Unpacking Meta OCD: A Deep Dive

Summary

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

Episode Title: Unpacking Meta OCD: A Deep Dive
Hosts: Dr. Celine Gelgec & Dr. Tori Miller
Date: November 3, 2025

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Episode Overview

In this engaging and insightful episode, Dr. Celine Gelgec and Dr. Tori Miller explore the nuanced and often misunderstood concept of "Meta OCD"—Obsessive-Compulsive Disorder that fixates on OCD itself, diagnosis, and treatment. Speaking directly to mental health professionals, they share clinical definitions, notable client experiences, and strategies for addressing meta OCD in therapy. The tone is conversational, empathetic, and deeply practical, offering both intellectual frameworks and hands-on guidance for clinicians navigating this "frustrating but common" OCD theme.

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Key Discussion Points & Insights

1. What is Meta OCD?

Definition & Clinical Experience

• (04:10) Dr. Celine Gelgec: "Meta ocd. In very short, is OCD about fucking ocd? So yes, I know, what the hell."
• Manifested as doubts about the legitimacy of one's OCD diagnosis, persistent questioning about whether treatment is deserved or being done "correctly," and preoccupations with therapy itself.
• (04:33) Practical examples:
  • “Is my therapist sure about my diagnosis?”
  • “But what if I don’t have OCD?”
  • “Do I deserve to be in treatment?”

2. The Perfectionistic & Moral Dimensions

• (04:57) Dr. Tori Miller: "I definitely think there’s a moral component … from moral scrupulosity … clients say, ‘Well, because if I don’t have OCD, that means I’m wasting your time.’”
• Meta OCD often ties into a profound fear of being a "fraud," unworthy, or even manipulative, amplifying shame and self-doubt.
• Clients worry they’re “manipulating” clinicians into treating them for something they don’t have, sometimes with extreme example concerns ("Because I’m really a pedophile…").

3. Why Meta OCD is Disruptive for Treatment

• Extremely frustrating and “disruptive” for both clients and clinicians (02:44).
• Treatment Impact:
  • Can stall or undermine progress in standard OCD therapy (ERP), as clients become fixated on whether they are complying “right” or are “deserving” (07:06).
  • Perfectionism Loop: Clients obsess about completing ERP or skill development exercises with flawless precision, devaluing their own successes (11:22).
• Quote:
  • (12:14) Dr. Celine Gelgec: “The wins are never celebrated … because it never feels enough.”

4. Manifestations in the Therapy Room

• Meta OCD often presents as repeated requests for reassurance, clarification of diagnosis, or “am I doing this right?”
• Can hijack therapy, leading therapists to inadvertently provide reassurance or stall exposure progress (07:28).
• Clients may attempt to indefinitely remain in “skill development” phases, avoiding exposure out of fear of "getting it wrong" (11:22).
• Challenge for clinicians:
  • Balancing empathy and compassion with the risk of enabling reassurance compulsions (08:31).
  • Noticing when reassurance-seeking is a compulsion rather than genuine curiosity.

5. Distinguishing Compulsions from Curiosity

• (17:51) Dr. Tori Miller: "[This is] the nuance and the artistry of the work that we do."
• Not all questions in therapy are compulsive—therapists must approach repeated doubts with curiosity before labeling them.
• Important to gently reflect on patterns: “If you notice that’s happening a lot… you start to sort of wonder out loud about whether this other function is happening…explore it.” (18:12)

6. Client Case Example—OCD Teen Group Exercise

• In a values/strengths selection exercise, teens with OCD struggle to select strengths for themselves due to intrusive perfectionistic meta-thinking and fear of "taking" strengths from others (13:20–15:02).
• (15:35) Dr. Tori Miller: “For most people with OCD, this aspect of wanting to do things well and right and good … causes so much distress.”

7. Metacognition, Self-Worth, and Fusion

• Intellectual and moral compulsions are tightly fused with clients’ self-worth—making them feel "more real" (21:33).
• "It lives in your mind… it feels more like an extension of yourself… gives it a sense of legitimacy." (21:48)

8. Clinical Strategies: Recognizing & Addressing Meta OCD

• Practice curiosity and avoid “OCD police” role (18:34).
• Psychoeducation is crucial—clinicians must tread gently, as clients often respond with defensiveness:
  • "No, no, no, I swear, this is not an OCD thing ..." (20:49)
• Guide clients from merely labeling emotions toward truly experiencing them in the body (19:05).
• Help clients spot mental safety behaviors such as checking, rumination, or replaying therapy assignments—these are forms of compulsions, too (19:36).
• Keep treatment collaborative; validate experiences but avoid enabling reassurance cycles (08:50).

