OBSESSIVE-COMPULSIVE DISORDER (OCD)

CLIENT PRESENTATION

Recurrent/Persistent Thoughts (1)¹
1. The client described recurrent and persistent thoughts or impulses that are viewed as senseless, intrusive, and time-consuming and that interfere with his/her daily routine.
2. The intensity of the recurrent and persistent thoughts and impulses is so severe that the client is unable to efficiently perform daily duties or interact in social relationships.
3. The strength of the client's obsessive thoughts has diminished and he/she has become more efficient in his/her daily routine.
4. The client reported that the obsessive thoughts are under significant control and he/she is able to focus attention and effort on the task at hand.
Failed Control Attempts (2)
1. The client reported failure at attempts to control or ignore his/her obsessive thoughts or impulses.
2. The client described many different failed attempts at learning to control or ignore his/her obsessions.
3. The client is beginning to experience some success at controlling and ignoring his/her obsessive thoughts and impulses.
Recognize Internal Source of Obsessions (3)
1. The client has a poor understanding that his/her obsessive thoughts are a product of his/her own mind.
2. The client reported that he/she recognizes that the obsessive thoughts are a product of his/her own mind and are not coming from some outside source or power.
3. The client acknowledged that the obsessive thoughts are related to anxiety and are not a sign of any psychotic process.
Excessive Concern about Dirt and Disease (4)
1. The client displays excessive concern about dirt.
2. The client has many unfounded fears about contracting a dreadful disease or illness.
3. The client has frequently changed his/her behavior due to his/her concerns and fears about germs and illnesses.
4. The strength of the client's fears about dirt, germs, and illnesses has decreased and he/she has become more stable in his/her activities.
5. The client reported that the excessive concerns about dirt and disease are under significant control and he/she is able to focus attention and effort on his/her regular activities.
Aggressive/Sexual Obsessions (5)
1. The client described persistent obsessive thoughts about committing aggressive actions.
2. The client has many troubling sexual thoughts and urges.
3. The client described often imagining troubling aggressive or sexual actions.
4. The client described that his/her aggressive, sexual thoughts are not compatible with his/her identifying values and morals.
5. As treatment has progressed, the client reports a decreased pattern of obsessions regarding aggressive or sexual activity.
6. The client reports that his/her aggressive, sexual thoughts, urges, or images are no longer occurring.
Religious Obsessions (6)
1. The client described persistent and troubling thoughts about religious issues.
2. The client described excessive concern about whether his/her actions are moral, right, or wrong.
3. When under stress, the client turns the focus away from the stressor and onto religious/moral issues.
4. The client described a decrease in persistent and troubling thoughts about religious issues.
Compulsive Compensatory Behavior (7)
1. The client described repetitive and intentional behaviors that are performed in a ritualistic fashion.
2. The client identified that his/her compulsive behaviors are in response to his/her obsessive thoughts and increased feelings of anxiety and fearfulness.
3. The client's compulsive behavior pattern follows rigid rules and has many repetitions to it.
4. The client reported a significant decrease in the frequency and intensity of his/her compulsive behaviors.
5. The client reports very little interference in his/her daily routine from his/her compensatory compulsive behavior rituals.
Disconnected Behavioral Compulsions (8)
1. The client reports repetitive and excessive behaviors that are performed to neutralize or prevent discomfort or some dreadful situation.
2. The client has identified that his/her behavior is not connected in any realistic way with what it is designed to neutralize or prevent.
3. The client has identified his/her ritualistic behavior as unconnected to his/her actual fears.
4. As treatment has progressed, the client's repetitive and excessive behaviors have decreased.
Compulsions Seen as Unreasonable (9)
1. The client acknowledged that his/her repetitive and compulsive behaviors are excessive and unreasonable.
2. The client's recognition of his/her compulsive behaviors as excessive and unreasonable has provided good motivation for cooperation with treatment and follow through on attempts to change.
Cleaning/Washing Compulsions (10)
1. The client has had many cleaning compulsions, including cleaning and recleaning of many household items.
2. The client has engaged in washing compulsions, including excessive hand washing, bathing, and showering.
3. The client has had such severe hand-washing compulsions that skin breakdown is occurring.
4. As the client has participated in treatment, his/her frequency of cleaning and washing has decreased.
Hoarding/Collecting (11)
1. The client regularly engages in hoarding items that are unnecessary.
2. The client described the unnecessary collecting of innocuous items.
3. The client has become quite agitated when others have accidentally or purposefully threatened his/her hoarding or collecting.
