Understanding Intrusive Thoughts Service (UITS)

“I can’t reassure them anymore.” “I feel like I’m failing.” Parents of teenagers with OCD say some version of this to me constantly, and none of them are failing. In this post, Marcus Lewton introduces his new book, When Your Teenager’s Mind Gets Loud, and makes the case that NICE guidance on adolescent OCD, unchanged since 2005, leaves parents carrying more than anyone tells them to expect.

Whenever I find myself working with an adolescent and their family where OCD has begun to take hold, there is a point in the work that arrives with a certain predictability. A parent, often after a period of careful listening and reflection, will ask what they should actually do. By then they usually understand the reassurance seeking cycle. They can see how they’ve been drawn into it, how their responses, given with care, have also been maintaining something that no one real

My experience of health and illness anxiety in adolescents has gradually moved me away from thinking of it as a primarily cognitive problem. This was not where I started. My clinical training pointed clearly in a different direction, and for good reason. The cognitive model of health anxiety is a genuinely compelling one. The account offered in texts like the Oxford Guide to Cognitive Behavioural Therapy, and in the broader clinical literature, makes a strong case: that what

Conversations with Child Psychotherapists

Even after 8–10 years of ERP, most don’t recover. The data is clear. So why are we still treating OCD like a procedural problem?

To many in government, a child’s mind is a datapoint. But some suffering isn’t measurable—it’s symbolic, not yet sayable, still surviving.

Why are my daughter’s intrusive thoughts so much darker than mine? A blog for the parent who quietly wonders—and wants to understand.

Repetitive thoughts aren’t always questions—they’re often cries. Listen beyond logic. It’s not about the answer. It’s about the feeling.

If your child won’t talk about their thoughts, don’t panic. Silence isn’t failure—it’s a signal. Here’s what to do instead.

Stop cataloguing rituals. Start listening for what breaks if they don’t happen. Treat the structure, not just the symptom.

Is your child expressing something—or just repeating it? Learn how to tell if a ritual is symbolising, or if it’s stuck in survival mode.

To abandon symbolic work is to leave the child un-met, and the therapist untouched. We must reclaim meaning, or risk becoming procedural.