9. Why Manualized Treatments May Fall Short

• Meta OCD often emerges mid-treatment, not at intake or simple assessment (like the Y-BOCS; 23:41).
• (23:06) Dr. Tori Miller: “This theme is a really good example of why ... the traditional manualized sort of treatments don’t necessarily offer the spread or the depth that sometimes conditions like OCD require.”
• Clinicians must allow for flexibility, ongoing assessment, and creativity.

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Notable Quotes & Timestamps

• “Meta OCD... is OCD about fucking OCD.”
  — Dr. Celine Gelgec (04:10)

• “It feels more like an extension of yourself… gives it a sense of legitimacy.”
  — Dr. Tori Miller (21:48)

• “The wins are never celebrated … because it never feels enough.”
  — Dr. Celine Gelgec (12:14)

• “Sometimes it is quite legitimately someone with questions and curiosity, and this is the nuance and the artistry of the work that we do.”
  — Dr. Tori Miller (17:51)

• “Let’s not think too much about our thinking.”
  — Dr. Tori Miller (25:12)

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Important Timestamps

• 02:05 — What is Meta OCD?
• 04:10 — Defining Meta OCD, Illustrative Examples
• 04:57 — The Moral Component: Scrupulosity, Worthiness
• 07:06 — Meta OCD Derailing Treatment, Perfectionistic Traps
• 11:22 — Perfectionism and Loss of Learning Opportunities
• 13:20–15:02 — Client Group Exercise: Struggling to Acknowledge Strengths
• 17:51 — Questions or Compulsions? Clinical Artistry
• 19:36 — Safety Behaviours, Mental Compulsions
• 21:33 — Fusion with Self, Compulsion Legitimacy
• 23:06 — Limitations of Manualized Treatments
• 25:12 — Episode Wrap-Up, Key Takeaway Moment

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Key Takeaways for Clinicians

• Meta OCD is a highly disruptive but common theme, often masked as “good client” behavior or intellectual curiosity.
• Recognize and compassionately challenge compulsive patterns of reassurance-seeking around diagnosis, deservingness, or treatment “correctness.”
• Gently provide psychoeducation, validate emotions, and bring clients into embodied experience, not just cognitive reframing.
• Manualized approaches may not capture the nuance of meta OCD—the best treatment is collaborative, flexible, and attuned to hidden compulsions.
• Remember to celebrate client wins and mitigate the perfectionism that undercuts treatment gains.

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“Let’s not think too much about our thinking.”
— Dr. Tori Miller (25:12)

Tune in next episode for more in-depth, real-world strategies on building confidence in OCD treatment.

Transcript

[Dr. Celine Galgic]

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[Dr. Celine Galgic]

Hi, I'm Dr. Celine Galgic.

[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 Galgic]

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. Hey again, Celine.

[Dr. Celine Galgic]

Hello. How are you doing with you?

[Dr. Tori Miller]

I'm good, I'm good.

[Dr. Celine Galgic]

Likewise.

[Dr. Tori Miller]

Yeah. Caffeinated.

[Dr. Celine Galgic]

I was going to say. How'd your coffee fix? It's so nice to be back again. I know.

[Dr. Tori Miller]

I'm feeling very comfy.

[Dr. Celine Galgic]

I know.

[Dr. Tori Miller]

Studio now.

[Dr. Celine Galgic]

It is actually quite comfy. Much more relaxed. I know.

[Dr. Tori Miller]

It feels really good to be in.

[Dr. Celine Galgic]

Here when I first started. Oh man, I know. Talking about today.

[Dr. Tori Miller]

Interesting topic that you've raised, I think. Really good one. What is meta ocd? And I'm guessing that most of the clinicians that are listening who work with people with OCD will know about this and it's very possible that you may clinicians may have seen this in the room but not actually known what it is or even recognize as part of ocd. It's a really. It's a kind of one of those lesser known themes, I reckon, but is actually incredibly common and quite disruptive, I reckon.

[Dr. Celine Galgic]

So disruptive.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

And so annoying. I know.

