,

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you all

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face the same systems and the same

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process that I do.

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Where CCPT is

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undervalued and underappreciated and underpromoted and all of those things,

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and Core Wellness has been an absolute champion of play therapy as a whole,

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but also about specifically child-centered play therapy,

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and they basically just gave me the green light and said

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any live event you wanna do,

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any CEU you wanna do,

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like let's make it happen.

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And so the event was an

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absolute incredible success.

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It was so much fun if you all

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were not able to come.

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Please make plans to come next year.

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It's gonna be an annual event in Tampa.

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What an incredible time.

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Three days of

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fun and

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CCPT and being with your tribe.

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But that is really a huge thanks to Katie and Joseph and the team at Core Wellness because

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I couldn't have done it without them.

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So,

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I just wanted to say thank you.

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Also to my team.

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I,

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I said this at the conference,

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but I don't,

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I don't think that my team gets enough credit.

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So my team being my son,

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my husband,

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and Mya,

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my

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executive assistant.

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I don't do anything that I do without those three.

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And so I just want to say

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out loud publicly

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that I know I'm the voice and the face and,

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and the coach and the speaker and all the things.

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And so I'm the one on the front lines,

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but

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really none of what I do happens without Mya and Eric and Kayne.

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So

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huge thank you to them as well.

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And oh my goodness,

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the conference was amazing.

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And actually the next couple of episodes,

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I want to summarize some of the content that I shared at that conference.

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It was brand new content,

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stuff that we came up with specifically just for the Field of Dreams event.

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So,

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I've never even coached it.

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I've never talked about it until that event.

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And for those of you that weren't able to attend,

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I wanna kind of just give you a little summary.

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So,

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that'll be the next couple of episodes,

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wanted to prepare you for that.

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All righty.

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So,

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let's dive into OCD a little bit.

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So,

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here's the thing.

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I think a lot of times parents come in

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with

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what they believe to be an OCD diagnosis,

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and unfortunately,

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sometimes kids are even diagnosed with OCD.

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And let's be really clear,

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children should not be diagnosed with OCD.

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There are certainly obsessive behaviors.

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There are certainly compulsive behaviors,

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and there are certainly behaviors that

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are consistent with OCD symptoms.

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But that is not a warranted childhood diagnosis.

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So often parents come in and that's their number one priority.

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You have to get my kid to stop

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fill in the blank behavior.

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Counting every time they leave the room,

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flicking the lights 6 times.

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They won't go to sleep unless we've read the story 8

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times in a row,

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whatever the obsessive compulsive behaviors are.

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And parents are at their wits' end,

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understandably,

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and they get to a point where they just want it to go away and they want it fixed.

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And so one of the things that we have to understand from a clinical standpoint

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is that

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OCD

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is not

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its own thing.

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I actually,

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I mean,

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I know I'm going against the DSM here,

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but

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I actually do not think OCD should be its own diagnosis.

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And here's why.

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OCD

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is unmanageable levels of anxiety.

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Turned into maladaptive coping.

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So you have absolutely paralyzing,

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unrelenting,

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overwhelming levels of anxiety,

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and we know

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that when you have a highly anxious kid,

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you end up with a huge need for power and control.

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And so it makes sense that if you have

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paralyzing anxiety,

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you're going to need to control something and it's no longer just

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what I eat,

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my sleep,

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my toileting,

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my obedience,

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it's

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I need structure.

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I need routine.

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I need things to be a certain way.

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And what happens organically usually.

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Is some repetitive

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thought,

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behavior,

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or activity

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is a little bit soothing in some way.

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By counting,

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they feel a little bit less anxious,

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or by doing a ritual,

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it gives them a little bit of peace.

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So what happens typically as an organic behavior

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then becomes maladaptive coping.

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But there's another layer to OCD that I want to make sure that we understand.

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So yes,

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absolutely unrelenting levels of anxiety.

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Coupled with perfectionistic tendencies.

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So you have a child that is bent toward perfectionism.

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Everything has to be perfect,

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ideal

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in the best possible scenario.

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There's usually some people pleasing that goes into that as well,

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but more perfectionistic if we had to weigh the two.

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And then you have anxiety on top of it,

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and you get kids that end up behaving with obsessive compulsive behaviors.

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So when a parent comes in and says,

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you have to get my kid too.

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That would be putting,

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as my phrase,

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a band-aid on a gaping wound.

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It's just like a child that comes in with selective mutism,

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and the parent's number one goal

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is you have to get my kid to start talking.

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That's never the goal.

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That's never the agenda.

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Same thing with obsessive and compulsive behaviors.

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It's not to get rid of those behaviors.

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It's to address the underlying issue,

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which is anxiety.

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We know that anxiety is well suited for child-centered play therapy.

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So first of all,

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we never have an agenda.

