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

Episode: Perfectionism, Process-Based Therapy & The Anxious Perfectionist
Hosts: Dr. Celine Gelgec & Dr. Victoria (Tori) Miller
Guest: Dr. Clarissa Ong
Date: March 23, 2026

Episode Overview

In this rich and insightful episode, Drs. Celine Gelgec and Tori Miller are joined by esteemed researcher and clinical psychologist Dr. Clarissa Ong, author of The Anxious Perfectionist. Together, they delve into the nuances of perfectionism, its relationship to OCD and anxiety, and the evolving use of process-based therapies—especially Acceptance and Commitment Therapy (ACT). With personal anecdotes and deep clinical wisdom, the discussion provides practical takeaways for clinicians and those affected by perfectionistic traits.

Key Discussion Points & Insights

1. Dr. Ong’s Path into OCD, Anxiety, and Perfectionism Research

[02:22–06:32]

• Dr. Ong’s research journey started with Randy Frost and Mike Twohig, focusing on hoarding and then ACT for OCD.
• Increasing curiosity about perfectionism as a cross-cutting process and less as a diagnosis-specific issue.

“I got more interested in perfectionism as a more cross-cutting pattern that’s less diagnosis specific…”
—Dr. Clarissa Ong [03:14]

• Adoption of process-based therapy: Focuses on evaluating “underlying patterns” and individual-level functioning rather than symptom reduction or merely group-level outcomes.

2. Understanding Perfectionism: Definition and Origins

[08:13–19:48]

• Ong defines perfectionism at its core as “rigidity with respect to rules”—how strictly people feel they must follow internal or external rules.
• Effects: Distress when rules can't be followed, anger at self or others, loss of personal identity and desires when their life is dictated by rules.
• Origins of perfectionism include:
  • Parental expectations and subtle socialization.
  • Societal validation (e.g., idolization of high achievers like Steve Jobs).
  • Compensation for neurodivergence or trauma.
  • Relational trauma and overcompensation following neglect.

“When we’re so rigid with respect to rules, then all the other pieces of perfectionism show up as well.”
—Dr. Clarissa Ong [11:54]

• Dr. Gelgec notes perfectionism as “multifaceted,” sometimes arising as an “overcompensation for neglect.”

3. Perfectionism Across Disorders

[19:48–23:32]

• Perfectionistic processes fuel not just OCD and anxiety but also depression and eating disorders.
• High standards and fear of not meeting them can lead to paralysis or avoidance, masking as depression.
• Perfectionism can be both a “painful” driver but may also be admired or reinforced in society and work.

4. Perfectionism: Helpful vs. Unhelpful Forms

[23:32–26:22]

• Dr. Miller shares her personal realization about perfectionism’s absurd reach (“perseverating on the color of my lipstick… that was the moment where I went, ‘this is just reaching the ridiculous’” [23:08]).
• Ong emphasizes context:
  • The same behavior can be adaptive or maladaptive depending on the situation.
  • Perfectionism driven by values (e.g., work ethic, kindness) can be positive if not fused with anxiety.
  • Anxiety “perverts” values—e.g., caring about others becomes compulsive people-pleasing.

“If you can find the elements of perfectionism that are much more like, this is important to me... and even without fear, this is who I would want to be. …the anxiety can get in the way.”
—Dr. Clarissa Ong [26:22]

5. Avoidance, Depression, and All-or-Nothing Striving

[29:33–32:22]

• Perfectionism can manifest as both relentless over-striving and, conversely, demotivation that looks like giving up (“I can’t do it perfectly so why try?”).
• This leads to internal stress, ruminative stuckness, and perceived lack of motivation in depression.
• Example: Students excelling academically may let self-care deteriorate due to impossible standards.

6. The Paralyzing Nature of Perfectionism

[32:22–33:43]

• Paralyzed by perfectionistic tendencies—difficulty enjoying leisure, getting “stuck” on minor details.
• Dr. Gelgec humorously relates her husband’s need for subtitles and pausing movies as a microcosm of perfectionism’s reach.

7. Rationale for ACT over CBT in Treating Perfectionism

[33:43–39:15]

• ACT as a “natural fit” for perfectionism because it seeks to shift people from inflexibility to psychological flexibility.
• Experiential work in ACT is particularly effective for perfectionism because it works directly with what arises in the therapeutic relationship rather than just in between-session homework or abstract psychoeducation.

“If ACT is about flexibility and the problem of perfectionism is about inflexibility, that seems like a really good fit.”
—Dr. Clarissa Ong [35:18]

• ACT emphasizes “function over form,” allowing therapists to challenge perfectionistic motivations even when therapy (home)work is performed “perfectly.”

8. Intervention Approaches for Perfectionism

[39:45–45:45]

• ACT skills for perfectionism: Acceptance, cognitive defusion (seeing thoughts as thoughts), values identification, and flexible action.
• Values work can itself be hijacked by perfectionism—people want to do “values work” perfectly, which becomes another rigid rule.
• For highly analytical clients, experiential methods cut through rumination and intellectualization.

