Writing on Adolescent OCD and Emotional Life

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.

“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.

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

You don’t need to be perfect. You need to stay in the room. What to say when you’re scared to say the wrong thing to your child.

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.

When reassurance doesn’t work, it’s not because you’re doing it wrong. Sometimes, it’s not about answers—it’s about staying close.

A parent’s first glimpse of OCD isn’t always a diagnosis—it’s the sense that their child is there, but behind a door they can’t yet open.