Breaking the Rules: A Clinician's Guide to Treating OCD

OCD or Anxiety? It's Not a Black and White Question | Dr Celin Gelgec & Dr Tori Miller The question has been coming up in supervision a lot lately. Is this OCD — or is it GAD? Specific phobia? Health anxiety? Social phobia? It sounds like a simple diagnostic question. It isn't. In this episode of Breaking the Rules, Dr Celin Gelgec and Dr Tori Miller dig into one of the most common and most confusing clinical challenges in the OCD space — differentiating OCD from anxiety disorders that present in similar ways. They explore why OCD and anxiety so frequently co-occur, how anxiety disorders can morph into OCD over time, and why we're increasingly seeing subclinical OCD presentations in the clinic — and why that's actually a good thing. They also talk about what to do when you genuinely can't tell. Why the DSM is a guide, not a definitive answer. And why the most important thing you can do is take your client along with you through the process — because a diagnosis that happens to someone, rather than with them, rarely lands the way it needs to. Celin also shares a story about a client who'd worked through most of her trigger list — and then asked if she had to do the rest. What Celin said, and why, is one of the most honest things we've put in an episode about what it actually means to be done. In this episode, you'll learn: Why OCD was only separated from the anxiety disorders in DSM-5 (2013) — and what that tells us about how much they overlap The anxiety disorders most commonly confused with OCD: GAD, health anxiety, specific phobia, and social phobia Why untreated or poorly treated anxiety disorders can morph into OCD over time — and what to watch for Why subclinical OCD is showing up more often — and why that's worth treating early The key diagnostic features that separate OCD from GAD in practice How scrupulosity OCD gets missed as social phobia — and why it matters Why you don't need to know the answer straight away — and how to take your client through the process What discharge from OCD treatment actually looks like — and who gets to decide New episodes of Breaking the Rules drop fortnightly. Follow or subscribe so you don't miss one. www.melbournewellbeinggroup.com.au Hosted on Acast. See acast.com/privacy for more information.

ERP is the gold standard for OCD. But what happens when it's not enough on its own? In this episode of Breaking the Rules, Dr Celin Gelgec and Dr Tori Miller explore one of the most important — and least talked about — questions in OCD treatment: when and how to bring in other therapeutic modalities, and how to do it without abandoning the principles that make ERP work. Tori shares what traditional manualized ERP actually looked like in the early days of her career — rate your SUDS, watch the clock, wait for the anxiety to come down — and how the field has shifted since the inhibitory learning model changed the way we think about exposure. Celin reflects on her experience of always working in an integrated way, and why the principles of ACT have always felt like ERP to her — because they are. They also get honest about the moments when ERP becomes a battle. When the exposure menu turns into a war. When a client has every reason in the world not to engage — and what to do instead. Whether you're a clinician looking to expand your toolkit or someone living with OCD who's wondered why their therapist keeps talking about values and mindfulness - this episode will change how you think about what treatment can look like. In this episode, you'll learn: What traditional manualized ERP actually looked like — and how it's evolved Why the inhibitory learning model changed everything about how we approach exposure How ACT principles map directly onto ERP — and why urge surfing is response prevention The question to ask before bringing in any new modality: is this ERP-friendly? What to do when a client refuses to engage with the exposure hierarchy How schema therapy, DBT, and imagery rescripting can be woven into OCD work without softening exposure Why ERP has a 20% dropout rate — and what that tells us about why integration matters When to hold the line and when to shift gears — and how to know the difference Why getting your client's life back is always the goal, even when it doesn't look like ERP New episodes of Breaking the Rules drop fortnightly. Follow or subscribe so you don't miss one. www.melbournewellbeinggroup.com.au Hosted on Acast. See acast.com/privacy for more information.

