Understanding Parental Accommodation in OCD: Breaking the Cycle

Summary

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

Episode: Understanding Parental Accommodation in OCD: Breaking the Cycle

Hosts: Dr. Celin Gelgec & Dr. Victoria Miller
Date: December 15, 2025

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Episode Overview

This episode dives deep into the critical topic of parental accommodation in OCD—what it is, why it happens, and how it impedes recovery. Dr. Celin Gelgec and Dr. Victoria Miller, clinical psychologists specializing in OCD, explore the nuances of accommodation both from the perspectives of the family and clinician. The episode synthesizes clinical insights, real-life scenarios, and evidence-based frameworks (notably the SPACE program) with a focus on practical advice for mental health professionals working with OCD-affected families.

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Key Discussion Points and Insights

1. What is Parental Accommodation?

[03:43]

• Accommodation means having a loved one participate in or permit OCD rituals out of well-intentioned concern.
• Can involve directly assisting compulsions, giving reassurance, or modifying family routines to avoid triggering OCD.
• It's well-meaning and comes from "a place of love and wanting to be understanding" (Dr. Gelgec, 04:05).

2. Why Does Accommodation Happen?

[04:55][05:09][06:29]

• "We make accommodations for all sorts of reasons... but when there's OCD in the picture, it unfortunately perpetuates and maintains OCD." (Dr. Miller, 05:10–06:29)
• Everyday accommodations (food preferences, checking for monsters) are harmless, but similar behaviors with OCD can allow compulsions to spiral.
• Accommodations can feel necessary, especially to prevent meltdowns or distress (e.g., in older teens/adults, [09:16]–[09:51]).

3. Accommodation: The Double-Edged Sword

[07:03][09:51][11:16]

• It often starts as small, seems harmless, but escalates: “What they thought was just a simple accommodation has become a beast that now controls the household… People don’t know how to stop.” (Dr. Miller, 06:29)
• Over time, families lose sight of how entrenched these patterns have become: “By the time clients come to us…it could be years. They’re like, ‘We don’t even know how we got here.’” (Dr. Gelgec, 07:13)
• Accommodating sends the message: “I don’t believe that you can handle the anxiety that you’re feeling.” (Dr. Miller, 11:16)

4. The Paradox: Accommodation Hurts More than It Helps

[11:24][12:27][13:44]

• “We’re sending the message [that anxiety] is dangerous. Like, we’re reinforcing the message.” (Dr. Gelgec, 11:24)
• To help, family must demonstrate faith in the person’s ability to face uncertainty and distress: “In therapy, what we’re trying to do is to get our clients to believe in their capacity to tolerate discomfort…” (Dr. Miller, 11:50)
• If families always “play along with OCD, there’s no way they can learn that message.” (Dr. Miller, 12:23)
• Building tolerance for feelings is essential for both client and family.

5. Exposure, ERP, and Family as Part of Treatment

[14:29][16:10][17:15]

• Not just about the person with OCD—parents and siblings/families must learn to sit with discomfort too ([13:44]).
• “When we do ERP, it’s a beautiful framework for life... Because what it does allows us not only to hold our feelings, but...to have tolerance to that uncertainty.” (Dr. Gelgec, 14:53)

6. How the SPACE Program & Psychoeducation Help

[16:14][17:24]

• Dr. Miller stresses being “quite specific about [the] importance” of reducing accommodations.
• SPACE program (Supportive Parenting for Anxious Childhood Emotions) offers a structure for parent-focused work—even if the young person isn’t in therapy ([17:15]).
• Some parents need only a session or two with guidance; others, a more structured approach.

7. Common Parental & Clinician Barriers

[18:32][19:20][20:50]

• Initial family responses to reducing accommodations are generally receptive—real challenges arise as they face the reality: “What actually has to happen... is where things get tricky... The question I get a lot: ‘Is it dangerous?’” (Dr. Miller, 19:20)
• Families fear emotional distress in their loved ones: “My child will be so terrified. I don’t feel that’s safe for them. I want to protect them from those emotions.” (Dr. Miller, 19:21)
• Parents often want to be the ‘coach’ and ‘make’ the child stop. The crucial lesson: “You can’t make your child stop compulsions. What you DO have control over is your own accommodating.” (Dr. Miller, 20:51)

