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

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.

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)

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]

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]

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.

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.