[Dr. Tori Miller]

I think it has a really big impact impact on treatment, which is one of the reasons why I think it's good to talk about.

[Dr. Celine Galgic]

Definitely. Yeah, man, I hate it with a passion. I'm like, come on ocd, this too, seriously. No, I know, I know. Like there was nothing else. Oh, yeah. It's a frustrating one, I think, when it comes up, not just for clients, but for us as clinicians too. Because you really feel stuck. I mean, I don't know about you, but I feel so stuck when it comes up. And it's not that you can't get out of it, it's just frustrating.

[Dr. Tori Miller]

Yeah, yeah, it is. And I think it's also kind of an intellectual one as well. So I think sometimes with some of the compulsions, I think the application of ERP is quite literal. You know, like if there's a contamination theme and someone is over washing their hands.

[Dr. Celine Galgic]

Yes.

[Dr. Tori Miller]

The solution is quite simple, which is wash your hands less, you know, and then, you know. But with this one, I think in anything where there's a particularly kind of like intellectual or mental ritual associated mental compulsions.

[Dr. Celine Galgic]

Yeah.

[Dr. Tori Miller]

It is a little bit more complicated, a bit more abstract, requires a little bit more creativity, a bit more thinking, a little bit more awareness to spot it.

[Dr. Celine Galgic]

It definitely stretches us.

[Dr. Tori Miller]

Yeah, yeah, yeah. All right, let's define it.

[Dr. Celine Galgic]

Yeah, I was gonna say let's pause there because I can see us like just continuing to agree and people are gonna be like, what is it?

[Dr. Tori Miller]

I agree, I agree. We've got to define it. All right, you do it.

[Dr. Celine Galgic]

So meta ocd. In very short, is OCD about fucking ocd? So yes, I know, what the hell. So you know, is my therapist sure about my diagnosis? But what if I don't have ocd? Do I deserve to be in treatment? Am I doing it right? But what if my clinician got it wrong?

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

And you're probably thinking, oh yeah, I've heard this. Yeah, I've heard this so many times. It's. I've attributed, I often attribute it to intense perfectionism.

[Dr. Tori Miller]

Yes.

[Dr. Celine Galgic]

Intellectualization. Etc. But I'm wondering, and we'll be curious to see, hear about your perspective in terms of. Do you feel like there might be other things linked in with it too?

[Dr. Tori Miller]

I definitely think there's a moral component.

[Dr. Celine Galgic]

Yes. Tell me more.

[Dr. Tori Miller]

I think it comes from sometimes from moral scrupulosity as well, particularly when people are having wonderings about whether they actually have ocd. When you drill down and explore what's sitting underneath that, what the what ifs are, it comes. A lot of clients said, well, because if I don't have ocd, that means that I'm wasting your time.

[Dr. Celine Galgic]

Yes.

[Dr. Tori Miller]

And I'm wasting, I'm wasting my parents money or you know, or I am sitting in this situation in the chair, using up your hour. When someone who has worse symptoms than me should be in here receiving your care. And therefore I am a bad person.

[Dr. Celine Galgic]

I'm a fraud.

[Dr. Tori Miller]

I'm a fraud. Or even further, like some. Sometimes the narrative is I'm actually deliberately manipulating you to think that I have OCD so that I can mistreat you or misuse you in some way. Yeah, yeah.

[Dr. Celine Galgic]

Because I'm really a pedophile.

[Dr. Tori Miller]

Yeah, that's right.

[Dr. Celine Galgic]

Or some other.

[Dr. Tori Miller]

That's right. And I'm just trying to get you to think. Think that I'm not actually a pedophile so that I can get away with being a pedophile.

[Dr. Celine Galgic]

Yes. Yeah, yeah, yeah, yeah. I would definitely agree with that.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

Yeah, for sure. Okay. So we've defined it very briefly.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

And we've given some examples in terms of what. How it can show up in the room where it bec. And you can probably tell where it becomes problematic is when you're going along. And you might not even recognize your clients might not even recognize it yet where they are playing along because you're working on other themes. And as we know, the themes aren't in the dsm. These are just things that we've come up within the community to kind of help us articulate, Tease it apart.

[Dr. Tori Miller]

And design. Yeah. And design interventions.

[Dr. Celine Galgic]

And design interventions around the different themes of ocd. So you might be working on other themes, and then all of a sudden, your client might come in and be like, oh, I wasn't too sure about this ERP task, so I wanted to just come back and clarify if I was doing it right or how I should have done it. Or they might start asking questions about their diagnosis. And you're like, what's going on here?

