Understanding the Link Between PTSD and OCD

Summary

Podcast Summary: "Understanding the Link Between PTSD and OCD"

Breaking the Rules: A Clinician's Guide to Treating OCD
Hosts: Dr. Celine Gelgec & Dr. Tori Miller
Date: December 29, 2025

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Episode Overview

In this episode, Dr. Celine Gelgec and Dr. Tori Miller explore the nuanced relationship between Post-Traumatic Stress Disorder (PTSD) and Obsessive Compulsive Disorder (OCD). Aimed at mental health professionals, they address common clinical dilemmas: Can OCD arise as a coping mechanism after trauma? How should clinicians approach treatment when both disorders are present? Their conversation draws from real-world cases, supervision questions, and a trauma-informed lens, all to equip clinicians with confidence and flexibility in their practice.

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Key Discussion Points and Insights

1. The Interplay Between PTSD and OCD

• OCD as a Maladaptive Coping Mechanism (02:45–04:10)
  • Trauma, including both major events and accumulative attachment trauma, can contribute to the development of OCD.
  • OCD may operate as a way for individuals to cope with overwhelming post-traumatic experiences.
• Complex Presentations
  • Trauma can amplify existing OCD predispositions or reshape the content and intensity of obsessions and compulsions.

Quote:

"I see it as OCD developing as almost a maladaptive coping mechanism in response to trauma."
— Dr. Celine Gelgec (02:45)

2. Trauma Themes Within OCD Symptomatology

• Obsession Themes and Family Dynamics (04:25–07:32)
  • Clients may develop OCD themes (like contamination or harm) linked to difficult family relationships or feelings of disgust, anger, or fear.
  • OCD rituals may manifest as efforts to manage emotions toward caregivers that are intolerable.

Quote:

"Is the client trying to cleanse themselves of the family member or do they feel angered or disgusted by that family member?"
— Dr. Celine Gelgec (04:52)

3. Clinical Challenges: Sequential vs. Integrated Treatment (07:32–10:11)

• The Myth of Linear Treatment Pathways
  • Many clinicians question whether to treat PTSD or OCD first, worrying about client safety and treatment efficacy.
  • Both hosts advocate for an integrated, trauma-informed approach, emphasizing flexibility rather than strict order.

Quote:

"You can do both. ... One week it's OCD, the next week it's PTSD ... and what do I do and how do I disentangle it?"
— Dr. Tori Miller (09:16)

• Trauma-Informed ERP
  • Exposure and Response Prevention (ERP) remains effective with trauma, provided there's attention to stabilization and the client's current capacity.

4. Practical Strategies for Integration (10:11–18:28)

• Skills Building & Window of Tolerance (14:14–15:15)
  • Emphasizing grounding and emotional regulation, especially for clients with a limited window of tolerance.
  • Recognize dissociation as a protective response that must be addressed to facilitate engagement.

Quote:

"If someone dissociates ... they're not being willful. They genuinely aren't connected."
— Dr. Celine Gelgec (14:58)

• ERP as 'Bookends' for Trauma Therapy (15:29–17:14)

  • Structured ERP exercises can serve as grounding anchors at the beginning and end of sessions that address trauma.
  • This blend supports both symptom management and emotional processing.

• Collaborative, Client-Guided Work (18:59–19:11)

  • Therapists should take their clients with them, not do treatment "to" them, building trust and insight collaboratively.

5. Borrowing Across Modalities and Practical Flexibility (20:27–22:49)

• No Need for Abrupt Modality Shifts
  • Integrate tools (e.g., imagery rescripting) from trauma therapies into OCD treatment as needed.
  • Informed consent and ongoing explanation are vital as techniques are introduced.

Quote:

"You can borrow technique ... imagery rescripting can be used as a standalone technique and there's a lot of research behind it, especially around this sort of situation."
— Dr. Celine Gelgec (21:17)

• Responsive, Not Rigid, Practice
  • Being able to fluidly adjust between CBT, supportive psychotherapy, or trauma-focused approaches fosters better client engagement.