4. As the client's functioning has improved, his/her desire to hoard or collect items has decreased.
5. The client's use of hoarding or collecting items has been eliminated.
Checking Compulsions (12)
1. The client identified that he/she frequently needs to check and recheck basic tasks.
2. The client frequently checks and rechecks to see whether or not doors or windows are locked.
3. The client frequently checks and rechecks to make sure that his/her homework has been done correctly.
4. The client has severe fears that others have been harmed and frequently checks and rechecks for no direct reason.
5. The client reports that he/she has significantly decreased his/her pattern of checking behaviors.
Arrangement Compulsions (13)
1. The client described frequently arranging objects to make certain that they are in “proper order,” for no apparent reason (e.g., stacking coins in a certain order).
2. The client described being overly focused on arranging necessary objects (e.g., laying out clothes each evening at the same time, wearing only certain clothes on certain days).
3. As treatment has progressed, the client reports a decrease in his/her compulsion to order or arrange objects.

INTERVENTIONS IMPLEMENTED

Establish Trust-Based Relationship (1)²
1. Initial trust level was established with the client through use of unconditional positive regard.
2. Warm acceptance and active listening techniques were utilized to establish the basis for a nurturing relationship.
3. The client has formed a trust-based relationship and has begun to express his/her thoughts and feelings regarding his/her adoption; positive feedback was provided.
4. Despite the use of active listening, warm acceptance, and unconditional positive regard, the client remains resistant to trust and does not share his/her thoughts and feelings.
Assess OCD History (2)
1. Active listening was used as the client described the nature, history, and severity of his/her obsessive thoughts and compulsive behaviors.
2. Through a clinical interview, the client described a severe degree of interference in his/her daily routine and ability to perform a task efficiently because of the significant problem with obsessive thoughts and compulsive behaviors.
3. The client was noted to have made many attempts to ignore or control the compulsive behaviors and obsessive thoughts, but without any consistent success.
4. It was noted that the client gave evidence of compulsive behaviors within the interview.
Refer/Conduct Substance Abuse Evaluation (3)
1. The client was referred for a substance abuse evaluation to assess the extent of his/her drug/alcohol usage and determine the need for treatment.
2. The findings from the substance abuse evaluation revealed the presence of a substance abuse problem and the need for treatment.
3. The findings from the substance abuse evaluation revealed the presence of a substance abuse problem that appears to be contributing to the client's behavior control problems.
4. The evaluation findings did not reveal the presence of a substance abuse problem or the need for treatment in this area.
Assess Level of Insight (4)
1. The client's level of insight toward the presenting problems was assessed.
2. The client was assessed in regard to the syntonic versus dystonic nature of his/her insight about the presenting problems.
3. The client was noted to demonstrate good insight into the problematic nature of the behavior and symptoms.
4. The client was noted to be in agreement with others' concerns and is motivated to work on change.
5. The client was noted to be ambivalent regarding the problems described and is reluctant to address the issues as a concern.
6. The client was noted to be resistant regarding acknowledgment of the problem areas, is not concerned about them, and has no motivation to make changes.
Assess for Correlated Disorders (5)
1. The client was assessed for evidence of research-based correlated disorders.
2. The client was assessed in regard to his/her level of vulnerability to suicide.
3. The client was identified as having a comorbid disorder, and treatment was adjusted to account for these concerns.
4. The client has been assessed for any correlated disorders, but none were found.
Assess for Culturally Based Confounding Issues (6)
1. The client was assessed for age-related issues that could help to better understand his/her clinical presentation.
2. The client was assessed for gender-related issues that could help to better understand his/her clinical presentation.
3. The client was assessed for cultural syndromes, cultural idioms of distress, or culturally based perceived causes that could help to better understand his/her clinical presentation.
4. Alternative factors have been identified as contributing to the client's currently defined “problem behavior,” and these were taken into account in regard to his/her treatment.
5. Culturally based factors that could help to account for the client's currently defined “problem behavior” were investigated, but no significant factors were identified.
