Contamination OCD Isn’t Quirky

Summary

Podcast Summary: Contamination OCD Isn’t Quirky

Breaking the Rules: A Clinician's Guide to Treating OCD
Hosts: Dr Celin Gelgec & Dr Victoria (Tori) Miller
Date: February 23, 2026
Duration: ~28 minutes of core content

Episode Overview

In this episode, Dr Celin Gelgec and Dr Tori Miller take a deep dive into contamination-themed OCD. Recognizing its reputation as the “cliché” of OCD presentations, they set out to counter common myths—especially the idea that contamination OCD is merely quirky, cute, or centered on simple handwashing. The discussion unpacks clinical realities, common struggles, and effective therapeutic approaches, including assessment nuances and exposure tasks. Designed for mental health professionals, it’s a guide for compassionate, nuanced, and evidence-based care.

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Key Discussion Points & Insights

1. What Is Contamination OCD?

[02:36-03:43]

• Definition: A deep fear of environmental contaminants: dirt, germs, chemicals, asbestos, and illness—but also “moral contamination”.
• Moral Scrupulosity: The fear that proximity to ‘bad’ people or behaviors can ‘rub off’ morally.
  • Dr. Tori Miller: “Fearing that the bad essence of that person or that thing will rub off on you...That will then turn you into a bad person.” [03:17]
• Stereotypes: Contamination OCD is not just hand-washing and cleaning.

2. Clinical Realities and Daily Impact

[03:44-09:40]

• Obsessive Cleaning: Spotting external compulsions is easier than mental ones, but the distress goes unappreciated.
  • Compulsive cleaning isn’t about pride or aesthetics—people would gladly stop if they could.
  • Sufferers often have physical consequences: eczema, dermatitis, bleeding from excessive washing.
• Daily Functioning: Daily routines are severely disrupted.
  • Example: Using multiple rolls of toilet paper, showering for hours, preparing food they feel unable to eat.
• Dr. Celine Gelgec: “Clients literally shower with bleach...Bleeding bums, cracked bums, everything, like, all of it.” [05:52]
• Eating and Food Safety OCD: Can mimic an eating disorder.
  • Tension between environmental values (avoiding food waste) and OCD-driven behaviors.
  • “Having clients who might present to therapy looking like they've got an eating disorder, when really we're dealing with contamination OCD.” [07:31]

3. The Hidden Debilitation & Social Effects

[09:41-12:00]

• Beyond Hygiene: Delays getting out the door, impacts work, family, relationships, and finances.
• COVID-19 as Trigger: Pandemic provided temporary validation but increased distress post-lockdown.
  • Dr. Tori Miller: “A lot of my clients with contamination felt so validated...as we started coming out...that's when a lot of it spiked.” [10:06-10:24]
• Family Dynamics: OCD’s reach can prompt behaviors in loved ones that are misaligned with their values.
  • Striking example of a parent “hosing down” their children out of contamination fear—realization leads to meaningful therapeutic action.

4. Treatment – Navigating ‘Ego-syntonic’ and ‘Ego-dystonic’ Aspects

[12:00-18:52]

• Assessment Challenges: Some contamination behaviors are considered ‘normal’ or ‘desired’ by clients.
• Flexibility of Rules: The aim is not rigid normalization but restoring agency and flexibility.
  • Dr. Celine Gelgec: “Our role is to help lead towards the gray.” [20:09]
  • Dr. Tori Miller: “Because it's about flexibility in life.” [14:48]
• Practical Questions for Guided Treatment:
  • What rules feel genuinely important versus OCD-driven?
  • Can clients be flexible when routines are disrupted (e.g., no soap in a public bathroom)?
  • Is health compromised by rigidity (avoiding eating or drinking to not use public toilets)?
• “Is This OCD or Normal?”:
  • There’s no “right” amount of handwashing; use WHO guidelines as rough parameters, but choices ultimately belong to the client.
  • Uncertainty and relinquishing certainty is itself valuable exposure work.
  • Dr. Tori Miller: “There is no right...they’re guidelines, our clients actually get to decide for themselves.” [19:15-19:34]

5. Examples of Exposure Tasks (ERP) and Assessment Strategies

[21:00-27:56]

