The Ickiness Factor: Pediatric OCD Case Study and Therapeutic Approach

This case study, titled "The Ickiness Factor," presents the treatment of a 12-year-old girl, Cassandra, with severe obsessive-compulsive disorder (OCD) admitted to a psychiatric inpatient unit. The paper details the use of a combined therapeutic approach, including psychodynamic, narrative, existential, and metaphor therapies, alongside more conventional treatments like cognitive-behavioral therapy (CBT) and medication management. The study highlights the challenges of countertransference and the importance of a reparative therapeutic alliance. The case study begins with Cassandra's history, including the onset of her OCD symptoms, which involved contamination obsessions, ritualistic behaviors, and family accommodation. Despite initial resistance to treatment and a poor therapeutic alliance with CBT, the integration of psychodynamic and narrative approaches, including the creation of a fictional character, led to a dramatic remission of her symptoms. The author argues for the value of integrating diverse therapeutic modalities, particularly in cases where traditional approaches prove insufficient, and emphasizes the significance of addressing complex psychodynamic conflicts in young patients. The paper also discusses the impact of OCD on the patient's functioning at home and school, and the need for exploring broader and more integrated treatments.