Intrusive Thoughts and Compulsions in Adolescent OCD A Psychoanalytic Framework for Treatment

Table of Contents

Dedication
Disclaimer
Foreword
Note for Clinicians
A Note on Language

Chapter One   The Heart of It

Chapter Two   Beyond the Label: Differentiating OCD in Practice

Chapter Three   From Infancy to Intrusions: Early Mechanisms in Adolescent OCD

Chapter Four  From Childhood Shadows to Adolescent Storms

Chapter Five   Before the Thought, the Feeling

Chapter Six     What We Know Works

Chapter Seven  The Threshold

Chapter Eight    The Claustrum Position in OCD

Chapter Nine The Psychic Retreat

Chapter Ten The Paranoid–Schizoid Position

Chapter Eleven The Depressive Position

Chapter Twelve  Measuring the Invisible — Integrating Reflection and Evidence

Chapter Thirteen  Closing Reflections

References

Index

Biography

Marcus Lewton is a child and adolescent clinical psychologist based in the UK. His work in independent practice and public services focuses on a wide range of adolescent mental health issues, with a specialist interest in intrusive thoughts and OCD.

'Written with moving clarity and deep compassion, this book brings together psychoanalytic insight and evidence-based practice in a truly integrative way, widening the frame beyond protocol and offering clinicians a framework for listening beneath symptoms to the emotional storms endured by adolescents living with OCD.  This book manages a rare achievement of being both conceptually robust and pragmatically adaptable, while keeping at its heart a steadfast commitment to help young people who are suffering to find meaning, connection, and hope.'

 Dr Rosa Hoshi, MSc, PhD, DClinPsy, C. Psychol, HCPC Reg Senior Tutor & Equality Diversity, Lead, Chartered Clinical Psychologist Cardiff University 

'This is a rare and remarkable book, that blends clinical insight with genuine heartfelt dedication to young people struggling with OCD. Clinicians will find practical guidance, rich psychological nuances and the writers compassionate voice that strengthens both their understanding and therapeutic presence. This book offers rich exploration of relational dynamics and clinical sensitivity that is relatable, engaging and insightful. It is thoughtful, grounded and attuned to realities of therapeutic work. Reading through the chapters, it is both practical and profound, and will undoubtedly enrich the work of therapists across all orientations. This book not only broadens our understanding of psychological struggle and resilience but also an invitations to a meaningful dialogue with their own inner selves.  A valuable book that enlightens the mind and touches the heart.'

Dr Manisha Kale, PhD, C.Psychol, HCPC Reg, UKCP (Systemic Psychotherapist), Chartered Clinical Psychologist & Systemic Psychotherapist, Child and Adolescent Mental Health Services (CAMHS) 

'As a psychotherapist working with families of distressed adolescents, I found this book a refreshingly clear summary of key ideas and concepts for clinicians at all stages working with OCD specifically, and with adolescence more generally. Additionally, the book uses language that reduces shame and avoids jargon to offer deep insight from the perspective of both practice-based evidence and evidence-based practice. Not only is this book invaluable for those working with such complex and distressing conditions, it is also a great example of how to write such a book to support and extend that work.
Working as I do with a focus on the relational and systemic aspects of mental distress, I find it particularly useful that the central premise privileges relationship. Readers are reminded that what matters is not the content of symptoms, but the relationship the adolescent has with them. What matters too is the relationship between client and therapist. And what matters most is the relationship parents have with their distressed child and the hope offered them here of permanent change for the better.'

Dr Anthony Brown, C.Psychol AFBPsS, Specialist Family & Systemic Psychotherapist, Child and Adolescent Mental Health Services (CAMHS) 

'This book is an invaluable resource rich, insightful, and deeply stimulating. Working daily with young people who experience obsessive-like symptoms, I found its practical strategies and fresh perspectives transformative. It offers new ways of thinking that will resonate with clinicians and families alike.' 

Megan Squire BSc (Hons), MSc Health Psychology, Child and Adolescent Mental Health Support Worker, CAMHS 
 
'I am delighted to recommend this timely book, which addresses a topic that is both bewildering and fascinating for clinicians. As Dr Lewton’s book rightly highlights, a sizeable proportion of cases involving children and young people with OCD know intellectually that compulsions do not reduce their exposure to harm. Yet, efforts at control and omnipotence lead to compulsions that are inherently self-reinforcing, limiting the effectiveness of evidence-based treatments. I have worked with many young people who have said, ‘I know the risk doesn’t exist—I just don’t know why I need to keep doing the compulsions.’ Dr Lewton’s text offers invaluable insights for clinicians, especially when compulsions serve as a form of psychological control and OCD becomes a way of organising the inner world during times of turmoil and upheaval.'

Dr Misbah Gladwyn-Khan, DClinPsy, C.Psychol, HCPC Reg (Clinical Psychologist), Adult Mental Health Services