• Disrupt Rituals and Compulsions:
  • Mess up routines—reduce soap/wipes, skip steps, do things out of order.
  • Reduce safety behaviors (e.g., putting toilet paper on seats, “chair-drobes” for clean/dirty clothes separation).
  • Family involvement: loved ones refuse to abide by OCD-driven rules.
• Imaginative Exposure:
  • Clients read stories/scripts about worst fears (e.g., food poisoning, being publicly humiliated due to perceived contamination).
• Data Gathering:
  • Ask clients about rituals—what, when, patterns—during assessment to target exposures effectively.
  • Dr. Celine Gelgec: “Collecting that data is really important. Because then it informs your exposure task planning.” [27:40-27:55]
• Notable Quotes:
  • Dr. Tori Miller: “It is a lovely feeling as a therapist to be able to say very clearly...you know this is the rule...But ultimately, that would just be reinforcing OCD.” [20:19-20:45]

---

Notable Quotes & Memorable Moments

• On Misconceptions:
  • Dr. Celine Gelgec: “Contamination isn't cutesy or quirky. It's pretty full on and very debilitating.” [10:24]
• On the Cost of OCD:
  • Dr. Tori Miller: “They talk about, you know, how sore their hands and their bodies are. You know, about the eczema and dermatitis they get...the sore knuckles, the redness from the hot, hot water and intense detergents.” [05:09]
• On Flexibility vs. Rigidity:
  • Dr. Tori Miller: “Are there compromises that you're making to your health and your well being by being too rigid around these rules? So I'm okay if you actually are someone who moves through your life where you have choice... But what about when you don't?” [15:38]
• On Family Impact:
  • Dr. Celine Gelgec: “OCD can be so insidious that it can really use that fear where people end up doing stuff that is so not in line with what they would otherwise want to be doing. And they don't really even realize it until someone calls it out.” [11:44]
• On Assessment:
  • Dr. Celine Gelgec: “When someone says they've got, you know, contamination, OCD...collecting that data is really important because then it informs your exposure task planning.” [27:40]

---

Important Timestamps

• 02:36 – Defining contamination OCD (including moral contamination)
• 05:03 – The “cliche” myth: handwashing is not always about aesthetics
• 06:23 – Food fears and overlap with eating disorders
• 10:06 – COVID-19’s impact on contamination OCD
• 11:50 – Example of impact on parenting and values
• 13:03 – Navigating client expectations and rules
• 14:37 – “OCD time” vs. everyday life (the difference between ‘OCD wash’ and ‘quick wash’)
• 16:14 – The “hand in the toilet” exposure and making exposures realistic
• 19:15 – No “right” answer to handwashing: guidelines not rules
• 20:09 – Therapeutic process: embracing the ‘grey’, not rigid rules
• 21:07 – Example ERP (Exposure & Response Prevention) tasks
• 22:32 – Differentiating between compulsions and rituals
• 27:40 – Importance of thorough assessment for exposure planning
• 28:16 – Summary and message to clinicians and sufferers

---

Takeaways for Clinicians

• Contamination OCD is complex, deeply distressing, and often vastly misunderstood.
• Treatment must balance respect for clients’ values with confronting OCD’s grip; flexibility, not rigid normalization, is the goal.
• Thorough assessment is key: understand both surface compulsions and underlying patterns.
• Exposure tasks should be individually tailored, realistic, and target both behavior and the intolerance of uncertainty.
• Family and social contexts matter; OCD’s consequences ripple outward.
• Supporting agency and self-efficacy is just as important as reducing symptoms.

---

“So just summarizing: contamination, not being cute or quirky, it's being quite dire, impacting lots of different aspects of life. There are so many other parts of contamination that we probably haven't even touched on.”
— Dr. Celin Gelgec [28:01]

---

For more insight, clinicians and those impacted are encouraged to listen to the full episode or seek professional consultation regarding OCD treatment.

Transcript

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[Dr. Celine Gelgich]

Hi, I'm Dr. Celine Gelgich.

[Dr. Tori Miller]

And I'm Dr. Tori Miller. Welcome to Breaking the Rules. On breaking the rules, we talk about all things OCD.

[Dr. Celine Gelgich]

Obsessive compulsive disorder. OCD impacts up to 1 to 2% of the population. We are here to provide not just education, but to inspire clinicians, families and people who are impacted by OCD to be able to access the treatment they need in order to get better.

[Dr. Tori Miller]

Catch us every fortnight wherever you get your podcasts.

[Dr. Celine Gelgich]

Welcome back, everybody. Today we're going to talk about a topic that we haven't talked about because we've always been like, it's too basic. It's so cliche, blah, blah, blah. It's contamination. We're finally doing it.

[Dr. Tori Miller]

I know, I know. Actually, we had to double check, didn't we, that we hadn't actually done it before. But I mean, I think we've like made reference to it quite a few times, but We've never really done a deep dive on contamination, which is funny, given it's one of the most common ones.

[Dr. Celine Gelgich]

Yes, absolutely. Yeah.