Assess Severity of Impairment (7)
1. The severity of the client's impairment was assessed to determine the appropriate level of care.
2. The client was assessed in regard to his/her impairment in social, relational, vocational, and occupational endeavors.
3. It was reflected to the client that his/her impairment appears to create mild to moderate effects on the client's functioning.
4. It was reflected to the client that his/her impairment appears to create severe to very severe effects on the client's functioning.
5. The client was continuously assessed for the severity of impairment, as well as the efficacy and appropriateness of treatment.
Assess for Pathogenic Care (8)
1. The home, school, and community of the client were assessed for pathogenic care and concerns.
2. The client's various environments were assessed for the persistent disregard of the child's needs, repeated changes in caregivers, limited opportunities for stable attachment, harsh discipline, or other grossly inept care.
3. Pathogenic care was identified and the treatment plan included strategies for managing or correcting these concerns and protecting the child.
4. No pathogenic care was identified and this was reflected to the client and caregivers.
Conduct Psychological Testing (9)
1. Psychological testing was administered to evaluate the nature and severity of the client's obsessive-compulsive problem.
2. The Children's Yale-Brown Obsessive-Compulsive Scale (Scahill et al.) was used to assess the client's frequency, intensity, duration, and history of obsessions and compulsions.
3. The psychological testing results indicate that the client experiences significant interference in his/her daily life from obsessive-compulsive rituals.
4. The psychological testing indicated a rather mild degree of OCD within the client.
5. The results of the psychological testing were interpreted to the client.
Refer for Medical Evaluation (10)
1. The client was referred to a physician for an evaluation for a medication prescription to aid in the control of his/her OCD.
2. The client has followed through with the referral for a medication evaluation and has been prescribed psychotropic medication to aid in the control of his/her OCD.
3. The client has failed to comply with the referral to a physician for a medication evaluation and was encouraged to do so.
Monitor Medication Compliance (11)
1. The client reported that he/she is taking the psychotropic medication as prescribed; the positive effect on controlling the OCD was emphasized.
2. The client reported complying with the psychotropic medication prescription, but that the effectiveness of the medication has been very limited or nonexistent; this information was relayed to the prescribing clinician.
3. The client has not consistently taken the psychotropic medication as prescribed and was encouraged to do so.
Provide Psychoeducation about OCD (12)
1. The client and parents were provided with initial psychoeducation about OCD.
2. The client and parents were provided with ongoing psychoeducation about OCD.
3. The client and parents were provided with a cognitive-behavioral conceptualization of OCD.
4. The client and parents were provided with information about the biopsychosocial factors influencing the development of OCD and how fear and avoidance serve to maintain the disorder.
Discuss Usefulness of Treatment (13)
1. A discussion was held about how treatment serves as an arena to desensitize learned fear, reality test obsessional fears and underlying beliefs, and build confidence in managing fears without compulsions.
2. The client was provided with a rationale for treatment as described in Up and Down the Worry Hill (Wagner).
3. Positive feedback was provided to the client as he/she displayed a clear understanding of the usefulness of treatment.
4. The client did not display a clear understanding of the usefulness of treatment and was provided with additional feedback in this area.
Assign Media about OCD (14)
1. The client was assigned to read psychoeducational portions of books, videos, or treatment manuals on the rationale for exposure and ritual prevention therapy.
2. The client was assigned to review the psychoeducational media for the rationale for cognitive restructuring for OCD.
3. The client was assigned to review information from Treating Your OCD with Exposure and Response (Ritual) Prevention: Workbook (Yadin, Foa, and Lichner).
4. The client was assigned to review portions of Brain Lock: Free Yourself from Obsessive-Compulsive Behavior (Schwartz).
5. The client was assigned to read excerpts from Obsessive-Compulsive Disorder: Help for Children and Adolescents (Waltz).
6. The client has read the assigned material on the rationale for OCD treatment; key points were reviewed.
7. The client has not read the assigned material on the rationale for OCD treatment and was redirected to do so.
Confirm Motivation for Treatment (15)
1. The client was reviewed in regard to his/her motivation to participate in treatment, and this was found to be significant.
2. The client's level of motivation to participate in treatment is fairly low, so motivational interviewing techniques were used to help unlock the client's motivation.
