The Challenges of Clinical Practice

Summary

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

Episode: The Challenges of Clinical Practice

Hosts: Dr Celin Gelgec & Dr Victoria Miller
Guest: Catherine McGrath
Date: November 17, 2025

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Main Theme & Purpose

This episode centers on the real, often messy challenges clinicians face while treating Obsessive Compulsive Disorder (OCD), particularly using Exposure and Response Prevention (ERP). Dr. Celin Gelgec, Dr. Victoria Miller, and their colleague Catherine McGrath openly share hard-learned lessons, personal vulnerabilities, and reflective moments from their clinical journeys. Their aim is to normalize imperfections in practice, reduce the sense of isolation for clinicians, and encourage openness, self-compassion, and continuous learning—especially for clinicians building confidence with OCD treatment.

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Key Discussion Points & Insights

1. Normalizing ‘Stuff-Ups’ and Embracing Vulnerability

• The Value of Sharing Mistakes

  • Clinicians often feel pressure to be perfect or all-knowing, yet even experienced practitioners make mistakes and face challenging moments (03:11–05:12).
  • Quote: “You don't have to know everything and therapy can still be good enough even when things don't go exactly according to plan.” – Dr. Tori Miller (04:36)

• The Importance of Reflection and Peer Support

  • The team regularly share missteps over lunch, finding comfort and normalization in others having similar experiences (05:26–05:51).

2. Early Career Struggles & Transition to Confidence

• Misattributing ‘Stuck’ Moments to Personal Failure

  • Catherine recounts a period where she felt solely responsible for a client’s stagnation, only later understanding how much the client’s readiness and context mattered. She learned to differentiate her role from client factors (06:08–07:42).
  • Quote: “I thought it was all me... now I can look at it and think, actually, this is about the difficulty of this work... the leap we’re asking our clients to do is so huge sometimes.” – Catherine McGrath (06:08–07:42)

• The Search for a “Magic Technique”

  • The team reflects on chasing elusive perfect solutions and over-reliance on resources and psychoeducation, often at the expense of real connection and curiosity with clients (08:06–08:45).

3. Missing Emotional Cues and the Consequences

• Relating to Clients on an Intellectual vs. Emotional Level

  • Dr. Celin Gelgec shares a story where her focus on psychoeducation led her to miss a client’s silent distress, resulting in an unexpected and regrettable drop-out (09:00–11:58).
  • Quote: “I didn’t ask her at all in session… how does it feel hearing me talk about this? ...I was very much just keeping it intellectual." – Dr. Celin Gelgec (10:14–11:03)

• Owning Missed Repair Opportunities

  • Sometimes rupture can’t be repaired; the team discusses sitting with that discomfort and using it as a powerful learning experience (11:03–11:41).

4. Holding the Therapeutic Space

• Shifting from Action to Presence

  • Early-career clinicians feel pressure to "do" (e.g., complete exposures quickly); with experience, they value "holding the space"—tolerating silence, distress, and being present rather than constantly fixing (12:42–14:07).
  • Quote: “Holding the space is the work a lot of the time… being able to tolerate feeling uncomfortable, not needing to do the fixing.” – Catherine McGrath (13:13)

• Unique Value of the Therapy Relationship

  • The hosts highlight how therapy offers a rare, undivided space, fundamentally different from daily interactions (14:07–15:31).

5. Danger of Assumptions and the Need to Return to Basics

• Assuming Clients’ Knowledge or Readiness

  • Dr. Miller notes her tendency to skip over basic techniques (e.g., deep breathing, grounding) due to assumptions, only to realize clients may not have these skills or might benefit from them regardless (15:35–17:12).
  • Quote: “Presuming that clients already know what I’m talking about… glossing over those things.” – Dr. Tori Miller (15:35)

• Clients Hear & Receive Information Differently

  • Sometimes a client will only grasp a concept after hearing it elsewhere, underscoring the importance of repetition and patience (17:31–18:45).

6. Pacing, Readiness and Meeting Clients Where They Are

• Checking Client Readiness
  • The team stresses the need to align their pace with clients’ emotional readiness, not just their own clinical agenda (18:54–19:28).

7. Engaging Families and Addressing Accommodation

• Involving Parents Systematically

  • Dr. Miller candidly discusses a long-standing oversight: not involving parents (or caregivers) early or deeply enough in ERP, and not exploring how family accommodations reinforce OCD (19:30–21:15).
  • Quote: “The thing I didn’t do enough was just a learning journey... not really understanding accommodations.” – Dr. Tori Miller (20:06)
  • The team references Ellie Leibowitz’s work and note their own “lightbulb moment” when realizing how much had been missed in previous approaches (21:40–22:57).
  • Quote: “Everyone accommodates. Good parents accommodate.” – Ellie Leibowitz, relayed by Catherine McGrath (21:40)

• Accommodations Are Subtle and Ubiquitous

  • Families often don’t realize the extent of their accommodations to OCD, and children are seldom motivated to disclose them (23:39–24:12).

