Collaborative Approach for Adolescents with Obsessive-Compulsive Disorder

Treatment of obsessive-compulsive disorder in childhood and adolescence requires cognitive behavior therapy (CBT) alone and/or the combination of medication with cognitive behavior therapy. The present case study describes psychotherapy for a high school girl with obsessive-compulsive disorder using...

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Published inJapanese Journal of Behavior Therapy Vol. 39; no. 2; pp. 111 - 120
Main Authors KOBAYASHI, Naomi, IGARASHI, Toko
Format Journal Article
LanguageJapanese
Published Japanese Association for Behavioral and Cognitive Therapies( JABCT ) 31.05.2013
一般社団法人 日本認知・行動療法学会
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ISSN0910-6529
2424-2594
DOI10.24468/jjbt.39.2_111

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Abstract Treatment of obsessive-compulsive disorder in childhood and adolescence requires cognitive behavior therapy (CBT) alone and/or the combination of medication with cognitive behavior therapy. The present case study describes psychotherapy for a high school girl with obsessive-compulsive disorder using a collaborative approach that included the client, her mother, and the therapist. The client had a history of unsuccessful medical and psychiatric single visits due to her resistance to share her symptoms and distress. The psychotherapy employed the treatment program of March & Mulle (2006/2008) ; the client was actively and spontaneously involved in her own treatment. Her symptoms successfully improved after 8 sessions within 4.5 months. Several key issues, such as establishing a trustful therapeutic relationship, as well as a "team" relationship, providing client-focused psycho-education to the client and her mother as her key person, and the clients daily based intervention including home visits are described. Especially, the importance of a collaborative approach for adolescent clients was discussed.
AbstractList Treatment of obsessive-compulsive disorder in childhood and adolescence requires cognitive behavior therapy (CBT) alone and/or the combination of medication with cognitive behavior therapy. The present case study describes psychotherapy for a high school girl with obsessive-compulsive disorder using a collaborative approach that included the client, her mother, and the therapist. The client had a history of unsuccessful medical and psychiatric single visits due to her resistance to share her symptoms and distress. The psychotherapy employed the treatment program of March & Mulle (2006/2008) ; the client was actively and spontaneously involved in her own treatment. Her symptoms successfully improved after 8 sessions within 4.5 months. Several key issues, such as establishing a trustful therapeutic relationship, as well as a "team" relationship, providing client-focused psycho-education to the client and her mother as her key person, and the clients daily based intervention including home visits are described. Especially, the importance of a collaborative approach for adolescent clients was discussed.
Treatment of obsessive-compulsive disorder in childhood and adolescence requires cognitive behavior therapy (CBT) alone and/or the combination of medication with cognitive behavior therapy. The present case study describes psychotherapy for a high school girl with obsessive-compulsive disorder using a collaborative approach that included the client, her mother, and the therapist. The client had a history of unsuccessful medical and psychiatric single visits due to her resistance to share her symptoms and distress. The psychotherapy employed the treatment program of March & Mulle (2006/2008) ; the client was actively and spontaneously involved in her own treatment. Her symptoms successfully improved after 8 sessions within 4.5 months. Several key issues, such as establishing a trustful therapeutic relationship, as well as a "team" relationship, providing client-focused psycho-education to the client and her mother as her key person, and the clients daily based intervention including home visits are described. Especially, the importance of a collaborative approach for adolescent clients was discussed. 本事例では、治療に抵抗を示す思春期強迫性障害の17歳の女子高校生に対して、マーチ&ミュール(2008)の児童・思春期のCLに対する治療法を参考に、行動療法の曝露反応妨害法を用い、CL、母親、およびセラピストによる自宅訪問を含んだ"チーム"による治療を行い、4カ月半で症状が改善した。"チーム"治療の際の、治療導入時の働きかけ、治療過程における"チーム"の役割と家族を"チーム"に含めることの重要性およびCLの主要な生活の場である自宅での治療について考察し、思春期強迫性障害CLに対する"チーム"による治療の必要性を検討した。
Author KOBAYASHI, Naomi
IGARASHI, Toko
Author_FL 五十嵐 透子
小林 奈穂美
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  organization: Counseling Room Sakura Niigata
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  organization: Clinical Psychology, Graduate School of Education, Joetsu University of Education
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References 4) Flament M.F. Obsessive compulsive disorder in adolescence : An epidemiological study. Journal of the American Academy of Child and Adolescent Psychiatry. (1988) vol.27, p.764-771.