3. A pros-cons analysis was conducted to assist the client in increasing his/her motivation.
4. The client was assisted in identifying his/her level of satisfaction with the status quo, his/her understanding of the benefits of making a change and his/her level of optimism for being able to make a change.
Monitor and Record Obsessions and Compulsions (16)
1. The client was instructed to self-monitor and record obsessions and compulsions.
2. The client was assisted in identifying triggers, specific fears, and mental or behavioral compulsions.
3. As treatment has progressed, the client's response to treatment was identified through his/her record of obsessions and compulsions.
4. The client was assisted in reviewing his/her record of obsessions and compulsions.
5. The client has not completed a regular record of obsessions and compulsions and was requested to do so.
Explore Schema and Self-Talk (17)
1. The client was assisted in exploring how his/her schema and self-talk mediate his/her obsessional fears and compulsive behaviors.
2. The client was assigned the exercise “Journal and Replace Self-Defeating Thoughts” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
3. The client's schema and self-talk were reviewed.
4. The client was reinforced for his/her insight into his/her self-talk and schema that support his/her obsessional fears and compulsive behaviors.
5. The client struggled to develop insight into his/her own self-talk and schema and was provided with tentative examples of these concepts.
Teach Cognitive Skills (18)
1. The client was taught cognitive skills, such as constructive self-talk, “bossing back” obsessions, distancing, and nonattachment.
2. The client was taught about letting obsessive thoughts, images and/or impulses come and go.
3. The client was assigned the exercise “Thought-Stopping” from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson and McInnis).
4. The client was reinforced for his/her use of cognitive skills such as constructive self-talk.
5. The client has not used cognitive skills very well, and was redirected to do so.
Enroll in Exposure and Ritual Prevention Therapy (19)
1. The client was assisted in coordination for exposure and “response” ritual prevention therapy.
2. The client was reviewed for individual versus group therapy, and the intensity at which he/she should be seen.
3. Exposure and ritual prevention therapy was conducted.
Assess Cues (20)
1. The client was assessed in regard to the nature of any external cues (e.g., persons, objects, situations) that precipitate the client's obsessions and compulsions.
2. The client was assessed in regard to the nature of any internal cues (e.g., thoughts, images, impulses) that precipitate the client's obsessions and compulsions.
3. The client was provided with feedback about his/her identification of cues.
Construct a Hierarchy of Fear Cues (21)
1. The client was directed to construct a hierarchy of feared internal and external cues.
2. The client was assigned the exercise “Gradual Exposure to Fear” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
3. The client was assisted in developing a hierarchy of internal and external fear cues.
4. The client has developed a useful hierarchy of feared internal and external cues, and positive feedback was provided.
5. The client has struggled to clearly develop a hierarchy of feared internal and external cues and was provided with additional assistance in this area.
Select Likely Successful Imaginal Exposure (22)
1. The client was assisted in identifying initial imaginal exposures with a bias toward those that have a likelihood of being successful experiences for the client.
2. Cognitive restructuring techniques were used within and after the imaginal exposure of the OCD cues.
3. Imaginal exposure and cognitive restructuring techniques were used as described in Treatment of OCD in Children and Adolescents (Wagner).
4. Imaginal exposure and cognitive restructuring techniques were used as described in OCD in Children and Adolescents (March and Mulle).
5. “Gradually Facing a Phobic Fear” from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis) was assigned to help the client complete imaginary exposures.
6. The client was provided with feedback about his/her use of imaginal exposures.
Teach Coping Strategies
1. The client was taught to use coping strategies, such as constructive self-talk, distraction, and distancing.
2. The client was directed to resist engaging in compulsive behaviors by using the coping strategies.
3. The client was directed to record attempts to resist compulsions.
4. The client was directed to complete the assignments from Treating Your OCD with Exposure and Response (Ritual) Prevention: Workbook (Yadin, Foa, and Lichner).
5. The client was assigned the exercise “Refocus Attention Away from Obsessions and Compulsions” from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
6. The client was assisted in reviewing his/her attempts to use coping strategies to resist obsessions and compulsions, with reinforcement for success and corrective feedback toward improvement.
Design Award System (24)
1. An award system was designed for the client for his/her successful resistance of the urge to engage in compulsive behaviors.
