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

Dr Bianca Mastromanno is a Clinical Psychologist who works extensively in the perinatal space. Bianca uses a trauma-informed, evidence-based approach to support parents and children living with mental health concerns.

In this episode, Bianca explains how she works with parents with OCD or other mental health challenges to explore and process their own childhood experiences to help them navigate the emotional challenges of parenthood. She also reflects on what she’s learnt from the parents she works with and from her own experiences as a parent.

This episode is part one of our two-part chat wi...

This is the final part of our two-part chat with Lindsay and Emily Stetzer. In the last episode, Lindsay and Emily opened up about their early experiences with OCD and how their lived experiences led them to create Presently Bracelets.

In this episode, Lindsay and Emily discuss the household dynamics of living in a family with OCD, the significance of non-accommodating support, and the role of exposure therapy, self-awareness, and trust in the recovery process.

Resources and links:

Lindsay and Emily Stetzer are sisters living with OCD and the Founders of Presently Bracelets. Presently Bracelets offer a range of bracelets to help you navigate intrusive thoughts and embrace the present moment. 

In this episode, Lindsay and Emily share their individual experiences with OCD and treatment, what helps them between sessions, and what they think therapists need to know from the perspective of someone with OCD. They also share how the phrase “my thoughts are passing clouds” led to the creation of Presently.

Resources and links:

This is the final part of our two-part chat with Chrissie Hodges. In the last episode, Chrissie shared her early experiences with OCD before embracing the challenges of OCD peer support and advocacy work.

In this episode, Chrissie reflects on her experiences with OCD treatments and what clinicians can and should be doing better. She also emphasises the importance of acknowledging the impacts of different OCD themes on the individual and how some themes might result in more trauma and stigma than others.

Resources and links:

Chrissie Hodges is an OCD Advocate, Peer Support Specialist, and Author of ‘Pure OCD: The Invisible Side of Obsessive-Compulsive Disorder’. For over a decade, Chrissie has worked closely with individuals living with OCD, as well as providing training to government agencies to enable them to better support people with OCD.

In this episode, Chrissie shares her powerful personal journey with OCD starting from age eight, describes how religious scrupulosity and emetophobia shaped her early experiences and opens up about her path from struggling in silence to becoming a prominent voice in the OCD community through peer support and...

Is tough love the right approach for people struggling with hoarding disorders, or is there another way?

In this episode, we explain how to recognise hoarding disorder and how it differs from having a collection or even hoarding-themed OCD. We explore how to navigate the intense shame experienced by people with a hoarding disorder or hoarding-themed OCD and how to sensitively and responsibly provide intervention.

Resources and links:

Celin discussing hoarding on The Conversation Hour on ABC Radio

Melbourne Wellbeing Group enquiry page

Webinars, books, and training b...

This is the final part of our two-part chat with Emily Crawford. In the last episode, Emily highlighted the importance of building supportive networks for mothers and the challenges mothers experience before and after birth.

In this episode, Emily discusses how to support mothers with mental health difficulties throughout pregnancy and after birth and how to provide interventions to mothers who are struggling.

Resources and links:

Nest Psychology website

Webinars, books, and training by Melbourne Wellbeing Group

OCD training workshops by Dr Celin Gelgec

OCD f...

Returning guest Emily Crawford is the Principal Psychologist at Nest Psychology and has more than 20 years of experience as an Educational and Developmental Psychologist supporting adults, children, adolescents, and their families with various mental health issues (including OCD). She is also a 'Tuning in to Kids' facilitator and a mother of four.

In this episode, Emily discusses the postnatal period for mothers and opens up about her experiences after childbirth. She explores the challenges mothers encounter before and after birth and the importance of supporting mothers and building communities so mothers can care for their babies.

We’re continuing our discussion about ambivalence. Ambivalence is when a client feels conflicted about treatment, either consciously or subconsciously, and can throw up stopping blocks in treatment. In the last episode, we looked at how to spot ambivalence and tackle it when you see it.

In this episode, we discuss the importance of motivational interviewing in exploring patient emotions and understanding how OCD plays into a patient’s identity. We also examine the role of patience and adaptability in treatment and how critical it is to address ambivalence through commitment, creativity, and curiosity.

Re...

What happens when a client wants to change but doesn’t know where to start, doesn’t want to do the work, or is in some other way conflicted? Ambivalence. Ambivalence is normal during therapy but can hinder a client’s progress if left unaddressed.

In this episode, we discuss some telltale signs of ambivalence in clients, understanding where ambivalence comes from, and how to work through it when it happens.

Resources and links:

Connect:

This episode is the final part of our two-part chat with Natasha Daniels. Natasha is a Therapist specialising in anxiety and OCD in children and created AT Parenting Survival to help the parents of children living with anxiety and OCD. 

