Values, Paradox, and OCD: Finding Flexibility in the Tension

Summary

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

Episode Summary: Values, Paradox, and OCD—Finding Flexibility in the Tension

Hosts: Dr. Celine Gelgec & Dr. Tori (Victoria) Miller
Date: January 12, 2026

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Overview of Episode's Main Theme

In this episode, Dr. Celine Gelgec and Dr. Tori Miller explore the concept of paradox in the treatment of OCD, specifically focusing on how values—so often central to exposure and response prevention (ERP) and Acceptance and Commitment Therapy (ACT)—can themselves become “sticky” or fused, much like obsessions and compulsions. The hosts encourage clinicians to move beyond binary thinking and help clients recognize, accept, and flexibly navigate the tension between opposing values. The discussion is open, reflective, and gives practical ideas for working with these complex dynamics in therapy.

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Key Discussion Points & Insights

1. Defining Fusion with Thoughts and Values

• Fusion with thoughts (as defined in ACT): When individuals cannot separate themselves from their thoughts, treating them as absolute truths requiring immediate action.
  • Dr. Celine Gelgec (03:31): "It's almost like they've become one with their thoughts and they treat their thoughts as being real, as being serious, as being advice to listen to. They have to act on them straight away..."
• Fusion with values: OCD clients may rigidly adhere to a value (e.g. “being a good person” = “never making mistakes”), making flexibility intolerable.
  • Dr. Celine Gelgec (04:23): "...when someone is fused with their values, someone with OCD, for example, who values being a good person, will go to the nth degree to uphold that and can't even fathom anything different."

2. Paradox in OCD and Binary Thinking

• Looping in paradoxes: Many clients and clinicians get stuck by treating values in all-or-nothing ways—e.g., “perfection or failure,” “certainty or total risk.”
• Binary thinking means striving for 100% of conflicting values, which is impossible and leads to frustration and stuckness.
  • Dr. Tori Miller (06:34): "A lot of people get caught in the tension of wanting one or the other. It's very sort of binary thinking. But both things can be true at the same time. But...you can't be 100% of both of these competing values..."

3. Why Clients Get Stuck in Value Paradoxes

• Inner rebellion: A refusal to compromise on valued identity (“I’ll be damned if I have to sacrifice my standards”).
  • Dr. Celine Gelgec (07:22): "...it's almost like an inner rebellion. Like I'll be damned if I need to have some level of flexibility but let go of this at the same time."
• Personality and cognitive styles: Clients with rigid or perfectionistic thinking are more susceptible.
• Self-battle and avoidance: The result is constant internal conflict and attempts to ignore or suppress the tension.

4. Common OCD Paradoxes Identified

• Perfectionism vs. Flexibility
• Health vs. Safety/Certainty
• Self-Protection vs. Growth
• Responsibility vs. Letting Go
• Purity vs. Imperfection (esp. in intrusive thoughts)
• Harm Avoidance vs. Personal Freedom
• Religious/Moral Integrity vs. Practicality
• Control vs. Trust
• Certainty vs. Paradox
  • Dr. Gelgec & Dr. Miller discuss these practical examples in depth (09:43–11:14), making them highly relatable for clinicians.

5. Spotting Paradox in the Therapy Room

• Clients express a wish for two incompatible things (e.g., “I want to feel totally safe but also live freely”).
• There is visible resistance or distress in discussing giving up one value for another.
• Many aren’t aware these paradoxes are driving their compulsions or avoidance.

6. Therapeutic Strategies for Addressing Value Tension

• Normalizing and mapping the tension: Help clients name and see both values are operating.
  • Dr. Celine Gelgec (13:46): "...when your client is stuck in therapy, one of the first questions to ask is...Is there a value clash here?...Are there values clashing?"
• Values clarification: Don’t assume clients know what their values truly are; explore deeply, not just with token responses (“family,” “success”).
• Identifying personal meanings: What does a value like “family” specifically mean for each client?
• Use of creative tools: Cards, visual mapping, role-based inquiry.
  • Dr. Gelgec (17:58): "I often will tailor the way to build it out based on what the client's preferences are. Sometimes more visual. Some clients just like to talk and brainstorm more..."
• Polarity mapping (from leadership literature): While not fully explained here, the hosts suggest adapting this tool to help clients “map out the tension” (20:46–21:09).

