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

Episode Summary: The Value of Self-Awareness, Trust, and Non-Accommodating Support

Hosts: Dr Celine Gelgec, Dr Victoria Miller
Guests: Emily and Lindsay Stetzer
Date: April 14, 2025

Episode Overview

In this episode, Dr. Celine Gelgec leads an insightful conversation with sisters Emily and Lindsay Stetzer, who openly share their lived experiences with OCD, the dynamics of growing up in a family affected by it, and their journey towards self-awareness and resilience. The episode focuses on the importance of non-accommodating support, experiential learning in therapy, and fostering trust and self-awareness as essential tools in recovery. The discussion provides practical advice for clinicians on how to balance support without enabling compulsions, how to avoid the trap of reassurance, and how to empower clients to face discomfort.

Key Discussion Points and Insights

Family Dynamics and Early OCD Experiences

• Navigating Diagnosis and Family Support

  • Lindsay reflects on being diagnosed earlier and the household's struggle to understand OCD in its various manifestations.
    • "I never thought about that our mom and our, and our dad, but our dad was like denying he had OCD when clearly we were struggling with it." (02:23, Lindsay)
  • Emily and Lindsay highlight the chaos and frustration stemming from their lack of understanding, with their mother taking proactive steps to seek support when few resources were available.

• Sibling and Parental Reactions

  • Sibling frustration and dynamics are candidly discussed:
    • "Lindsay, go to sleep... stop asking me these questions." (03:49, Emily)
    • "I was annoying. I was annoying." (04:08, Lindsay)
    • "OCD was annoying." (04:10, Emily)
  • Over time, the sisters' mutual empathy and support grew, helping them and their family better manage OCD challenges.

Self-Awareness and Evolution Through Therapy

• The Role and Impact of Exposure Therapy

  • Emily explains the transformative power of exposure therapy and how keeping track of thoughts, fears, and compulsions increased her self-awareness:
    • "Just keeping track of what you're going through is super, super helpful... so much of therapy can spill over into just everyday teachings." (09:15, Emily)
  • Lindsay stresses that therapy evolved beyond OCD, becoming a tool for general mental well-being.

• Mindfulness and Grounding Techniques

  • Both sisters detail personal strategies such as:
    • Noting how anxiety manifests physically: “Where do you feel it in your body? Taking yourself out of your mind and taking it into what physically you feel.” (11:47, Lindsay)
    • Using “check the facts” (12:36, Lindsay), balanced to avoid compulsive checking.
    • Applying the “delay, delay, delay” strategy, and stepping back to see intrusive thoughts as products of OCD.

Trust and Self-Reliance in Recovery

• Building Self-Trust
  • Lindsay describes the challenge of trusting oneself, especially when OCD erodes confidence in personal judgment:
    • "Trusting myself, trusting what I know and what I see. And the fact that we're all walking across the street... I know I could see it." (13:12, Lindsay)
  • “You coach yourself through it. Like you are your own personal trainer when it comes to OCD." (14:19, Dr. Celine)

Non-Accommodating Support and the Role of Clinicians

• The Power of Withholding Reassurance

  • Emily finds value in her therapist’s refusal to provide reassurance for OCD-driven questions:
    • “I find it really helpful. Well, I find it frustrating, but, like, in the best way possible.” (15:52, Emily)
    • “In the long run, it’s probably more helpful… just to let us feel discomfort.” (16:21, Emily)
  • Lindsay shares a therapist strategy that builds agency:
    • “If I question her, like, 'What did you just say?' She says to me, 'What do you think I just said?'... It's just trusting yourself.” (16:57, Lindsay)

• Therapists as Empowerers, Not Rescuers

  • Dr. Celine emphasizes the need for therapists to resist being pulled into reassurance:
    • “Trust that we can handle it. We can handle this. Push the buttons.” (17:53)
  • Memorable client moment (anecdotal, playful):
    • "Are you asking me for reassurance?"... "Fuck you, Celine. Just answer. Come on. Just once." (18:14, Dr. Celine and anecdotal client)

The Journey of Acceptance and Experiential Learning

• Learning Through Discomfort
  • Emily and Lindsay describe the necessity of experiencing discomfort as part of recovery:
    • “The more you give in to the OCD, the more control it has over you.” (19:54, Lindsay)
    • “We know that that is going to be the most helpful thing for us and that's going to make us feel better in the long run, is to make ourselves feel uncomfortable now.” (21:28, Emily)
  • Therapy is framed as a unique, personal process:
    • “Every person... you can't give them the same prescription. Everyone’s going to have a different [journey].” (23:05, Lindsay)

Notable Quotes & Memorable Moments

• On Diagnosis and Self-Understanding:

  • “She told me I had OCD. And I was like, no, I don’t think so, because my sister has OCD.” (05:39, Emily)

• On mutual family growth:

  • “We’re constantly teaching them [our parents] also... just things that maybe have bothered them that we're trying to use to help them be okay.” (08:47, Lindsay)

• On therapy tools:

  • “Delay, delay, delay and take a pause... I write down in my journal exactly what I'm thinking... keeping track of what you're going through is super, super helpful.” (09:15, Emily)

• On the therapist's approach:

  • “She’s very good at figuring out which stuff she can reassure me on and which stuff she can’t… in the long run, it’s probably more helpful just to let us feel discomfort.” (16:21, Emily)

• On experiential learning with ERP:

  • “You can’t get there until you’ve felt the discomfort… and then you get out the other end and you’re like, wow, I got through that.” (22:14, Emily)

Timestamps of Key Segments

• 00:55 – Introduction and recap of part one
• 02:23-05:39 – The sisters discuss family dynamics, diagnosis, and early experiences of OCD
• 06:25-08:24 – College experiences; manifestation of OCD and recognition
• 09:15-11:47 – Effective therapy techniques (exposure, tracking, delay, self-awareness)
• 12:27-14:19 – Grounding, “check the facts,” self-trust strategies
• 15:37-18:57 – Advice for therapists: non-accommodation, avoidance of reassurance
• 19:54-23:35 – Discovering acceptance: the discomfort-growth connection and therapy’s timeline
• 24:19-24:59 – Guests share about their mental health advocacy project, Presently Bracelets

Practical Advice for Clinicians

• Resist the urge to reassure. Allow clients to sit with discomfort and build their own tolerance and resilience.
• Encourage self-trust. Shift reassurance-seeking toward client self-reflection and self-efficacy.
• Tailor therapy to the individual. Recovery is nonlinear and unique to each person; avoid one-size-fits-all approaches.
• Empower clients through experiential learning. The lessons of ERP must be felt, not just intellectually understood.

Resource Highlight

Presently Bracelets – For every bracelet purchased, a donation is made to mental health nonprofits. More information at presentlybracelets.com

This episode stands out for its candid, compassionate exploration of living with OCD and the core ingredients for meaningful recovery—self-awareness, trust, and supportive, non-accommodating care. The Stetzer sisters’ voices provide a rich, experiential complement to clinical wisdom, equipping clinicians with both perspective and practical tools to “break the rules” compassionately in OCD treatment.