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

And so you're likely then dealing with Meadow ocd.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

And that becomes really frustrating because that client. Like that clients will even start to sometimes turn treatment principles into a thing. So it becomes this idea of, am I implementing distress tolerance skills correctly? Am I doing this? Am I doing that? And there's this huge preoccupation around it. But really, it's avoidance.

[Dr. Tori Miller]

Yeah, that's right.

[Dr. Celine Galgic]

It's a huge component of avoidance because.

[Dr. Tori Miller]

It'S a real trap, isn't it? Because it's really understandable if a client comes to you and says, look, can you tell me a little bit more about. I'm just not sure that my symptoms really do align with a diagnosis of ocd. It makes sense that we would take that fairly Seriously. And we'd go back over it again, and we'd go back over it again. And then I think where we get stuck is if we're going over it again and again and then again, you know, or there's, you know, there's this theme of lacking deservingness of being in the room and, and therefore lack of engagement in therapy because they don't feel like they're. They're worthy of your time. I think it's really. It's a really understandable compulsion to sort of end up falling into, you know, providing reassurance or over educating and things, because oftentimes the anxiety that is associated for our clients with feeling and thinking this way, you know, it's really great. It's. It's really significant. And there's a. It generates it, at least for me, like, and I'm sure for you, huge amount of empathy and compassion.

[Dr. Celine Galgic]

Absolutely.

[Dr. Tori Miller]

Yeah. And I want to reassure them. I want them to feel like they're. They're worthy of being in the room. Yeah, yeah, yeah. And deserving of. Of treatment, intervention. But then to not then fall into the trap of providing reassurance is really hard. Yeah, yeah, yeah, yeah.

[Dr. Celine Galgic]

One of my favorite lines is, well, maybe you don't, and maybe you are wasting someone's time and what do we do with that?

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

Or maybe I don't know what I'm doing.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

And I got the diagnosis wrong.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

You know, those sorts of things. I think our ways of tapping into that and not feeding the reassurance, and hopefully I'm not skipping too far ahead in terms of, well, what do we do with it when it shows up, but absolutely providing that little bit of reassurance to begin with, empathizing and bringing in that compassion, but walking that fine line of not providing that reassurance, but it will always serve, it will always feel reassuring in the beginning.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

Right. And so I think another thing I often tell my clients is I'll only say this once if you ask me again.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

So, yeah, that's how it looks, shows up. And it can be really problematic because it can really hamstring treatments.

[Dr. Tori Miller]

Yeah, yeah. And I think the. The perfectionism component of that too, is really problematic because what we're talking about here is where clients start to worry that they're not doing their treatment correctly. So it might be less about, do they or don't they have OCD that that might be fine? That might not be how meta OCD is. Is showing up. It might be more that they're worried that if they don't do it perfectly, then it doesn't count, it's not effective. Or they might be really sort of really preoccupied with. With the nature of do they understand the exercise perfectly? And do they really understand what ERP is, how they do it, how to implement distress tolerance skills? And so they might want to keep you in the skill development phase for a really long time and prevent progression into actually doing the exposure. And then it also may mean that they minimize efforts and exposures that they do after they've done them because there's a sense of, well, I don't know for sure that it counts because I didn't do it perfectly. And, and so even replaying, going over in their mind, how did I do that exposure. Let's walk through that sort of replaying in their mind how they tolerated their distress. And so, in fact, it's sort of, in fact undermining all of the exposure that they did because they're so preoccupied with wanting certainty that they did it properly.

[Dr. Celine Galgic]

The chance at learning is lost.

[Dr. Tori Miller]

Yes.

[Dr. Celine Galgic]

Because there's this huge preoccupation about that perfection.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

And I think that becomes really frustrating because then when that learning opportunity is lost, it's harder for generalization to happen.

[Dr. Tori Miller]

Yeah, absolutely.