Four years in, and we're going back to basics. In this episode of Breaking the Rules, Celin and Tori walk through the full OCD assessment process from the ground up - because with new listeners joining and so much focus on treatment in recent episodes, it felt like the right time to start at the beginning. How do you actually assess for OCD? What does a comprehensive clinical interview look like? When do you bring in psychometrics? And what happens when the OCD isn't responding to ERP the way it should? Celine and Tori cover the full assessment process — from taking a developmental history to using the Y-BOCS, working through the DSM-5 criteria, and navigating differential diagnosis. They also discuss PANDAS and PANS: the rare but important condition where OCD is triggered by an infection, why ERP alone won't work, and how asking one simple question about recent illness can completely change a treatment pathway. Whether you're a clinician new to the OCD space, refreshing the fundamentals, or someone who's wondered how OCD gets diagnosed — this one's for you. In this episode, you'll learn: Why a full developmental history is non-negotiable — even with adult clients The two age of onset clusters for OCD and why they matter How to use the Y-BOCS as an interview tool rather than a take-home questionnaire Why scoring the Y-BOCS isn't enough — and what you still need to check Jonathan Grayson's Freedom from OCD scale as an alternative for clinicians new to the space The DSM-5 criteria for OCD explained in plain language How to differentiate OCD from anxiety disorders, autism, OCPD, and other co-occurring conditions What the insight specifier really means — and why good insight doesn't mean mild OCD What PANDAS and PANS are, how to spot them, and why they require medical treatment first How a thorough assessment sets you up seamlessly for ERP Also featuring: a baby learning to roll over in the background. www.melbournewellbeinggroup.com.au Hosted on Acast. See acast.com/privacy for more information.

When Therapists Spiral Too: What OCD Taught Us About Ourselves Can therapists get caught in the same OCD traps as their clients? Absolutely. In this honest and vulnerable episode of Breaking the Rules, Dr Tori Miller and Dr Dr Celin Gelgec pull back the curtain on a real moment where a late-night social media post sent Celine into an OCD-style spiral of doubt, reassurance seeking and perfectionism. What started as curiosity quickly became hours of researching, second-guessing herself and questioning everything she thought she knew. Using this experience, they explore one of the most important concepts in OCD treatment: transference and countertransference. They discuss how therapists can unknowingly absorb a client's uncertainty, feel the urge to rescue, reassure or change course, and why recognising these reactions is essential for effective treatment. This episode is a powerful reminder that clinicians are human too. The goal isn't to eliminate uncertainty or become the perfect therapist—it's to notice what's happening, stay grounded, and continue modelling the very skills we ask our clients to practise every day. Whether you're an OCD clinician, a mental health professional, or someone living with OCD, this conversation offers valuable insight into perfectionism, uncertainty, and why learning to tolerate not knowing is at the heart of recovery. In this episode you'll learn: How therapists can become caught in the same uncertainty loops as their clients. What transference and countertransference look like in OCD treatment. Why noticing your own urges to rescue, reassure or "fix" can make you a better clinician. Learn more about Melbourne Wellbeing Group: https://melbournewellbeinggroup.com.au Hosted on Acast. See acast.com/privacy for more information.

Sex & OCD: The Theme No One Wants to Talk About Sex is one of the most misunderstood and least talked about themes in OCD - but it's also one of the most common. In this episode of Breaking the Rules, Dr Tori Miller and Dr Celin Gelgec explore how OCD can latch onto sex, relationships, identity and intimacy, creating overwhelming shame, fear and uncertainty for people of all ages. From sexual orientation OCD, relationship OCD and contamination fears around intimacy, to intrusive thoughts about loved ones, children or animals, they explain why these thoughts say nothing about who you are—and everything about how OCD operates. This episode is also a practical conversation for clinicians. Dr Tori and Dr Celine discuss how to ask the difficult questions, build enough trust for clients to disclose taboo themes, and create a therapy space where shame no longer has to be carried alone. They also explore how trauma can intersect with sexual-themed OCD, why careful assessment matters, and how Exposure and Response Prevention (ERP) can be adapted to support recovery. Whether you're living with OCD, supporting someone who is, or working as a mental health professional, this episode offers reassurance, practical guidance and a powerful reminder: intrusive thoughts are not intentions, and you are not defined by the content of your mind. In this episode you'll learn: Why sexual-themed OCD is far more common than most people realise. How shame keeps people trapped in silence and delays treatment. How clinicians can confidently assess and treat taboo OCD themes using evidence-based approaches. Learn more about Melbourne Wellbeing Group: https://melbournewellbeinggroup.com.au Hosted on Acast. See acast.com/privacy for more information.