In our last episode, Natasha shared how she got into working with children, how to adapt ERP for young people, and the importance of rapport, fun, and play in therapy. 

In this episode, Natasha opens up about why she loves working with the parents of children with OCD and anxiety. She explains how she works wi...

Natasha Daniels is a Therapist specialising in anxiety and OCD in children. Natasha is the creator of the AT Parenting Survival website to provide parents with advice for helping their children living with anxiety and OCD. Natasha has drawn on two decades of experience to create a YouTube channel and a podcast and has also written several books.

In this episode, Natasha reveals what drew her to working with children and teens with anxiety and OCD, as well as their parents. She discusses how to adapt ERP for younger clients, the significance of building rapport, and how...

Perfectionism. It’s a complicated trait that shows up a lot when working with OCD. It can present in a range of ways and can look like self-loathing, anger, people-pleasing, or even a strong sense of doubt and uncertainty in clients.

In this skills episode, we dig into how perfectionism can manifest in a client, how it might present in a session, and how to address it when it does.

Connect:

This show is produced in collaboration with Wavelength Creative. Vis...

This is the final part of our chat with  Associate Professor of Psychology and convenor of the clinical psychology program at the University of Melbourne, Dr Brett Deacon.

In our previous conversations with Brett, he explained safety behaviours, accommodation behaviours from family and clinicians, and how accommodating behaviours that reduce discomfort can limit the efficacy of treatment for clients with OCD.

In this episode, Brett expands on how clinicians can balance moving too quickly or too slowly in ERP. He also explains how he uses one simple and kind of gross demonstration in the classroom t...

George Habib is a Clinical Psychologist and Associate Director of Wellbeing Services at the University of Melbourne. Alongside this role, he's been working in his own clinical practice for over 25 years. His work, deeply rooted in trauma support and symptom interpretation, has shaped his leadership in health services and legal aid.

In this episode, George tackles the clinician’s role in structured OCD treatment, highlighting the necessity of addressing deep-seated triggers. You’ll discover how a clinician’s strict adherence to protocols could influence the therapeutic journey. You’ll gain insights into how various therapeutic modalities can be integ...

In our last episode, Associate Professor of Psychology and convenor of the clinical psychology program at the University of Melbourne, Dr Brett Deacon, explained the concept of safety behaviours and how to manage them in OCD treatment.

In this episode, Brett dives into the data behind safety behaviours and accommodations. He expands on how making more accommodations can impact treatment and how clinician accommodations can be as limiting as parental or familial accommodations.

Resources and links:

Dr Brett Deacon is an Associate Professor of Psychology and convenor of the clinical psychology program at the University of Melbourne. Brett has worked in the field of psychology for over 15 years with a focus on exposure therapy for anxiety and OCD. He has published many papers on therapist barriers to exposure therapy and strategies for overcoming them and is a co-author of ‘Exposure Therapy for Anxiety: Principles and Practice’.

Throughout the next three episodes, Brett explores the role of clinicians in exposure therapy and how their feelings could be holding back the client.

In toda...

Guilt and shame are a normal part of the human experience. Where it can become a problem is when clients are unable to overcome, or even identify, guilt and shame they may be feeling which can lead to a “stuckness” in treatment that can be frustrating and upsetting.

In this skills episode, we’ll explain the difference between guilt and shame, discuss telltale signs to look for in clients, and how to address these emotions if they are impacting treatment.

Connect:

T...

Joanne Isbister is a Certified Genetic Counsellor at the Royal Melbourne Hospital. Jo has over 15 years of experience as a genetic counsellor and has clinical experience in perinatal, paediatric, and adult genetics. After Identifying a gap in local services, Jo is developing a clinical service at the RMH to provide equitable access to psychiatric genetic medicine for those in need.

In today’s episode, Jo will explain what genetic counselling is and how it helps patients. She talks about the complexities of patient mental health histories and the implications of shame and stigma on patients. Jo also br...

Penny Moodie is a Co-founder of So OCD and the Author of "The Joy Thief". Penny is a passionate OCD advocate and her book, “The Joy Thief” is a deeply personal exploration of OCD along with practical advice from mental health professionals.

In this episode, Penny describes the experience of writing "The Joy Thief", the effect it had on her own OCD, and the things she learnt along the way. She also shares her hopes and wishes for others with OCD who want to reclaim their happiness from their condition.   

Resources and links:

One of the main roles of a clinician is to provide as much knowledge as possible when supporting clients in treatment. But when does knowledge and education, or psychoeducation as it's known, become a reassurance trap when treating OCD?

In this skills episode, we'll explore how to detect if psychoeducation is bordering on reassurance, and how to navigate that with your client. We'll also discuss the importance of transparent conversations, how sometimes providing a little bit of reassurance is alright, and that even we clinicians have to learn to accept uncertainty. 

