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

Episoder

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  I Think My Child Might Have OCD: What Do I Do? 21.09.2026 33min

  This one's for the parents.In this episode of Breaking the Rules, Dr Celin Gelgec and Dr Tori Miller tackle one of the most common questions they hear from families - I think my child might have OCD. Where do I even start?The episode begins with Celin sharing a moment from a school tour with her three-year-old daughter — catching herself wondering whether her daughter's leaf-counting was a compulsion, before laughing and pulling herself back. It's a perfect illustration of what happens when you know too much. And also of the core question this episode explores: how do you tell the difference between normal childhood behaviour and something worth paying attention to?They walk through the watch, wait, wonder principle — why not rushing in to diagnose, label, or rescue is often the most helpful thing a parent can do. They explore what normal development looks like at different ages, why the 7–12 age group is when OCD most commonly first emerges, and what the telltale signs are that something has shifted from typical childhood anxiety to something more persistent.They also get practical — what to do if you're worried, who to talk to, and which resources are worth your time.Warm, funny, honest, and genuinely useful. Whether you're a parent with questions, a clinician who works with families, or someone who grew up with OCD and is finally making sense of it — this one's for you.In this episode, you'll learn:Why context and developmental age are everything when it comes to reading your child's behaviourThe watch, wait, wonder principle — and why not rushing in is actually the most helpful thing you can doWhat typical development looks like at different ages — and why so much of what looks like OCD is actually completely normalWhy the 7–12 age group is when OCD most commonly begins — and what developmental factors contribute to thatThe difference between typical childhood anxiety and reassurance-seeking vs OCD-specific patternsThe telltale signs that something has shifted — frequency, intensity, impact on functioning, and family lifeThe one sign that's most specific to OCD: when one reassurance is never enough, and it needs to be said in just the right wayPractical next steps — GP, maternal child health, psychologist, and the community resources worth knowing aboutWhy your job as a parent is not to stop what's happening — it's to help them with what's happeningResources mentioned:Anxiety Recovery Centre of VictoriaInternational OCD Foundation — iocdf.orgNatasha Daniels — YouTube and parenting communityEli Lebowitz — resources for familiesNew 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.
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  OCD or Anxiety? It's Not a Black and White Question 07.09.2026 31min

  OCD or Anxiety? It's Not a Black and White Question 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 overlapThe anxiety disorders most commonly confused with OCD: GAD, health anxiety, specific phobia, and social phobiaWhy untreated or poorly treated anxiety disorders can morph into OCD over time — and what to watch forWhy subclinical OCD is showing up more often — and why that's worth treating earlyThe key diagnostic features that separate OCD from GAD in practiceHow scrupulosity OCD gets missed as social phobia — and why it mattersWhy you don't need to know the answer straight away — and how to take your client through the processWhat discharge from OCD treatment actually looks like — and who gets to decideNew 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.
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  Getting Creative with OCD Therapy: When to Go Beyond ERP 24.08.2026 32min

  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 evolvedWhy the inhibitory learning model changed everything about how we approach exposureHow ACT principles map directly onto ERP — and why urge surfing is response preventionThe 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 hierarchyHow schema therapy, DBT, and imagery rescripting can be woven into OCD work without softening exposureWhy ERP has a 20% dropout rate — and what that tells us about why integration mattersWhen to hold the line and when to shift gears — and how to know the differenceWhy getting your client's life back is always the goal, even when it doesn't look like ERPNew 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.
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  Assessing OCD: The Complete Guide for Clinicians 10.08.2026 41min

  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 clientsThe two age of onset clusters for OCD and why they matterHow to use the Y-BOCS as an interview tool rather than a take-home questionnaireWhy scoring the Y-BOCS isn't enough — and what you still need to checkJonathan Grayson's Freedom from OCD scale as an alternative for clinicians new to the spaceThe DSM-5 criteria for OCD explained in plain languageHow to differentiate OCD from anxiety disorders, autism, OCPD, and other co-occurring conditionsWhat the insight specifier really means — and why good insight doesn't mean mild OCDWhat PANDAS and PANS are, how to spot them, and why they require medical treatment firstHow a thorough assessment sets you up seamlessly for ERPAlso featuring: a baby learning to roll over in the background.www.melbournewellbeinggroup.com.au Hosted on Acast. See acast.com/privacy for more information.
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  The OCD Trap Even Therapists Fall Into 27.07.2026 28min

  When Therapists Spiral Too: What OCD Taught Us About OurselvesCan 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.
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  Sex & OCD: The Theme No One Wants to Talk About 13.07.2026 35min

  Sex & OCD: The Theme No One Wants to Talk AboutSex 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.
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  When OCD Looks Like An Eating Disorder with Dr Alissa Knight: Part 2 29.06.2026 32min

  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 treatmentDr 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 linkwww.melbournewellbeinggroup.com.au Hosted on Acast. See acast.com/privacy for more information.
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  The Truth About Eating Disorder Treatment with Dr Alissa Knight: Part 1 15.06.2026 21min

  Eating Disorders, OCD & The Problem With Traditional Treatment | Dr Alissa KnightFor 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 compassionThis 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.
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  Exposure Therapy in a Public Bathroom 18.05.2026 16min

  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 mediaThe appeal of curated lifestyles and polished aestheticsWhen healthy habits start becoming rigid or anxiety-drivenParallels with orthorexia and other wellness trendsHow social media trends can reinforce perfectionism and controlWhen checking, reassurance seeking, and contamination fears creep inHow compulsive behaviours can sometimes hide behind socially rewarded habitsThe importance of flexibility, connection, and values when evaluating lifestyle choicesQuestions clinicians can ask when assessing whether a habit has become unhealthyUltimately, 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.
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  Why OCD Gets Worse Before It Gets Better (Extinction Bursts) 04.05.2026 19min