OCD, Eating Disorders & ARFID: Where Do You Start? | Dr Alissa Knight (Part 2) In Part 2 of our conversation with eating disorder specialist with Dr Alissa Knight, we dive deeper into one of the most complex areas of mental health treatment: the overlap between OCD, eating disorders, autism, trauma, and ARFID. How do clinicians untangle symptoms when OCD and eating disorders are working together? What happens when OCD disguises itself as an eating disorder, or when an eating disorder hides behind OCD? And how do you know where to begin treatment when both conditions are causing significant distress? Dr Alissa shares her unique, person-centred approach to formulation, treatment planning, and building trust with clients who have often been misunderstood, misdiagnosed, or passed between services. She also provides practical insights into working with ARFID, including how Exposure and Response Prevention (ERP) can be adapted to help people gradually overcome intense fears around food. This episode is packed with clinical wisdom for psychologists, therapists, students, families, and anyone interested in understanding the deeper relationship between OCD and eating disorders. In this episode, you'll learn: • Why OCD and eating disorders so commonly occur together • How OCD can unintentionally protect and reinforce eating disorder behaviours • The difference between OCD-driven food restriction and eating disorder pathology • How to determine which condition to treat first • Why collaboration and client buy-in are essential for successful treatment • The role of trauma, autism and nervous system dysregulation in eating disorders • Practical ways to adapt ERP for ARFID treatment • Why rapport is often more important than any therapy model • The biggest mistakes clinicians make when working with eating disorders • How to help clients feel safe, understood and empowered in treatment Dr Alissa also shares a powerful reminder for clinicians: your greatest therapeutic tool isn't a treatment manual, it's your ability to connect with another human being. Whether you're treating OCD, ARFID, anorexia nervosa, or working with complex presentations, this episode offers a refreshing perspective on what effective and compassionate care can look like. To learn more about Dr Alissa Knight follow this link www.melbournewellbeinggroup.com.au Hosted on Acast. See acast.com/privacy for more information.

Eating Disorders, OCD & The Problem With Traditional Treatment | Dr Alissa Knight For the Season Premiere of Breaking the Rules, Dr Celin Gelgec and Dr Tori Miller are joined by eating disorder specialist Dr Alissa Knight from Calming Suite Psychology Clinic in Adelaide for a powerful and thought-provoking conversation about eating disorders, trauma, OCD, and why traditional treatment approaches may be failing many young people. After seeing Dr Alissa present at the Child and Adolescent Mental Health Conference, Celine and Tori knew they had to bring her onto the podcast. What follows is an honest discussion about the realities of eating disorder treatment, the fear-based messages many clinicians receive, and why genuine connection, trust, and understanding a person's full story may be far more important than rigid treatment manuals. Together, they explore the complex relationship between eating disorders and OCD, the role of trauma and attachment, why relapse rates remain so high, and how a more collaborative and compassionate approach can help people move towards true wellness rather than simply chasing "recovery." In this episode, you'll learn: • Why eating disorders are far more than food and weight • The hidden links between OCD, trauma, anxiety and eating disorders • How traditional treatment approaches can unintentionally damage trust • Why rapport and connection are often the most important therapeutic tools • The dangers of fear-based treatment and clinician burnout • How trauma-informed care can change outcomes for young people • Why wellness may be a more helpful goal than "recovery" • The challenges clinicians face when balancing medical risk and compassion This conversation challenges long-held assumptions about eating disorder treatment and offers a hopeful, human-centred perspective for clinicians, families, and anyone supporting a loved one through recovery. If you're a clinician, parent, educator, or someone living with OCD or an eating disorder, this is an episode you won't want to miss. To learn more about Dr Alissa Knight follow this link Hosted on Acast. See acast.com/privacy for more information.

In this episode of Breaking the Rules , we record from an unusual location — the bathroom floor of a public restroom — as we explore an increasingly popular social media trend: “clean girl culture.” Across platforms like TikTok and Instagram, the clean girl aesthetic promotes a polished, minimalist lifestyle — natural makeup, tidy wardrobes, “clean” eating, and curated routines that appear effortless and healthy. But when does a healthy routine become rigidity, anxiety, or compulsive behavior ? In this conversation we unpack how trends like clean girl culture can blur the line between wellbeing and preoccupation , and how certain aspects of the aesthetic can overlap with OCD patterns , particularly around contamination, checking, perfectionism, and the need for control. We also explore the broader question clinicians and individuals often face: how do we know when something has gone too far? In this episode we discuss: What “clean girl culture” is and why it’s trending on social media The appeal of curated lifestyles and polished aesthetics When healthy habits start becoming rigid or anxiety-driven Parallels with orthorexia and other wellness trends How social media trends can reinforce perfectionism and control When checking, reassurance seeking, and contamination fears creep in How compulsive behaviours can sometimes hide behind socially rewarded habits The importance of flexibility, connection, and values when evaluating lifestyle choices Questions clinicians can ask when assessing whether a habit has become unhealthy Ultimately, this episode isn’t about criticising trends — it’s about helping people reflect on the “why” behind their behaviours and recognizing when something that started as self-care begins to shrink a person’s life instead of expanding it. Hosted on Acast. See acast.com/privacy for more information.