2. The client was rewarded for openly sharing obsessive thoughts with others.
Assign Exposure Homework (25)
1. The client was assigned exposure homework exercises in which he/she gradually reduces time given per day to obsessions and/or compulsions.
2. The client was encouraged to use his/her coping strategies.
3. The parents were reminded to use reinforcement for the child's success.
4. The client was assigned the exercise “Ritual Exposure and Response Prevention” from the Child Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
5. The client's implementation of the homework exercise has had a positive impact on compulsive behavior reduction.
Develop Parents' Interventions (26)
1. A family therapy session was held to identify specific, positive ways that the parents can help the client manage his/her obsessions or compulsions.
2. The client's parents were reinforced for their identification of specific techniques to help the client manage his/her obsessions or compulsions.
3. The client's parents were provided with tentative examples of ways to help the client manage his/her obsessions or compulsions (e.g., parents refocus attention away from obsessions/compulsions by engaging in recreational activity or talking about other topics; parents encourage the client to participate in feared activity).
4. The family was reinforced for the use of techniques to help the client manage his/her obsessions or compulsions.
5. The family has not regularly prompted the client to use management techniques to control his/her obsessions or compulsions and was redirected to do so.
Encourage Calmness and Support (27)
1. The client's parents were encouraged to remain calm, patient, and supportive when faced with the client's obsessions or compulsions.
2. The client's parents were instructed about specific ways in which they can display calmness, patience, and support when faced with the client's obsessions or compulsions.
3. The client's parents were discouraged from reacting strongly with anger or frustration to the client's obsessions or compulsions.
4. The client's parents were reinforced for their calm, patient support for the client.
5. The parents have not consistently displayed calm, patient support of the client and were redirected to do so.
Teach Family Members Role (28)
1. Family members were taught about their appropriate role in helping the client adhere to treatment.
2. The family members were assisted in identifying changing tendencies to reinforce the client's OCD.
3. Family members were recommended to read Freeing Your Child from Obsessive-Compulsive Disorder: Powerful, Practical Solutions to Overcoming Your Child's Fears, Worries, and Phobias (Chansky).
4. Family members were directed to read Helping Your Child with OCD (Fitzgibbons and Petrick).
5. Family members were reinforced for their appropriate role in helping the client adhere to treatment.
6. When family members tended to reinforce the client's OCD symptoms, they were redirected.
Teach Stress Management to Family (29)
1. The client's family members were taught about stress management techniques.
2. Family members were assigned the exercise “Progressive Muscle Relaxation” from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
3. Family members were assigned the exercise “Problem-Solving Exercise” from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
Differentiate between Lapse and Relapse (30)
1. A discussion was held with the client regarding the distinction between a lapse and a relapse.
2. A lapse was associated with an initial and reversible return of symptoms, fear, or urges to avoid.
3. A relapse was associated with the decision to return to fearful and avoidant patterns.
4. The client was provided with support and encouragement as he/she displayed an understanding of the difference between a lapse and a relapse.
Discuss Management of Lapse Risk Situations (31)
1. The client was assisted in identifying future situations or circumstances in which lapses could occur.
2. The session focused on rehearsing the management of future situations or circumstances in which lapses could occur.
3. The client was reinforced for his/her appropriate use of lapse management skills.
4. The client was redirected in regard to his/her poor use of lapse management skills.
Encourage Routine Use of Strategies (32)
1. The client was instructed to routinely use the strategies that he/she has learned in therapy (e.g., cognitive restructuring, exposure).
2. The client was urged to find ways to build his/her new strategies into his/her life as much as possible.
3. The client was reinforced as he/she reported ways in which he/she has incorporated coping strategies into his/her life and routine.
4. The client was redirected about ways to incorporate his/her new strategies into his/her routine and life.
Schedule “Maintenance Sessions” (33)
1. “Maintenance sessions” were proposed to help maintain therapeutic gains and adjust to life without anger outbursts.
2. The client was reinforced for agreeing to the scheduling of “maintenance sessions.”
3. The client refused to schedule “maintenance sessions,” and this was processed.
4. An award system was designed as described in Treatment of OCD in Children and Adolescents (Wagner).
5. An award system was developed as described in OCD in Children and Adolescents (March and Mulle).
6. “Refocus Attention Away from Obsessions and Compulsion” from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis) was used to encourage the use of refocusing techniques.