8. Family Dynamics & The Therapeutic Turning Point

[21:22][22:21]

• Once parents grasp the concept, “it drops the power struggle really quickly and starts changing the dynamic in the family... really motivating for parents to keep going.” (Dr. Gelgec, 21:02, 21:35)
• Families report greater intimacy, connection, and sense of hope when they persevere: “They notice OCD reducing and the space that opens up inside their family for time spent together, which they just love and thought they’d lost forever.” (Dr. Miller, 21:45)

9. Normalizing Short-term Distress for Long-term Gain

[19:51][23:49][24:51]

• “We have to kind of go through that intensity first in order for change to happen.” (Dr. Miller, 19:51; Dr. Gelgec, 19:56)
• “What we’re advocating is short-term pain for long-term gain.” (Dr. Gelgec, 24:51)
• Expect backlash and distress initially, but “if we keep pushing through... the change happens.” (Dr. Gelgec, 24:52)

10. When Parents or Clinicians Fear Crisis (e.g., Threats of Self-Harm)

[25:45][26:01][26:23]

• Clinicians often ask: “But what if the child starts threatening self harm or suicide? What do I do then?” (Dr. Gelgec, 25:45)
• “We need to be validating, compassionate, but not accommodate still.” (Dr. Gelgec, 26:02)
• Safety plans are vital, but “it's not a reason not to reduce accommodation.” (Dr. Miller, 26:47)
• High distress signals more scaffolding is needed, not less progress ([27:11]).

11. Clinician Guidance—Be Brave!

[27:42][27:55]

• "Integrate [accommodation] into the assessment... Be brave, be bold, go there. Recommend parent work or partner work... Get those changes happening in the family. It’ll be amazing what a difference it makes." (Dr. Miller, 27:42–28:01)

12. Parental Work Can Help Even Without Client Therapy

[28:04][28:14]

• “It works just as effectively if the person with OCD isn't in therapy… the data is actually amazing on that.” (Dr. Gelgec, 28:04–28:14)
• "You've got nothing to lose." (Dr. Miller, 28:25)

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Notable Quotes & Memorable Moments

• "The more we accommodate, the worse OCD gets. And what we want to be able to do is to not empower OCD. We want to empower the person who has OCD."
  – Dr. Celin Gelgec [04:37]
• “If people want OCD to go… the accommodations have to go too.”
  – Dr. Victoria Miller [10:29]
• “When you spell it out like that, people are like, ‘No, but that’s not what I actually believe. I actually believe they can handle it.’”
  – Dr. Victoria Miller [11:41]
• "We really need to be able to show our clients that they can do hard things and build their confidence, because we're going to have emotions. We can't—we're feeling beings before we're thinking beings."
  – Dr. Celin Gelgec [12:27]
• “I often say, I'm asking you to jump off a cliff right now with me. I'm telling you that there's a safety net down there, but you can't see it... Trust the process.”
  – Dr. Celin Gelgec [22:23]
• “What we're advocating is short-term pain for long-term gain.”
  – Dr. Celin Gelgec [24:51]
• "It's not a reason not to reduce accommodation. If those are the behaviors... to avoid distress, that is something that really needs to be attended to in therapy."
  – Dr. Victoria Miller [26:47]
• “Bonus—it works just as effectively if the person with OCD isn’t in therapy, so they don’t actually have to be in therapy.”
  – Dr. Celin Gelgec [28:04]

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Timestamps for Key Segments

• What is Parental Accommodation? – [03:43]
• Accommodation vs. Typical Parenting/Familial Behavior – [05:10]
• Escalation and Entrenchment of Accommodation – [06:29]
• The Message Accommodation Sends – [11:16]
• Encouraging Client/Family Resilience – [12:27]
• Why Exposure (ERP) Helps Families & Clients – [14:29]
• The SPACE Program & Parent-Only Interventions – [16:14]
• Barriers—Parental Fears, Misunderstandings, Pushback – [18:32], [19:20]
• Letting Go of the ‘Coach’ Role – [20:50]
• Family Dynamics—The Therapeutic Turning Point – [21:22], [22:21]
• Coping With Initial Distress When Reducing Accommodation – [24:51]
• Managing Crisis/Self-Harm Risk – [26:01]
• Clinician Recommendations—Go There! – [27:42]
• Parental Change is Effective Even Without Client’s Participation – [28:04]

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Final Takeaways

• Parental (or loved one) accommodation, though instinctively protective, is a major barrier to OCD recovery.
• Reducing accommodation is an act of faith in the client's ability to face discomfort.
• The process involves short-term distress but long-term relief and reconnection for the family.
• Parent-only interventions (like SPACE) are effective even if the person with OCD doesn't engage directly in therapy.
• Clinicians and families alike must be brave, persistent, and compassionate amidst inevitable setbacks.