In this episode of Breaking the Rules , we unpack one of the most confusing and frustrating parts of OCD treatment: extinction bursts . If you’ve ever started exposure therapy and felt like your intrusive thoughts suddenly became louder, more intense, or more frequent, you’re not alone. Many people interpret this spike in discomfort as proof that therapy isn’t working — when in reality, it can be evidence that change is actually happening. We explore what extinction bursts are, why they occur when people begin changing compulsive behaviors, and why the brain often reacts with a kind of “hissy fit” when long-standing patterns are challenged. This episode focuses on helping both clinicians and individuals understand that the initial surge in anxiety, intrusive thoughts, or urges isn’t failure — it’s often the brain’s attempt to pull you back into familiar safety behaviors. We also discuss practical ways clinicians can prepare clients for extinction bursts , coach them through these moments, and help them recognize these experiences as part of the change process rather than a sign that treatment is going wrong. In this episode we discuss: What extinction bursts are and why they happen Why OCD often gets louder when compulsions start changing How long-standing habits create powerful neural patterns Why many people misinterpret extinction bursts as therapy failure The role of psychoeducation in preparing clients for this phase of treatment Coaching clients to observe and ride out the “burst” Using curiosity instead of self-judgment during difficult moments Why discomfort during treatment can actually be evidence of progress Helping clients track patterns without becoming trapped in distress monitoring Reframing extinction bursts as a sign of meaningful change Hosted on Acast. See acast.com/privacy for more information.

In this episode of Breaking the Rules , we do something a little different — we guide you through a live experiential exercise used in therapy to demonstrate how Exposure and Response Prevention (ERP) actually feels in the moment. Using a simple jelly bean (or Mentos), we walk through an exercise that highlights one of the most important lessons in OCD treatment: the urge to escape discomfort can be powerful, but it can also be tolerated. Through this exercise, we explore how quickly the mind and body react to discomfort, how intrusive thoughts and urges show up, and how reconnecting with meaning and values can shift our relationship with those experiences. Experiential exercises like this are commonly used in ACT, DBT, and ERP therapy because they allow people to learn through doing , rather than just talking about the skills intellectually. In this episode we discuss: What experiential exercises are and why they are powerful in therapy Why learning skills during calm moments is different from using them during triggers The Mentos (or jelly bean) exercise used to simulate urge surfing and response prevention What happens in the mind and body when discomfort rises Intrusive thoughts, urges, and the instinct to escape discomfort The role of meaning and values in increasing distress tolerance Why acceptance changes our relationship to discomfort , not the discomfort itself How clinicians can use this exercise with clients, families, and teen group. Hosted on Acast. See acast.com/privacy for more information.

In this episode of Breaking the Rules , we explore one of the most frustrating and often misunderstood impacts of OCD - how it interferes with studying, productivity, and performance at work . For many people, OCD hides behind traits that are often praised: diligence, responsibility, perfectionism, and attention to detail. But beneath the surface, what may look like hard work or conscientiousness can actually be hours of painful compulsions, paralysis, and mental exhaustion . We unpack how OCD shows up in school, university, and the workplace — from endlessly rewriting emails and rereading textbooks, to missed deadlines, avoidance, and overwhelming fatigue. We also discuss how these patterns can sometimes be mistaken for ADHD, learning difficulties, or lack of motivation , making accurate assessment and treatment even more important. Most importantly, we share practical strategies clinicians and individuals can use to support functioning while treating the underlying OCD. In this episode we discuss: Why OCD often becomes most visible in study and work environments How compulsions like checking, rereading, researching, and reassurance seeking sabotage productivity The difference between perfectionism and OCD paralysis Why OCD is often misinterpreted as ADHD or executive dysfunction The emotional toll of feeling “ineffective” despite working incredibly hard Strategies for managing compulsions while studying or working Setting limits around checking, researching, and rewriting Learning the practice of “good enough” Rebuilding trust in your own judgement after OCD Using values to guide action when motivation disappears Hosted on Acast. See acast.com/privacy for more information.