8. The Ongoing Necessity of Reflection & Self-Compassion

• Growth Comes from Honest Reflection

  • The clinicians advocate for ongoing self-reflection, supervision, and peer support, warning against defensiveness and self-blame (24:45–28:03).
  • Quote: “If we lose the ability to self-reflect… that’s a dangerous path.” – Dr. Celin Gelgec (25:06)

• Letting Go of Perfectionism

  • A key lesson is accepting not having all the answers, growing alongside clients, and showing professional curiosity (25:31–26:34).

• Self-Care and Boundaries

  • The conversation closes with a call for clinicians to show themselves compassion, care for their boundaries, and use reflective spaces such as supervision (26:21–27:12).
  • Quote: “Because your client walked out and didn’t come back, we’ve all had that… that doesn’t mean you can no longer be a therapist.” – Catherine McGrath (26:36)

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Notable Quotes & Memorable Moments

• Normalizing Mistakes: “Therapy can still be really effective even if we’re not perfect clinicians.” – Dr. Tori Miller (04:36)
• On “Doing” vs. “Being”: “Holding the space is the work a lot of the time.” – Catherine McGrath (13:13)
• Importance of Supervision: “Allow yourself to be vulnerable in supervision. Have a supervisor who allows that.” – Dr. Tori Miller & Dr. Celin Gelgec (27:34–27:53)
• Final Reflection: “Be kind to yourself. Keep swimming. The learning curve is hard, not without mistakes.” – Joint summary by all three speakers (27:19–28:14)

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Key Segment Timestamps

• Intro and Episode Set-up: 02:18–03:41
• Why Share Mistakes? 03:41–05:27
• First Big Clinical Lessons: 06:08–07:42
• Chasing the Magic Technique: 08:06–08:45
• Missing Emotional Cues: 09:00–11:58
• Switch from Action to Presence: 12:42–14:07
• Value of the Therapy Relationship: 14:07–15:35
• Assumptions in Practice: 15:35–18:45
• Client Readiness and Pacing: 18:54–19:28
• Engaging Family and Accommodation: 19:30–24:31
• Reflection, Supervision, and Self-Compassion: 24:45–28:14
• Final Summary: 27:19–28:14

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Tone and Language

The episode is warm, validating, highly conversational, and honest—full of clinical humility with gentle self-deprecation and encouragement. The clinicians provide reassurance to listeners, particularly those early in their careers, that being imperfect is not only normal but essential for growth in OCD practice.

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Final Takeaways

• Perfection is Impossible: Clinical growth is built on honest reflection, learning from errors, and accepting vulnerability.
• Client Collaboration is Key: Therapy is done with—not to—clients.
• Self-Compassion is Essential: It’s as vital for clinicians as it is for clients; supervision and community help.
• Never Stop Reflecting and Learning: Openness, humility, and a willingness to adapt are crucial for providing the best care in the evolving field of OCD treatment.

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For OCD clinicians and mental health professionals, this episode is both an invitation and a comfort—reminding you that the ‘mess’ is where the heart of real progress, for both client and clinician, lies.

Transcript

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[Host 1 (Possibly Dr. Celine Galgic)]

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[Sherrell Dorsey]

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[Host 1 (Possibly Dr. Celine Galgic)]

ACAST helps creators launch, grow and monetize their podcasts everywhere. Acast.com. Hi, I'm Dr. Celine Galgic.

[Dr. Tori Miller]

And I'm Dr. Tori Miller. Welcome to Breaking the Rules. On Breaking the Rules, we talk about.

[Host 1 (Possibly Dr. Celine Galgic)]

All things OCD 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.

[Host 1 (Possibly Dr. Celine Galgic)]

Hello Hello. Today we have a very special guest. Very special, which will be fun. Yeah, we have the lovely Catherine McGrath who is one of our team members actually, and she's coming back onto the show to talk to us about or to talk with us actually. We're going to have like a little group chat about our biggest learnings as clinicians.

[Dr. Tori Miller]

Yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

Things hard stuff that we've learned as clinicians. So we thought this would be a really interesting topic. But also demonstrating, sitting in awkwardness and admitting our stuff ups along the way. We are human.

[Dr. Tori Miller]

Yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

And they happen in therapy. Ruptures happen and stuff happens in therapy. And we thought we'd share them with you guys.