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For mental health professionals: Start integrating the assessment of accommodation into your initial evaluations, provide targeted psychoeducation, and consider family or partner-focused therapeutic work when treating OCD, regardless of the client's age or direct therapy participation.

Transcript

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[Dr. Celine Gelgich]

Hi, I'm Dr. Celine Gelgich.

[Dr. Tori Miller]

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

[Dr. Celine Gelgich]

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. Hello there.

[Dr. Celine Gelgich]

Hi.

[Dr. Tori Miller]

Hello.

[Dr. Celine Gelgich]

How you going?

[Dr. Tori Miller]

Pretty good. Yes, pretty good. How are you going?

[Dr. Celine Gelgich]

Oh, I'm good on the home stretch. Ten weeks to go. Although by the time this video comes out, baby may have already come. Baby might already be here.

[Dr. Tori Miller]

Another baby podcast baby.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

Yes.

[Dr. Celine Gelgich]

Very cute.

[Dr. Tori Miller]

So cute. Oh, segue.

[Dr. Celine Gelgich]

Yes. We're talking about parenting today.

[Instacart Ad Voice]

Yes.

[Dr. Celine Gelgich]

I love that. Very smooth story.

[Dr. Tori Miller]

I swear I didn't plan that.

[Dr. Celine Gelgich]

Yeah, you did. No, like as in like, you know.

[Dr. Tori Miller]

Oh, yeah, yeah, yeah, you're right. So we were thinking, weren't we, that it's been a while since we've talked specifically about parental accommodation.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

That this is something that we have talked with Ali Liebowitz, Dr.

[Dr. Celine Gelgich]

Professor I would say professor. Let's go. Professor.

[Dr. Tori Miller]

Professor.

[Dr. Celine Gelgich]

He's a professor in our eyes.

[Dr. Tori Miller]

Yeah. From Yale, and. And his amazing work. So for those who haven't listened, go back and listen. It's an. It's an incredible episode, but we. I know that we reference parental accommodation, but it's been a while since we've really done a sort of a deep dive into what do we mean? And why is it so important as clinicians that we are attending to this? Whether we're. Whether we're working with young people or adults, it actually doesn't matter. We're probably going to reference mostly today, parental accommodations. But this is true for parents of adult children. Partners, completely. Yeah, yeah, yeah. Any kind of.

[Dr. Celine Gelgich]

Anyone living with someone who has ocd.

[Dr. Tori Miller]

Housemates, siblings. Yes, it all applies. Yeah, it all applies. So, yeah, let's. Let's do it.

[Dr. Celine Gelgich]

Let's kick it off. What do we mean when we're saying parental accommodation? What? Or any accommodation. Accommodation in general, meaning making permission for OC or giving permission for OCD to be there. And what I mean by that is when someone who is, like, maybe they're a housemate or a loved one, a child, whoever it is, asking you to either be involved in rituals and compulsions or seeking reassurance in some way, and we're kind of allowing it to be there, so. Because we don't want to see the person going through it suffer. Exactly. And we're, well meaning as well. It's not like, you know, we're doing it in some sort of way to be malicious. It comes from a very. It comes from a place of love and, like, wanting to be understanding.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And to show compassion in some sort, in some form of way.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

But what you'll discover through this episode today, and what Ellie Leibowitz talks about as well, is this idea of the more we accommodate, the worse OCD gets. Yeah. And what we want to be able to do is to not empower ocd.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

We want to empower the person who has ocd.

[Dr. Tori Miller]

Yeah, yeah, yeah, yeah. Agreed. That was a beautiful summary. And I think the reason that this is so such a tricky area for a lot of people is because accommodations for our loved ones is actually really ordinary and a part of everyday life.

[Dr. Celine Gelgich]

Yeah.