[Dr. Tori Miller]

So what do we mean by contamination theme? Ocd, Celine?

[Dr. Celine Gelgich]

We mean a deep fear of environmental contaminants. I think, in a nutshell, dirt, germs, environmental stuff like asbestos, chemicals, that kind of stuff. Illness. Did I miss anything?

[Dr. Tori Miller]

I mean, look, that, you know, that could be. It's pretty broad. Yeah. It's pretty endless. But I. The one thing also can be. Is moral contamination.

[Dr. Celine Gelgich]

Yes, I was gonna. Yes. And what you mean by that is

[Dr. Tori Miller]

believing that by virtue by proxy of like being near someone or watching some content online.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

Someone who perhaps is behaving in a way that is opposite to your values and then kind of like moral scrupulosity, kind of like being afraid that. Of being a bad person is fearing that the bad essence of that person or that thing will rub off on you and therefore leave like a. Will tarnish you or leave a stain on you.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

That will then turn you into a bad person. So kind of hurt you in some way. Yeah.

[Dr. Celine Gelgich]

Immoral.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Behavior.

[Dr. Tori Miller]

Yeah, yeah, yeah, yeah, yeah. But I think, you know, I mean, I think, you know, this is the one that people think of when they think about ocd.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

People are often thinking about obsessive cleaning, hand washing. And I think people are kind of right to sort of, you know, that this one comes to mind. I think it's. They're compulsions that are easier to spot in other people because they're, you know, they're happening outwardly as opposed to, you know, mental compulsions.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

But also it's. It's like what movies have always represented OCD as being.

[Dr. Celine Gelgich]

And.

[Dr. Tori Miller]

Yeah, and I think. But this is also, I think one of the best demonstrations of the difference between, I think, what colloquially OCD is understood as and what contamination theme OCD is, which is the intense distress that is associated that people with OCD experience while doing the hand washing or the cleaning. They might have beautiful looking homes, potentially. I mean, that is actually a cliche. A lot of people with OCD who do sort of obsessive cleaning their place actually might not be tidy and organized. They might be compulsively just cleaning down, like the, you know, the. The kitchen, you know, the oven or the stove or the.

[Dr. Celine Gelgich]

Whatever it might be. Yeah.

[Dr. Tori Miller]

So it's. It's not. There isn't necessarily, you know, like, you know, an aesthetic element might not look

[Dr. Celine Gelgich]

like a display home.

[Dr. Tori Miller]

Exactly. But sometimes it does. But I think that that's you know, people, when they. When they do see that or have, you know, they. They assume, oh, you know, this person's really house proud. But in fact, a lot of people, though CD saying, I just wish I could stop. I want to rest, I want to sit down. They talk about, you know, how sore their hands and their bodies are. You know, about the eczema and dermatitis they get. That's right. Like the sore knuckles, the redness from the hot, hot water and the intense detergents. And also not being able to, like, leave the toilet because of excessive wiping or the expensive grocery bills.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

From having to buy copious amounts of cleaning product or so detergent.

[Dr. Celine Gelgich]

Yes. Body wash clients literally shower with bleach.

[Dr. Tori Miller]

Yes.

[Dr. Celine Gelgich]

Which is horrendous. Yeah.

[Dr. Tori Miller]

So people using four or five rolls of toilet paper per toilet visit.

[Dr. Celine Gelgich]

Yeah, absolutely.

[Dr. Tori Miller]

Yeah, yeah.

[Dr. Celine Gelgich]

Bleeding bums, cracked bums, everything, like, all of it, like, extremely painful, terrible. So we're talking about extreme.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

But it happens. Or having showers for three or four hours at a time.

[Dr. Tori Miller]

Yeah, yeah. Preparing a beautiful meal but then not being able to eat it.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

Because the. The fear associated with, did I cook this properly? Did I contaminate my meal somewhere along the way? And so. Or. Or making. You know, I've got a client who does a lot of meal prep. She often gets really exhausted, and so having food in the freezer is really important. But if. If she, for example, does some meal prep and then, say, is leaving the rice to cool, and she's got really, really rules that she's having trouble challenging around food safety. If. If the rice is left cooling and not put in the fridge within, like, just a few seconds or, you know, 30 seconds a minute over, the food's gone to her. She can't tolerate the idea of eating it.

[Dr. Celine Gelgich]

Yeah. So she then creates problems in other ways, too.

[Dr. Tori Miller]

That's right. I mean, she's. She struggles to grapple with the food waste that she creates because she's very environmentally conscious, but also she's hungry.

[Dr. Celine Gelgich]

Yeah, yeah. She's really sad.