[Dr. Tori Miller]

Yeah.

[Catherine McGrath]

Yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

Thanks for joining us, Catherine.

[Catherine McGrath]

Thanks for having me back. Yeah.

[Dr. Tori Miller]

Look, it's tough and I think one of the reasons why I really like the idea of this topic is because, um, I suppose through, if we, if we think about OCD and ERP in particular. Right. I think that we have a lot of members. Myself, you know, like, you know, once upon a time I hadn't learned erp and you know, you have to be very courageous to step into it and inevitably when you're beginning a learning journey, you know, you don't know everything and you, you, you know, you do a good enough job but, you know, perhaps.

[Host 1 (Possibly Dr. Celine Galgic)]

Cringe moments, early career.

[Dr. Tori Miller]

Yeah. But, but I, I think I, I think I really like the idea of us sharing, the three of us sharing our experiences with learning ERP and stepping into this space because we have a lot of people who are learning ERP still.

[Host 1 (Possibly Dr. Celine Galgic)]

Yes.

[Dr. Tori Miller]

Who are meeting with an. Someone with OCD for the first time for students, for registrars. You know, I think it's really important to know that you don't have to know everything and therapy can still be good enough even, even when things don't go exactly according to plan or even if there's a missed opportunity and you realize later, oh my Gosh, I was 100% indulging OCD in that session. Just dawned on me and that that's okay. That that's okay that we're, you know, therapy can still be really effective even if we're not perfect clinicians.

[Host 1 (Possibly Dr. Celine Galgic)]

Yes.

[Dr. Tori Miller]

And, and also I think my, I think my hope, I suspect we all have this hope is that by sharing these, we might even help others avoid.

[Host 1 (Possibly Dr. Celine Galgic)]

These mistakes, you know? Yes.

[Catherine McGrath]

Or maybe normalize it too.

[Host 1 (Possibly Dr. Celine Galgic)]

Yes, and normalize it too.

[Catherine McGrath]

Yes. We sit there at lunch often and we'll go, oh my goodness, this just happened. And then you go, oh, okay, this happened to other people too, or they've had other experiences.

[Host 1 (Possibly Dr. Celine Galgic)]

Yeah.

[Catherine McGrath]

It's quite comforting actually as well, because Tori and I were talking this week, something came up and I was like, oh, this is one of those lessons that I've learned so it happens.

[Dr. Tori Miller]

So true.

[Host 1 (Possibly Dr. Celine Galgic)]

And I think so true.

[Catherine McGrath]

I think for the young staff, too, then they look at experienced clinicians and think, oh, you just know how to do it and you must say the right thing all the time. Which I'd like to pretend was true. But, yeah, yeah, that's true.

[Host 1 (Possibly Dr. Celine Galgic)]

Do you want to kick us off, Katherine?

[Catherine McGrath]

Yeah. Well, I was thinking, probably one that came to mind actually, this week, you know, talking with Tori and I said, oh, I just was feeling a bit stuck with a client and thinking, what am I doing? And. And I'd remembered I'd been stuck a previous time with this very same client. And I thought, what's the difference between now and then? And this is a couple of years have gone past. And I realized in that. That when I was stuck the first time, I thought it was all me and I thought it was because I didn't know enough, or maybe I'd done ERP wrong and all the way I'd suggested the exposure tasks was wrong or I hadn't delivered it correctly, when actually now I can look at it. And I thought, actually, no, it's about what the client was bringing in the room as well. And because we're back at a very similar space and now I'm like, no, no, what we did then, and it was what we needed to do and it was really successful for them, but, you know, the ebbs and flows of working with ocd. And we're back here again, and we ended up having the same conversation where I thought, oh, am I suggesting, you know, the client sort of questioning, are you sure this is right? You sure this is the only solution for me? And I said, well, there are options, but this is, you know, what I think we need to do. And rather than me immediately thinking it was something that I was doing, I thought, oh, actually, this is one of those learning moments where I thought, no, no, this is about the difficulty of this work.

[Dr. Tori Miller]

Yeah.

[Catherine McGrath]

And how hard doing ERP is. When you were saying earlier, like, that leap as a clinician to be courageous and do it, but then the leap we're asking our clients to do as well is so huge sometimes.

[Dr. Tori Miller]

Yeah. Yeah.

[Catherine McGrath]

I've.

[Dr. Tori Miller]

I've definitely been in that place before where I have thought that the, The. The reason things weren't progressing was because I wasn't sort of. I wasn't somehow good enough, or I wasn't applying the principles in a sophisticated enough way, or I wasn't explaining it.