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We.

[Dr. Tori Miller]

We make accommodations for all sorts of reasons. And that might be because, let's say, take simple, simple example of a parent with a young child. Oh, like, I'm. I'm scared. There's a monster under my bed. And parents typically say, no, there's not. I'll check under your bed. Oh, look, no, there's no monster under there. And I'll check the cupboard. Or like, I've heard of people making like monster go away sprays or whatever, which are really cute. They like spray under the bed. And yeah, kids go off to sleep and they feel really reassured. And it's, it's a lovely sort of ritual that, you know, you might do a couple of times. And there are all sorts of things that we do. Like, I know for my children, for example, that, um, my daughter has had, as she's been growing up, sort of just preferences around food and around, for example, not wanting certain things touching on her plate. She's just not super adventurous with food. She wants things to be separate. And we've accommodated that within reason. Because you know what, it's not really doing any harm. And yeah, you know, she just doesn't want certain flavors mixing. Okay, that's fine. And so parents do this. We all do it. We do it for our partners, don't we?

[Dr. Celine Gelgich]

Yeah, absolutely.

[Dr. Tori Miller]

It's just the tricky thing is, isn't it, that when there's OCD in the picture, it unfortunately, it perpetuates and maintains ocd. And so people often end up in these sticky situations, these dilemmas where they've been accommodating for a long time and they thought they were doing the right thing and then they kind of. It goes too far and it doesn't stop. And what they thought was just a simple accommodation has become a beast that now controls the household and the relationship and it becomes nasty and insidious and it can't. And. And people don't know how to stop.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

And it's really overwhelming. And. And it actually is. Is actually something that has to be ceased in order for the person with OCD to recover.

[Dr. Celine Gelgich]

Absolutely. And like, by the time clients come to us, for example, it could be years.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And they're like, we don't even know how we got here.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Because it's such a slow burn process. And I think if you've got. Literally, it's really hard to tell the difference between what sounds like ocd, because a lot of the time, especially when kids are really little, it's not that obvious.

[Dr. Tori Miller]

No, it's not.

[Dr. Celine Gelgich]

It doesn't fit in with the typical themes that we would see with ocd. So it's so easy to miss and so easy to do.

[Dr. Tori Miller]

And it could also be subclinical. It could also be, you know, developing OCD presentation that's not actually diagnosable yet.

[Dr. Celine Gelgich]

Exactly, exactly. And if you do go and seek help from a clinician because there might be some separation anxiety or something else going on, reassurance actually is sometimes part of treatment because it can be really effective for anxiety disorders.

[Dr. Tori Miller]

Like, I will pick you up after school. Yes, I will be here at 3 o'.

[Dr. Celine Gelgich]

Clock. Yes, you can eat that. Yes, all of those things.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And so. But what we know about OCD is it's not an anxiety disorder. Anxiety is a huge component of it, but it very much is its own thing. And so for me, conceptually, I think this is one of the reasons why it stands alone. And there's talk about it going back in with the anxiety disorder. So I. In terms of the dsm, do you think it will? I don't know. There's talk about it. But I'm really curious to see what would happen from a treatment perspective if that was the case. Because for me, it helps me keep it simple, separate.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Because we treat it so differently.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And so I think it's a really easy trap to kind of fall into when we're accommodating with really little kids, with older adults or siblings or housemates or whatnot, or like, you know, partners, older children. If we don't understand what OCD is, it's the same sort of trap that we fall into. It can be really easy to kind of start saying. Saying yes to things. Or sometimes you just want to get out of the house.

[Dr. Tori Miller]

Yeah, true.

[Dr. Celine Gelgich]

And I need to get the family moving.

[Dr. Tori Miller]

Yeah. And what I reckon, I also see with older teens and adults is the conundrum of the power that the person with OCD has in terms of. With a little kid who's having a meltdown. Yeah. It's much more manageable. It might be distressing and exhausting and all of those things, but with a. With an older teen or an adult who's having a meltdown, it can feel frightening. It can feel really scary. And so people are often really wanting to accommodate, to. To. To make sure that a meltdown doesn't happen or ends as quickly as possible.