6. Clinician Competence and Supervision (23:00–25:06)

• Expanding Comfort and Skill
  • Clinicians are encouraged to trust their training in CBT, ACT, or schema therapy as adequate preparation for treating co-occurring OCD and trauma.
  • When uncertain, seek supervision rather than immediately referring out.

Quote:

"I think that our competencies now, training as psychologists, make us very capable of pivoting, of learning new techniques, of weaving things together."
— Dr. Tori Miller (23:43)

• Pitfalls of Over-Referral
  • Over-cautiousness can inadvertently harm clients, especially those sensitive to rejection or abandonment.

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Memorable Moments & Notable Quotes

• "You'll extinguish one [symptom], yeah, but it'll pop up over here."
  — Dr. Tori Miller (11:42)
• "It can be fluid. ... You can bring things in."
  — Dr. Celine Gelgec (22:12)
• "Let's not be so black and white."
  — Dr. Celine Gelgec (25:46)

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Important Timestamps

• OCD as response to trauma: 02:45–04:10
• Family dynamics feeding OCD themes: 04:50–07:32
• Treating both OCD and PTSD simultaneously: 09:14–10:11
• Blended intervention strategy: 10:11–13:40
• Dissociation and emotional grounding: 14:44–15:27
• ERP as anchor in trauma sessions: 15:29–17:14
• Borrowing across modalities: 20:27–22:49
• Supervision and professional development: 23:00–25:09

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Takeaway Messages

• Treat PTSD and OCD together: Integrated, trauma-informed approaches are not just possible, but often necessary and effective.
• Stay client-centered and flexible: Blend evidence-based techniques as needed, anchored by responsive, collaborative relationships.
• Trust your training and seek support: Competence grows with real-world experience, ongoing education, and supervision.
• Don’t let fear or rigidity create barriers: Avoidance or "black-and-white" thinking leads to disservice; engagement and curiosity foster growth for both clients and clinicians.

Final thought:

"We hope we've given you lots of reassurance without accommodating, but to be able to work with what's in front of you."
— Dr. Celine Gelgec (26:00)

Transcript

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[Dr. Celine Gilgic]

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[Dr. Celine Gilgic]

Hi, I'm Dr. Celine Gilgic.

[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 Gilgic]

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.

[Dr. Celine Gilgic]

Welcome back to another episode of Breaking the Rules. Thank you for joining us today. Hello.

[Dr. Tori Miller]

Hello. How you doing? Yeah, I'm pretty good.

[Dr. Celine Gilgic]

Yeah.

[Dr. Tori Miller]

Yeah, I'm pretty good. Yeah.

[Dr. Celine Gilgic]

That's good.

[Dr. Tori Miller]

I'm, I'm looking forward to this topic.

[Dr. Celine Gilgic]

Yes.

[Dr. Tori Miller]

Tricky one, I know, but an important one. And one that comes up, I think, a lot in supervision and just around the lunch table at work.

[Dr. Celine Gilgic]

Yes.

[Dr. Tori Miller]

Yeah. And that is PTSD and ocd.

[Dr. Celine Gilgic]

Yes.

[Dr. Tori Miller]

And how to manage both at the same time.

[Dr. Celine Gilgic]

Yes.

[Dr. Tori Miller]

Yeah, yeah, yeah, yeah, yeah, yeah. It comes up a lot, doesn't it?

[Dr. Celine Gilgic]

It really does. One of the questions I often get is, can OCD happen as a result of trauma? My question, my answer often is yes. For me, I see it as. And I'd be curious to see, to hear your thoughts as well. I see it as OCD developing as almost a maladaptive coping mechanism in response to trauma. And it doesn't have to be a significant traumatic event like a massive. It could just be an accumulation of attachment trauma.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gilgic]

As well. And, and what we mean by that is just really difficult family relationships growing up and the impact that can have and still have in some relationships and then OCD developing as a way of coping with that. Yeah.