[Dr. Tori Miller]

She's hungry a lot of the time.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

Because she just can't eat.

[Dr. Celine Gelgich]

Won't do it.

[Dr. Tori Miller]

She won't eat.

[Dr. Celine Gelgich]

Yeah. And I think the consequence of that is having clients who might present to therapy looking like they've got an eating disorder.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

When really we're dealing with contamination. Ocd.

[Dr. Tori Miller]

Yeah, that's right.

[Dr. Celine Gelgich]

So that's an important differential.

[Dr. Tori Miller]

Yeah, yeah, yeah.

[Dr. Celine Gelgich]

So you've painted a really, I'm not going to say beautiful picture. Dire picture.

[Dr. Tori Miller]

I know. It's pretty.

[Dr. Celine Gelgich]

Yeah. Of what contamination. OCD actually looks like. Like, I remember having a meeting with my thesis supervisor back in the day and when he found out I was working with people with ocd, he was like, oh. Oh. You know, that could. That sounds really easy. It's just like a bit of washing and checking in and you're done and I'm like, mate, if you only knew.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

What it was actually like, which is what you've described it as. It's horrendous.

[Dr. Tori Miller]

Yes.

[Dr. Celine Gelgich]

It's not just a bit of washing and checking. So much more than that, as you

[Dr. Tori Miller]

describe it, really holds people hostage just from getting through what a lot of us take for granted. Just like the basic sort of routines of life, you know, being able to go to the toilet. I mean, if we think about, you know, for a lot of us, I mean, sometimes we've got the luxury of time in the shower or in the toilet, but for a lot of people, we have to dash in and out because we've got kids or we've got. We're at work or at school. So for people, even if that.

[Dr. Celine Gelgich]

If we've got the luxury of time. Right. It's very different feeling.

[Dr. Tori Miller]

It's still a choice, isn't it?

[Dr. Celine Gelgich]

It is. Because, you know, when you've got the luxury of time, you're standing on the show, you're like, oh, this water feels so nice. I'll just, like, loiter here for a little bit longer.

[Dr. Tori Miller]

I know.

[Dr. Celine Gelgich]

Et cetera, et cetera.

[Dr. Tori Miller]

Maybe I'll exfoliate today or I'll wash

[Dr. Celine Gelgich]

my hair thoroughly or whatever.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

As opposed to 1, 2, 3, 4. I've got to start again. And, like, you know. No, I've got to do five pumps of soap. No, that didn't feel right. I've got to do it again. No, I've got to do it this way. No, I need.

[Dr. Tori Miller]

Oh, no, I forgot a step. I have to start all over again.

[Dr. Celine Gelgich]

Yes, exactly.

[Dr. Tori Miller]

Yeah. I don't feel clean enough. I don't feel clean enough.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

I'm stepping out of the shower. Oh, it doesn't feel right. I have to start all over. Yeah, I'm going to get back in.

[Dr. Celine Gelgich]

Yeah, yeah, exactly.

[Dr. Tori Miller]

And it really holds up people's lives. It prevents people from getting out of the door in the morning. It also impacts families, it impacts water bills, partners. Yep.

[Dr. Celine Gelgich]

Work as well, function. Any type of functioning, really.

[Dr. Tori Miller]

Yep. It's devastating. Yeah. And then, of course, we're just talking about sort of contaminants, you know, but we haven't talked about illness yet either. About, you know, how afraid people with contamination theme oc, ocd can be moving through the community.

[Dr. Celine Gelgich]

Yeah. And Covid was like a prime example. Although a lot of my clients with contamination felt so validated.

[Dr. Tori Miller]

Yeah. During COVID And safer in some ways because everyone was masking.

[Dr. Celine Gelgich]

Yeah. And using. And using hand sanitizer or washing their hands or whatever. Or, you know, whatever else it might be.

[Dr. Tori Miller]

Yeah, that's right. And staying home.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

Isolating and quarantining if they were sick.

[Dr. Celine Gelgich]

I think it was as we started as. I mean, we're in Melbourne, so we had horrendous lockdowns for nearly two years. But, like, as we started coming out of all of that, I think that's when a lot of it spiked even more so because people started feeling unsafe, but then also feeling really angry going, why aren't people still sanitizing? Why are people still washing their hands? Why are people still doing whatever else it is. Yeah, yeah. So contamination isn't cutesy or quirky. It's pretty full on.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And very debilitating. Impacts families, partners, children. Oh, I remember I worked with a client once who would literally ask her children to strip at the front door when they came home from school and would just hose them down. Which is abusive, really, if you think about it. It's like a very delicate conversation around. And my client was mortified when we were, you know, opening up this conversation, talking about it and very. Then motivated to. Not because it was so against her values as a mother and just. And, you know, led to really great treatment outcomes in the end. But at the same time, like, I guess the reason why I'm bringing it up is because OCD can be so insidious that it can really use that fear where people end up doing stuff that is so not in line with what they would otherwise want to be doing. And they don't really even realize it until someone calls it out.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And they're like, holy, this is not. No, this needs to stop. Like, this is not what I want to be doing. And that can be really full on.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Yeah. So that's what it looks like.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Yeah. What do we do with it?

