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

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.

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)

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)

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

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.

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.

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.