In this episode of Breaking the Rules, we’re joined by researcher and clinician Dr. Clarissa Ong to unpack the complex relationship between perfectionism, anxiety, and OCD — and to explore how process-based therapy, particularly ACT, offers a powerful lens for understanding and treating these patterns. Drawing on her research and her book The Anxious Perfectionist, Clarissa helps us move beyond surface-level symptoms and into the underlying processes that drive rigidity, rule-following, self-criticism, and all-or-nothing thinking. We explore perfectionism not as a simple personality trait, but as a pattern of inflexible rule-governed behaviour — one that can show up across OCD, generalized anxiety, depression, eating disorders, and beyond. The conversation dives into how values can become fused with perfectionistic rules, how therapy itself can become “a thing to perfect,” and why flexibility — not flawless performance — is the real treatment target. 💬 Key themes: • Perfectionism as rigidity around internal rules and standards • The overlap between perfectionism, OCD, and generalized anxiety • Why perfectionism is often more process than diagnosis • ACT vs CBT in the treatment of perfectionism • Experiential work vs intellectualizing in therapy • How values can become hijacked by perfectionism • The “all-or-nothing” trap and treatment drop-off • The role of context in determining helpful vs unhelpful striving • Therapist perfectionism and projected expectations • Letting go of the need to be liked This conversation is especially valuable for clinicians wanting to deepen their formulations beyond symptom reduction and into process-based change. https://www.melbournewellbeinggroup.com.au Hosted on Acast. See acast.com/privacy for more information.

In this episode of Breaking the Rules , we explore when and why OCD tends to peak across the lifespan — and why symptoms often intensify during moments of growth, change, and meaning rather than out of nowhere. Drawing on clinical experience and developmental theory, this conversation looks at the predictable windows of vulnerability where OCD commonly emerges or flares: childhood and puberty, late adolescence and young adulthood, and major life transitions such as starting high school, exams, relationships, parenthood, grief, and identity shifts. Rather than focusing solely on symptoms, the discussion centres on formulation, psychoeducation, and normalisation — helping both clinicians and clients answer the critical question: why now? 💬 Key themes: The two most common ages of onset for OCD Puberty, hormones, and emotional intensity Individuation, identity formation, and existential anxiety Why OCD spikes when life becomes meaningful New parenthood, responsibility, and fear of harm How values drive OCD themes during transitions Understanding symptom “shape-shifting” across life stages Using developmental context to reduce fear and shame Anticipating flare-ups and planning support proactively 💡 “OCD often shows up when life matters most.” 🧠 “These thoughts tell us what we care about.” 💬 “Be alert, not alarmed.” 🔖 Chapters 00:00 Introduction: When does OCD peak? 01:30 Early onset and puberty 03:30 Adolescence, identity, and individuation 06:00 Hormones, emotions, and existential fear 08:00 Life transitions and meaning 10:00 New parenthood and responsibility 12:00 Why themes change over time 14:00 Using formulation to answer ‘why now?’ 16:00 Anticipating flare-ups and building support #OCD #MentalHealthPodcast #BreakingTheRulesPodcast #OCDRecovery #ClinicianSupport #LifeTransitions #PerinatalMentalHealth #AdolescentMentalHealth #TherapyTalk #MentalHealthAwareness Hosted on Acast. See acast.com/privacy for more information.