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

I think is a question to ask, but also I think another one to consider would be how one thing that often comes to mind that comes up, especially with supervisees, is how do we operate with it in therapy when some of it is actually ego syntonic.

[Dr. Tori Miller]

Yeah, that's right.

[Dr. Celine Gelgich]

Because there's. That can make it really prickly as well, what? One at a time.

[Sleep Number Salesperson]

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[Dr. Tori Miller]

What do you do with it? When's a component? Because I often find that as well, that where there are components with your ego dystonic and the. And aspects that are ego syntonic. The client I was referencing before, who, you know, is so lovely, but there are certain things that she doesn't want to compromise on and certain things that she's willing to be flexible on and. Yeah, yeah. And I think. But I think one of the things that's really challenging for her is that she has a lot of people in her world telling her what the rules should be and what choices she should be making and where the change should be happening that she finds really challenging because she thinks really differently. Yeah.

[Dr. Celine Gelgich]

Yep. I always aim for being led by the client as long as there's no severe functional impact on themselves and others. So for me, it becomes this discussion around, well, what are those expectations? What are those rules for yourself? What feels normal? I guess because what is normal really? Versus what is the extra? You know, and so it could even be something as simple as, well, I like to be able to wash my hands after I go to the bathroom. Okay, what does that look like? Because not everyone does that.

[Dr. Tori Miller]

No, that's true.

[Dr. Celine Gelgich]

And. And which oftentimes clients will be just completely disgusted by and mortified. I see.

[Dr. Tori Miller]

I'm justified not touching the bathroom door. They say I'm right to not touch that door with my hand because not

[Dr. Celine Gelgich]

everyone washes their hands after toilet. And my answer often is, well, so what? But it's. Then the conversation becomes around, okay, if you. If that's a normal thing you want to be able to do, that's fine. But then what does that look like?

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Does that then become an OCD hand wash? Are we doing a certain number of pumps of soap versus washing till it feels right versus scalding hot water? Yes. And all the rest of it. Or are we doing a quick slap, a pump of soap on there just quickly? Not sometimes. Not even. Because I don't have time. I've got to run out. I've got a meeting to get to or whatever, quickly wash my hands and then out I go.

[Dr. Tori Miller]

That's right.

[Dr. Celine Gelgich]

So are we thinking about it in OCD time and clients 9 out of 10 times know the difference? Yes, that's right. It's like, how can we do a slap dash wash. Yeah. Versus an OCD wash?

[Dr. Tori Miller]

Because it's about flexibility in life.

[Dr. Celine Gelgich]

Right, Exactly.

[Dr. Tori Miller]

Do you know what if my clients say, no, I really value hand Hygiene. And so I am going to make sure that I always wash my hands before cooking. Cooking and eating. And I'm going to wash my hands after cooking and I'm going to wash them every time I go to the bathroom. Like, yeah, okay, sure. Like, you know, it's your choice to make.

[Dr. Celine Gelgich]

Yes, but how are you doing it?

[Dr. Tori Miller]

But how are you doing it? And then, but then also, what happens if, let's say you're on a road trip and you're going to a public bathroom.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

And there's no soap.

[Dr. Celine Gelgich]

Yeah, exactly.

[Dr. Tori Miller]

You know, because there are situations where we know people will choose not to eat or drink so that they avoid having to use public bathrooms, which is really unhealthy. Unhealthy and not safe.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

So it's a case of, well, what are there compromises that you're making to your health and your well being by being too rigid around these rules? So I'm okay. If you actually are someone who moves through your life where you have choice, that these are the choices that you're making. But what about when you don't? Yeah, what about, you know, can you be flexible? Can you be flexible? What if you do. You're late for something and you have to race to the bathroom. Can you do it quickly?

[Sleep Number Salesperson]

Quickly.

[Dr. Tori Miller]

So that you're on time for your appointment? You know, are there, you know, can if. If you dropped something important in the toilet?

[Dr. Celine Gelgich]

I was just gonna say that. Yeah, that's one. Can you use with our team.

