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

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 happening Resources mentioned: Anxiety Recovery Centre of VictoriaInternational OCD Foundation — iocdf.orgNatasha Daniels — YouTube and parenting communityEli Lebowitz — resources for families 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.

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 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 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 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 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 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 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 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 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.

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.

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.

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 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.

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.