[Host 1 (Possibly Dr. Celine Galgic)]

Properly or you were missing the magic technique.

[Catherine McGrath]

Yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

Or something.

[Catherine McGrath]

Yeah. I'm waiting for the magic. Yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

Yes.

[Dr. Tori Miller]

Yeah, yeah, yeah. And I don't feel like in those moments then I. I got all up in my head and forgot to sort of continue exploring things with the client, and instead I doubled down on resources and worksheets and psychoeducation and, you know, as opposed to just being curious with the client. Tell, you know, tell me more what's going on here. Tell me more. Yeah, yeah. So probably miss some opportunities.

[Host 1 (Possibly Dr. Celine Galgic)]

Yeah, totally.

[Catherine McGrath]

And rather than trying to convince them also, like with those worksheets and think, this is why. And I'll show you an excerpt from one of these books. And it's not just me that thinks.

[Host 1 (Possibly Dr. Celine Galgic)]

This here's a whole chapter on motivation.

[Catherine McGrath]

I do know what I'm talking about. Yeah, you missed the point. Yeah, not in the room, it's not. Yeah, about that at all.

[Dr. Tori Miller]

Yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

Speaking of missing the point, I've told you that guys, this story before, and I may have mentioned it on the podcast in a previous episode, but I remember very early in my career just totally misreading how distressed a client was when I was talking about psychoeducation in the very early sessions of therapy and the client was masking, like, there was like. You know, when someone starts to feel really sad or upset, either their posture might change even just a little bit, or nothing might change, but you might see, like tiny bits of red popping up into their eyes because you can see the emotion creeping in. Right. None of that was happening. It was just super composed. But there would have been something that I totally missed for sure. But I was working through Cycle Ed and we're talking about and talking about what ERP is like and what it is and all that sort of stuff. And I thought the session went great. So there I am typing my notes afterwards and all that sort of stuff. And after five minutes, Admin walked in and was like, what did you do to that client? I just froze. And I was like, what do you mean? And they're like, well, they cancelled all the rest of their appointments. And I was like, oh, fuck. What?

[Sherrell Dorsey]

What do you mean, oh, shit?

[Host 1 (Possibly Dr. Celine Galgic)]

And I was racking my. What did I say? What did I do? And then I was like, I reckon I scared the shit out of her about talking about what ERP is. And I didn't ask her at all in session. I didn't say, how does that sound? How is this feeling? Is, you know, does this feel scary? Like, what's going on for you? How does it feel hearing me talk about this and what the expectations Are. And do you have any questions? Like I would have asked you have any questions? Because that's something I typically ask. But all the other stuff. Yeah, I know I didn't ask.

[Dr. Tori Miller]

And so questions isn't about the emotional experience of. It is like.

[Host 1 (Possibly Dr. Celine Galgic)]

No, exactly. Yeah, exactly. I just like checking emotional experience. Yeah, exactly.

[Dr. Tori Miller]

Was I clear that you're going to feel terrible?

[Host 1 (Possibly Dr. Celine Galgic)]

I wasn't checking in with her about what her emotions were like.

[Dr. Tori Miller]

Yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

I was very much just keeping it intellectual.

[Dr. Tori Miller]

Yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

Which for me is an early career psychologist. I think I hid in that safety and I think a lot of us do of the intellectual part of therapy and we might skim around the emotions, but for us it's still learning how to do that for ourselves and how to regulate that in the room to help co regulate our clients. And so that was a huge miss to me and you know, obviously reached out to this client and all that sort of stuff, but heard nothing back. Fair enough. Um, but you weren't able to repair. No, I couldn't repair, which is, you know, hard. And sometimes a lot of the time we don't get the chance to repair.

[Dr. Tori Miller]

Yeah, it's true.

[Host 1 (Possibly Dr. Celine Galgic)]

I, you know, I love the chance to be able to repair with clients. I think that's really important and helpful for them too, because it's a, it's a learning experience and a teaching moment. But I think too, since then I've overcompensated and to this day I'm constantly.

[Catherine McGrath]

Checking in.

[Host 1 (Possibly Dr. Celine Galgic)]

About where they're at. Stop asking me for reassurance. Celine.

[Dr. Tori Miller]

I've reassured you once. You only get what? You only get reassurance once.

[Host 1 (Possibly Dr. Celine Galgic)]

We all need it. I'm sure you're okay. You sure this is okay?

[Dr. Tori Miller]

Yeah, but I think you're right. Like, I think we can probably all relate to that. The notion of, like, we're doing therapy to our clients, not with our clients. Yeah, yeah, yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

And then first start.