7. Moving Beyond “Sit with Uncertainty”

• Warning against overusing the phrase without context: Simply instructing clients to “accept uncertainty” can feel empty or invalidating.
  • Dr. Tori Miller (21:36): "...we can't just keep saying this to our clients over and over again and expect them to just have radical acceptance one day."
• Instead, clinicians should use value tension conversations to help clients see what meaningful life gains can come through acceptance and compromise.
  • Dr. Miller (23:35): "...if we can go that step further and look at the things they can gain...in terms of being able to attend to other values...I think actually gives a beautiful reason to accept."

8. Recovery and Reclaiming Identity

• Acceptance allows clients to move beyond OCD-defined values to a more authentic self.
  • Dr. Gelgec (23:54): "...you're building a sense of self for your client, which OCD takes away from clients. And when a client can build that sense of self outside of OCD, then life becomes so much more enjoyable."

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Notable Quotes & Memorable Moments

• On value fusion:
  Dr. Celine Gelgec (04:23): "I'm not asking you to change your value system. I think it's a beautiful value system to be wanting to be seen as a good person. But that also comes at a cost."
• On binary thinking and paradox:
  Dr. Tori Miller (06:34): "It's very sort of binary thinking. But both things can be true at the same time..."
• On sitting with uncertainty:
  Dr. Tori Miller (21:36): "We can't just keep saying this to our clients over and over again and expect them to just have radical acceptance one day..."
• On the benefit of acceptance:
  Dr. Celine Gelgec (23:54): "...when a client can build that sense of self outside of OCD, then life becomes so much more enjoyable."
• On the future of research:
  Dr. Celine Gelgec (16:19): "...if anyone wants to help us run a research study, please get in touch, because this is something I think we could benefit from hugely."

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Timestamps for Important Segments

| Timestamp | Topic / Discussion | |------------|---------------------------------------------------------| | 02:16 | Introduction to today's theme: values and paradox | | 03:31 | Fusion with thoughts and ACT fundamentals | | 04:23 | Fusion with values in OCD: real-world examples | | 06:34 | Paradox and binary thinking | | 09:43 | How paradox shows up in session; common OCD paradoxes | | 13:46 | Spotting value clashes and their role in stuckness | | 17:25 | First therapeutic step: insight and identification | | 17:58 | Deepening values clarification; practical techniques | | 20:46 | Polarity mapping and mapping value tension | | 21:36 | Limits of “sit with uncertainty” as a one-size-fits-all message | | 23:54 | Building selfhood beyond OCD |

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Final Thoughts

The episode delivers an in-depth, compassionate look at how paradox and clashing values contribute to the suffering and “stuckness” characteristic of OCD. Dr. Gelgec and Dr. Miller push beyond standard interventions, inviting clinicians to get curious, map out client value tensions, and facilitate flexible, values-based decision-making for recovery.

By broadening clients’ awareness of their values and helping them work with—rather than against—the inherent paradoxes, clinicians can support clients in reclaiming their lives from OCD.

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For clinicians:
Consider listening to the full episode to hear more examples and the hosts’ nuanced discussion style. If you’re interested in building your own skill in polarity mapping or creative values clarification, reach out as the hosts welcome further dialogue and potential research collaboration.

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

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.

[Dr. Celine Gelgich]

Hi, everyone. Welcome to the next episode of Breaking the Rules. So glad you could join us today.

[Dr. Tori Miller]

Hello.

[Dr. Celine Gelgich]

Hi. How you going, Tori?

[Dr. Tori Miller]

I'm all right.

[Amazon Pharmacy Narrator]

All right.

[Dr. Tori Miller]

Just had a coffee.

[Dr. Celine Gelgich]

Yeah. Feeling buzzed, feeling buzzy. Yeah, I love it. We are talking about values today. And paradox.

[Dr. Tori Miller]

Yes.

[Dr. Celine Gelgich]

Yeah, yeah, lots of. Today's gonna be a little bit different, I think in terms of we're gonna be very open and curious today.

[Dr. Tori Miller]

Yeah, yeah.