[Dr. Tori Miller]

What are your thoughts? I, I agree. I think, you know, I, I also conceptualize OCD as being a form of coping and sometimes it may be because there's the predispicing. Predisposition was already there and then the, the impact of the trauma sort of amplifies the experience. But we also know that people with OCD experience trauma and you sometimes just end up with a sort of a really complicated mix. But, but regardless. Regardless, I definitely see a lot of the compulsive behaviors coming in as a way of, of managing just the intensity of the post traumatic experience.

[Dr. Celine Gilgic]

Yes.

[Dr. Tori Miller]

And also really influencing the themes of the obsessions or perhaps the intensity of the obsessions or the preoccupation.

[Dr. Celine Gilgic]

Yes.

[Dr. Tori Miller]

With what's going through one's mind.

[Dr. Celine Gilgic]

Yes.

[Dr. Tori Miller]

Yeah. Especially understandably in relation to the themes of safety.

[Dr. Celine Gilgic]

Yeah, absolutely.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gilgic]

Yeah, for sure. Do you ever notice themes that are not unrelated but feel stretchy? Because I think for some sometimes it can be. Not a lot of this, but a handful of clients where they might develop OCD and we might be linking it to trauma, but are finding it hard to put the link together. Have you ever noticed that?

[Dr. Tori Miller]

Tell me more, tell me more.

[Dr. Celine Gilgic]

So one that comes to mind is someone who might be experiencing difficult family relationships and starts experiencing contamination triggers. And it can feel stretchy. But I think if we were to think about it, because where my mind then goes, and these are questions that often come up in supervision, but where my mind goes is, is the client trying to cleanse themselves of the family member or do they feel angered or disgusted by that family member and so don't want anything to do with them or don't want them to sit in the chair because they might contaminate the chair or something else that might be happening? Do you ever notice those sorts of things?

[Dr. Tori Miller]

I do things where I think sometimes it can manifest in. I think you're right. Contamination is probably a common one.

[Dr. Celine Gilgic]

Yeah.

[Dr. Tori Miller]

The idea of I'm disgusting and dirty.

[Dr. Celine Gilgic]

Yes.

[Dr. Tori Miller]

Therefore I need. I'm Smelly. I will be rejected. I'm anticipating rejection.

[Dr. Celine Gilgic]

Yes.

[Dr. Tori Miller]

Plus I also know, you know, I think about the idea of also the management of these intolerable ideas and thoughts about family or parents sort of being shifted into, you know, like almost like I can't tolerate how. What I think about you. So I kind of manage that by going, it's not me, it's the ocd. So I sometimes wonder if it's. If it's sort of managed in that way as well, you know, because that is a more tolerable.

[Dr. Celine Gilgic]

Yeah. I think an example of that. Correct me if I'm on the right track as you and following is harm thoughts.

[Dr. Tori Miller]

Yes.

[Dr. Celine Gilgic]

When teenagers, for example, might actually be really shitty with their parents and can't tolerate that thought. And so then it swings the other way and they're just, mum, are you okay? Dad, are you okay? Then, you know, and they need to check on them through the night and make sure they're still breathing or they're worried something bad's gonna happen to their parents because they feel so much guilt for having those.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gilgic]

Very normal thoughts about being pissed off with your.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gilgic]

With your parents as a teenager.

[Dr. Tori Miller]

Yeah. Confession happens too. Yeah. So being angry, wanting to separate, wanting to grow, individuate all of those things and then. Yeah. And then it sort of spirals into confessing. Yeah. And not necessarily confessing. You know, this is what I think and feel about you, but confessing unrelated things. But it's a way of trying to reconnect and sort of manage that sort of emotional distance that they're starting to feel secondary to individuation. Yeah.

[Dr. Celine Gilgic]

Or even manage their parents emotions.

[Dr. Tori Miller]

Yeah, yeah, yeah.

[Dr. Celine Gilgic]

Sorry, I digressed a little, but you're right.