[Catherine McGrath]

Yeah. What the therapy is, I think, particularly with OCD work, if, you know, it's like, right, this is what I've got to do. And I've got to get to the erp, Particularly again, people early, maybe not early career, but newer to work, newer to the area.

[Host 1 (Possibly Dr. Celine Galgic)]

Yeah, yeah, yeah.

[Catherine McGrath]

And so I've got to go and we've got to do some exposure tasks and I haven't done them yet. And I know, I remember sort of getting caught up in that, thinking, oh, I've done this many sessions and. And they haven't, you know, got through all these items on their list. They haven't, you know, we haven't done exposure tasks to this. And I think that sort of link that was when you were talking about your client. It also made me think of probably one of those other learnings of this work is that actually holding the space is the work a lot of the time.

[Dr. Tori Miller]

Can you, can you define what holding the space means for people who might not be familiar with that term?

[Catherine McGrath]

Yeah. So, you know, sitting with the silence, sitting with the pain, sitting with the discomfort and being able to tolerate feeling uncomfortable, not needing to do the fixing as well, I think. So we get caught a lot early days, you know, here's some worksheets, here's how we're going to do it. We need to try and fix this.

[Host 1 (Possibly Dr. Celine Galgic)]

And I certainly get caught up in the anxiety, right. To like want to fix it or we might shift gears too quickly and too much when the anxiety feels really intense because we feel like we have to make it go away or fix it. Right, Yeah, I hear you.

[Dr. Tori Miller]

Yeah, yeah.

[Catherine McGrath]

And so also showing them that we can tolerate whatever distress, pain, discomfort they're feeling, that we can hold a space for that. I think there's a modeling to that too, but also a lesson for me in the importance of that space that we create for clients that probably nowhere else in their world they have.

[Host 1 (Possibly Dr. Celine Galgic)]

Yeah.

[Dr. Tori Miller]

It's a very beautiful and unique space, isn't it, that therapy is? I think, one of the things that I get caught up. It's not necessarily ERP and OCD treatment space specific, but get caught up in wondering whether I'm being useful and, and I don't mean being accountable and making sure that what I'm providing is evidence based treatment. Because that is part and parcel of being a psychologist where scientists, practitioners, you know, we are, we are taught to make sure that everything that we're doing is evidence based. I'm talking about, you know, just minimizing, I think, you know, the experience of being in the therapy room and around some of those, you know, process oriented aspects of work where you might not be getting to the, the action oriented aspects like doing an exposure, exposure exercise. You've actually spent a lot of time talking, you know, empathizing. And it's just a great reminder, Catherine, what you said, about how special and unique that space is, that in most interactions in life, people are jumping in and sharing their own personal experiences or their problem solving for you, or they might be even be dismissive. It's just not the same. It's very special, isn't it? And I think we can as, as clinicians, we can spoil that a bit, can't we? If we get to. In our head about. Certainly that's, that's been a vulnerability of mine.

[Host 1 (Possibly Dr. Celine Galgic)]

Yeah, yeah, yeah. Do you want to elaborate a little bit more on that?

[Dr. Tori Miller]

Oh, yeah. Just in terms of, I think, think presuming that clients already know what I'm talking about. So not perhaps teaching deep breathing because I presume everyone knows how to deep breathe. Or presuming that someone would think that doing a meditation together in session would seem silly because, you know, everyone does meditation everywhere and you know, you do it in school and it's encouraged in the workplace and every app has it, you know, and so presuming that it wouldn't be interesting to the client or of value or even like even some more specific mindfulness based techniques like grounding, you know, the 5, 4, 3, 2, 1 exercise, sort of glossing over those things. Presuming that I don't need to teach them or that people wouldn't be interested or engaged in learning or practicing together. Because I just think, oh, you know, it's, it's not really particularly interesting or special, you know.

[Catherine McGrath]

Do you think like you're filtering out in those moments? You know, like we self filter sometimes out things that we think, oh, no, this client probably won't, you know, they'll probably roll their eyes when I mentioned.

[Dr. Tori Miller]

And I, I think sometimes you're right. There's probably a sort of a, a transference component there where I'm making presumptions about what someone would and wouldn't want to engage with, depending on how they're presenting in the room and perhaps their own anxieties, their own worries about not being a good enough client, not being a good enough patient. You know, I think I'm probably responding a bit to that.

[Host 1 (Possibly Dr. Celine Galgic)]

Sometimes I carry hostility about the, like I've done ERP before.

[Catherine McGrath]

Yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

What's going to be different this time?

[Dr. Tori Miller]

How, how could I make a difference? They've already had three practitioners. They've had OCD for 30 years. What, what, what have I got that.

