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

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 no...

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...

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...

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 w...

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...

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 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...

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...

This honest and reflective episode takes listeners inside the therapy room—where clinical learnings, vulnerability, and growth unfold in real time.

Ms Catherine McGrath (Clinical Team Lead and Senior Psychologist) sharea hard-earned lessons from working with OCD clients using ERP (Exposure and Response Prevention), and open up about the emotional toll, missed opportunities, and the courage it takes to keep learning.

From the power of self-compassion to the importance of holding space and involving parents in the therapeutic process, this conversation is a valuable reminder that clinicians don’t need to be perf...

In this episode, we explore the often misunderstood world of Meta OCD—a subtype of obsessive-compulsive disorder where the obsession becomes the diagnosis itself. Clients plagued by questions like "Do I really have OCD?" or "Is this the right treatment?" can become trapped in a mental loop that stalls progress and fuels perfectionism, self-doubt, and avoidance.

We discuss how Meta OCD complicates therapy, disrupts client engagement, and challenges traditional treatment methods. From moral scrupulosity to obsessive intellectualization, this conversation is a must-listen for anyone working in mental health, or for those navigating OCD themselves.

In this insightful episode, we explore the tangled web of health anxiety, OCD, and death anxiety, unpacking how these psychological disorders often overlap and feed into each other. From obsessive thought patterns and compulsions to the deep-rooted fear of mortality, our speakers dive deep into the inner workings of anxiety disorders and what makes treatment so complex—and so crucial.

💬 We discuss:

In this episode, we dive deep into the world of Exposure and Response Prevention (ERP)—the gold standard treatment for Obsessive-Compulsive Disorder (OCD)—through a clinical and ethical lens.

We unpack the delicate balance between challenging clients and protecting their autonomy, exploring how therapeutic trust, client consent, and collaborative exposure tasks shape the success of ERP. This conversation asks the tough questions: How far is too far in exposure therapy? And what happens when fear is no longer the enemy, but the doorway to healing?

💬 Key themes:

With suicide remaining a leading cause of death for people aged between 15-44 in Australia, clinicians in the OCD space need to ask the question: How do we differentiate between suicidal ideation and obsessive intrusive suicidal thoughts?

In this episode, we discuss how to work with a client when they come to you with suicidal thoughts, why it is critical to take all mentions of suicide seriously, and how to determine whether a person with OCD is presenting with suicidal ideation consistent with wishes to die or whether it's intrusive suicidal OCD.

This episode contains...

Felicity Phillips is the Founder of Weight of the World, a community-driven organisation supporting people with eating disorders and their carers through recovery. Weight of the World aims to provide peer support and education while challenging diet culture and promoting body neutrality.

In this episode, Felicity shares her personal journey from pre-professional ballet to developing an eating disorder and ultimately finding recovery, explains the alarming rise of "skinny talk" on social media and how algorithms target vulnerable users within seconds, and reveals the powerful parallels between eating disorders and addiction that challenge common misconceptions about these complex...

It's normal to have doubts and questions about our relationships sometimes. Am I in love with my partner? Am I spending enough time with my parents? Are my friends mad at me? But what happens when those normal, passing concerns turn into an obsession?

In this episode, we explain the difference between ordinary relationship concerns and relationship OCD (ROCD), how to identify when ROCD is showing up, and what the next steps are for helping clients manage it.

Resources and links:

This is the final part of our two-part chat with Dr Bianca Mastromanno. In the last episode, Bianca discussed how she works with parents to process their childhood experiences and help them navigate parenthood themselves.

In this episode, Bianca opens up about her personal experiences with parenting anxiety, digs into the challenges faced by parents with OCD, the impact of OCD on early parenthood, and how clinicians can support parents during the vulnerable early days of new parenthood.

Resources and links:

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 with...

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 an...

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...