  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 happenWhy OCD often gets louder when compulsions start changingHow long-standing habits create powerful neural patternsWhy many people misinterpret extinction bursts as therapy failureThe role of psychoeducation in preparing clients for this phase of treatmentCoaching clients to observe and ride out the “burst”Using curiosity instead of self-judgment during difficult momentsWhy discomfort during treatment can actually be evidence of progressHelping clients track patterns without becoming trapped in distress monitoringReframing extinction bursts as a sign of meaningful change Hosted on Acast. See acast.com/privacy for more information.
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  What Exposure Therapy Actually Feels Like (The Mentos/Jelly Bean Exercise) 20.04.2026 16min

  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 therapyWhy learning skills during calm moments is different from using them during triggersThe Mentos (or jelly bean) exercise used to simulate urge surfing and response preventionWhat happens in the mind and body when discomfort risesIntrusive thoughts, urges, and the instinct to escape discomfortThe role of meaning and values in increasing distress toleranceWhy acceptance changes our relationship to discomfort, not the discomfort itselfHow clinicians can use this exercise with clients, families, and teen group. Hosted on Acast. See acast.com/privacy for more information.
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  OCD and Productivity: The Struggle Behind the Scenes 06.04.2026 28min

  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 environmentsHow compulsions like checking, rereading, researching, and reassurance seeking sabotage productivityThe difference between perfectionism and OCD paralysisWhy OCD is often misinterpreted as ADHD or executive dysfunctionThe emotional toll of feeling “ineffective” despite working incredibly hardStrategies for managing compulsions while studying or workingSetting limits around checking, researching, and rewritingLearning the practice of “good enough”Rebuilding trust in your own judgement after OCDUsing values to guide action when motivation disappears Hosted on Acast. See acast.com/privacy for more information.
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  Perfectionism, Process-Based Therapy & The Anxious Perfectionist 23.03.2026 59min

  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 likedThis 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.
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  Developmental Patterns in OCD Onset and Flare-Ups 09.03.2026 17min

  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 OCDPuberty, hormones, and emotional intensityIndividuation, identity formation, and existential anxietyWhy OCD spikes when life becomes meaningfulNew parenthood, responsibility, and fear of harmHow values drive OCD themes during transitionsUnderstanding symptom “shape-shifting” across life stagesUsing developmental context to reduce fear and shameAnticipating 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.
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  Contamination OCD Isn’t Quirky 23.02.2026 27min

  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 doorsWhy it’s not about being “clean” or “house-proud”The physical toll: pain, skin damage, exhaustion, hungerFood avoidance, illness fears, and misdiagnosis with eating disordersMoral contamination and value-based fearEgo-syntonic vs ego-dystonic rulesHow to assess contamination OCD properlyFlexibility vs rigidity in treatmentERP without reinforcing “right vs wrong” rulesHelping 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.
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  Readiness, Uncertainty, and Behaviour Change in OCD Treatment 09.02.2026 21min

  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 choiceThe difference between thoughts, feelings, and bodily sensationsHow emotional reasoning keeps OCD in controlThe trap of waiting for certainty before actingUsing ACT, motivational interviewing, and values-based actionHelping clients name fear, dread, shame, and excitement accuratelyWhy language matters in therapy—and how it can open or close changeMoving clients out of intellectual insight and into embodied experienceSupporting 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.
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  Moral Scrupulosity vs OCPD 26.01.2026 31min

  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 OCDWhy guilt, confessing, and reassurance-seeking are so stickyHow moral scrupulosity differs from OCPD at a structural levelWhy ERP works for OCD—but often fails for OCPDThe role of values, culture, religion, and social media pressureCommon compulsions: confessing, rumination, reassurance, over-apologisingWhen rigidity is fear-driven vs personality-basedHow to treat OCPD using schema, ACT, and DBT-informed approachesWhat 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.
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  Values, Paradox, and OCD: Finding Flexibility in the Tension 12.01.2026 23min

  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🔖 Chapters00:00 Introduction: Values and Paradox in OCD02:00 What It Means to Be Fused with Thoughts and Values05:00 Why Clients Get Stuck in Rigidity08:00 Common Paradoxes in OCD11:00 The Cost of Perfectionism and Fear of Imperfection14:00 Exploring Value Clashes in Therapy17:00 Building Insight and Flexibility20:00 Beyond “Sit with Uncertainty”: Context and Meaning22:30 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.
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  Understanding the Link Between PTSD and OCD 29.12.2025 24min

  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🔖 Chapters00:00 Understanding PTSD and OCD02:55 The Interplay of Trauma and OCD05:42 Navigating Treatment Challenges08:53 Integrating ERP with Trauma Therapy11:55 Building a Trauma-Informed Approach14:54 Fluidity in Therapeutic Techniques17:49 Empowering Clinicians to Address Trauma23:44 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.
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  Understanding Parental Accommodation in OCD: Breaking the Cycle 15.12.2025 27min

  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🔖 Chapters00:00 Introducing the topic: Parental Accommodation and OCD02:00 What it means to accommodate and why we do it05:00 How everyday reassurance turns into OCD reinforcement08:00 Fear, meltdowns, and why it’s hard for families to stop accommodating11:00 Emotions, modelling, and learning to tolerate discomfort14:00 The SPACE model and clinician guidance17:00 Working with parental fear and client safety21:00 Reducing accommodation step-by-step25:00 Supporting families when clients resist change26:40 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.