Encourage Use of a Coach (34)
1. The client was encouraged to involve a support person or coach who can help him/her to resist the urge to engage in compulsive behavior or to take his/her mind off obsessive thoughts.
2. The client was reinforced as he/she has enlisted the assistance of a coach.
3. The client was urged to regularly use his/her coach.
Refer to Support Group (35)
1. The client was referred to a support group to help maintain and support the gains made in therapy.
2. The client's parents were referred to a support group to help support and maintain the gains made in therapy.
3. The client has attended the support group and his/her experience was reviewed.
4. The client's parents have attended the support group and their experience was reviewed.
5. The support group has not been attended and the use of such support groups was reinforced.
Use ACT Approach (36)
1. Acceptance and Commitment Therapy (ACT) procedures were applied.
2. The client was assisted in accepting and openly experiencing anxious or obsessive thoughts and feelings, without being overly impacted by them.
3. The client was encouraged to commit his/her time and effort to activities that are consistent with identified personally meaningful values.
4. The client was directed to read portions of The Mindful Way through Anxiety: Break Free from Chronic Worry and Reclaim Your Life (Orsillo and Roemer).
5. The client was directed to read portions of The Stress Reduction Workbook for Teens: Mindfulness Skills to Help You Deal with Stress (Biegel).
6. The client has engaged well in the ACT approach and was reinforced for applying these concepts to his/her symptoms and lifestyle.
7. The client has not engaged well in the ACT approach and remedial efforts toward engagement were applied.
Encourage Feelings Sharing (37)
1. The client was encouraged, supported, and assisted in identifying and expressing feelings related to key unresolved life issues.
2. The client was assigned the exercise “Surface Behavior/Inner Feelings” in the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, and McInnis
3. As the client shared his/her feelings regarding life issues, he/she reported a decreased level of emotional intensity around these issues; he/she was reinforced for this progress.
4. It was difficult for the client to get in touch with, clarify, and express emotions, as his/her pattern is to detach himself/herself from feelings; this pattern was reflected to the client.
Assign Ericksonian Task (38)
1. The client was assigned an Ericksonian task of performing a behavior that is centered around the obsession or compulsion instead of trying to avoid it.
2. As the client has faced the issue directly and performed a task, bringing feelings to the surface, the results of this were processed.
3. As the client has processed his/her feelings regarding the anxiety-provoking issue, the intensity of those feelings has been noted to be diminishing.
4. The client has not used the Ericksonian task and was redirected to do so.
Create Strategic Ordeal (39)
1. A strategic ordeal (Haley) was created with the client that offered a guarantee of cure for the obsession or compulsion.
2. The client has engaged in the assigned strategic ordeal to help him/her overcome the OCD impulses.
3. It was noted that the strategic ordeal has been quite successful at helping the client reduce OCD symptoms and feelings of anxiety.
4. The client has not been successful at implementing the strategic ordeal consistently and was encouraged to do so.
Obtain Detailed Family History (40)
1. A detailed family history was obtained, including important past and present interpersonal relationships and experiences.
2. Dynamics that may contribute to the emergence, maintenance, and exacerbation of the OCD symptoms were identified.
3. The client was assisted in gaining insight into the connection between past and present interpersonal relationships and the emergence of the OCD symptoms.
Address Family Issues (41)
1. Family therapy sessions were conducted in order to address past and/or present conflicts.
2. The dynamics of family issues and how they contribute to the emergence, maintenance, and exacerbation of the OCD symptoms were reviewed within the family therapy sessions.
Encourage Skills to Decrease Hoarding (42)
1. The client was encouraged to use cognitive and behavioral coping strategies while reducing hoarded items from possession.
2. Calming skills, cognitive restructuring, distraction, and ritual prevention techniques were emphasized as a way to combat symptoms when reducing hoarded items from possession.
3. The client was assigned the exercise “Decreasing What You Save or Collect” from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
4. The client was reinforced for his/her regular use of cognitive and behavioral coping skills as he/she has reduced hoarded items from possession.
5. The client has not regularly used cognitive-behavioral coping strategies to reduce hoarded items from possession, and was provided with remedial feedback in this area.