In this long-awaited episode of Breaking the Rules , we finally do a deep dive into contamination-themed OCD — one of the most common, misunderstood, and physically debilitating OCD presentations. This conversation goes far beyond clichés about handwashing and cleanliness. We unpack what contamination OCD actually looks like day-to-day: the pain, the exhaustion, the food avoidance, the disrupted routines, the impact on relationships, parenting, work, and health — and the quiet suffering that often goes unseen. We explore both physical contamination fears (germs, illness, food safety, asbestos, chemicals) and moral contamination , where people fear being “tainted” by proximity to someone or something that conflicts with their values. The episode also tackles one of the trickiest clinical questions: how to work with ego-syntonic rules without turning therapy into another rigid rule system. This is an essential listen for clinicians, clients, and loved ones wanting a clearer, more compassionate understanding of contamination OCD — and how ERP can be done flexibly, ethically, and effectively. 💬 Key themes: What contamination OCD really looks like behind closed doors Why it’s not about being “clean” or “house-proud” The physical toll: pain, skin damage, exhaustion, hunger Food avoidance, illness fears, and misdiagnosis with eating disorders Moral contamination and value-based fear Ego-syntonic vs ego-dystonic rules How to assess contamination OCD properly Flexibility vs rigidity in treatment ERP without reinforcing “right vs wrong” rules Helping clients choose values over compulsions 💡 “Contamination OCD holds people hostage.” 🧠 “This isn’t quirky — it’s devastating.” 💬 “There is no ‘right’ amount. Flexibility is the goal.” 🔖 Chapters 00:00 Why we avoided this topic (and why we’re doing it now) 01:00 What contamination OCD actually means 02:30 Moral contamination explained 05:00 The physical and emotional toll 08:00 Illness fears, COVID, and community safety 10:00 When contamination affects parenting and relationships 12:00 Ego-syntonic rules and client-led goals 14:00 Flexibility vs rigid hygiene rules 16:00 ERP and realistic exposure work 19:00 Messing up rituals and tolerating uncertainty 22:00 Assessment questions clinicians should be asking 25:00 Creative exposure ideas 27:30 Final reflections and encouragement #OCD #ContaminationOCD #ERP #TherapyPodcast #MentalHealthProfessionals #OCDRecovery #ExposureTherapy #BreakingTheRulesPodcast #ClinicianSupport #MentalHealthAwareness Hosted on Acast. See acast.com/privacy for more information.

In this reflective and practical episode of Breaking the Rules , the hosts unpack a phrase that shows up constantly in therapy rooms: “I don’t feel ready.” What does it actually mean? Is readiness a feeling—or is it a decision we make in the presence of fear, uncertainty, and discomfort? Using OCD as the primary lens, this conversation explores how clients often wait for certainty, calm, or clarity before taking action—and how that waiting quietly reinforces avoidance. The discussion moves beyond symptom management and into the deeper work of distinguishing thoughts vs feelings , building emotional literacy, and helping clients move forward despite anxiety rather than waiting for it to disappear. This episode is especially valuable for clinicians working with ambivalence , treatment resistance , or clients who feel “stuck” before starting ERP or making meaningful behavioural change. 💬 Key themes: Why “ready” is not an emotion—but a choice The difference between thoughts, feelings, and bodily sensations How emotional reasoning keeps OCD in control The trap of waiting for certainty before acting Using ACT, motivational interviewing, and values-based action Helping clients name fear, dread, shame, and excitement accurately Why language matters in therapy—and how it can open or close change Moving clients out of intellectual insight and into embodied experience Supporting behaviour change without reassurance or avoidance 💡 “Ready is not a feeling—it’s a decision.” 🧠 “Certainty is the fantasy OCD keeps chasing.” 💬 “Of course you’re scared—and you can still act.” 🔖 Chapters 00:00 Introduction and the origin of the idea 03:00 What clients mean when they say “I don’t feel ready” 05:00 Readiness, certainty, and the OCD trap 07:00 Thoughts vs feelings: why we confuse them 09:30 Emotional reasoning and avoidance 11:00 Values-based action and willingness 13:00 Naming emotions vs shutting change down 15:00 Anxiety, excitement, and bodily sensations 17:00 Moving from insight to action 19:00 Why waiting for readiness keeps clients stuck 21:00 Final reflections for clinicians #OCD #TherapyPodcast #MentalHealthProfessionals #ERP #ACT #BehaviourChange #ValuesBasedLiving #BreakingTheRulesPodcast #ClinicianSupport #AnxietyRecovery Hosted on Acast. See acast.com/privacy for more information.