14) 岡嶋 美代. ほか. OS-3-1 児童思春期の強迫性障害の治療成績 : 思春期集団集中治療と他との比較(一般演題(口頭発表),認知行動療法を全国民に提供するために、総力の結集を!). 日本行動療法学会大会発表論文集. 一般社団法人日本認知・行動療法学会. (2009) no.35, p.212-213. http://search.jamas.or.jp/link/ui/2010101956
16) 飯倉 康郎. 強迫性障害の行動療法--症例と治療形式の工夫 (特別企画 行動療法). こころの科学. 日本評論社. (2001) p.26-32. http://search.jamas.or.jp/link/ui/2002006297
10) Pediatric OCD Treatment Study Team. Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: The Pediatric OCD Treatment Study (POTS) randomized controlled trial. Journal of the American Medical Association. (2004) vol.292, p.1969-1976.
5) Hanna G.L. Demographic and clinical features of obsessive-compulsive disorder in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry. (1995) vol.34, p.19-27.
18) 山崎 透. 手を洗うのをやめられない--強迫性障害 (特集 小児科医が知っておくべき思春期の心) -- (訴えや症状からみた心の問題). 小児科診療. 診断と治療社. (2010) vol.73, no.1, p.45-49. http://search.jamas.or.jp/link/ui/2010101194
11) Rapoport J.L. Childhood obsessive compulsive disorder. Journal of Child Psychology and Psychiatry. (1986) vol.27, p.289-296.
15) 五十嵐 透子. "こころのなか"の確認行為を主とする強迫性障害への行動療法を中心としたサイコセラピー--人格傾向を考慮して. 心理臨床学研究. 日本心理臨床学会 誠信書房(発売). (2001) vol.19, no.5, p.441-453. http://search.jamas.or.jp/link/ui/2002148237
17) 佐藤 寛. ほか. 児童の強迫性障害に対する認知行動療法の適用. 児童青年精神医学とその近接領域. 日本児童青年精神医学会. (2006) vol.47, no.3, p.274-281. http://search.jamas.or.jp/link/ui/2007024519
2) Barrett P. Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: A controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry. (2004) vol.43, p.46-62.
1) ベァ一 L.訳. 強迫性障害からの脱出. 晶文社. (2008
12) Rapoport J.L. Obsessive-compulsive disorder in children and adolescents. American Psychiatric Press. (1989
13) Stewart S.E. Long-term outcome of pediatric obsessive-compulsive disorder: A meta-analysis and qualitative review of the literature. Acta Psychiatrica Scandinavica. (2004) vol.110, p.4-13.
9) 成田善弘. 強迫症の臨床研究. 金剛出版. (1994
6) 原井宏明. 図解優しくわかる強迫性障害. ナッメ出版企画. (2012
7) マーチ,J.S. エキヌパートコンセンサスガイドライン強迫性障害(QCD) の治療ライフイヌ. (1999
3) エリクソン,E. H.訳編. 自我同一性. 誠信?戻. (1975
8) マーチ,J.S. 認知行動療法による子どもの強迫性 ?障害治療プログラムOCDをやっつけろ. 岩崎学術出版社. (2008
References_xml – reference: 7) マーチ,J.S. エキヌパートコンセンサスガイドライン強迫性障害(QCD) の治療ライフイヌ. (1999)
– reference: 15) 五十嵐 透子. "こころのなか"の確認行為を主とする強迫性障害への行動療法を中心としたサイコセラピー--人格傾向を考慮して. 心理臨床学研究. 日本心理臨床学会 誠信書房(発売). (2001) vol.19, no.5, p.441-453. http://search.jamas.or.jp/link/ui/2002148237
– reference: 10) Pediatric OCD Treatment Study Team. Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: The Pediatric OCD Treatment Study (POTS) randomized controlled trial. Journal of the American Medical Association. (2004) vol.292, p.1969-1976.
– reference: 12) Rapoport J.L. Obsessive-compulsive disorder in children and adolescents. American Psychiatric Press. (1989)
– reference: 14) 岡嶋 美代. ほか. OS-3-1 児童思春期の強迫性障害の治療成績 : 思春期集団集中治療と他との比較(一般演題(口頭発表),認知行動療法を全国民に提供するために、総力の結集を!). 日本行動療法学会大会発表論文集. 一般社団法人日本認知・行動療法学会. (2009) no.35, p.212-213. http://search.jamas.or.jp/link/ui/2010101956
– reference: 4) Flament M.F. Obsessive compulsive disorder in adolescence : An epidemiological study. Journal of the American Academy of Child and Adolescent Psychiatry. (1988) vol.27, p.764-771.
– reference: 17) 佐藤 寛. ほか. 児童の強迫性障害に対する認知行動療法の適用. 児童青年精神医学とその近接領域. 日本児童青年精神医学会. (2006) vol.47, no.3, p.274-281. http://search.jamas.or.jp/link/ui/2007024519
– reference: 18) 山崎 透. 手を洗うのをやめられない--強迫性障害 (特集 小児科医が知っておくべき思春期の心) -- (訴えや症状からみた心の問題). 小児科診療. 診断と治療社. (2010) vol.73, no.1, p.45-49. http://search.jamas.or.jp/link/ui/2010101194
– reference: 16) 飯倉 康郎. 強迫性障害の行動療法--症例と治療形式の工夫 (特別企画 行動療法). こころの科学. 日本評論社. (2001) p.26-32. http://search.jamas.or.jp/link/ui/2002006297
– reference: 11) Rapoport J.L. Childhood obsessive compulsive disorder. Journal of Child Psychology and Psychiatry. (1986) vol.27, p.289-296.
– reference: 5) Hanna G.L. Demographic and clinical features of obsessive-compulsive disorder in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry. (1995) vol.34, p.19-27.
– reference: 3) エリクソン,E. H.訳編. 自我同一性. 誠信?戻. (1975)
– reference: 8) マーチ,J.S. 認知行動療法による子どもの強迫性 ?障害治療プログラムOCDをやっつけろ. 岩崎学術出版社. (2008)
– reference: 1) ベァ一 L.訳. 強迫性障害からの脱出. 晶文社. (2008)
– reference: 13) Stewart S.E. Long-term outcome of pediatric obsessive-compulsive disorder: A meta-analysis and qualitative review of the literature. Acta Psychiatrica Scandinavica. (2004) vol.110, p.4-13.
– reference: 6) 原井宏明. 図解優しくわかる強迫性障害. ナッメ出版企画. (2012)
– reference: 2) Barrett P. Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: A controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry. (2004) vol.43, p.46-62.
– reference: 9) 成田善弘. 強迫症の臨床研究. 金剛出版. (1994)
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SubjectTerms adolescent
collaborative approach
exposure and response prevention
home visits
obsessive-compulsive disorder (OCD)
チーム
強迫性障害
思春期
曝露反応妨害法
自宅訪問
Title Collaborative Approach for Adolescents with Obsessive-Compulsive Disorder
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