[Dr. Celine Gelgich]

And just wander together.

[Dr. Tori Miller]

Well, that's right. Because this is something that you've been thinking about.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

And doing a bit of reading about. And I'm certainly very curious. And certainly the idea of paradox is one that I think comes into the therapy space with ocd, often every session. But we might not address it sort of outright. Yes. I think we often think about this in relation to stuckness, don't we?

[Dr. Celine Gelgich]

Yes. And when a client is fused with their values, which essentially keeps them stuck.

[Dr. Tori Miller]

Yeah. Yeah. So let's start there. Tell me about fused thoughts. What is it? What does it look like? I think let's define it, because this is a word that I think is thrown around a lot.

[Dr. Celine Gelgich]

Oh, yeah.

[Dr. Tori Miller]

But I do think it's worth really sort of drilling down on.

[Dr. Celine Gelgich]

Yes. I think if we think about it from an acceptance and commitment therapy perspective, we can have an understanding of what it means to be fused with our thoughts. In a sense that thoughts can be really sticky reoccurring, and clients find it really hard. Or people who are stuck in their thoughts or fused with their thoughts find it really hard to separate. It's almost like they've become one with their thoughts and they treat their thoughts as being real, as being serious, as being advice to listen to. They have to act on them straight away, so on and so on, so forth.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And when we're working with that, we can work on this concept of separating or diffusing from thoughts, between the client separating themselves from their thoughts and having just a little bit of a healthy gap.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

So that they can start to exercise different levels of choices.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

We can see similar things occurring when a client is fused with their value system. And so this is what we're going to focus on today, I think, and just be curious about in terms of how that happens and why that happens and what that can look like in the room. And what I mean by that is when someone is fused with their values, someone with ocd, for example, who values being a good person, will go to the nth degree to uphold that and can't even fathom, like, anything different.

[Dr. Shoshana Ungerleiter]

Yeah.

[Dr. Celine Gelgich]

Which is what we're trying to do when it comes to erp.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

We're trying to introduce this idea of the other side of that coin.

[Dr. Tori Miller]

Yeah. Almost like, you know, the only way to be a good person is to be perfect. You know, like anything less than that.

[Dr. Celine Gelgich]

Is wrong or immoral.

[Dr. Tori Miller]

Is wrong or immoral. Yes. So it's intolerable because if you're not perfect, then you're basically bad.

[Dr. Celine Gelgich]

Yes. And what's the point?

[Dr. Tori Miller]

And what's the point? Yes.

[Dr. Celine Gelgich]

And so when we're working with exposure therapy, we can. This often can come up. And a lot of the time, clinicians themselves feel stuck because they don't know how to get in in terms of how to even work with the client. To introduce some level of flexibility. Like I often say to my clients. I'm not asking you to change your value system. I think it's a beautiful value system to be wanting to be seen as a good person. But that also comes at a cost.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Right. And so. And clients will bring it to you anyway. They're like I want to be flexible but I also like being perfectionistic.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And so there are a list of these what we call. It's really a paradox. And this is what we mean by that in terms of how do we toe the line of A and B as opposed to it being a be.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

If that makes sense.

[Dr. Tori Miller]

Yeah. It sure does. Because I think a lot of people get caught in. In the tension of wanting one or the other.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

And feeling like it has to be once. It's very sort of binary thinking. But both things can be true at the same time. But in order for us to tolerate, you know, kind of attending to both values, there's got to be flexibility and compromise. Doesn't there? Like it. You know, we can't have. We can't be 100% of both of these competing values at the same time. It's not possible.

[Dr. Celine Gelgich]

No it's not.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

It's not.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And I think we can get caught up in the idea that it can be possible.

[Dr. Tori Miller]

You can have it all.

[Dr. Celine Gelgich]

You can have it all. But it's that age old saying of like you can have it all but not all at once. Right. But I think people get stuck in that. Of wanting to either prove to themselves that they can have it all or they build resentment around it.

[Dr. Tori Miller]

Why do you reckon that is? Why do you reckon people get stuck. Stuck here?