[Dr. Tori Miller]

But these are the things that we think about when there's complexity like trauma because we often are talking about complex relationships. I mean, not all trauma is specific to interpersonal or interrelational trauma. I mean we could be talking about a major car accident or something like that. But. But these things, these experiences do get projected onto sort of the OCD experience and we can see it represented in the symptomatology. I think one of the things that I, I think clinicians struggle with and I probably struggled in the same way once upon it. I mean I probably, I know that I did, but was when you're presented with someone who has, say, PTSD or cptsd and they need a lot of support in relation to their coping, their regulation, because you can sometimes have someone who is quite unwell in the room with you, who dissociates, who has significant difficulty regulating their emotions and their arousal levels and all of these things, it can be very. It can feel very scary to then to be saying to someone because who. Because they also have ocd, to be saying to them, well, now we're going to make you, we're going to activate you, we're going to bring on panic at a time when you don't sort of feel like, for this person, that the panic is safe.

[Dr. Celine Gilgic]

Yeah.

[Dr. Tori Miller]

And I think this is where it gets. I mean, interesting, complicated. Tricky is the wrong word because it's actually really manageable.

[Dr. Celine Gilgic]

It is manageable.

[Dr. Tori Miller]

It's really manageable.

[Dr. Celine Gilgic]

It really is.

[Dr. Tori Miller]

It's not as dangerous as it feels. As long as we are using trauma informed methodology.

[Dr. Celine Gilgic]

Yes, I would agree. Yeah. It's not something that we should be avoiding.

[Dr. Tori Miller]

No.

[Dr. Celine Gilgic]

Because it starts to feel.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gilgic]

Messy.

[Dr. Tori Miller]

Yeah, that's right. Yeah. And I think people can kind of feel like we've got to do these things in sequential order, like, oh, what do I. What do I treat first? Yeah, the OCD is so bad. And it's. Yeah, it's because of all. For all the reasons that we were just talking about maintaining the ptsd, but then they're not safe to do the ERP because they. We haven't treated the ptsd, so how do we do it? And one week it's OCD that they want to talk about, the other week is next week is ptsd. And, yes, we're not making ground on either of these things. And what do I do and how do I disentangle it?

[Dr. Celine Gilgic]

Yeah, that's so true. That's one of the most common things I think is, am I doing harm to my client if I stop doing ERP and shift gears? Because I can see the trauma showing up and I know that needs work and I know what I need to do, but do I just stop that and shift gears and. No, you can do both. How do I do both? Yes, that's what we're here for today.

[Dr. Tori Miller]

It's true, it's true. Because you can do both. You can do both.

[Dr. Celine Gilgic]

And I often say to my clients, you know, this, what we talk about, this form and function of, like, you can see what OCD looks like. And so one of the quickest ways of building insight is to look at OCD and go, how is OCD showing up? And when you notice OCD showing up rather than reacting to that, how can we respond to that? And go, is there something else going on right now? What else is Happening right now. Is there a trauma trigger happening? And more often than not there is, sometimes there isn't and often there is. And so I often say to my clients, all my supervisees, when you're teaching and working with your client on recognize, like, you know, aside from doing what you would normally do in terms of like teaching a lot of grounding and stabilization and doing all that work in terms of making sure they're able to hold the emotions and the triggers and there's a sense of safety, but then working towards recognizing how to use those tools when OCD shows up, checking in if there's trauma triggers happening, but then also still using ERP to resist the OCD compulsion. Because if that's the first urge that comes up, you kind of erp. You're making it sound so easy. You ERP your way out of that one and then you shift gears and move into.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gilgic]

You know, and then work through, through the original trigger. Because if you're not addressing the core issue, you're just going to see OCD shape shifting all over the place.

[Dr. Tori Miller]

Yeah, that's right. You'll. You'll extinguish one. Yeah, but it'll pop up over here.

[Dr. Celine Gilgic]

Yeah. It'll be like that crocodile game where their heads come up at those carnivals and you. The whack a mole.

[Dr. Tori Miller]

The whack a mole.

[Dr. Celine Gilgic]

Yeah, yeah, thank you. That game.