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We know that.

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So the goal is not that the child talks or that

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the child stops reading 8 books before they go to sleep.

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We're never going to have any kind of agenda,

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but we're also going to help parents have

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appropriate expectations.

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The goal is 100% not to address

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the manifestation

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of what's going on.

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It's to address what's going on.

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And in this case,

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it's super high levels of anxiety and perfectionism

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and therefore need for control.

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And so what we will often see in the playroom

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is kids come in

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and they have very rigid

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thoughts

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on what should and shouldn't be.

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And so they use a lot of imperatives.

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They behave in ways that indicate that they operate under a

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system of imperatives or they actually say it out loud,

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such as,

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it can't,

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it shouldn't,

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I won't,

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I'm not allowed,

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it's not OK.

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There's extremism in their thinking.

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This Lego can't be in the Lincoln log bin.

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Those markers shouldn't be

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in a disarray.

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I can't

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leave the room without turning the lights on 5 times.

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There's all of these very rigid,

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imperative

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driven thoughts,

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and therefore behaviors.

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And so what we do in the playroom.

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is we

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treat it as high levels of anxiety,

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which means we know we're going to elevate

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reflecting feelings with that child,

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because one of the reasons that a child gets such high

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levels of anxiety is they don't have an emotional vocabulary.

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They're sensitive.

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They're big feelers.

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So they get these big feelings,

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and they don't know what they are,

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they don't know how to define them,

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they don't know what to do with them.

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And they end up

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very highly anxious.

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So we're going to reflect feelings.

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Even more so than we would with a child with different concerns.

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Because

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we're trying to help them build an emotional vocabulary,

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that's our standard,

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but with kids that present with OCD behaviors.

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We're now recognizing that there's

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a perfectionism and imperative-based thinking.

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So at that point,

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not only do we reflect feelings,

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but we also do some enlargements

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of

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Wants and needs versus reality.

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So here's what that looks like.

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Kid says.

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This can't be over here.

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This belongs over there.

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And we reflect content

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and or feelings.

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You're irritated that that

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is not where you want it to be,

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or

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you think that that should go over there.

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And then here's where we work in kind of like a pseudo enlargement,

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but really it's more about

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needs and wants versus reality.

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But sometimes things are in different spots.

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Or

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I have to make sure

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that the door is locked.

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Oh,

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it's important to you

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to make sure that the door is locked.

280
00:09:54,520 --> 00:09:56,809
But sometimes things aren't how we want them to be.

281
00:09:58,849 --> 00:10:00,830
And what we're doing over time.

282
00:10:01,549 --> 00:10:02,770
Is helping the child.

283
00:10:04,020 --> 00:10:07,119
Who is subconsciously driven to believe

284
00:10:07,619 --> 00:10:12,859
that the world cannot function without them trying to regulate and control it.

285
00:10:14,469 --> 00:10:17,690
That just because they think something does not make it true.

286
00:10:18,950 --> 00:10:20,489
There is no reality.

287
00:10:21,099 --> 00:10:24,239
In some of the things that they believe and think and do.

288
00:10:25,239 --> 00:10:27,859
And so over time with the reflection of feeling

289
00:10:27,859 --> 00:10:31,580
and with those needs or wants versus reality statements.

290
00:10:32,369 --> 00:10:35,219
They start to realize that the guard could come down a little bit.

291
00:10:35,840 --> 00:10:37,359
And they don't have to control everything,

292
00:10:37,400 --> 00:10:39,239
and the anxiety will reduce a little bit,

293
00:10:39,479 --> 00:10:41,200
and their emotional vocabulary will grow,

294
00:10:41,210 --> 00:10:43,539
and they'll be better equipped to handle things like that.

295
00:10:44,640 --> 00:10:45,229
And again,

296
00:10:45,400 --> 00:10:48,059
we're not addressing the behaviors.

297
00:10:49,390 --> 00:10:51,169
We are helping the child realize

298
00:10:51,669 --> 00:10:54,669
that they do not have to have the burden.

299
00:10:55,809 --> 00:10:57,150
Of keeping everything

300
00:10:57,289 --> 00:10:57,950
afloat.

301
00:10:59,450 --> 00:11:00,030
I had

302
00:11:00,409 --> 00:11:01,210
a teenager,

303
00:11:01,289 --> 00:11:02,049
13.

304
00:11:02,960 --> 00:11:04,260
That came in

305
00:11:04,679 --> 00:11:05,299
with

306
00:11:05,559 --> 00:11:06,140
a

307
00:11:06,520 --> 00:11:08,020
bag full of candy in his pocket.

308
00:11:09,150 --> 00:11:13,010
And so he sits down on the yoga ball and he starts opening up the candy.

