Podcast Summary

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

Episode: Supporting New Parents with OCD

Hosts: Dr. Celine Gelgec & Dr. Victoria Miller

Guest: Dr. Bianca Mastromano, Clinical & Forensic Psychologist

Date: May 12, 2025

1. Episode Overview

This episode delves into the complexities of supporting new parents struggling with OCD, particularly during the perinatal period (preconception, pregnancy, and early parenthood). The conversation, featuring Dr. Bianca Mastromano, explores the blurred lines between normative anxieties of parenting and clinical OCD, the role of trauma and perfectionism, and practical clinical advice for mental health professionals.

2. Key Discussion Points and Insights

A. The Challenges of New Parenthood and OCD

• Obsessive Time of Life

  • The perinatal phase is naturally anxiety-provoking and riddled with uncertainty and doubt ([03:31]).
  • It's a time when normal, even adaptive, obsessing may occur, making it hard to distinguish between healthy concern and pathological OCD.

• Perfectionism and Social Pressure

  • Societal expectations and unwieldy, literal parenting guidelines (breast/bottle feeding, solids, sleep routines) amplify parental anxiety, sometimes to the point of compulsion ([01:59], [04:10]).
  • Quote, Dr. Mastromano:

    "There are a lot of explicit social pressures...in the perinatal period for feeding, breast or bottle, for sleep, for solids." ([02:49])

B. The Blurred Lines: Normal Anxiety vs. OCD

• Ego-dystonic vs. Ego-syntonic Experiences

  • Many new parents experience ego-dystonic thoughts but follow rigid rules out of insecurity—sometimes mirroring compulsive behavior ([05:37]).
  • The criteria for OCD in parents are tricky due to "fusion with perfection and guidelines," where following rules may feel right (ego-syntonic) and justified ([06:23]).
  • Quote, Dr. Gelgec:

    "It's this real fusion with perfection and guidelines and rules and all of it, when really, I think it comes from a deep sense of this is going to help me stay on track. Because I'm terrified of what it might look like if there's an inch of flexibility..." ([06:46])

• Functional Impact as a Key Diagnostic Clue

  • Clinicians are encouraged to focus on the functional impact of behaviors rather than over-relying on ego-syntonic/dystonic distinctions ([08:12]).

C. Trauma, OCD, and Parenting

• Complex Trauma and OCD

  • A significant number of parents with OCD have complex trauma histories, making presentation and treatment more complicated ([09:18]).
  • Dr. Mastromano often uses EMDR before ERP (Exposure and Response Prevention) with such clients.
  • Quote, Dr. Mastromano:

    "Often, we've got a lot of complex trauma there in their history...and I often find that it can be very difficult for them to get a sense of, yeah, well, okay, what is good? What does it mean to be a good mother?" ([09:18])

• Co-regulation of Trauma and OCD

  • Targeting trauma is often necessary, otherwise OCD may serve as a maladaptive coping strategy ([10:50]).

D. Shame, Stigma, and Help-Seeking

• Hidden Struggles

  • Many parents hide intrusive thoughts out of shame, fearing judgment from even their partners or clinicians ([15:10]).
  • The normalization of intrusive thoughts is crucial to reducing shame.

• The Risk of Dismissal vs. Validation

  • Clinicians must carefully balance normalizing common parental worries and failing to recognize clinical OCD ([15:29], [18:09]).
  • Resources like Good Moms Have Scary Thoughts by Karen Kleiman are recommended for parents ([15:40]).

