Hello! I am hoping to brainstorm some ideas regarding making a plan around showering. I am currently working with a family who would like to address their child's long morning routines, specifically her 2 hour showers. The family is required to change their own shower schedule, as well as modify their own bathroom routines. This causes a significant ripple effect on how the family starts their days. Parents have even discussed the increase in their water bills. When looking at the criteria to pick an initial accommodation, parents would like to start with how to lessen their accommodation around allowing her to take a shower for as long as she needs. The first thought would be to gradually shorten how long she is allowed to shower (instituting a timer), and even turning off the water for the entire house so other children would be able to utilize the bathroom. The reason why I take pause is because it is requiring their daughter to change her behavior, and not just the parents. In theory, how can the family maintain their schedules without impeding on her privacy? Has anyone else made a plan around showering/morning routines? Any suggestions or ideas would be extremely helpful! Thank you!
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The approach involved in SPACE, is to help the adults change their behavior and withdraw accommodation. This means changing what they do not trying to change the child's behavior directly. Showering for long periods of time is a common behavior in people with OCD. It is consistent with SPACE to control what parents can control and stop accommodating the childs long showers. This could turning on and off water supply or perhaps turning off the hot water only. It could also involve not providing supplies or rationing supplies of soap or other products.
Use of timers and similar interventions may work as part of CBT for this type of behavior, but it is an attempt to directly change the behavior of the child which is not part of SPACE. It is true that some interventions might impact the child's privacy, but that doesn't automatically mean the intervention is not acceptable.
You need to begin by functional analysis. Behaviors by the parent that accommodate the child reinforce the anxiety problem.