[Dr. Celine Gelgich]

Yeah, exactly. Because you have really serious threats sometimes, like, you know, I'm going to hurt myself. I'm going to kill myself. I'm going to cut myself. You don't understand me. Or they might run away. Raging, door slamming, throwing things, being aggressive towards other siblings who they thought started it kind of thing. You know, all those. And they're really scary.

[Dr. Tori Miller]

That's really scary. St. Yeah, it is.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

So we can really understand why accommodations occur and. And And I think that this is. That this is the key, isn't it? Is. Is that we know that accommodations come from a place of love and compassion.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

It's just that if people want OCD to go or to reduce the accommodations, have to go, have to go to. And Ellie Leibitz talks about this in a really nice way, doesn't he, where he talks about the idea that one of the reasons why accommodations perpetuate or maintain OCD is because what we're doing is we're ultimately the subtext of accommodating someone when they're feeling really afraid or anxious, and we do what they. The OCD is telling them to do or telling us to do. Is that when we do that accommodation, like we say, yeah, absolutely. I'll get you fresh tongs. Or whatever we're saying, I don't believe that you can handle the anxiety that you're feeling.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

I don't believe that you can tolerate panic. We'd better get rid of this as quick as possible, because otherwise something bad might happen.

[Dr. Celine Gelgich]

Yeah. We're sending the message that is dangerous. Like, we're reinforcing the message.

[Dr. Tori Miller]

Absolutely. And. And that's often not the message that loved ones actually want to be sending.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

And it's. It's. And when you spell it out like that, people are like, no, but that's not what I actually believe. I actually believe that they can handle it.

[Dr. Celine Gelgich]

That's.

[Dr. Tori Miller]

Of course they can handle it.

[Dr. Celine Gelgich]

Yeah. And there's a bit of an oh, shit moment when we explain it to our clients like that. They're like, actually, that's true.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

But that's why it's so important, isn't it? Because ultimately, in therapy, what we're trying to do is to get our clients to believe in their capacity to tolerate discomfort and uncertainty and pain and waves of panic and really emotions, and to learn that they pass on their own, that they don't have to intervene, that they don't have to do compulsions to have these things move on, and that they can get on with their day and they can live their life without being engaged in these compulsions. And so if we, as their loved ones are. Are playing along with ocd, there's no way they can learn that message.

[Dr. Celine Gelgich]

Absolutely not. I 100 agree. Like, we really need to be able to show our clients that they can do hard things and build their confidence, because we're going to have emotions. We can't. We're feeling beings before we're thinking, being.

[Dr. Tori Miller]

Yes.

[Dr. Celine Gelgich]

Right.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

We feel Things first. And so if we don't have role models in our life who show us how to be able to handle our emotions, maladaptive ways kind of creep in.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

But if parents and loved ones learn how to be able. This is the thing, they have to learn it for themselves too. Right. Because it depends on the role models we had in our own lives. Exactly.

[Dr. Tori Miller]

Are they.

[Dr. Celine Gelgich]

Exactly. And we don't mean like, it could also be well meaning parents who, you know, you could have had your emotions and they don't want you to suffer, so they'll try and distract you or they'll try and take it away from you or they'll problem solve or whatever else it is. And so you don't think positive. Yeah, exactly. So it's not necessarily about having massive traffic trauma or attachment trauma or anything else that it could also be the other end of the spectrum where we don't necessarily. We get sent this message of feelings are not. Shouldn't, shouldn't be there. Yeah, I guess. Or we shouldn't have them.

[Dr. Tori Miller]

And so the happiness trap, right?

[Dr. Celine Gelgich]

Yes, exactly. And so when we kind of work with our families and loved ones to help them recognize this, because that's really what the treatment is in a sense of. We work with, not necessarily the person with ocd, but with families and loved ones to teach them how they can sit with their own discomfort to be able to hold.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Their loved one. And their loved one can also be in therapy, but they're doing their own thing and learning through exposure and all that sort of stuff. And we have lots of interesting reactions when we tell them that we working with parents or loved ones about reducing accommodations. Um, but really it's about this idea of learning how to build tolerance to those feelings. Because we can't turn it off.

[Dr. Tori Miller]

No.

[Dr. Celine Gelgich]

We're going to have feelings whether we like them or not, about lots of different things. And not fueling OCD by reducing those accommodations. The best thing that we can do.

[Dr. Tori Miller]

And I think this is what we often say, isn't it, about OCD treatment and when we do erp, is that, yes, we're treating erp, but it's also a beautiful framework for life.