In this in-depth episode of Breaking the Rules , we unpack two commonly confused but fundamentally different clinical presentations: moral scrupulosity (OCD) and Obsessive Compulsive Personality Disorder (OCPD) . While they may look similar on the surface—perfectionism, rigid values, intense guilt—the treatment implications couldn’t be more different. The conversation explores how moral scrupulosity shows up across children, teens, and adults, often hiding beneath “good behaviour,” people-pleasing, over-apologising, and chronic self-monitoring. We also dive into why some clients become stuck in ERP when the underlying issue isn’t OCD at all, but rigidity, control, and ego-syntonic perfectionism associated with OCPD. This episode is especially valuable for clinicians navigating stuckness , treatment resistance, or confusing presentations—and for anyone who has ever felt trapped by the need to be a “good person.” 💬 Key themes: What moral scrupulosity really looks like in OCD Why guilt, confessing, and reassurance-seeking are so sticky How moral scrupulosity differs from OCPD at a structural level Why ERP works for OCD—but often fails for OCPD The role of values, culture, religion, and social media pressure Common compulsions: confessing, rumination, reassurance, over-apologising When rigidity is fear-driven vs personality-based How to treat OCPD using schema, ACT, and DBT-informed approaches What to do when moral scrupulosity and OCPD co-occur 💡 “OCD hijacks your values and turns them against you.” 🧠 “Good people still have messy thoughts.” 💬 “Rigidity isn’t always anxiety—sometimes it’s identity.” 🔖 Chapters 00:00 Introduction and why this topic matters 02:00 What is moral scrupulosity? 05:30 Why it’s common in kids and teens 08:00 Defining OCPD and why it’s often mislabelled as OCD 11:00 Key differences between OCD and OCPD 14:00 Guilt, confessing, and moral pressure in adolescents 17:00 Social media, cancel culture, and moral anxiety 20:00 Common compulsions in moral scrupulosity 22:00 Psychoeducation vs reassurance 24:00 ERP exposures for moral scrupulosity 27:00 Treating OCPD: flexibility over exposure 30:00 When moral scrupulosity and OCPD overlap 33:00 Differential diagnosis, supervision, and formulation 36:00 Clinical honesty and naming rigidity in the room #OCD #MoralScrupulosity #OCPD #TherapyPodcast #MentalHealthProfessionals #ERP #Perfectionism #ValuesBasedTherapy #ClinicianSupport #BreakingTheRulesPodcast Hosted on Acast. See acast.com/privacy for more information.

In this thought-provoking episode of Breaking the Rules, the hosts explore how values and paradox show up in the therapy room—especially when working with clients who experience OCD. Drawing from Acceptance and Commitment Therapy (ACT) principles, they discuss how being “fused” with one’s values can keep clients stuck in rigidity, perfectionism, and fear of imperfection. The conversation dives into the art of helping clients find flexibility between competing values—like control vs trust, safety vs freedom, and perfectionism vs growth—and how learning to hold both truths can open the door to meaningful change. They also unpack how clinicians can use values-based reflection, curiosity, and compassion to move clients beyond “sitting with uncertainty” toward truly living aligned, balanced lives. 💬 Key themes: • What it means to be fused with thoughts and values • Common paradoxes in OCD (purity vs imperfection, safety vs health, control vs trust) • Using values work to build insight and reduce rigidity • The connection between values, uncertainty, and acceptance • Why “sit with uncertainty” isn’t enough without context • Mapping paradoxes and value clashes in therapy • How building self-concept helps clients reclaim life beyond OCD 🔖 Chapters 00:00 Introduction: Values and Paradox in OCD 02:00 What It Means to Be Fused with Thoughts and Values 05:00 Why Clients Get Stuck in Rigidity 08:00 Common Paradoxes in OCD 11:00 The Cost of Perfectionism and Fear of Imperfection 14:00 Exploring Value Clashes in Therapy 17:00 Building Insight and Flexibility 20:00 Beyond “Sit with Uncertainty”: Context and Meaning 22:30 Rebuilding Self and Identity Outside OCD #OCD #TherapyPodcast #AcceptanceAndCommitmentTherapy #MentalHealthMatters #ValuesBasedTherapy #ACT #BreakingTheRulesPodcast #ClinicianSupport #OCDRecovery #TherapyTalk #UncertaintyTolerance Hosted on Acast. See acast.com/privacy for more information.