[Dr. Tori Miller]

Yeah. Yeah. Can you stick your hand in there to get it out? Yeah, yeah. And then tolerate still having that important thing in your life?

[Dr. Celine Gelgich]

Exactly. Because the question we often get asked is, do I have to stick my hands in the toilet? Because it's a very common exposure therapy task that a lot of ERP therapists love to use.

[Dr. Tori Miller]

Yeah, yeah.

[Dr. Celine Gelgich]

And the I. And our answer all the time is. Yeah, if you drop something in there, you need to be able to fish it out.

[Dr. Tori Miller]

That's right.

[Dr. Celine Gelgich]

Because a lot of the time when it comes to things like sticking your hands in the toilet and whatnot as an exposure task, clients will dismiss it because they're like, oh, it's not realistic. Fine, I'll do it anyway.

[Dr. Tori Miller]

But who cares? Because I know, I know in my mind that it's not going to happen.

[Dr. Celine Gelgich]

So I guess I do it.

[Dr. Tori Miller]

Yeah, yeah. So whatever.

[Dr. Celine Gelgich]

Yeah. But then we always come back with, but what if you drop something in there? You know, and then you get the, well, I'll pull my sleeve over. Well, sure, but your sleeve's still going to get toilet water on. Yeah.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And that's probably worse, to be honest, than just, just your hand. In answer to your question, that's where I go with it in terms of.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

When it's ego syntonic. What, what. Where do you go with it? And the short answer is work out what your client wants and doesn't want and then work out the flexibility aspect of it as you've described as. Well, like, can you do it flexibly quickly if you need to and so on and so forth. Because you don't want to be the all knowing clinician who's like, no, all of this needs to go.

[Dr. Tori Miller]

No, that's right.

[Dr. Celine Gelgich]

There might be some clinicians out there, I mean, might get shot down for saying this, but there might be some clinicians out there who take it to that level and then bring it back.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

So you can do it that way as well.

[Dr. Tori Miller]

And I do think that sometimes there's merit in that.

[Dr. Celine Gelgich]

There is.

[Dr. Tori Miller]

Because I think sometimes it's about a client having the opportunity to experience that they can do those challenging things so that they can have an experience of capability.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

That they can take with them into the future so that if they're in a pickle they can say, hey, I've done that before.

[Dr. Celine Gelgich]

Absolutely.

[Dr. Tori Miller]

And those emotions faded and it didn't feel as bad as I thought or it did feel as bad as, as. But it was awful. But I coped, you know, like I moved through and those feelings dissipated and so it's worth it in this moment.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

So I do think sometimes, yeah, it's worth going and pushing and going over the line so that they can kind of have a, an experience, an evidence. Yeah. To refer to and to also to build up that sense of. Yeah. Self esteem, self efficacy, capability, belief in themselves. All of those things. Yeah.

[Dr. Celine Gelgich]

Confidence around that.

[Dr. Tori Miller]

But I know a lot of, a lot of my supervisees often ask me, you know, like what, you know, what is right here. Yes, like what is right? Like how much hand washing is the right amount of hand washing. So in terms of thinking about what goal should I be guiding my client towards? And we can't answer that. No, there is no right.

[Dr. Celine Gelgich]

There is no right.

[Dr. Tori Miller]

I mean, look, the World Health Organization sort of specifies some general guidelines for health and well being.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

Around hand washing and things. But outside of those. But they're not rules, they're guidelines.

[Dr. Celine Gelgich]

Guidelines.

[Dr. Tori Miller]

They're guidelines our clients actually get to decide for themselves. They do, yeah.

[Dr. Celine Gelgich]

And I think it's really important because that in itself can be quite therapeutic and an exposure task in and of itself because it sometimes even having the discussion around pulling back on how long they wash their hands for or how many pumps of soap or how long they're in the shower for or how long they spend disinfecting something or wiping their phone down or whatever else it might be, that in itself can be quite anxiety provoking. But the uncertainty of not knowing.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

What's right or wrong, which kind of is what sits underneath, is a really nice exposure task to work with.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

So there doesn't actually have to be. I think as therapists we can get caught up in the black and white aspect of it too. But our role is to help lead towards the gray.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And just gently shift it back to our clients, going, well, this is where you actually get to make a choice.

[Dr. Tori Miller]

Yeah. Because it is a. It is a lovely feeling as a therapist to be able to say very clearly, you know, like to have a really clear shared goal of like, you know, this is the rule and, you know, you know, let's work towards this. And then, you know, when you've achieved it, it's a nice smart goal.

[Dr. Celine Gelgich]

And, you know, it all fits in neatly.