[Dr. Tori Miller]

Yeah, yeah, yeah, yeah, yeah, no, that's right. I, I too agree that, that we need to do both. I think what some clinicians find tricky and look, and it is tricky, let's be honest, is that I think when there is co occurring PTSD or cptsd, there are days when a client will come in and they will have more capacity or less capacity to do some of these things. Yes. And sometimes they will understandably be highly avoidant and other days they won't. And so we can't work in a really linear fashion in a way that we could with a more straightforward, simple sort of OCD presentation. And I think we have to be fluid and creative in our work and we have to be flexible and know that it's okay to sort of, to move in and out of things.

[Dr. Celine Gilgic]

Yes.

[Dr. Tori Miller]

I also think that the trauma informed lens means knowing about what trauma is. Yes, knowing what trauma, what, how we define trauma. About the impacts on, on the body and on the mind, about what the symptoms of PTSD and CPTSD are, how they manifest, what, what dysregulation looks like. What it looks like in the room.

[Dr. Celine Gilgic]

Yes, especially in the room.

[Dr. Tori Miller]

Yep, yep. So knowing how to recognize that.

[Dr. Celine Gilgic]

Yeah.

[Dr. Tori Miller]

And knowing. And then formulating that for our clients. And. And then the treatment of OCD and PTSD can then become. Actually Is very similar.

[Dr. Celine Gilgic]

Yes.

[Dr. Tori Miller]

Because in both. In both instances, we're talking about facing fears, setting boundaries, regulating the body, urge surfing.

[Dr. Celine Gilgic]

Yes.

[Dr. Tori Miller]

Tolerating distress.

[Dr. Celine Gilgic]

Yes.

[Dr. Tori Miller]

Yep. All of these things. Yeah. And. And so they actually work together.

[Dr. Celine Gilgic]

They do really well. Beautifully. They do, yeah. And also building a healthy adult self outside of OCD and trauma and recognizing that you're living with what's happening, not trying to get rid of what's happening.

[Dr. Tori Miller]

Yeah, that's right.

[Dr. Celine Gilgic]

Yeah.

[Dr. Tori Miller]

Yeah, That's.

[Dr. Celine Gilgic]

Which I think is the tenet of therapy in a sense of, like, a lot of the times clients will struggle with that idea, but once they work towards that acceptance and drop that struggle, it becomes a lot easier to do.

[Dr. Tori Miller]

Yeah, yeah, yeah, that's right.

[Dr. Celine Gilgic]

Yeah.

[Dr. Tori Miller]

I think when there is really profound PTSD or cptsd, I think one thing that we do have to be really mindful of is that sometimes the window of tolerance might be very small for someone relative to someone without those disorders.

[Dr. Celine Gilgic]

Yes.

[Dr. Tori Miller]

And so we might have to start in small ways. We might have to do, you know, a bit more skill building.

[Dr. Celine Gilgic]

Yes.

[Dr. Tori Miller]

And just have some of those. I'm going to use the term safety measures, but I don't really mean safety behaviors.

[Dr. Celine Gilgic]

I mean, do you mean like the.

[Dr. Tori Miller]

Stabilized, stabilization, grounding sort of techniques ready to go?

[Dr. Celine Gilgic]

Yeah.

[Dr. Tori Miller]

So especially if. If someone dissociates and don't underestimate the.

[Dr. Celine Gilgic]

Power of dissociation, because it shows up a lot.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gilgic]

And I don't. Like, a lot of the time, supervisees will be like, my client just keeps saying, I don't know, I don't know, I don't know. And it's like, well, they're not being willful. They genuinely aren't connected.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gilgic]

So how can we work with our clients to connect them?

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gilgic]

Do we need to teach them the language?

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gilgic]

Do we need to literally, you know, work through that process of what does it mean for joy? What does it mean for sadness and terror and fear and all these sorts of things? How can we reconnect them to their body?

[Dr. Tori Miller]

Yeah, yeah, that's right. That's right.

[Dr. Celine Gilgic]

Because that shows up a fair bit, I think.

[Dr. Tori Miller]

Yeah, it really does. It really does. And then I think that, like, a model that I really like to use is that I think that actually doing structured ERP can actually be a really lovely way to anchor the. The treatment for ptsd.