In this powerful and insightful episode, we explore the connection between PTSD and OCD, two conditions that often intersect in complex and misunderstood ways. The discussion dives into how trauma can shape obsessive-compulsive patterns, how compulsions can emerge as coping mechanisms, and why a trauma-informed approach is essential for effective treatment. The speakers unpack the challenges of working with co-occurring trauma and OCD, emphasizing flexibility, creativity, and compassion in clinical work. From ERP integration to managing dissociation and building client insight, this conversation offers a nuanced understanding of how clinicians can hold both trauma and OCD safely in the therapy room. 💬 Key themes: • How trauma can trigger or intensify OCD symptoms • Compulsions as coping mechanisms for post-traumatic stress • Why ERP and trauma therapy can complement each other • The importance of trauma-informed care in OCD treatment • Recognizing and managing dissociation during therapy • Building client insight and resilience through psychoeducation • Empowering clinicians to work confidently with trauma and OCD 🔖 Chapters 00:00 Understanding PTSD and OCD 02:55 The Interplay of Trauma and OCD 05:42 Navigating Treatment Challenges 08:53 Integrating ERP with Trauma Therapy 11:55 Building a Trauma-Informed Approach 14:54 Fluidity in Therapeutic Techniques 17:49 Empowering Clinicians to Address Trauma 23:44 Conclusion and Encouragement for Clinicians #PTSD #OCD #TraumaInformedCare #ERP #MentalHealthPodcast #TherapyTalk #ClinicianSupport #TraumaRecovery #OCDTreatment #CopingMechanisms #TherapyForTrauma Hosted on Acast. See acast.com/privacy for more information.

In this insightful episode, we explore the concept of parental accommodation — the well-intentioned ways family members and loved ones may unknowingly reinforce OCD behaviours. Drawing from the research of Professor Eli Liebowitz (Yale) and real-world clinical experience, the hosts unpack how accommodation develops, why it’s so hard to stop, and how families can begin to make meaningful change. From checking, reassuring, or adapting routines “just to keep the peace,” to facing meltdowns, fear, or guilt when setting limits — this conversation goes deep into what it means to hold boundaries with compassion. You’ll hear about ERP therapy, the SPACE model, and practical ways clinicians and parents can work together to reduce accommodation and empower recovery. 💬 Key themes: • What “parental accommodation” means and how it maintains OCD • Why well-meaning reassurance can make symptoms stronger • The difference between anxiety disorders and OCD • Supporting children, teens, and adults through distress safely • Helping parents tolerate their own emotions and model resilience • How reducing accommodation can rebuild connection and trust in families • Managing clinician fears around self-harm threats and safety planning 🔖 Chapters 00:00 Introducing the topic: Parental Accommodation and OCD 02:00 What it means to accommodate and why we do it 05:00 How everyday reassurance turns into OCD reinforcement 08:00 Fear, meltdowns, and why it’s hard for families to stop accommodating 11:00 Emotions, modelling, and learning to tolerate discomfort 14:00 The SPACE model and clinician guidance 17:00 Working with parental fear and client safety 21:00 Reducing accommodation step-by-step 25:00 Supporting families when clients resist change 26:40 Why it works — even if the client isn’t in therapy #OCD #ERP #ParentalAccommodation #MentalHealthPodcast #TherapyTalk #FamilyTherapy #SPACEModel #OCDRecovery #ClinicianSupport #ParentingAndMentalHealth #EmotionalRegulation Hosted on Acast. See acast.com/privacy for more information.

The perinatal period is one of the most vulnerable—and transformative—times in a parent’s life. In this episode, we explore the challenges of perinatal mental health , with a particular focus on OCD and how intrusive thoughts can impact new parents during this stage. Our speakers discuss the role of psychoeducation , the importance of therapeutic trust , and how clinicians can best support parents navigating overwhelming thoughts and fears. We also examine the value of bringing babies into therapy , collaborative care , and the crucial reminder that intrusive thoughts do not define someone’s ability to be a loving, capable parent. 💬 Key themes: Why the perinatal period heightens vulnerability The role of OCD and intrusive thoughts in early parenting Using psychoeducation to normalize and reduce shame Building rapport so clients feel safe to share difficult thoughts The potential benefits of including babies in therapy sessions Collaborative care and supporting parents holistically 🔖 Chapters 00:00 Introduction to Perinatal Mental Health and OCD 02:50 Understanding Vulnerability in the Perinatal Period 05:47 Therapeutic Approaches for Clinicians 08:47 The Importance of Psychoeducation 11:45 Building Rapport and Trust with Clients 14:50 Managing Intrusive Thoughts in Therapy 17:49 Collaborative Care and Support Systems 20:51 Incorporating Babies in Therapy Sessions 23:45 Creating a Supportive Environment for New Parents #PerinatalMentalHealth #OCD #IntrusiveThoughts #NewParents #MaternalHealth #TherapyTalk #ParentingSupport #MentalHealthAwareness #Psychoeducation #ClinicianSupport Hosted on Acast. See acast.com/privacy for more information.