E. Practical Advice for Clinicians

• Contextual Case-by-Case Assessment

  • Assess functional impact, personal and environmental factors, and use screening tools like the Y-BOCS when in doubt ([18:56]).
  • Quote, Dr. Mastromano:

    "I often use this phrase normal but not fine, where parents will often be like, is this normal? ...Birth trauma is statistically normal and common and pregnancy loss is statistically normal and common. Normal isn't fine." ([19:04])

• Embrace Uncertainty in the Diagnostic Process

  • It's acceptable not to have immediate answers; clinicians can "wait and see" and collaboratively experiment with clients ([20:33]).
  • Quote, Dr. Miller:

    "We don't have to know in a single session whether it does or doesn't meet the diagnostic criteria for OCD...We can be extremely helpful to our clients even without knowing for sure if it is OCD or not." ([21:33])

• Countertransference and Therapeutic Urgency

  • Clinicians should notice their own anxiety and urgency to "fix"—this can mirror parental urgency and obscure richer attachment or developmental work ([21:53]).

3. Notable Quotes & Memorable Moments

• On the uncertainty of parenthood:

  "It's a very obsessive time, don't you think? ... So much more doubt, so much uncertainty, and so much more hunting than we would ordinarily do..." – Dr. Miller ([03:31])

• On clinical self-disclosure:

  "I was measuring her head, and my husband walked in...and he was like, what would your clients say if they saw you right now?" – Dr. Gelgec ([08:43])

• On shame and seeking help:

  "For so many people with OCD...rather than asking for help, they hide away in shame." – Dr. Miller ([15:04])

• On supporting new parents as clinicians:

  "Normal isn't fine...I want to validate, but I also don't want this person to leave the room thinking, 'Oh, I guess I just sort of almost need to just suck this up...'" – Dr. Mastromano ([19:04])

• On normalization and experimentation in therapy:

  "We often have more time than it perhaps feels and we can be extremely helpful to our clients even without knowing for sure if it is OCD or not." – Dr. Miller ([21:33])

4. Timestamps of Important Segments

| Segment | Timestamp (MM:SS) | |--------------------------------------------------|-------------------| | Introduction of Guest/Topic | 01:14 | | Social Pressures, Perfectionism, and Compulsions | 01:59–04:10 | | Ego-dystonic vs Ego-syntonic in Parenting OCD | 05:37–08:12 | | Trauma and OCD in Parents | 09:18–10:50 | | Shame & Seeking Help | 15:04–16:24 | | Resources for Parents (Books, etc.) | 15:40–16:24 | | Clinical Advice on Assessment and Validation | 18:09–20:30 | | Embracing Uncertainty in Diagnosis | 20:33–21:53 | | Countertransference for Clinicians | 21:53 | | Guest’s Personal Intrusive Thoughts | 23:34–26:36 | | Recommendations & Resources | 26:45–31:39 |

5. Recommended Resources Mentioned

• Books & Authors

  • Good Moms Have Scary Thoughts by Karen Kleiman ([15:40])
  • The Good Enough Mother (podcast) by Dr. Sophie Brock ([26:45])
  • Matrescence by Lucy Jones ([26:45])
  • The Magic Years (discussed in relation to toddler development; exact author not recalled, see [27:58])

• Support Organizations

  • PANDA: Perinatal Anxiety & Depression Australia (for both mothers and fathers) ([13:22])

6. Tone and Original Language Reflected

The conversation is candid, supportive, and often self-revelatory, mixing professional insight with lived experience as parents and clinicians. The episode encourages openness, self-forgiveness, and a nuanced understanding of distress in the perinatal period, while underlining the unique challenges and opportunities for clinicians working with new parents experiencing OCD.

7. Conclusion

This episode is a valuable resource for clinicians supporting new parents with OCD. It underscores the importance of nuanced assessment, awareness of trauma, careful normalization without dismissal, and clinicians’ own self-reflection. Listeners are left with practical advice, resources, and reassurance that “breaking the rules”—showing flexibility, creativity, and curiosity—is not only permissible but essential in supporting new families.

Notable Closing Reflection

"I wish I was more aware of the very subtle environmental messaging about what it means to be a good parent." – Dr. Mastromano ([26:45])

For full resource links and further episode details, visit the Melbourne Wellbeing Group website or the episode’s show notes.