[Dr. Celine Gelgich]

That is such a good question. One thing that comes to mind for me is it's almost like an inner rebellion. Like I'll be damned if. You know.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

If I need to have some level of flexibility but let go of this at the same time.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Or I'll be damned if I want to be a good person but have to tolerate some level of uncomfortable thoughts and feelings.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

You know what I mean? It's almost like this inner rebellion around it.

[Dr. Tori Miller]

I kind of wondered a bit about that as well. About like just how intolerable it feels to not be able to be something 100%. I don't accept that. I don't accept that. There's not a way that there's not some kind of life hack that I can't implement to make this work.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

Yeah. And I think also there's probably some cognitive kind of styles in there, some sort of personality temperament stuff about sort of people, you know, who naturally have a bit more rigidity in their thinking.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

Would you agree?

[Dr. Celine Gelgich]

I agree.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Yeah, Yeah, I think so. But I think what that does is you end up just battling against yourself.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Right. And then whatever the outcome is ends up happening to you.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

So that's unhelpful.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

You know, that's the same time.

[Dr. Tori Miller]

Yeah. Yeah. And I, I, I agree, you know, with, with what you're saying here about the OCD space, because I think that people do get so caught in their head and in these cycles of behaving, of trying to, trying to be true to their values and fight these, these paradoxes, and it's, it's a very painful experience for them, and it's, it's a really difficult thing for them to shift on their own.

[Dr. Celine Gelgich]

Absolutely.

[Dr. Tori Miller]

And, and, and it is actually, I think, a very difficult thing to accept. Yeah, I think it's a really difficult thing to accept.

[Dr. Celine Gelgich]

I agree. And it can take some clients almost a lifetime.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Of trying to reconcile those two things.

[Dr. Tori Miller]

What do you think it looks like when someone that we're working in the room with is sort of stuck in this state? What do you think it looks like? Is it the things that they're saying? Is it things that they're doing? Like, how would a clinician spot it if we think that someone is stuck in the, in, you know, in kind of being fused or.

[Dr. Celine Gelgich]

Yeah, let's use some examples. So we have commonly identified paradox paradoxes.

[Dr. Tori Miller]

Yeah, paradoxes.

[Dr. Celine Gelgich]

Paradoxes. I think, anyway, within ocd, one of them being. So these are just some examples. One of them being perfectionism versus flexibility. So we've got perfectionism and rigidity on one end, flexibility on the other. Health versus safety. And I mean, health from the perspective of wanting to live a healthy, balanced life versus craving, safety and certainty.

[Dr. Tori Miller]

So a desperate need to want both, to want to be. Have 100% certainty that we're safe.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

But also.

[Dr. Celine Gelgich]

And I'm not gonna stick.

[Dr. Tori Miller]

Yeah. But also a real thirst for a healthy, balanced life and. Yeah, yeah, yeah, yeah. Okay.

[Dr. Celine Gelgich]

Self protection versus growth. Personal focus versus social focus or other focus. Responsibility versus letting go. Purity versus imperfections or like impure thoughts. Yeah. Harm avoidance versus personal freedom. Religious and moral integrity versus practicality. So real world and personal needs.

[Dr. Tori Miller]

Oh, that's a biggie.

[Dr. Celine Gelgich]

Yeah, it's a huge one. Control versus trust.

[Dr. Tori Miller]

Oh, mate.

[Dr. Celine Gelgich]

Yeah. And then certainty versus paradox.

[Dr. Tori Miller]

Yeah, yeah.

[Dr. Celine Gelgich]

So you can see, even just through that list.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

What. How your clients would bring that to session.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Right. Of, like, wanting, like, health and safety, for example, someone who, you know, is checking if their chicken is cooked through properly and asking for lots of reassurance and has all these rituals and compulsions around behavior, but then comes to therapy, is desperate to be rid of all these obsessions and compulsions and is struggling with letting go.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And so the fear sits in. But if I let go, then I have to sit with the risk of potentially the awful thing I'm worried about happening.

[Dr. Tori Miller]

Yeah. And I don't want to accept that risk.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

I want to. I want to have both. I want to have the certainty that there is no risk.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

As I go about my free love in life.

[Dr. Celine Gelgich]

Yeah, exactly. Exactly. So why can't I do that and why can't you help me do that? I wish, but I also, like, I think, you know, is there an answer to that? Like, can we have both of those things? I don't know if we can.