[Host 1 (Possibly Dr. Celine Galgic)]

What am I gonna bring?

[Dr. Tori Miller]

Yeah, yeah, yeah. I think that's definitely something that I've, I've not.

[Host 1 (Possibly Dr. Celine Galgic)]

Yeah.

[Dr. Tori Miller]

You know, it's a trap I can definitely fall into. Yeah, yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

That's a, that is a hard lesson in terms of recognizing that, sitting in that and trying to be able to be mindful of not making those assumptions. I like even just the assumption of they've been through ERP before. I'll skip psychoed.

[Catherine McGrath]

Yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

When we Forget sometimes that people come in with anxiety.

[Catherine McGrath]

Yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

They're not always taking in what we're telling them.

[Dr. Tori Miller]

Yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

And sometimes they'll hear it differently. Or the perfect example of this, I think, is when you've been talking about something with your client for a couple of months, and then they come in like, so what's this thing on YouTube? And they talked about blah, blah, blah. And in your head you're like, we've been fucking talking about this for three fucking months. And you. It registers to you on YouTube.

[Catherine McGrath]

I've had that.

[Dr. Tori Miller]

But it was a TED Talk.

[Host 1 (Possibly Dr. Celine Galgic)]

Oh, yeah, yeah. Same deal.

[Catherine McGrath]

I had someone do the Groove, our OCD group, and they said. I went to group and they taught us this amazing thing. And I was like, oh, wow, I should learn what this is in my. Yeah, but it was the process.

[Dr. Tori Miller]

I mean, I don't know. It's just how humans work.

[Catherine McGrath]

Right.

[Dr. Tori Miller]

Sometimes we have to hear it a.

[Catherine McGrath]

Different way at a different time or in a.

[Dr. Tori Miller]

Sits differently or in a state of readiness or just explained in a slightly different way. There's all sorts of factors there.

[Host 1 (Possibly Dr. Celine Galgic)]

Yeah. I've been caught up in that, too. In making those assumptions.

[Dr. Tori Miller]

Yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

And then going, no, no, no. I have to hold back.

[Dr. Tori Miller]

Yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

Go through that process.

[Dr. Tori Miller]

Yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

And check in, you know, the concept of readiness, too.

[Catherine McGrath]

I think.

[Host 1 (Possibly Dr. Celine Galgic)]

Yes.

[Catherine McGrath]

Is such an important lesson along the way as well. Like, we might think, these are all the things we want to do. And I know how I need to work on this. But the readiness of the client is something that we have to also pace ourselves around. We have to meet them where they're at. And if they didn't hear when you did the beautiful lot of psychoeducation. But when they sat in their room and listened to a TED Talk, that was part of it, wasn't it? That they just weren't ready in that moment. Yeah, that's right.

[Host 1 (Possibly Dr. Celine Galgic)]

That's right. Yeah.

[Dr. Tori Miller]

Yeah. I think another. Another lesson I learned the hard. The hard way, or a hard lesson that I learned was I didn't include parents enough.

[Host 1 (Possibly Dr. Celine Galgic)]

Oh, yeah.

[Dr. Tori Miller]

In the early stages.

[Host 1 (Possibly Dr. Celine Galgic)]

Yeah.

[Dr. Tori Miller]

And even though when I was really diving into OCD treatment using erp, this is going back a while now. I'd had plenty of experience working with parents, so it wasn't a case of. Of discomfort working with, you know, doing systems work, working with families, because I'd done. I'd done plenty of it. So I'm talking about, you know, 10 years worth.

[Host 1 (Possibly Dr. Celine Galgic)]

Yeah.

[Dr. Tori Miller]

I think there were a couple of things that held me back. One was not really just a learning journey, understanding accommodations.

[Host 1 (Possibly Dr. Celine Galgic)]

Yes.

[Dr. Tori Miller]

So I think that that was something I didn't do enough of in the beginning, only because I. I just hadn't learned it yet. I just had been focused. My learning was just focused around individual treatment for OCD and about supporting parents sort of in terms of relationships and hardships.

[Host 1 (Possibly Dr. Celine Galgic)]

But parents teaching them to be pseudo therapists almost at home.

[Catherine McGrath]

Yes.

[Dr. Tori Miller]

So teaching parents to support their kids with their. With their own personal erp. And parents were really asking me, you know, what else can I do? I really. Whatever you tell me to do, I'll do it. And I think it was partly that I didn't know. I think the other thing that sometimes I did was once I did start to learn about accommodations and start to do the work in that way, was probably too quick to believe parents when they said that they don't engage in accommodations. And it's not necessarily. I think I realize now that a lot of time OCD is so insidious that families just didn't realize that they were engaging in accommodation.