[Dr. Tori Miller]

It all fits in neatly. But, you know, ultimately that's actually, that's, you know, that would just be reinforcing ocd, this idea that there's a right and a wrong and that it should be rule bound and. Yeah, yeah, yeah.

[Dr. Celine Gelgich]

So mess it up.

[Dr. Tori Miller]

Yeah, that's right. So speaking of messing it up.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

Some example. Some example exposures.

[Dr. Celine Gelgich]

Oh, well, we've got the toilet hands in the toilet.

[Dr. Tori Miller]

Stick your hands in the toilet, sitting

[Dr. Celine Gelgich]

on the toilet without putting. Hovering over the toilet seat or putting toilet paper down. Reducing showers.

[Dr. Tori Miller]

Yep, reducing. Yeah, reducing Any kind of ritual.

[Dr. Celine Gelgich]

Any kind of ritual.

[Dr. Tori Miller]

So that might be using less body wash, less wipes, skipping steps, messing the steps up. So not doing them in a particular order. Yeah.

[Dr. Celine Gelgich]

I was gonna say if it's ritualized, Someone asked me the other day, what's the difference between rituals and compulsions? Which I think a nice question. Compulsions being the behavior we do internally or externally in response to an urge. And it can be quite, I guess, impulsive sometimes. Rituals are compulsions, basically, but they're ritualistic, so they have a pattern to them. So, for example, if the compulsion is to hand wash, it might be a ritualistic compulsion. So it might be that you hand wash in a particular pattern to a certain number. You might have a certain number of pumps of soap, you might do your hands this way and then this way and then this way and this way. And under each fingernail.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And if the pattern gets interrupted, you got to start again, etc. Etc. So that's basically the difference between those two things. So one thing, when you're data gathering, it will be a really nice thing to ask your clients to go, okay, so this is a compulsion. Is there a pattern to it?

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Is it ritualistic? So you can definitely mess up the ritual urge. Surf to start again if it feels messed up. Could be another nice one. Reducing the number of wipes. Reducing the number. So only going in with maybe one toilet roll. That's right. Instead of three toilet rolls. We might cut that down using scripts. If clients are freaking out about starting off with things, not asking for reassurance about whether you smell or not if you haven't used more than one toilet roll.

[Dr. Tori Miller]

Reducing. Checking.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

Around, you know, like, you know, food being cooked, food being cooked, used by day.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

Things like that. Checking. Did you wash your hands or did you wash the carrot before you cooked it?

[Dr. Celine Gelgich]

Yes. Another one people do is have inside clothes and outside clothes.

[Dr. Tori Miller]

Yes. Inside clothes go outside and outside clothes come inside. Yes.

[Dr. Celine Gelgich]

But they also go back into the cupboard.

[Dr. Tori Miller]

Yes.

[Dr. Celine Gelgich]

They don't stay on. The chair drove.

[Dr. Tori Miller]

The chair drove.

[Dr. Celine Gelgich]

Have you heard of that?

[Dr. Tori Miller]

Yes, My husband has a chair drove.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

My husband.

[Dr. Celine Gelgich]

Husband has a chair floor.

[Dr. Tori Miller]

A floor floor. Yes. Reducing. Like things like Glenn Twentying.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

Spraying. And. And what's it gonna say? I don't know. Over to you. While I think of what I was gonna say.

[Dr. Celine Gelgich]

Not calling the asbestos hotline. Yes. Whatever they. The organization. Yeah. To check for that.

[Dr. Tori Miller]

Oh, I was gonna say, like,

[Dr. Celine Gelgich]

people

[Dr. Tori Miller]

with contamination fears often want to sit in a particular place on a particular chair and prevent people like sitting on their bed or sitting in or even

[Dr. Celine Gelgich]

coming into their room.

[Dr. Tori Miller]

That's exactly right.

[Dr. Celine Gelgich]

So. Or hugging their loved ones.

[Dr. Tori Miller]

Yes. That's really my heart. So shifting. Shifting those compulsions around. So resisting the urge to say to someone, you can't sit there.

[Dr. Celine Gelgich]

Or.

[Dr. Tori Miller]

Or if we're talking about sort of family accommodation, not abiding by those rules, sit wherever you want. Mix it up. Yep. Yep. Don't. Don't get out of the room. Yep. Don't get out of clean plate. Sit on the bed. Roll on the bed.

[Dr. Celine Gelgich]

Don't tell them who cooked dinner. Nope.

[Dr. Tori Miller]

That's right. Don't. Don't tell them if they're. If it's. The sheets were fresh.