[Dr. Celine Galgic]

And what we mean by generalization for the non psychs who are listening, is the ability to learn through an experience and apply that to different situations. And not everyone is capable of that. And so that. That's another podcast episode, I think. But a lot of the time that's what we hope for as therapists, to be able to experience, have a learning experience that's different to what our brain anticipates is going to happen and being able to apply that to different situations. And so when we lose that, that becomes problematic and everything feels new, but also just backtracking a little bit like a true perfectionist. The wins are never celebrated.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

Because it never feels enough.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

And we've got to move to the next thing and the next thing and the thing after that again. So. Yeah, that itself, I think we often. I know you and I are really big on celebrating, so we always pull them up and going, hang on a second. You haven't done this for two years. We're stopping and celebrating this. Two years, like, you know, and you've just done it, which is amazing.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

And then the awkwardness comes in and all the weird feelings.

[Dr. Tori Miller]

I know. Do you know, I had. This is a slight side topic, but in our teen OCD treatment group the other week at this really interesting experience Right. Where we were doing a values exercise and. Yes, no, we were. Was values or strengths, you know, kind of integrated. And the group was absolutely rubbish at selecting strengths or values for themselves.

[Dr. Celine Galgic]

Oh, of course, yeah, absolutely.

[Dr. Tori Miller]

Yeah. It was really, really difficult. It took them. They agonized over it and the, the feelings of guilt that it brought up for them that they may be identifying with something that wasn't correct or that they might be taking a strength card that somebody else wanted or that someone else in might also think that they have that strength, but if they choose it for themselves, it might mean that the other person doesn't feel like they can also choose it. And, you know, it was so, so complicated for them, you know, and you can see all of these sorts of perfectionistic kind of components and the, the, the thinking about their thinking that was coming into the room or that metacognitive stuff that was really getting in the, in the way of just sitting in the emotions and just being tuned into picking a card, selecting it, tuning into their, you know, into themselves because they were thinking about their thinking so much. And now that wasn't necessarily a compulsive act. So that's not exactly what we're talking about, but we're talking about sort of metacognitions and how they can turn into compulsions. And it was just a really interesting thing how it wasn't just one or two members of the group, it was the whole group. And to the point where we.

[Dr. Celine Galgic]

That's really hard.

[Dr. Tori Miller]

Yeah. And then when we pivoted, because they were having such a hard time with it, we pivoted to then selecting cards for each other.

[Dr. Celine Galgic]

Yeah.

[Dr. Tori Miller]

And damn, didn't they do that? Well, like when they could kind of identify with sort of the selflessness and the generosity of who they are as, as individuals and giving to each other. They were very comfortable with that. And the. And they didn't do so much thinking about that because it wasn't activating them in the same way. So we actually end up. The next week we came back and was like, we're doing that again.

[Dr. Celine Galgic]

Yes.

[Dr. Tori Miller]

And this time we're going to sit with the discomfort and we're not going to avoid it. We're not going to crack jokes and, and avoid the discomfort comfort. Instead, what we're going to do is we're going to say out loud the things that we're thinking, the thoughts that are popping into our minds. We're going to identify and observe our emotions and we're going to surf the urge to avoid, to disconnect. You know, to. To distance ourselves from this, and we're going to end up each with a selection of. Of cards that reflects the people that we believe we are.

[Dr. Celine Galgic]

Yeah.

[Dr. Tori Miller]

It was really interesting, and I love that. Yeah. And it just really showed how for most people with ocd, this aspect of wanting to do things well and right and good and to be constantly. That sense of responsibility, to constantly be demonstrating that you're. You're a good person is just so. It just plagues them. It just causes so much distress. And I think that that just really sits underneath a lot of what. Yeah.

[Dr. Celine Galgic]

Is.

[Dr. Tori Miller]

And so where this sort of meta OCD stuff comes in. Yeah, it's so it's.

[Dr. Celine Galgic]

That's a beautiful example of. Of that.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

Of meta OCD coming in and, like, the thinking. About the thinking.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

And just plaguing.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

And so you painted a really beautiful picture around what it could feel like for a client and the things to be mindful of. And that in itself is an exposure exercise. Like what? A beautiful exposure exercise to be able to come back and learn, to be able to sit in it.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

Rather than intellectualize and just stay in our head about it. Yeah, yeah, yeah. I really love that, but it does. It plagues. And this idea of I can do to others but not myself. Yeah. And that's okay.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

Because I'm a bad person or undeserving, or if people knew the thoughts that I had, then they wouldn't want to be friends with me, or they wouldn't want to be married to me, or they wouldn't want to know me as a person, or I'd be in jail or some other thing.

