This article describes the course of treatment for a 10-year-old boy presenting with a particularly challenging manifestation of pediatric Obsessive-Compulsive Disorder (OCD). Guided by a manualized cognitive-behavioral protocol, cognitive and exposure-based techniques were tailored to “match” the clients' interests and content of symptoms (stabbing self and mother). Several sources of information (continuous self-monitoring, rating scales, self-and parent-report) indicated significant treatment gains that were sustained 3 months posttreatment and offer possible insight as to the relative efficacy of treatment components. Several challenges were encountered, most notably designing and supervising exposure exercises involving sharp objects. Several treatment implications are discussed including tailoring manualized treatments, managed care issues, and recommendations for students, clinicians, and supervisors.
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