[Dr. Tori Miller]

No, we can't.

[Dr. Celine Gelgich]

I think it's, like, near impossible to have those things. So does that mean we have to give something up or do we work towards acceptance?

[Dr. Tori Miller]

I think only through delusion could we have. Honestly, like. And you know what? I think that that is how a lot of us manage the process of acceptance is kind of through avoidance. I mean, this is kind of the existential death anxiety stuff that we talk about all the time.

[Dr. Celine Gelgich]

Right.

[Dr. Tori Miller]

Which is that we. We cope with it by pretending it doesn't exist.

[Dr. Celine Gelgich]

Yes. If I ignore it, it'll go away.

[Dr. Tori Miller]

Yeah, yeah, yeah. I will. I will take all these supplements, or I will go to the gym every day and. Or I will immerse myself in work so that I don't have to think about it. You know, I'll drive my car really fast, you know, and feel the wind in my hair and, you know, and feel immortal. But. And. But just ignoring it, I think, is sort of is a way that people are kind of resisting, you know, what you're saying about, like, holding space for both at the same time, That's a very, like. Yeah.

[Dr. Celine Gelgich]

It's an uncomfortable space to be in.

[Dr. Tori Miller]

Yeah, yeah.

[Dr. Celine Gelgich]

And I think, as you described, we do all these things to kind of avoid it, ignore it, pretend it doesn't exist. And when it comes to light, and this is why we're talking about it today, because it's worth exploring in therapy. Like, when your client is stuck in therapy, one of the first questions to ask Is. Yes. What is going on for the client? But is there a value clash here?

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Are there values clashing?

[Dr. Tori Miller]

Why is it so hard to let this go?

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

Why is it so hard to accept this?

[Dr. Celine Gelgich]

Exactly.

[Dr. Tori Miller]

Yeah. What comes to mind when you think or imagine yourself letting go of this? Not engaging the compulsion, walking the other way, engaging in opposite action.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

What comes to mind?

[Dr. Celine Gelgich]

Yes. Yeah, exactly. And then working together with your client to kind of pinpoint both ends of the value clash, like the health versus safety or the trust versus control, you know, all those things that we listed out before and then helping them to identify that a paradox actually exists. Because I think half the time clients don't even know.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

That that paradox exists.

[Dr. Tori Miller]

Yeah. That they want these two competing things.

[Dr. Celine Gelgich]

Yeah, yeah. And I think once a client can be aware that those competing tensions exists. Exist. Then they can do something about it.

[Dr. Tori Miller]

Yeah, yeah, yeah. Because we can. We can bring their awareness to actually what they're missing out on or the things that they're sacrificing by being too rigid. Yes, yeah. And do some of that values based decision making.

[Dr. Celine Gelgich]

Yeah, yeah, exactly. Which goes for further than something like, you know, a pros and cons analysis.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

You know, where you sit and you just talk about what are the pros of living this way? What are the cons of living this way? I think when you bring values into it, especially for someone with ocd, because OCD truly tackles or uses someone's value system and turns it against them.

[Dr. Tori Miller]

Yeah, absolutely.

[Dr. Celine Gelgich]

And it creates this false sense of security. And I think it does that very well through this paradox, this tension where it takes one and it almost makes it enemy, like in a sense. And then you've got the other side of that that the client is kind of clinging onto or desperately wanting but can't access.

[Dr. Tori Miller]

Yeah. And it kind of, it, it then makes me think of like the ego dystonic nature of some of the obsessions and, and the reason that they're ego dystonic, that is because of this tension.

[Dr. Celine Gelgich]

Exactly.

[Dr. Tori Miller]

Because if, if that tension didn't exist, if they didn't have completely opposing.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

This particular value, they'd be all in.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

Be like, no, no, no. I just want to be safe. And I will live a very happy life in my home, separated from the world. You know, like, there is no tension here. I don't, I don't need. I don't need to make any changes because this brings me great satisfaction.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

I think it is by very definition of like this paradox that exists that we have ocd, right?

[Dr. Celine Gelgich]

Yeah, exactly. I would agree.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And so is this spoken about in the literature? Not very much, actually, which I've, you know, been really surprised about, maybe in different ways, but I haven't been exposed to it explicitly. If someone has, please send it our way, I'd love to read it.