[Dr. Celine Gilgic]

Yeah.

[Dr. Tori Miller]

Because it's kind of like. Because when. When you're working with someone with trauma and, you know, you anchor them in a session.

[Dr. Celine Gilgic]

Yeah.

[Dr. Tori Miller]

And then you often. You let them guide you through things, you know, the kinds of memories that they want to remember or the thoughts that they want to explore. And you kind of. You go there, you do regulation, you do grounding, and then as the session is coming to an end, you make sure that that person is anchored and. And ready to leave so in a contained way out of the therapy room. And I like to think about ERP as potentially being great bookends.

[Dr. Celine Gilgic]

Yes.

[Dr. Tori Miller]

For that session.

[Dr. Celine Gilgic]

Yes.

[Dr. Tori Miller]

Because it's. It can be if we think about it in its kind of basic behavioral form. A lovely way of. Kind of going, How'd you go with your homework? What's OCD been up to this week?

[Dr. Celine Gilgic]

Yes.

[Dr. Tori Miller]

Okay. You know, now. Now you know, where are we at and what are we exploring today? And what's been on your mind and where do you want to go? And let's talk and let's, you know, yada, Yada, yada. Grounding, etc. Etc. You wave your way through.

[Dr. Celine Gilgic]

Yeah.

[Dr. Tori Miller]

And then you come out and go, how are we doing? We're regulated. We're back. Fantastic. Great work. Let's talk homework for this week. What kind of thing do you want to work on this week?

[Dr. Celine Gilgic]

Yeah.

[Dr. Tori Miller]

Let's get some forms out. These are really actually great grounding. They are, you know, and kind of reorienting strategies that you can use to send someone off into the week feeling like they've got something tangible to work on.

[Dr. Celine Gilgic]

Yes.

[Dr. Tori Miller]

You know that, you know, it's more cognitive at that point in time, which means it sort of allows them to. To step away from the intensity of the emotional experience of exploring their trauma.

[Dr. Celine Gilgic]

Yeah.

[Dr. Tori Miller]

And then off they go. I mean, I make it sound so.

[Dr. Celine Gilgic]

Simple, but, you know, I know both. That's all you do, folks. I know.

[Dr. Tori Miller]

That's it.

[Dr. Celine Gilgic]

That's our recipe. I really love that. Because it allows clients to then connect their trauma and how it shows up as ocd.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gilgic]

And then just coming back up the different levels of intensity.

[Dr. Tori Miller]

Yeah, yeah.

[Dr. Celine Gilgic]

And then back out into the real world. Yeah, that's right.

[Dr. Tori Miller]

I agree. Because. And sometimes that'll happen in the room where people will be exploring something and they'll. They'll notice the urges that they're getting at the time. And sometimes it'll be more sort of a trauma lens where it'll be like, I want to stop talking. I want to stop talking. Other Times it might be, I want to wash or I want to, you know, I'm noticing how dirty I feel or, you know, I need to check something.

[Dr. Celine Gilgic]

Yeah.

[Dr. Tori Miller]

Whatever that is. So you can urge stuff in the moment, but other times it might be more in sort of. In sort of a cognitive. The theme of the obsessions.

[Dr. Celine Gilgic]

Yeah.

[Dr. Tori Miller]

What I tend to find is that in the early stages the clients might not have that insight and they need to be more regulated or have attended to their trauma in a sort of, you know, they need to do that process first and then as it goes on. Which is actually not untrue to. Just when we do ERP with. Yeah, actually, yeah. You do some of the, like the meaty stuff, like, you know, do some of the practical stuff, you know, reducing accommodations. Then as time goes on you're like, oh, let's explore that.

[Dr. Celine Gilgic]

Yes, exactly.

[Dr. Tori Miller]

What does that mean?

[Dr. Celine Gilgic]

Yes.

[Dr. Tori Miller]

What? Oh, yeah. What an interesting observation. Yeah, yeah, let's make, let's connect those dots.