“It’s almost like, the rules can sometimes look like a perversion of values… you care about good work ethic so you should work till 2am every day. Right. If not, it means you obviously don’t care about your work.”
—Dr. Clarissa Ong [27:20]

9. OCD and Its Relationship With Perfectionism

[45:45–47:09]

• Significant clinical overlap—OCD’s core of ritualized rule-following mirrors perfectionistic rigidity.
• Perfectionism is even broader: Their ACT for perfectionism group recruited more with GAD than with OCD, highlighting its trans-diagnostic reach.

10. Research: ACT for Perfectionism—Efficacy and Clinical Nuance

[46:07–54:31]

• One randomized clinical trial: ACT outperformed waitlist control—the minimum bar, but efficacy versus CBT remains to be tested.
• Challenge: Valued action tends to “rebound” (fade) post-treatment, even when self-compassion and symptom improvement remain.
• Both therapists and clients must be alert to perfectionism creeping into treatment—setting rigid standards for what “good therapy” or “proper recovery” should look like.

“There’s something about... I went off track. How do I get back on track? Probably that’s the skill that might be missing, because it’s almost like... in therapy we’re keeping people on track, less so letting them get off track and then teaching them how to get back on track.”
—Dr. Clarissa Ong [49:01]

• Flexibility, especially around values work, is crucial; therapists must resist colluding with rigid “treatment rules.”

11. Working with Uncertainty and Rule Loss

[56:18–59:14]

• Helping clients develop willingness to act without new rigid rules—navigating the “vacuum” that comes with letting go of perfectionism.
• For neurodivergent individuals: having rules can be adaptive, but rigidity is what causes impairment.
• It’s not the rule that’s problematic, but the way someone interacts with it.

Notable Quotes & Memorable Moments

• The all-or-nothing cycle of perfectionism:
  “I’ve definitely had clients where they can’t even enjoy movies because it’s like, if I can’t hear every single word...”
  —Dr. Clarissa Ong [32:07]

• On society’s valorization of perfectionism:
  “My understanding is [Steve Jobs] is very mean to everyone. Like, he couldn’t buy furniture because there’s no perfect furniture. But we think, on average, society thinks, ‘Wow, he’s such a genius.’”
  —Dr. Clarissa Ong [13:55]

• Personal anecdote highlighting perfectionism’s reach:
  “The point at which I realized my perfectionism was quite unhelpful was when I was perseverating on the color of my lipstick that I’d worn to an event and whether it was or wasn’t the right shade.”
  —Dr. Tori Miller [23:06]

• Values and flexibility:
  “Part of human pain and complexity is we will never be able to do all the things we want to do... And that’s sort of the paradoxical nature of values... And I think that’s really hard for someone who’s very outcomes-oriented.”
  —Dr. Clarissa Ong [54:12]

Timestamps for Major Segments

• Guest Introduction & Research Background — [01:50–06:32]
• Defining Perfectionism & Its Origins — [11:46–19:48]
• Manifestations across Disorders — [19:48–23:32]
• Perfectionism: Helpful vs Unhelpful — [23:32–26:22]
• Perfectionism, Avoidance, Depression — [29:33–32:22]
• Day-to-Day Perfectionistic Behavior — [32:22–33:43]
• Why ACT for Perfectionism? — [33:43–39:15]
• ACT Interventions, Values, and Flexibility — [39:45–45:45]
• OCD & Perfectionism Overlap — [45:45–47:09]
• ACT for Perfectionism: Evidence & Challenges — [46:07–54:31]
• Flexibility, Values, and Rule-Holding — [52:58–59:14]
• Personal Intrusive Thoughts & Reflections — [60:29–62:32]

Closing Reflections: Intrusive Thoughts & Advice

[60:29–62:32]

• Dr. Ong shares her own intrusive thoughts:
  • Need for approval (“I need people to like me”)
  • Struggle with stopping work (“I need to finish it”)—leading to overworking.
• Her big life lesson:
  • “Not everyone will like you. And that’s just how it is… I wish I had known that sooner.” [61:37]

Practical Takeaways for Clinicians

• Recognize perfectionism's many faces—striving and avoidance.
• Go beyond symptom checklists; look at underlying processes (e.g., rigidity).
• Watch for perfectionism’s infiltration of treatment itself and address it openly.
• Remember values work can become a new “rule”—model and encourage values flexibility.
• ACT can be uniquely suited; use experiential methods and tailor them to client readiness.
• Allow for ebb and flow—expect progress to be non-linear for both clients and therapists.

For more from Dr. Ong, consult her book The Anxious Perfectionist and her published research. The conversation continues with more resources at Melbourne Wellbeing Group and in future episodes of Breaking the Rules.