[Host 1 (Possibly Dr. Celine Galgic)]

Yeah. They wouldn't have known because it's so subtle.

[Catherine McGrath]

Right.

[Host 1 (Possibly Dr. Celine Galgic)]

Like, you think it's just a quick reassurance or whatever it is, or you engage it, or you end up following through with whatever the request is from your child just to help relieve the anxiety, relieve the pain, but also to get the family going.

[Dr. Tori Miller]

Yeah, absolutely.

[Host 1 (Possibly Dr. Celine Galgic)]

And to keep the peace.

[Dr. Tori Miller]

Yeah. Because you got to get the kids to school.

[Sherrell Dorsey]

Right?

[Host 1 (Possibly Dr. Celine Galgic)]

Yeah.

[Dr. Tori Miller]

Yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

Have you.

[Dr. Tori Miller]

Has that ever happened to you, Catherine?

[Catherine McGrath]

I think. And sometimes it's a real tipping point, isn't it? Like, I always remember Ellie Leibowitz talks about, you know, everyone accommodates. Good parents accommodate. So we do that. So where's that point where it tips over? It's really hard for parents to then be cognizant of that point where it switches from being something that parents do every day, that something that is then, like, dysfunctional now, that is impairing the child, because actually they're doing it out of a place of love, compassion, wanting to help the child or get the family out the door, because we're waiting for, you know, these rituals to be done, or just reassuring them because they're fearful or they're scared. What's innately within a parent is to want to comfort and remove that fear.

[Host 1 (Possibly Dr. Celine Galgic)]

Yeah, for sure. But I remember, Catherine, when we did the workshop with Ellie, we both went, fuck. We've been working with parents wrong. For, like, 15 years. Do you remember that feeling?

[Catherine McGrath]

I remember that because I think we text each Other when this thing goes. Oh my goodness.

[Host 1 (Possibly Dr. Celine Galgic)]

And he did say that he was like, you guys will. You know, this is what was done.

[Dr. Tori Miller]

Yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

What was done was what you've just described. And we're only really just fully understanding accommodations now. So that was a very hard lesson, which is a relieving one.

[Dr. Tori Miller]

The thing is like, that we were doing wrong was bringing in the parent for like the last 10 minute sessions to provide handover and like, you know, Johnny's gonna, you know, do this for homework. Do this for homework. He has to touch the, the bench before it's been wiped down. And here's how you can support him with this.

[Host 1 (Possibly Dr. Celine Galgic)]

Yes. Yeah.

[Dr. Tori Miller]

Whereas now we know.

[Host 1 (Possibly Dr. Celine Galgic)]

Yeah.

[Dr. Tori Miller]

Actually the, the role for parents is actually quite different. Yeah, yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

Or even be like, these are some things you can say if he asks you for reassurance. This is what it is. Like, you know, just some real.

[Dr. Tori Miller]

Yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

Symptom management stuff as opposed to removing accommodations. Yeah, yeah.

[Catherine McGrath]

And that how we educate parents of their role in the process. And maybe not just parents even. I mean, partners, caregivers.

[Host 1 (Possibly Dr. Celine Galgic)]

Yeah, yeah.

[Catherine McGrath]

With someone that has ocd, it's around. It's not just about the individual getting therapy. So then it's like, actually there's two parts to this because you. If we work on all these things that might be certain rituals that a client might be going through, but we're missing this whole piece of accommodation that's happening, then you're not doing the really critical parts of the work either. But we thought that we were so very much so. And it can get missed because it's also for a lot of our, and particularly children, they don't probably realize either. And also they're not motivated to want to call that out.

[Host 1 (Possibly Dr. Celine Galgic)]

No.

[Catherine McGrath]

Why won't they removed?

[Host 1 (Possibly Dr. Celine Galgic)]

Yes.

[Catherine McGrath]

I'll feel uncomfortable, please.

[Dr. Tori Miller]

In the teen group, whenever we get to the point where it's like, now it's time for us to tell your parents how to reduce accommodations.

[Host 1 (Possibly Dr. Celine Galgic)]

They're like, no, don't do it, don't do it. Like, do you have to send that video?

[Dr. Tori Miller]

Don't take it away.

[Host 1 (Possibly Dr. Celine Galgic)]

Do you have to tell them? Yes. Oh man. Yeah. It's so true. Yeah.

[Dr. Tori Miller]

Yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

It's just these, some of these hard lessons are ones that are, I think, worth experiencing.