[Dr. Celine Gelgich]

Absolutely.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Yeah, completely. I agree with that.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Because what it does allows us to be able to not only hold our feelings, but to also be able to have tolerance to that uncertainty that creeps up because life is so uncertain.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

There are so many uncertainties in life that we already sit with.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Right. We both drove here today. Yeah. How do we know our cars while we live in Melbourne. How do we even know our cars are still parked outside? Very high chance of them being stolen right now.

[Dr. Tori Miller]

I could do with a new car.

[Dr. Celine Gelgich]

Yeah. You know, but like these little things that we do, we lock the front door when we leave the house or, you know, we flick the switch off when you turn your hair dryer or hair straightener off or whatever else it is. Or you might have a doubt thought that creeps into your mind. So you're like, oh, I'll just quickly double check that. Or you might be filling in bank details of a transfer and you might think, let me just make sure I've got this correct. Or might be sending an important email to your boss or whatever else it is. Or you might be answering a question on an exam at school.

[Dr. Tori Miller]

Yep.

[Dr. Celine Gelgich]

There are lots of things that we tolerate. Why is it that we can tolerate those but not others? I think that's a different episode altogether and has a huge set in value base, but I think it does set us up for life in a really helpful way.

[Dr. Tori Miller]

Yeah, yeah, yeah. So let's talk about what it looks like in therapy.

[Dr. Celine Gelgich]

Yes.

[Instacart Ad Voice]

Yeah.

[Dr. Tori Miller]

I think we both work pretty similarly. Yeah. So look, I think, I think when I first started I probably wasn't as probably assertive as I am now about the importance of, of parents doing very specific work around or reducing accommodations. I think at the beginning I was much more sort of casual in general about weaving it in here or there. But actually I think that the most effective outcomes comes from being quite specific about it. In an ideal world, I think we would spend quite a bit of time working with, with parents. And there's the beautiful space model that, you know, Ellie Lewis has developed which people can get, we're both trained in and, and people can get their training in. But we also know that not all the, not all families can afford to have both a young person in therapy and themselves. We know in Australia Medicare doesn't cover parenting work particularly well. But also I've. I definitely have worked with families who just get it really quick.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

And, and actually only one.

[Dr. Celine Gelgich]

It doesn't take much.

[Dr. Tori Miller]

It doesn't take much. One or two sessions and their own kind of motivation and desire to read and to, to learn. Actually, just, you know, a couple of sessions, giving them some guidance is actually. Yeah, actually fine. So I think every case needs to be sort of assessed on its merit. But the way that I like to work is that part of the psychoeducation that I do with families in the beginning is very much around assessing for not only the compulsions that are happening, the obsessions, the OCD symptoms, but also the accommodations that are happening in the household. And that's with my adult clients, too. If they live with a partner, if they're still living at home, assessing who is maintaining what, and then talking about how that is going to be something that is going to have to reduce, and then making a plan as to how aggressively we. We address that and whether that is in the very sort of structured, you know, 8 to 12 session space model, which we can deliver, or whether it's two or three sessions and some guidance to get people on their way.

[Dr. Celine Gelgich]

How do you find parents react to that or respond to that when you first introduce it? Do you get, like, a lot of pushback?

[Dr. Tori Miller]

No, actually, not at the beginning. I think what I. I think what I tend to experience is that most of the time, families really want things to be different. And so they're very willing and they're often asking, what can I do? What. Whatever it is. You know, my child is suffering so much, our family's a wreck. Whatever it is. Right. I. I think it's a couple of sessions later when we're talking about what actually has to happen and about the notion of reducing accommodations and what they have to do. I think where things get tricky because what understandably bubbles up for families is terror and fear. And the question I get a lot, is it dangerous?

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

My. But if I don't do that accommodation, my child will be so, so terrified. I don't feel that's safe for them. I want to protect them from those emotions. And I think that that's where the sticking point is, is trying to help parents see that emotions aren't dangerous and that. And that. And to believe that it, that it can change.

[Dr. Celine Gelgich]

Yeah.

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With.

[Dr. Tori Miller]

With. With different choices. Yeah.

[Dr. Celine Gelgich]

And we have to kind of go through that intensity first in order for change to happen.