[Dr. Tori Miller]

Yeah. Yeah. Or I'm undeserving of this, identifying as being a generous person, because, sure, I'm generous in this way, but then a generous person wouldn't have thoughts like this. A generous person wouldn't, you know, imagine, you know, stabbing their friend or. Or, you know, have thoughts about, you know, naked children's bodies, you know, and so that. Just sort of denying, you know, that part of yourself and your identity because you don't feel like you're worthy. Yeah, yeah, yeah. And so then what we as clinicians have to do when we're in the room is spot it when it's happening. And, you know, sometimes, I mean, this is what we're saying before. Right. Sometimes it is quite legitimately someone with questions and curiosity, and this is the nuance and the artistry of the work that we do.

[Dr. Celine Galgic]

Right.

[Dr. Tori Miller]

Which is that, you know, how annoying would it be if every time someone asked a question in therapy, you were like, no, we're going to urge. The urge to ask that question.

[Dr. Celine Galgic]

Therapist in the face. If that was me, like, stop being the ocd, please.

[Dr. Tori Miller]

Not everything is ocd. Sometimes I just have a question.

[Dr. Celine Galgic]

Oh, for sure. Yeah.

[Dr. Tori Miller]

Right. So we have to approach it with curiosity. And. And if you notice that's happening a lot over, that's when you start to sort of wonder out loud about whether this other function is happening and. And with curiosity, just explore it. Because even the process of curiously expl Exploring something is a form of exposure. Would you agree?

[Dr. Celine Galgic]

100. Yeah. The. Yeah. And that's something I often say to my supervisors is the conversation in itself will be triggering because their minds, your client's mind, is already going there. You're already bringing it up. You're starting to take the lid off. But our role then is to, like you said, recognize it and bring them into the feelings, bring them into their body, bring them into their emotions. Not just to label the emotions and to label what's going on, because that's still a form of intellectualization, but really feeling and sitting in it.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

I think the. The naming part is one thing, but the sitting part is another. And I think that sometimes we can miss that too, as clinicians, because we think if it's coming up, then they're sitting with it, but not always. Yeah, you know.

[Dr. Tori Miller]

Yeah, that's true.

[Dr. Celine Galgic]

So I think. Yeah, definitely. Just the conversation in itself. I can relate to that.

[Dr. Tori Miller]

Yeah. Yeah. And then helping our clients to spot things. Things like safety behaviors, like you're talking about, you know, we're talking about before the, you know, the recurring kind of going over things in your mind, checking.

[Dr. Celine Galgic]

That you've done things.

[Dr. Tori Miller]

That's a form. It's a compulsion, but it's a safety behavior. Right. It's a way of. Of making sure that you can be sure. And once our clients are aware, I mean, that's a big part of the process, is helping our clients to recognize compulsions so that they have the opportunity to resist them.

[Dr. Celine Galgic]

Yes. And I think this one is a trickier one. I don't know about you, but you drug. You helped me remember when you said. And when you were talking about clients being curious, it reminded me of when a time, not a time, but a lot of times when clients feel so fused with the triggers that are meta OCD that. Not that we need to convince our clients, but when providing psychoeducation around it, when we're being curious and exploring it and we don't want to be patronizing, like we said. Right. And be the OCD police. But we're being curious and exploring it and going, oh, shit, this is murder. Ocd. Like, this is a thing. Providing that education. You can sometimes get that defensiveness, I've noticed, in terms of. No, no, no, I swear, this is not an OCD thing. And that can feel really tricky, too. And we don't have to convince our clients, but it's this education around.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

Well, let's have a think about and look at what kind of impact is this having on your treatment. What kind of impact is this having on life? Is this a similar pattern to other themes of OCD that's coming up for you and I guess just kind of going about it that way and being gentle in your approach.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

Education. Have you noticed that pushback sometimes with some of your clients?

[Dr. Tori Miller]

Yeah, yeah, yeah, definitely clients.

[Dr. Celine Galgic]

Yeah, they do. They do.

[Dr. Tori Miller]

Yeah. No, I'm agreeing.

[Dr. Celine Galgic]

Like, I feel like there's a stronger fuse.

[Dr. Tori Miller]

Yeah, yeah. I think sometimes I think. What do I think? I think sometimes you're right. The. The. When there's an intellectual component to it.

[Dr. Celine Galgic]

Yeah.

[Dr. Tori Miller]

I think it is harder to spot as a compulsion. And because I think it. Because it lives in your mind, I think perhaps it feels more like an extension of yourself.