[Dr. Celine Gilgic]

Absolutely. Because what you're doing then is you're taking your client with you.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gilgic]

As opposed to doing it to them. Yeah, yeah. Because it's very much something that your clients are definitely going to have the brakes on right from the very get go. And so in order for them to be able to be open and trust that process, it's something that you need to allow them to be able to do for themselves as well. Yeah.

[Dr. Tori Miller]

Agree.

[Dr. Celine Gilgic]

With guidance along the way.

[Dr. Tori Miller]

Agreed.

[Dr. Celine Gilgic]

Yeah.

[Dr. Tori Miller]

Right. Yeah. So I think, I think this is a very manageable. You know, it definitely is. Yeah. I think it, it, it happens. I think it happens quite frequently. We often have clients who present with histories of trauma, whether they meet criteria for PTSD or not. And I think, I mean, we should all be trauma informed if we work as clinicians. Yeah, I think it's essential, it's an essential part of our development that we have. We're really competent in how to support people who have experienced trauma. Yeah. But I think it is, you can, we can really weave these two together and I don't think we have to be frightened of it or think that, you know, they have to be done in silos. We can absolutely weave them together and it makes sense to. That. We do, actually. Yeah. Especially when there's good rapport. Especially when we're connected with our clients. Like why wouldn't we?

[Dr. Celine Gilgic]

Exactly. Yeah, exactly. Another question that comes up frequently in supervision for me is do I need to do like, if I'm working on trauma, do I need to stop ERP and do. And switch gears to something like schema therapy or EMDR or something like that. And we've already answered the question in terms of you can do both together. Another thing you can. Another thing that I often say to my clinicians, like Supervisees, is you can take it another step further. And you don't have to start like, okay, we're going to park ERP now and I'm going to teach you all about schema therapy or all about emd. I'm going to go through Psycho it all over again and we're going to do this, these, these, and these are the techniques and we're going to do the YSQ and all this sort of stuff. That was a mouthful. But what you can do is provide informed consent about the techniques you're going to use. But you can borrow technique like, for example, imagery rescripting can be used as a standalone technique and there's a lot of research behind it, especially around this sort of situation where you might be doing ERP with a client and notice trauma kind of creeping in. And with permission, you can bring in an imagery rescript as a tool which aligns very nicely with ERP, actually, in terms of its principles and tenants and all that sort of stuff. And when you weave it in in that way, you can get really great results and allow the client to build that insight into what's happening using the stabilization tools you've taught them so that they can keep working on the ERP side of things as well. So it's not something that we need to. It doesn't need to feel. Stop and start.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gilgic]

Or jarring. You can bring things fluid. It can be fluid.

[Dr. Tori Miller]

Ye. Yeah, absolutely.

[Dr. Celine Gilgic]

Yeah. You can bring things in.

[Dr. Tori Miller]

Yeah. In the same way that, I mean, you know, someone might be doing traditional cbt. But. Pause for a moment. Yeah. To just spend a session, you know, just doing more like supportive psychotherapy and move away from the whiteboard or the worksheets and just sit for a minute. Or vice versa.

[Dr. Celine Gilgic]

Exactly.

[Dr. Tori Miller]

You're doing traditional sort of that more traditional supportive psychotherapy and then you notice an opportunity for education and problem solving. So go. Let me show you something. Let me extrapolate on this.

[Dr. Celine Gilgic]

Yeah.

[Dr. Tori Miller]

To show you something that I think is really going to help you.

[Dr. Celine Gilgic]

Yes.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gilgic]

Because that's what makes you a responsive clinician rather than someone who's trying to stick to their own agenda.

[Dr. Tori Miller]

Yes.

[Dr. Celine Gilgic]

And not address what's actually going on in the room. Because that's the fastest way of losing a client.

[Dr. Tori Miller]

Agreed.

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[Dr. Tori Miller]

I think experientially that doesn't feel great for clients.

[Dr. Celine Gilgic]

No, that.

[Dr. Tori Miller]

And I think also, I mean, I do really respect people, you know, that. That the importance that we as psychologists agree to, that we will work within our competencies.

[Dr. Celine Gilgic]

Yes.