309
00:11:14,250 --> 00:11:17,270
And he offered me some and was talking about how

310
00:11:17,690 --> 00:11:18,840
it's strawberry flavored,

311
00:11:18,849 --> 00:11:19,690
and I said,

312
00:11:20,210 --> 00:11:23,130
I think you had something strawberry before with you.

313
00:11:23,210 --> 00:11:23,650
And he was like,

314
00:11:23,729 --> 00:11:23,890
Yeah,

315
00:11:23,969 --> 00:11:25,809
last time I brought whatever strawberry.

316
00:11:26,090 --> 00:11:27,289
And then there had been another day when

317
00:11:27,289 --> 00:11:29,289
I was actually eating strawberries in the playroom,

318
00:11:29,299 --> 00:11:30,630
and he asked if I could have some.

319
00:11:31,289 --> 00:11:32,229
So I said,

320
00:11:32,890 --> 00:11:33,510
wow,

321
00:11:33,890 --> 00:11:36,169
we've had a lot of strawberry memories together

322
00:11:36,169 --> 00:11:37,789
or something along the lines of that.

323
00:11:38,210 --> 00:11:38,979
And he goes,

324
00:11:39,250 --> 00:11:39,330
Yeah,

325
00:11:39,369 --> 00:11:40,650
I have a strawberry problem.

326
00:11:43,309 --> 00:11:43,919
And

327
00:11:44,070 --> 00:11:44,890
I said,

328
00:11:45,150 --> 00:11:45,590
hm.

329
00:11:46,239 --> 00:11:48,190
You think you have a strawberry problem.

330
00:11:48,929 --> 00:11:50,750
Seems like you just really like strawberries.

331
00:11:51,880 --> 00:11:52,109
Now,

332
00:11:52,119 --> 00:11:54,900
I did not do that with the intention of

333
00:11:55,400 --> 00:11:57,659
I wanted him to gain a different perspective.

334
00:11:58,039 --> 00:11:58,929
I just

335
00:12:00,130 --> 00:12:01,830
Said that because that's

336
00:12:02,169 --> 00:12:03,770
what's that's what seemed relevant to me.

337
00:12:04,520 --> 00:12:06,250
Like you're labeling this as a problem,

338
00:12:06,299 --> 00:12:08,109
but it just seems like you like strawberries.

339
00:12:09,590 --> 00:12:10,390
And

340
00:12:10,750 --> 00:12:12,190
that week he went home.

341
00:12:12,710 --> 00:12:15,070
Dad came in for the PC the following week.

342
00:12:16,010 --> 00:12:16,849
And when I said,

343
00:12:16,969 --> 00:12:18,169
so tell me how things have been going,

344
00:12:18,250 --> 00:12:18,409
you know,

345
00:12:18,489 --> 00:12:19,130
give me an update.

346
00:12:19,210 --> 00:12:20,669
I wonder what you've been noticing.

347
00:12:21,169 --> 00:12:21,710
And he says,

348
00:12:21,809 --> 00:12:22,270
well,

349
00:12:23,530 --> 00:12:26,130
He told me that he really likes it that you.

350
00:12:27,369 --> 00:12:29,250
Make him see things differently.

351
00:12:30,229 --> 00:12:30,710
And I was like,

352
00:12:30,750 --> 00:12:31,469
I wonder what you mean.

353
00:12:31,590 --> 00:12:31,710
I mean,

354
00:12:31,789 --> 00:12:32,750
did he give you an example?

355
00:12:32,830 --> 00:12:33,309
And he goes,

356
00:12:33,549 --> 00:12:33,659
well,

357
00:12:33,750 --> 00:12:35,150
not like a specific example,

358
00:12:35,229 --> 00:12:36,549
but he just mentioned that

359
00:12:36,789 --> 00:12:38,840
he was talking to you about strawberries,

360
00:12:39,349 --> 00:12:40,010
and

361
00:12:40,390 --> 00:12:44,140
he realized that you had a totally different perspective and,

362
00:12:44,349 --> 00:12:46,460
and he realized that he does that a lot.

363
00:12:46,950 --> 00:12:50,390
He has a negative perspective and he's realizing that

364
00:12:50,390 --> 00:12:52,609
there's always a positive perspective that he could take.

365
00:12:54,219 --> 00:12:57,840
And I've never forgotten that because I just thought to myself,

366
00:12:58,299 --> 00:12:59,960
it was just contrasting.

367
00:13:00,849 --> 00:13:02,039
His natural default.

368
00:13:02,130 --> 00:13:04,669
And same thing with kids with OCD behaviors.

369
00:13:05,169 --> 00:13:06,650
Their natural default is,

370
00:13:06,770 --> 00:13:07,080
oh no,

371
00:13:07,159 --> 00:13:07,890
what if I have to,

372
00:13:07,960 --> 00:13:08,690
I can't let this go.

