A case study integrating CBT with narrative therapy externalizing techniques with a child with OCD: How to flush away the Silly Gremlin. A single-case experimental design

Problem: Evidence exists for the use of cognitive behavioral therapy (CBT) combined with externalizing techniques from narrative therapy for pediatric obsessive compulsive disorder (OCD); however, no research gives a detailed account of what the externalizing process looks like in session or how it is incorporated into conceptualization. Literature is appraised with respect to the referral, assessment, formulation, intervention and outcome. Methods: The case describes a 10-year-old boy who was referred with severe OCD. The evidence-based CBT model for OCD in child and adolescent populations was applied to the case. This was integrated with the externalizing technique from narrative therapy. Using these models, a shared formulation of the difficulties was developed, and created a new narrative. The intervention was assessed using the single-case experimental design. Findings and Conclusions: On all but one routine outcome measure positive clinically significant changes were made, and the young person managed to reach his therapeutic goals. Gains maintained over a month follow-up period. The use of externalizing was an effective and developmentally appropriate intervention and is discussed further. The case highlighted the need for more research detailing externalizing processes.