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

Episode Summary: Readiness, Uncertainty, and Behaviour Change in OCD Treatment

Hosts: Dr Celin Gelgec and Dr Victoria ("Tori") Miller
Date: February 9, 2026

Overview of the Episode's Main Theme

This episode centers on the critical—but often misunderstood—concepts of readiness, uncertainty, and behavior change in OCD treatment. Dr Gelgec and Dr Miller discuss how both clinicians and clients frequently conflate feelings of anxiety, uncertainty, and trepidation with the actual readiness to engage in therapy or exposure tasks. They explore the pitfalls of waiting to "feel ready," the necessity of embracing messiness and discomfort, and the importance of correctly labeling emotions in the therapeutic process.

Key Discussion Points and Insights

1. "Ready" Is Not a Feeling—It's a Decision

[04:53–06:07]

• Dr Gelgec recounts hearing on another podcast that "ready is not a feeling, it’s a decision," which she describes as “mind-blowing,” especially after 15 years of practice.
• The hosts reflect on how both clinicians and clients repeatedly state, “I don’t feel ready,” but rarely pause to examine what they actually mean.

“Ready is not a feeling, it’s a decision.” — Dr Gelgec [05:02]

• They highlight how the phrase is commonly used as a catch-all for a host of emotional experiences (fear, nervousness, uncertainty, dread).

2. The Pursuit of Certainty & the Myth of Complete Readiness

[06:07–10:24]

• Many individuals, especially those with OCD, have a “wish, fantasy, or desire” for an unambiguous feeling of certainty before starting something, particularly exposure tasks in therapy.
• Dr Miller notes, "That lovely, satisfying, peaceful sort of feeling…doesn’t stay for long. But we’re, I think, when we’re talking about ‘are we ready,’ we’re talking about a wish for clarity and certainty." [07:17]
• Both agree: there will never be a perfect feeling of readiness. Discomfort is intrinsic to being human and part of the process.
• The hosts use a Harry Potter analogy to illustrate how uncomfortable and confusing it can be to feel many emotions at once — yet this is normal, not pathological.

3. Clinician and Client Difficulties with Uncertainty

[10:24–13:15]

• Not only do clients feel stuck by uncertainty and a lack of readiness, but clinicians do as well.
• They discuss common feelings of being "stuck," frustrated, or challenged alongside clients.
• Techniques to move forward:
  • Motivational Interviewing
  • Acceptance and Commitment Therapy (ACT): Emphasizing willingness and accepting discomfort.
  • Values-Guided Action: Returning to client values to motivate action despite fear or uncertainty.

“Feel the fear, but do it anyway.” — Dr Gelgec [11:58]

• Therapy doesn’t mean clients haven't tried before; therapy gives them tools rather than relying on willpower or avoidance.

4. Importance of Language: Helping Clients Accurately Name Emotions

[13:15–16:00]

• Language matters: Allowing clients to say "I don't feel ready" can prevent them from accessing and labeling the real emotions (e.g., "I feel afraid" or "I feel excited").
• Naming and feeling: Not just identifying the emotion, but actually allowing oneself (and clients) to sit with and feel it, rather than staying in the head/intellectual realm.
• Dr Miller describes:

  “When we’re able to get our clients to tune into those things…to notice them without judgment, it really helps with acceptance.” [14:01]

• Points out common confusion between excitement and anxiety—physiologically similar but emotionally different; precise labeling can open new doors to insight and change.

5. A Practical Framework for Bridging Thoughts, Feelings, and Action

[17:03–18:11]

• Dr Gelgec introduces a learning model:
  • Share experience and thoughts
  • Reflect and distinguish thoughts vs. feelings
  • Move into experiential/ bodily feelings
  • Finally, proceed to action/intervention
• Skipping steps shortchanges emotional processing and successful behavior change.

6. Common Thought and Feeling Confusions in Clients

[18:24–20:50]

• The clinicians list typical phrases confusing thoughts and feelings:
  • “I feel fat” (thought, not emotion)
  • “I feel dumb,” “I feel ugly,” or similar self-critical statements
  • In OCD: “I feel like a bad person,” “I feel like a murderer/pedophile,” “I feel dirty”
• Importance: Distinguishing these opens up clinical insight into what truly drives OCD symptoms—for example, underlying shame, guilt, or disgust and corresponding physical sensations (e.g., “groinal response”).

“If we’re not weaving [the feelings and sensations] into our exposure tasks, we’re missing a whole chunk of what could be driving those exposures.” — Dr Gelgec [20:45]

7. Beyond Symptom Management: Richness and Depth in Therapy

[20:56–21:47]

• Once comfortable with ERP and rapport, clinicians can dive deeper to explore the emotional roots (schema work, rescripting early emotional experiences).
• This enhances therapy beyond symptom management, enriching the therapeutic process and outcomes.

8. Final Thoughts and Takeaways

[21:47–22:26]

• Clinicians are encouraged to move beyond manualized treatments, be curious, and explore the emotional and cognitive landscape with clients.
• Don’t be afraid to sit with both thoughts and feelings, even if it feels “messy”—that’s where meaningful, lasting change occurs.

“Have the confidence to step away from the manualized treatment and, you know, observe in the room, be curious, be transparent, explore. There are just really rich and interesting but also effective places that we can go.” — Dr Miller [21:56]

Notable Quotes and Memorable Moments

• “Ready is not a feeling, it’s a decision.” — Dr Gelgec [05:02]
• “That lovely, satisfying, peaceful sort of feeling…doesn’t stay for long. But we’re, I think, when we’re talking about ‘are we ready,’ we’re talking about a wish for clarity and certainty.” — Dr Miller [07:17]
• “Even a lion gets scared.” — Dr Miller [08:14]
• “Feel the fear, but do it anyway.” — Dr Gelgec [11:58]
• “When we’re able to get our clients to tune into those things…to notice them without judgment, it really helps with acceptance.” — Dr Miller [14:01]
• “If we’re not weaving [the feelings and sensations] into our exposure tasks, we’re missing a whole chunk of what could be driving those exposures.” — Dr Gelgec [20:45]
• “Have the confidence to step away from the manualized treatment and, you know, observe in the room, be curious, be transparent, explore.” — Dr Miller [21:56]

Timestamps for Important Segments

• 04:53: Introduction of “Ready is not a feeling, it’s a decision.”
• 06:07: Unpacking use of "ready"—what feelings are being substituted?
• 07:17: The fantasy of certainty and its role in OCD.
• 11:58: Using values-guided action and accepting discomfort.
• 13:15: Why language about readiness matters; naming emotions.
• 17:03: Four-step model for moving clients from thought to action.
• 18:24: Examples of common thought-feeling confusions.
• 20:45: Ensuring exposures target core feelings, not just thoughts.
• 21:56: Encouragement to move beyond protocols and be curious in therapy.

Conclusion

Drs Gelgec and Miller provide a lively, insightful conversation full of practical takeaways for clinicians and anyone invested in effective OCD treatment. By challenging common misconceptions about readiness, emphasizing the human experience of uncertainty, and providing frameworks for integrating thoughts and feelings, they encourage therapists to foster deeper, more transformative change.

Don’t wait to “feel ready”—embrace the messiness, name the feelings, and help clients act in line with their values, even when it’s hard.