373
00:13:08,770 --> 00:13:09,919
I have to make sure this happens.

374
00:13:09,929 --> 00:13:10,609
I shouldn't do this,

375
00:13:10,650 --> 00:13:11,549
I must do this.

376
00:13:12,450 --> 00:13:14,169
And so sometimes just saying,

377
00:13:14,390 --> 00:13:14,679
hmm,

378
00:13:14,690 --> 00:13:15,969
you feel like you have to do that,

379
00:13:16,070 --> 00:13:16,510
but

380
00:13:17,289 --> 00:13:19,590
sometimes we don't do the things that we feel like we have to do.

381
00:13:20,390 --> 00:13:23,090
That's just acknowledgement of the reality of the world.

382
00:13:24,270 --> 00:13:28,690
And it sheds some light on there's a different perspective because kids get stuck

383
00:13:28,989 --> 00:13:30,690
in myopic ruts

384
00:13:30,950 --> 00:13:31,489
and they

385
00:13:31,590 --> 00:13:33,309
only think there's one way.

386
00:13:34,599 --> 00:13:35,030
So,

387
00:13:35,169 --> 00:13:36,799
hopefully that will give you

388
00:13:37,119 --> 00:13:38,840
a little more insight as to OCD.

389
00:13:38,919 --> 00:13:41,500
We're never going to help a parent think

390
00:13:41,890 --> 00:13:44,320
that that's going to be the approach or the agenda,

391
00:13:44,330 --> 00:13:46,380
that we're just going to reduce the behaviors.

392
00:13:47,280 --> 00:13:48,690
And we have to see it for what it is.

393
00:13:48,770 --> 00:13:50,289
Anxiety and perfectionism.

394
00:13:50,530 --> 00:13:53,130
We know both of those are well suited for CCPT.

395
00:13:53,250 --> 00:13:53,630
So

396
00:13:53,770 --> 00:13:54,770
we trust the process,

397
00:13:54,849 --> 00:13:55,989
we adhere to the model,

398
00:13:56,650 --> 00:13:58,510
and we elevate a few things

399
00:13:59,049 --> 00:13:59,789
skill-wise,

400
00:14:00,369 --> 00:14:01,679
but really at the end of the day,

401
00:14:01,729 --> 00:14:04,750
the child's going to do the work that they need to do.

402
00:14:05,289 --> 00:14:08,070
And so OCD is not really its own separate

403
00:14:08,330 --> 00:14:09,989
and distinct thing for us.

404
00:14:10,409 --> 00:14:12,950
It's just a different kind of anxiety.

405
00:14:13,409 --> 00:14:15,450
So I hope that gives you some perspective and insight.

406
00:14:16,210 --> 00:14:17,059
Please send me an email.

407
00:14:17,179 --> 00:14:18,099
I would love to hear from you,

408
00:14:18,179 --> 00:14:19,409
brenna@thekidcounselor.

409
00:14:19,659 --> 00:14:21,940
You can also call the number and leave a voicemail

410
00:14:21,940 --> 00:14:24,039
if you'd like to ask a question or say hello.

411
00:14:24,179 --> 00:14:24,960
If you're in the States,

412
00:14:25,169 --> 00:14:27,799
813-812-5525.

413
00:14:28,260 --> 00:14:29,619
And if you haven't checked it out,

414
00:14:29,820 --> 00:14:32,159
come hang out with us in the CCPT Collective.

415
00:14:32,640 --> 00:14:34,320
That's a really resourceful,

416
00:14:34,400 --> 00:14:34,880
helpful,

417
00:14:34,960 --> 00:14:36,099
encouraging place

418
00:14:36,289 --> 00:14:37,919
for CCPTs around the world,

419
00:14:37,960 --> 00:14:39,630
and we hang out a couple of times a week,

420
00:14:39,960 --> 00:14:41,760
and there's all kinds of stuff in there.

421
00:14:41,929 --> 00:14:42,460
So,

422
00:14:42,479 --> 00:14:44,510
if you feel like you would like some support,

423
00:14:44,799 --> 00:14:46,520
we'd love to hang out with you in the collective.

424
00:14:46,630 --> 00:14:47,419
Check that out too.

425
00:14:47,760 --> 00:14:48,320
I love y'all.

426
00:14:48,419 --> 00:14:49,239
I hope you have a great week.

427
00:14:49,320 --> 00:14:50,099
We'll talk again soon.

428
00:14:50,400 --> 00:14:50,640
Bye.

429
00:14:51,760 --> 00:14:55,549
Thank you for listening to the Play Therapy Podcast with Dr. Brenna Hicks.

430
00:14:55,799 --> 00:14:57,719
For more episodes and resources,

431
00:14:57,880 --> 00:15:02,640
please go to www.playtherapypodcast.com.