[Dr. Celine Gelgich]

Yep.

[Dr. Tori Miller]

Freshly remade that day.

[Dr. Celine Gelgich]

Yeah. Another one that comes up. Up is hand washes. In between loads of washing.

[Dr. Tori Miller]

Yes.

[Dr. Celine Gelgich]

So for example.

[Dr. Tori Miller]

Yes.

[Dr. Celine Gelgich]

Someone might.

[Dr. Tori Miller]

Yes.

[Dr. Celine Gelgich]

Throw their clothes in the wash, then wash their hands and then get the next pile and put that in and wash their hands and then the next pile.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Wash their hands and then pop it in the dryer and wash hands in between each kind of moving along and then making sure that those clean clothes are in the clean hamper, which hasn't been near the dirty hamper, which then has to be folded a certain way and so on and so forth.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

So that up.

[Dr. Tori Miller]

Messing that up. Yeah, yeah. There are so many ways. And then. And then what you can also do is do exposure to the. To what's sitting underneath. So if it is about fear of getting sick, it might be writing stories, writing scripts, reading content around people getting sick or you getting sick or spreading sickness. It could be reading information about food poisoning. It could be like reading about the mushroom lady. Yes, that's right. Yeah, that's right.

[Dr. Celine Gelgich]

For anyone overseas, we had a lady who. Well, we didn't have. But there was. It was a trial. There was a case of a lady who. She's been convicted. Is that the word?

[Dr. Tori Miller]

She's been convicted and sentenced. Yeah.

[Dr. Celine Gelgich]

For murdering. Was it three family members. So she made beef Wellington with poisoned mushrooms and they passed away and she got convicted for their murder. So that's who I mean by mushroom lady.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

So reading about her.

[Dr. Tori Miller]

Yep, yep, yep. And. And also then. Or it could be, you know, like writing a story about how, you know, you go to the toilet and you wipe, but then there's poo left on your bottom, and so then you stain your underpants, and then you go to work or you go to school and you actually smell. And then people around you notice a smell and then they move away from you and then they realize it's you. And then you lose your friends or you lose your job and you. You're publicly humiliated, and then you let your family down and so on and so forth until it's just a really disastrous ending.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

And all worst fears have come to fruition. And then reading that and reading it and reading it and reading it.

[Dr. Celine Gelgich]

Another one that comes to mind, which is so subtle, is not cuffing your pants. So a lot of clients letting their

[Dr. Tori Miller]

pants touch the ground.

[Dr. Celine Gelgich]

Yeah. Cuff up the bottom of their pants. So they're not not letting their pants touch the ground.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Because it collects germs off the ground and so on and so forth. So that's a real subtle one.

[Dr. Tori Miller]

Yeah, yeah. There are so many things.

[Dr. Celine Gelgich]

There are so many things. Yeah. Like, we're talking about the exposure tasks at the moment, but these are all things that you can throw in your assessment.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

In terms of do you or have you ever done blah, blah, blah, blah, blah. When someone says they've got, you know, contamination, ocd. Yeah. Collecting that data is.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Really important.

[Dr. Tori Miller]

Yeah, yeah, yeah.

[Dr. Celine Gelgich]

Because then it informs your exposure task.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Planning.

[Dr. Tori Miller]

Yeah, yeah, yeah, agreed.

[Dr. Celine Gelgich]

All right.

[Dr. Tori Miller]

I reckon that's comprehensive enough.

[Dr. Celine Gelgich]

I think so. That's pretty good. All right, so just summarizing contamination, not being cute or quirky, it's being quite dire, impacting lots of different aspects of life. And there are so many other parts of contamination that we probably haven't even touched on.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Because it's not just hand washing and stuff. Like, there's so many things from food to relationships to cleanliness, environmental contaminants like asbestos or other chemicals in the air and all that sort of stuff. The most recent one that's coming up is fiberglass in insulation that's being used that people are worried about now. Sort of like an asbestos thing.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And all that sort of stuff. So there's so many ways contamination can impact people with OCD and the, like, their loved ones around them. But today we've covered all of that, but also talked a little bit about what to look for in assessment, how to treat what kind of exposure tasks you can do. So hopefully it's a lot of food for thought, not just for us as clinicians, but for anyone with OCD that's listening and you feel brave enough to give it a go.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Do so with the guidance of your therapists.

[Dr. Tori Miller]

Yeah. Okay. It's gonna be worth it. Yeah.

[Dr. Celine Gelgich]

Nice one.

[Dr. Tori Miller]

Amazing.

[Dr. Celine Gelgich]

All right, thank you guys so much for watching. Catch you next time.

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