[Dr. Tori Miller]

Yeah. Yeah.

[Dr. Celine Gelgich]

It's kind of like she has to get worse before it gets better again.

[Dr. Tori Miller]

Yeah, that's right.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

And then I think, also I think what parents are often expecting is when they say, what can I do to support. They're often thinking really understandably in terms of how can I support my child to change.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

So thinking about themselves as, how can I be a coach? Tell me what their homework is, I'll make sure they get it done.

[Dr. Celine Gelgich]

Which is how we used to do parent work.

[Dr. Tori Miller]

100. Yeah, 100.

[Dr. Celine Gelgich]

But it's different now.

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Yeah.

[Dr. Tori Miller]

And so, and, and they are desperate for their kids to stop doing compulsions. And so it's really hard for them to let go of that. That idea that their role is actually not to make their child stop engaging in compulsions. Because you can't make your child. You can influence, you know, you can talk, you can build awareness and insight and willingness and all of those things. We can't make them stop.

[Dr. Celine Gelgich]

No, of course stop.

[Dr. Tori Miller]

You can encourage them to stop. You can't make them. But what parents can do, what they actually have control over, is their own accommodating and stopping their own accommodating. And that's a hard thing for parents to shake.

[Dr. Celine Gelgich]

I think so. But that's also one of my favorite tenets of the space program, I think, because it helps once parents grasp that concept, and especially the parent who is probably a little bit more authoritarian as opposed to the other parent who's a bit more permissive. There's usually one.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

One is one and the other is the other. Once they grasp that concept, it drops the power struggle really quickly and starts changing the dynamic in the family. It's actually really beautiful.

[Dr. Tori Miller]

It is.

[Dr. Celine Gelgich]

And really motivating for parents to keep going because there isn't that power struggle anymore. And the daily arguing and the yelling and the screaming and the fighting and all of it.

[Dr. Tori Miller]

I know. And families often report that after doing this, that they. They feel a greater sense of intimacy and connection and closeness and. And it's amazing how they. They notice OCD reducing and that. And the space that. That opens up inside their family for time spent together, which they just love and thought they'd lost forever. You know, and. And it's. Yeah. It's actually a beautiful thing. But, yeah. Those first few sessions, when you're. When you're wanting a family to get. To sort of be teaching the concept of it. Getting them on board and also asking them to have faith.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

To have faith in the process.

[Dr. Celine Gelgich]

Yeah. Which is really hard to do. I often describe it as. I often say, I'm asking you to jump off a cliff right now with me.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

I'm telling you that there's a safety net down there, but you can't see it. I wouldn't want to jump either, but you could have. Trust the process.

[Dr. Tori Miller]

Let's go.

[Dr. Celine Gelgich]

Let's go for this. No. Yeah, absolutely. I love seeing that change as well, in terms of, like, families just really coming together because it's a real grief around.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

When families come to us around what they've lost.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And the. I, you know, thinking that it's forever and the idea of what they're Losing as well in terms of a future with their kids. It's like sometimes working with teens, especially, like one of one that comes to mind was someone who hadn't hugged their parent for like. Actually, I've had a few of these for years.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And it's just so heartbreaking and so sad. But I think once parents can kind of wrap their head around the concepts that you've been talking about so beautifully and we see that change, it's so motivating for a lot of families. But we also see the other side of that too, because for some families it takes a lot longer for that shift to happen.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Understandably there's other complexities involved. Or sometimes parents really struggling with those concepts because they've got their own stuff going on, which is understandable.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And what we see is OCD sometimes reacting to that and getting worse. And the other thing we do see too is the long term, I guess, damage, quote unquote, of accommodations not being removed. You know, parents kind of get caught up in this idea of, I don't want to cause harm to my child. Yeah. And continue to kind of give in to those accommodations. Because the short term pain is really intense. But what we're advocating is short term pain for long term gain. Yeah. So it's a temporary increase in distress. And sometimes I don't know about you, but sometimes I've had clients come back really shitty going, it's getting worse. This isn't helping. Blah, blah, blah. Like, is this even what we're meant to be doing? Are you sure you even know what you're talking about?

