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

Dr Celin Gelgec and Dr Victoria Miller
  • 4.9 (31)
  • Mental Health
  • Updated Fortnightly

Breaking the Rules is a show for mental health professionals designed to help you build confidence in treating Obsessive Compulsive Disorder (OCD). Effective treatment of OCD requires commitment, creativity and the recognition that things can sometimes get a little … messy. And on the show, you’ll hear from a range of leading professionals and learn everything there is to know about OCD and other related mental health concerns. This podcast is brought to you by Melbourne Wellbeing Group, a psychology practice based in Melbourne with a special focus on treating OCD. Hosted on Acast. See acast.com/privacy for more information.

  1. 5 days ago

    The OCD Trap Even Therapists Fall Into

    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.

  2. 13 July

    Sex & OCD: The Theme No One Wants to Talk About

    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.

  3. 29 June

    When OCD Looks Like An Eating Disorder with Dr Alissa Knight: Part 2

    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.

  4. 15 June

    The Truth About Eating Disorder Treatment with Dr Alissa Knight: Part 1

    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.

  5. 18 May

    Exposure Therapy in a Public Bathroom

    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.

  6. 4 May

    Why OCD Gets Worse Before It Gets Better (Extinction Bursts)

    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.

  7. 20 Apr

    What Exposure Therapy Actually Feels Like (The Mentos/Jelly Bean Exercise)

    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.

  8. 6 Apr

    OCD and Productivity: The Struggle Behind the Scenes

    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.

See All (81)

4.9
out of 5
31 Ratings

About

Breaking the Rules is a show for mental health professionals designed to help you build confidence in treating Obsessive Compulsive Disorder (OCD). Effective treatment of OCD requires commitment, creativity and the recognition that things can sometimes get a little … messy. And on the show, you’ll hear from a range of leading professionals and learn everything there is to know about OCD and other related mental health concerns. This podcast is brought to you by Melbourne Wellbeing Group, a psychology practice based in Melbourne with a special focus on treating OCD. Hosted on Acast. See acast.com/privacy for more information.

Information