Strategic Pressure for OCD: The Treatment of Last Resort

Jonathan Grayson, PhD Presenter
The Grayson LA Treatment Center of Anxiety & OCD
Pasadena, CA 
United States
Thursday, March 28: 9:30 AM  - 11:30 AM 
Master Clinician Session 
Meeting Room Level 2 
Room: Arkansas 



Although research and clinical practice has found that OCD can be overcome through the treatment using of exposure and response prevention, families and parents often find themselves struggling with a sufferer who refuses treatment. The results of this are devastating upon everyone. Sufferers with the potential for fulfilling lives may become housebound for countless years. Families, desperate to help, but helpless because they don't know how, often become prisoners of sufferers' obsessions. Too often these sufferers are told treatment won't be possible until they are ready. Unfortunately, these people have given up on their lives and there often seems to be no "rock bottom" that wakes them up. Strategic Pressure is an intervention developed by Lee Fitzgibbons and me to help treatment refusers and their families. Through the use of family pressure and a series of hierarchical forced choices, treatment refusers can make progress and can make the transition to active treatment participants. As with many techniques, this seemingly simple approach is complicated to successfully implement. The presentation will focus on: 1) the mechanics and rationale underlying strategic pressure; 2) strategic pressure's strengths and limitations; 3) advantages and disadvantages of strategic pressure compared to other approaches, (e.g., intensive OCD inpatient programs); 4) ethical considerations; and 5) illustrative case presentations and their outcomes.

Learning Objectives

1. Attendees will understand the rationale for using Strategic Pressure and how to determine when it is appropriate to institute Strategic Pressure.

2. Attendees will learn how to motivate and educate families about their role in strategic pressure.
3. Attendees will learn the how to create therapeutic forced choices and how to transform the treatment refusing patient into a collaborator in his/her own program. 

Audience Level



Children & Adolescents


Diversity - No


120 minutes


Obsessive Compulsive Disorder

Treatment Approach

Exposure Therapy