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Lots of anger. Understandably. But us holding that and making room for that and moving through it and working through it goes a long way. And. And shows actually the accommodations are making it worse.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And it's getting stronger and it's getting louder and you're becoming more and more unhappy. Yeah. But if we keep pushing through and working on reducing and working through those internal hurdles, the change happens.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Yeah. So for some families, it can take longer. And what feels damaging in the short term if left untreated is actually worse in the long run.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Yeah, that's right. So.

[Dr. Tori Miller]

And I think it's worth it. Yeah. And understandably, sometimes in the mess of it all, parents struggle to believe that. But I agree. And we've seen it. We've seen that it's worth it.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

Haven't we?

[Dr. Celine Gelgich]

Absolutely. Yeah. And I find clinicians can push back on it too, sometimes. Have you noticed that with supervisees.

[Dr. Tori Miller]

Yeah. Yeah. I think Because I think as clinicians where, you know, our training is often to focus on the. The patient, I think. Yeah. On the client.

[Dr. Celine Gelgich]

Yeah. I think one of the hardest things for, like, you know, if you're a clinician, listening to this or watching this, one of the hardest things that come up for a lot of supervisees is, but what if the child starts threatening self harm or suicide? What do I do then?

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Because they feel a sense of responsibility, like I caused this. Yeah. Sort of thing. And so for me, the message is always, we've still got to hold the boundary, but we need to be validating, compassionate, but not accommodate still.

[Dr. Tori Miller]

Yeah, absolutely.

[Dr. Celine Gelgich]

And if there is a threat, we have to take it seriously.

[Dr. Tori Miller]

Yeah, that's right.

[Dr. Celine Gelgich]

And follow through with what we would normally do.

[Dr. Tori Miller]

Develop a safety plan as clinicians with the young person in the family and have a family act on that safety plan. If a young person threatens suicide or threatens to run away or. Yep. Threatens self harm or engages in self harm, then we just.

[Dr. Celine Gelgich]

As we would respond.

[Dr. Tori Miller]

Yep. If they were presenting with those behaviors in another situation. Absolutely.

[Dr. Celine Gelgich]

Exactly.

[Dr. Tori Miller]

It's not a reason not to reduce accommodation. Yeah. Because if that is. If those are the behaviors that a young person is choosing to engage with to avoid distress and that is something that really needs to be attended to in therapy and that just adds another layer of things for us to help them with.

[Dr. Celine Gelgich]

Exactly, exactly. Right.

[Dr. Tori Miller]

Yeah. If their distress is so great that. And their tolerance is so low, that's a really important thing to know. And to integrate into therapy. It's not a reason not to reduce accommodation.

[Dr. Celine Gelgich]

That's exactly right. For me, it's a signal of just showing that we've got more work to do.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And it just shows how unwell the client is.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

In terms of. Or how low their tolerance is to emotion and providing more scaffolding.

[Dr. Tori Miller]

Yeah, exactly.

[Dr. Celine Gelgich]

For them to be able to.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Build that tolerance. Yeah, yeah. But like you said, not a reason to avoid the accommodation.

[Dr. Tori Miller]

Yeah, yeah, yeah.

[Dr. Celine Gelgich]

Well, I think.

[Dr. Tori Miller]

I mean, there's not a reason not to do it.

[Dr. Celine Gelgich]

Right, exactly.

[Dr. Tori Miller]

Integrate it into the assessment.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

Make sure it's something that you're thinking about and talking with your. Your clients, loved ones about.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

Be brave, be bold, go there. Recommend parent work or partner work or sibling work or whenever it needs to be. Needs to be done.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

Get those changes happening in the family. It'll be amazing. What a difference it makes.

[Dr. Celine Gelgich]

Makes a huge difference.

[Dr. Tori Miller]

Yeah. To. To your clients. Ocd.

[Dr. Celine Gelgich]

And bonus, it works just as effectively if the person with ocd isn't in therapy, so they don't actually have to be in therapy.

[Dr. Tori Miller]

Yeah, that's right.

[Dr. Celine Gelgich]

So the data is actually amazing on that. It shows efficacy and change even if clients aren't in therapy. Yeah. Yeah. So go ahead.

[Dr. Tori Miller]

Yeah, that's right. You got nothing to lose.

[Dr. Celine Gelgich]

You've got nothing to lose.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

All right.

[Dr. Celine Gelgich]

Thank you so much for listening and for watching. We'll catch you next time.

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