Connect:

Dr Luca Cocchi is a Group Leader and Associate Professor at QIMR Berghofer, who is currently working on ways to improve TMS for its usage in OCD treatment. Dr Philip Mosley is a Psychiatrist and Clinician-Scientist at QIMR Berghofer, where he is currently researching DBS for treatment-refractory OCD. 

In this episode, Phillip explains deep brain stimulation (or DBS) and how it's being used to treat severe and treatment-resistant OCD. Phillip and Luca also discuss the outcomes of recent clinical trials and explain how accessible these treatments currently are for Australians. 

This episode is part two of...

Dr Luca Cocchi is a Group Leader and Associate Professor at QIMR Berghofer, where he is currently working on ways to improve TMS for its usage in OCD treatment. Dr Philip Mosley is a Psychiatrist and Clinician-Scientist at QIMR Berghofer, who is currently researching DBS for treatment-refractory OCD.

In this episode, Luca and Phillip explain the neuroscience behind OCD, as well as what treatment-resistant OCD means and why it happens. Plus, Luca breaks down the exciting possibilities of transcranial magnetic stimulation (or TMS) for OCD.

This episode is part one of our two-part chat with...

Welcome back to another skills episode! Today, we're covering something you may have heard mentioned a few times in our previous episodes: meditation. Mindfulness-based strategies can be incredibly useful for clients and clinicians alike, and there are many ways they can be helpful when integrated with ERP.

In this episode, we'll explain why mindfulness is so important, and share how you can best teach it to your clients. You'll also hear us discuss why it's important for all of us to learn to feel our feelings, and to understand the difference between noticing thoughts and dismissing them...

Hannah Gersh is a Psychologist and Clinical Registrar at the Melbourne Wellbeing Group. As an early-career psychologist, Hannah understands how nerve-wracking it can be to start in the industry, and is here to share her experiences to help ease the nerves of any other early-career psychologist. 

In this episode, Hannah shares how she found her way into working with OCD, as well as how she deals with nerves and feelings of inadequacy. She'll explain what she's found most useful for her development as an early-career psychologist, before sharing some advice for clinicians looking to get into the O...

Welcome back to our deep dive into creating ERP tasks, where we're continuing to explore the ways you can get creative in treatment, regardless of the presentation or the subtype.

In this episode, we're exploring different ways to create ERP tasks in the context of pure OCD, and paedophilic OCD. We'll share the ways to help your clients interrupt mental compulsions, as well as how to create safe and appropriate tasks for managing paedophilic intrusive thoughts. Plus, we'll share how you can take the learnings from these subtypes, and apply them to creating ERP tasks in any...

Welcome back to another skills episode! This week, we're following on from our previous skills episode, "What is ERP?", with an episode on how to create ERP tasks. We'll be exploring all the ways you can break the rules and get creative with ERP, whilst still remaining evidence based in treatment.

In this episode, we'll explore how to design exposure tasks for OCD, regardless of the subtype. We'll also share how important it is to stay collaborative, creative, and courageous — regardless of whether you're a client or clinician.

This episode is part one of our tw...

Penny Moodie and Rosie Frankish are the Co-founders of the So OCD website, a resource built to provide local support for Australians with OCD. Penny Moodie is an OCD advocate, with a background in media and communications, who is currently studying for a social work degree whilst writing a book about OCD. Rosie Frankish has a background in psychology and currently works in the community mental health sector, developing and delivering specialist mental health and homelessness programs across Victoria.

In this episode, Penny and Rosie discuss all things family support, including what they believe family members need...

Penny Moodie and Rosie Frankish are the Co-founders of So OCD, a website resource built to provide local support for Australians with OCD. Penny Moodie is an OCD advocate, with a background in media and communications, who is currently writing a book about OCD whilst studying for a social work degree. Rosie Frankish has a background in psychology and currently works in the community mental health sector, where she is involved in the development and delivery of specialist mental health and homelessness programs across Victoria.

In this episode, Penny and Rosie share their stories of being diagnosed...

Navigating the process of supporting loved ones in treatment can feel like walking through a minefield. It's easy to question if it's appropriate to involve yourself in the treatment process, where the boundaries lie, and how to even begin. These questions can feel overwhelming and often lead to us doing nothing at all.

In this skills episode, we discuss how clinicians can expand their treatment plans to include a client's family and friends, while still maintaining appropriate boundaries. We'll also emphasise the importance of accessing knowledge, practising self-care, communicating, and holding space for grief for those who...

Dr Jonathan Abramowitz is a clinical psychologist, author, and Professor for the Department of Psychology and Neuroscience at the University of North Carolina in America. With over 25 years of experience, Jon is recognised internationally as a leading authority on the treatment and study of OCD and is dedicated to researching and publishing his findings on OCD treatment and passing on his knowledge to the next generation of clinical psychology students. 

