Dear Therapist:

My teenage son (18) had been struggling with anxious and obsessive thoughts and went to see a therapist based on the recommendation of our rov. He was also told by the rov that medication could be an option as well. He was very against taking medication, probably out of a concern for shidduchim, and decided to just try therapy. The issue is that since he knows that the option of medication is out there, he has been harping on that over and over. He is ruminating that maybe medication is the best way to go and would be most helpful etc. I believe that this is interfering with him being invested and committed to the therapy. Do you have any suggestions for dealing with this?

Response:

It seems to me that the issue is rather straightforward. As you mentioned, your son is prone to anxiety and obsessive thoughts. Until relatively recently, obsessive-compulsive disorder was considered an anxiety disorder. In the latest iterations of the diagnostic book, OCD has been granted its own category.

Whether or not OCD is officially considered an anxiety disorder is meaningless to me in a practical sense. In fact, obsessions (and the compulsions that often follow) are, in my estimation, usually symptoms of anxiety. For example, if I have an unconscious fear of being attacked, I may consciously obsess about the locks on my doors. Since I am not consciously aware of my underlying fear, I spin my wheels trying o relieve the “itch” that I have about the locks being properly latched. Thus, I create and follow a ritual in which I check each lock exactly eight times. Of course this only relieves the immediate tension, in effect reinforcing repression of the underlying fear.

Your son seems to have anxiety that is manifesting, at least in part, as obsessive thoughts. His repetitive concerns regarding medication are likely another manifestation of these obsessive thoughts. I cannot speak to whether medication is an option for him; this is something that should be discussed with his therapist and a psychiatrist. However, being that his medication concerns appear to be yet another symptom of OCD/anxiety, I would assume that this is something that is being addressed by his therapist.

This does not necessarily mean that your son and his therapist are working directly on reducing his obsessive thoughts with regard to medication (although it very well might). It does, however, mean that this should at least be discussed as a part of the larger obsession and anxiety issue. The more that your son understands his underlying fears and is able to face them without obsessions or compulsions, the less anxious he will become.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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