[Dr. Tori Miller]

I do think the clinicians, because they're anxious, take it a step too far sometimes and say, I can't go anywhere near that disorder because I've, you know, I. I'm not an expert in that. So therefore I have to refer my client on.

[Dr. Celine Gilgic]

Yes.

[Dr. Tori Miller]

And I don't think that's true. I think that our competencies now, training as psychologists, make us very capable of pivoting, of learning new techniques, of weaving things together.

[Dr. Celine Gilgic]

Yeah.

[Dr. Tori Miller]

I. I think that we probably do a disservice to our clients and actually accidentally do harm by telling someone, sorry, I can't do trauma. You have to see someone else. Off you go. I can do the ERP bit, but you probably need to go off there and do that. I think that the first thing we should do before we react in that way is go to supervision.

[Dr. Celine Gilgic]

Absolutely. Because the thing is, especially in this space, like, it's not like, where you're being asked to treat something that is so far out of your scope that you have zero skill set in.

[Dr. Tori Miller]

That's right.

[Dr. Celine Gilgic]

Because if you've got training in cbt, or if you've got training and acceptance and commitment therapy, or if you've got training in schema therapy, you have a very solid foundation with a very strong evidence base for working with OCD and trauma.

[Dr. Tori Miller]

Yeah, absolutely.

[Dr. Celine Gilgic]

So you're not being an incompetent clinician.

[Dr. Tori Miller]

That's right.

[Dr. Celine Gilgic]

What you need to do is. And we all start with one client.

[Dr. Tori Miller]

Yep.

[Dr. Celine Gilgic]

We've all started from our very first client in something.

[Dr. Tori Miller]

Right, Absolutely.

[Dr. Celine Gilgic]

And so what you then need to do is go, okay, I've got. What does the evidence tell me in terms of which treatments are appropriate for this condition? I've been trained in that. But if you're not sure how to apply it to that particular condition, that's what supervision, reading and learning and peer consultation is for.

[Dr. Tori Miller]

That's right.

[Dr. Celine Gilgic]

And that's how we develop as clinicians. That's right.

[Dr. Tori Miller]

Yeah. That's right. Preach. I couldn't agree more.

[Dr. Celine Gilgic]

No, I know.

[Dr. Tori Miller]

Yeah. Yeah.

[Dr. Celine Gilgic]

But it does. It feels scary. And I think as psychologists, we are terrified of doing the wrong thing.

[Dr. Tori Miller]

I know.

[Dr. Celine Gilgic]

And causing harm. And we don't want to.

[Dr. Tori Miller]

No.

[Dr. Celine Gilgic]

So we freak out and off we go.

[Dr. Tori Miller]

Yeah. Which actually, the irony is that is causes harm.

[Dr. Celine Gilgic]

It does. Especially if we have clients who are sensitive to rejection.

[Dr. Tori Miller]

Yeah, that's.

[Dr. Celine Gilgic]

Or abandonment or whatever else it might be.

[Dr. Tori Miller]

Yeah, that's right.

[Dr. Celine Gilgic]

Yeah.

[Dr. Tori Miller]

All right. So the long and the short of it is you can do both together. You can do both together. Yes, it's very possible.

[Dr. Celine Gilgic]

Let's not be so black and white.

[Dr. Tori Miller]

Let's not be so black and white. Yeah. Love it. I hope that this has helped.

[Dr. Celine Gilgic]

I hope so, too.

[Dr. Tori Miller]

Clinicians feel the courage to give it a go and to do a bit.

[Dr. Celine Gilgic]

More reading and a little bit more confidence.

[Dr. Tori Miller]

Yep. Yeah, that's right.

[Dr. Celine Gilgic]

We hope we've given you lots of reassurance without accommodating, but to be able to work with what's in front of you.

[Dr. Tori Miller]

Yeah, that's right. Yeah. Yeah. Fabulous.

[Dr. Celine Gilgic]

Amazing.

[Dr. Tori Miller]

All right, thanks, Lean.

[Dr. Celine Gilgic]

Thanks so much for watching and listening.

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[Dr. Celine Gilgic]

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