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Am J Psychother. 2014;68(1):57-79.

"The ickiness factor:" case study of an unconventional psychotherapeutic approach to pediatric OCD.


Obsessive-compulsive disorder (OCD) is a complex condition with biological, genetic, and psychosocial causes. Traditional evidence-based treatments include cognitive-behavioural therapy, either alone or in combination with serotonin-specific reuptake inhibitors (SSRI's), other serotonergic agents, or atypical antipsychotics. These treatments, however, often do not lead to remission, and therefore, it is crucial to explore other less conventional therapeutic approaches. This paper describes a case study in which psychodynamic, narrative, existential, and metaphor therapy in combination with more conventional treatments led to a dramatic remission of severe OCD in a 12 year old hospitalized on a psychiatric inpatient unit. The paper, which is written partly in the form of a story to demonstrate on a meta-level the power of narrative, is also intended to illustrate the challenges of countertransference in the treatment of patients with severe OCD, and the ways in which a reparative therapeutic alliance can lead to unexpected and vital change.

[Indexed for MEDLINE]

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