In today's episode, Jon explains how to integrate the inhibitory learning model into clinical practice and the importance of maintaining consistency in that process. He then shares h...

Dr Jonathan Abramowitz is a world-renowned clinical psychologist and a Professor in the Department of Psychology and Neuroscience at the University of North Carolina. Jon has over 25 years of experience working in the treatment of OCD and related disorders and has contributed to hundreds of scientific publications in that time. He also trains clinical psychology students and is the author of several books and book chapters. 

In today's episode, Jon explains how he came to be involved with OCD treatment and research in the first place. He shares his insights on the evolution of the inhibitory learning m...

It's easy to get bogged down in the options that are available when deciding on treatment options for clients. Treatment for OCD can include inpatient treatment, one-on-one treatment, group therapy, and anything in between. 

In this episode, we're going to do a deep dive into group therapy, and how to adapt ERP to work in a group therapy setting (spoiler alert: it's easier than you think). We'll explore the structure of a group therapy session, and how to manage challenges such as cost and time limitations. Plus, we'll discuss the power of group therapy, and how beneficial i...

Dr Jonathan Grayson is a Licensed Psychologist, Author, and Director of the Grayson Center in LA and the Adjunct Clinical Assistant Professor of Psychiatry and the Behavioral Sciences at the University of Southern California. Jonathan has specialised in OCD treatment for over 40 years and even authored an award-winning book on the topic, 'Freedom from Obsessive Compulsive Disorder: a Personalised Recovery Program for Living with Uncertainty.'

In this episode, Jonathan continues explaining what it's like to live in genuine uncertainty and explores the challenges both clients and clinicians can face when fully embracing uncertainty. Plus, he shares...

Dr Jonathan Grayson is the Director of the Grayson Center in LA as well as the Adjunct Clinical Assistant Professor of Psychiatry and Behavioral Sciences at the University of California. Jonathan has over 40 years of experience in the treatment of OCD and was the recipient of a Lifetime Achievement Award from the International OCD Foundation.

In today's episode, Jonathan explores the concept of uncertainty and how to get better without knowing all the answers. He then goes on to share valuable insights into how to discuss uncertainty with clients and even demonstrates how it works in treatment. 

Dr Clair Lawson is a clinical psychologist and the Director of her group private practice, Lawson Clinical Psychology, in Perth, Western Australia. She has over 21 years of experience working as a clinical psychologist in government and private practice settings and has spent much of this time treating OCD. Clair is also a training supervisor for clinical psychology students at the University of Western Australia and a mentor for allied health businesses looking to increase their impact.

In today's episode, Clair shares her perspective on what ERP is like in a group therapy setting and the ways you...

Paul Salkovskis is a Professor from the Oxford University in the UK. Paul has worked as a clinical psychologist since 1979 and as a researcher interested in the treatment of anxiety disorders, including OCD, panic disorder, agoraphobia, and health anxiety. He's also on the editorial board for several psychology journals and is the current president of the British Association for Behavioural and Cognitive Psychotherapies. 

In today's episode, Paul explores the current research trajectory into OCD and treatment options. Paul shares his knowledge from years of working with OCD and his ideas on how betrayal functions in OCD. He f...

Dr Eli Lebowitz is an Associate Professor from Yale University who studies and treats childhood and adolescent anxiety. Eli is also the Program for Anxiety Disorders Director at the Yale Child Study Centre. His research focuses on the development, neurobiology, and treatment of anxiety, but his passion lies in exploring cross-generational and family influences on anxiety and related disorders.

In today's episode, Eli shares some ways clinicians can support parents if their children are diagnosed with OCD. He also details some of the reasons we might be getting it wrong in supporting families and explains how the...

Emily Crawford is an Educational and Development Psychologist with over 20 years of experience supporting adults, children, adolescents, and their families with various mental health issues (including OCD). She is passionate about engaging parents in the support of their children and tailoring approaches to support her client's individual needs. Emily is also a 'Tuning in to Kids' facilitator and a mother of four young children herself.

In today's episode, Emily breaks down all things meltdowns. She shares why kids have meltdowns, what parents can do when their child is melting down, and why it's so hard for parents...

Dr Marie Karakis is an Educational and Developmental Psychologist who works closely with neurodiverse young people, including those with autism, ADHD, and OCD. She is also the Director of Young Minds Psychology, a private practice that provides assessment, intervention, treatment, and school consultations.

In today's episode, Marie shares her insights into the similarities and differences between autism and OCD in young people and what to consider when treating OCD in neurodiverse clients. Plus, Marie details some of the things she found most useful in her practice, such as the importance of forming client connections.