[Dr. Tori Miller]

Yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

Because it helps us be reflective, it helps us grow, it helps us improve the way that we work. We're talking about them in the hope that others don't repeat them, but also to normalize them as well. And like we said earlier, to be able to make sure that we stay reflective.

[Dr. Tori Miller]

Yeah, that's right.

[Host 1 (Possibly Dr. Celine Galgic)]

Because I think that's a dangerous path in terms of if we lose the ability to self reflect and. And not take things to supervision or be my, like, you know, worried about. Oh, I think I stuffed that up. I don't want to tell my supervisor in case they get angry at me or annoyed at me or report me or.

[Dr. Tori Miller]

Yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

Do whatever else it is. Like, hopefully this conversation inspires people to be comfortable to talk about the hard.

[Catherine McGrath]

Things and think about what our job, you know, like, often.

[Host 1 (Possibly Dr. Celine Galgic)]

Yeah.

[Catherine McGrath]

What's my job here? What's my role here? And it isn't to be perfect and I don't have to have all the answers. That's. That was a shocking one to have to learn and sit with. Very difficult. But to actually do that. The curiosity ongoing alongside your clients and work with them on that. Like, I'm wondering why. I'm curious why that might be happening rather than me having to respond with. It's happening because of this.

[Host 1 (Possibly Dr. Celine Galgic)]

Yes. Yeah, yeah, yeah, yeah.

[Dr. Tori Miller]

I agree.

[Host 1 (Possibly Dr. Celine Galgic)]

Yeah, yeah, yeah, yeah. Should we summarize or. Before we do that, is there anything else that you guys want to share before we wrap up?

[Dr. Tori Miller]

I mean, how long you got?

[Host 1 (Possibly Dr. Celine Galgic)]

I know we could be here all day.

[Catherine McGrath]

I mean, very quickly, and I won't go. But I think just all of this talked around, you know, that idea of the compassion we need to actually have for ourselves and the boundaries and limits we set for ourselves. And I just think each one of the things we've talked about probably links to that.

[Dr. Tori Miller]

Yeah.

[Catherine McGrath]

You know, like because your client walked out and didn't come back, we've all had that. And that doesn't equal. I can no longer be a therapist and I don't know how to do this. So we need to look at how we look after ourselves in that process, which is using our supervision and reflective spaces and all those things. So I feel like that part we could go on about how we need to look after ourselves as clinicians and stuff for a long time and it's really important. But I think each one of the things we've talked about today is probably encompassed in that as well. Yeah, yeah, yeah. I think you're right.

[Host 1 (Possibly Dr. Celine Galgic)]

That's a really nice point to make.

[Dr. Tori Miller]

Yeah, yeah, yeah.

[Host 1 (Possibly Dr. Celine Galgic)]

Do you want to summary.

[Dr. Tori Miller]

Keep going? Yes, I think is a summary.

[Host 1 (Possibly Dr. Celine Galgic)]

Yeah. Be kind to yourself.

[Dr. Tori Miller]

Be kind to yourself.

[Host 1 (Possibly Dr. Celine Galgic)]

Keep swimming.

[Dr. Tori Miller]

Just keep swimming. Just keep swimming.

[Catherine McGrath]

Yeah.

[Dr. Tori Miller]

I think the summary is the learning curve is hard.

[Host 1 (Possibly Dr. Celine Galgic)]

Yeah.

[Dr. Tori Miller]

The learning curve is not without mistakes. I think start from a place of knowledge, get the foundations and then get going and allow yourself to be vulnerable in supervision. Reflect on fully.

[Host 1 (Possibly Dr. Celine Galgic)]

Have a supervisor who allows that.

[Dr. Tori Miller]

Yes, that's right.

[Host 1 (Possibly Dr. Celine Galgic)]

That's important.

[Dr. Tori Miller]

To reflect on your experiences. Think about them. Watch out for defensiveness where we're client blaming.

[Host 1 (Possibly Dr. Celine Galgic)]

Yeah, yeah.

[Dr. Tori Miller]

But also personalizing and blaming ourselves for everything. To talk it out with someone else bringing in that self compassion and just find the learning moments and continue growing.

[Host 1 (Possibly Dr. Celine Galgic)]

Yeah yeah. I love that. Thank you.

[Dr. Tori Miller]

Thanks for chatting. Catherine.

[Host 1 (Possibly Dr. Celine Galgic)]

Thanks for joining us.

[Catherine McGrath]

Catherine thanks for having me back. Lovely to see you both. Yeah you too hun.

[Host 1 (Possibly Dr. Celine Galgic)]

Thanks everyone for watching and listening. We'll catch you guys in our next episode.

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[Host 1 (Possibly Dr. Celine Galgic)]

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