Writing on Adolescent OCD and Emotional Life

An intrusive thought is not a moral offence, but OCD can make it feel as though it is. For some adolescents, a frightening image or unwanted thought becomes an imagined sin, followed by a private demand for payment: confess, check, avoid, seek reassurance, give something up. This essay considers why the punishment can seem to match the fear, and what may help loosen that cruel logic.

Why does one adolescent become preoccupied with a particular intrusive thought while another fears something entirely different? This piece explores the idea that intrusive thoughts are not random. Their content may gather around what is most emotionally alive, morally charged and developmentally unsettled in the young person’s inner world. Understanding that context can reduce shame and help explain why this thought, for this adolescent, at this moment.

By the time a young person reaches CAMHS, their OCD has usually been described many times. The clinician may know the rituals, the risk concerns and the reassurance being sought at home, yet know very little about the young person. Meltzer helps us think about what enters the room with them: the institution, the pressure for certainty and the fear that an intrusive thought will be treated as a confession. The task is to create an encounter in which thought remains possible.

What if compulsive checking is not simply an attempt to remove doubt, but a retreat from a question that cannot be answered? Drawing on Donald Meltzer’s idea of aesthetic conflict, this piece considers how adolescent OCD may convert the uncertainty of bodies, parents and other minds into rituals with rules. The compulsion offers a procedure where emotional life offers none.

In Chapter 13, Closing Reflections, of Intrusive Thoughts and Compulsions in Adolescent OCD, I argued that what mattered most clinically was not the content of an adolescent’s obsessions or compulsions, but the relationship they had with them. Since finishing the book, one question has stayed with me: could this framework apply more broadly? The more I reflect on it, the more cautious I have become

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?

Not all dark thoughts in adolescence are perverse. Some are collapse. Know the difference—and listen for structure, not content.

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

MERP teaches us something Bion knew all along: we must think about thought—not just resist it—if we are to metabolise experience.

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

Listening to psychic architecture means attuning to deep emotional structures beneath symptoms—containment, presence, warmth, care.

Can we treat OCD without understanding it? A fictional debate between two clinicians explores timing, structure, and symbolic readiness.

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.

When OCD rituals don’t respond to logic, it’s not defiance—it’s emotional code. Learn how to listen for what’s really being said.

What if OCD isn’t one condition, but four psychic positions? A new way to understand rituals, retreat, and recovery in young people.

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

When a young person stops symbolising, rituals remain—but meaning drains out. Symbolic collapse is quiet, but devastating. (Lecture 2).

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