[Dr. Celine Galgic]

Yes.

[Dr. Tori Miller]

And something that is tied to your belief system and your self worth.

[Dr. Celine Galgic]

Yeah.

[Dr. Tori Miller]

And your self worth. And so it feels more organic and more real and therefore more worthy of sort of being believed. And it's sort of. It gives it a sense of legitimacy.

[Dr. Celine Galgic]

Yeah.

[Dr. Tori Miller]

Whereas I think, as opposed to sometimes the physical compulsions that have a sort of ridiculousness to them.

[Dr. Celine Galgic]

Yes.

[Dr. Tori Miller]

I think are easy.

[Dr. Celine Galgic]

And you can dismiss them too.

[Dr. Tori Miller]

Right.

[Dr. Celine Galgic]

Like, a lot of the times our clients, like, I know this doesn't make sense, or I know this is stupid. Or anxiety removed.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

Or distress removed. I. I can. I know that I'm not going to do that, or I know that I love my partner in the case of our, like, relationship. OCD or some other thing that it might be.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

But, yeah, it does feel more attached to sense of self. Yeah, yeah, yeah, yeah. No, that's fair.

[Dr. Tori Miller]

Yeah, yeah, yeah.

[Dr. Celine Galgic]

Interesting. It's such an interesting. Like, OCD can take so many forms.

[Dr. Tori Miller]

Yeah, it can.

[Dr. Celine Galgic]

And this. This one can be problematic in therapy. We've, you know, providing examples of how and how it's showing up and all that sort of stuff. And I think, too, that it's not one to dismiss, to be curious about it. Don't be patronizing about It. And when it does show up, we treat it.

[Dr. Tori Miller]

Yeah, that's right.

[Dr. Celine Galgic]

Just the way we do with other things. Yeah.

[Dr. Tori Miller]

But I think this theme is a really good example of why, you know, the traditional manualized sort of treatments don't necessarily offer. Offer the spread or the depth that sometimes conditions like OCD require. Yeah. Where there's a. A lot of thinking off the garden path kind of work that you've got to do. And it's not quite as simple as just building a hierarchy and just sort of strategically going through it. That there's a lot that clinicians and clients learn together along the way as you're doing the work.

[Dr. Celine Galgic]

Yeah.

[Dr. Tori Miller]

Because something like meta OCD, you might not spot by doing a Y box at the beginning.

[Dr. Celine Galgic]

No chance.

[Dr. Tori Miller]

It's more likely to be something that comes up further down treatment or as you're applying the ERP principles or even as a consequence of, you know, being quite a long way into therapy. And then someone. That's where the, you know, do I even have ocd? Kind of questions start to come up.

[Dr. Celine Galgic]

Yeah.

[Dr. Tori Miller]

And I think if you're just taking that sort of simple, manualized approach, these are the sorts of we miss compulsions and that we end up missing.

[Dr. Celine Galgic]

Yes. Yeah. Yeah, yeah. 100.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

Yeah. I would agree with that.

[Dr. Tori Miller]

Yeah. Which.

[Dr. Celine Galgic]

It's not a shame. That's not what I'm trying to say. It's a missed opportunity.

[Dr. Tori Miller]

Missed opportunity.

[Dr. Celine Galgic]

What it is. It's a missed opportunity at learning for yourself as a therapist.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

And it's a missed opportunity for our clients because we eventually want them to be their own therapists, too. And we want them to be able to recognize what is helpful and unhelpful. What is them. Truly them.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

Versus what is ocd. And it also just goes to show and hopefully feels validating for a lot of our clients out there and others as well, who are experiencing it. Just how insidious it is. And its tentacles can kind of get into everything. Yeah. Which is frustrating. Yeah. I think. Yeah.

[Dr. Tori Miller]

So. So I reckon let's end there. That's beautiful. Note to finish on Seline.

[Dr. Celine Galgic]

Yeah, I think so, too.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Galgic]

Short and sweet today.

[Dr. Tori Miller]

Short and sweet. Let's not think too much about our thinking.

[Dr. Celine Galgic]

Nice one. I love it. I love it. All right, well, then, see you guys next episode.

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[Dr. Celine Galgic]

Hey. How's it going?

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[Dr. Celine Galgic]

They are. Yeah.

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[Dr. Celine Galgic]

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