[Dr. Tori Miller]

Agreed.

[Dr. Celine Gelgich]

A lot of what we're talking about actually exists in the leadership field. There's a lot of talk about paradox and those clashing values in the area of leadership. And so I think we've just been starting to think about this makes so much sense for the OCD space as well, because of all the things we've just been talking about.

[Dr. Tori Miller]

So where do we go from here? Because I'm thinking I'm imagining myself in the position of a clinician. Right. And you can see in your client in front of you the tangled mess, the resistance, the tension that's building. I know I need to stop, but I can't. I don't want to. I'm resisting. You know, how do we as clinicians help our clients to make shifts to learn to conceptualize these things? How do we weave this in?

[Dr. Celine Gelgich]

Yeah, well, building insight around the tension would be the first step, and just even encouraging them or even noticing it together and mapping out the pattern together and working out what that is. And I think the next step I would take is talk about what the values actually are, because I think a lot of the time people don't even know what it is that's important to them.

[Dr. Tori Miller]

Yeah, I would agree.

[Dr. Celine Gelgich]

And so working together to be able to do that can be really helpful.

[Dr. Tori Miller]

Do you have a favorite way of doing that?

[Dr. Celine Gelgich]

Not really. A lot of the time, I mean, it depends on the client. I often will tailor the way to build it out based on what the client's preferences are. Sometimes more visual. Some clients just like to talk and brainstorm more. So sometimes I'll use card, like value cards. Other times we'll just sit and jot stuff down. Other times I might post some scenarios and be like, if this was a scenario, how would you respond? What's important to you here? Or different contexts and roles, like, might ask them what their roles are and what's important to them in each of those things. It just really depends on who's in front of you.

[Dr. Tori Miller]

Yeah. So you can be quite creative and playful.

[Dr. Celine Gelgich]

Yeah, yeah, yeah. I think that's important.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And so just working through that, which can sometimes take a while.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

As well.

[Dr. Tori Miller]

Well, because I agree. I think, you know, we in the field talk about values a Lot. It's been an amazing sort of contribution to. To the therapeutic and psychological space. You know, the concept of values, I think it's been. It's been remarkable. Yeah. Remarkably helpful. But just because we talk about it a lot doesn't mean that our clients have necessarily been introduced to it.

[Dr. Celine Gelgich]

Exactly.

[Dr. Tori Miller]

Or have an expansive vocabulary around it. I think that often when people think about values, they think about, well, family, you know, generosity, loyalty, money, you know, hard work sort of thing. But actually, you know, it's what they actually mean. Yeah, that's right. And it can be so expansive and that there are so many values that we can have that actually just aren't on that tokenistic list of 10 or.

[Dr. Celine Gelgich]

Whatever that people think about. Exactly.

[Dr. Tori Miller]

Yeah. So I think. I think maybe don't assume that your clients know what their values are.

[Dr. Celine Gelgich]

I would agree with that. Because a lot of the time you'll get blank stairs.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Or just generic stuff like you talked about.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And our role is to kind of help break down what it is in each of those sections that is actually important to your client. Because someone might write family down, or three people might write family down, but what is it about family that they actually value and want? And each of those would be very different. Yeah, yeah, exactly. So I think when you're thinking about paradox and you're noticing the tensions that are there, and you and your client are identifying these values that are there that are kind of sitting on both ends of the spectrum, then working out how to map that out and how to map out the tension so that they can see how the tension exists. And like I said before, a lot of this sits in leadership, so not much of this is actually in the OCD space. And if anyone wants to help us run a research study, please get in touch, because this is something I think we could benefit from hugely. Yeah. Is the technique that's used in the leadership space is called polarity mapping. So you've got two poles, and how do you map those out? How do you map out the tension to encourage a client to see not just the pros and cons, but, like, how the value is actually influencing their behavior. And then in this space, how does OCD influence that behavior?

[Dr. Tori Miller]

So that would be really interesting.

[Dr. Celine Gelgich]

It is really interesting. Way too complicated to explain over a podcast episode, but worth reading about, I think, and worth thinking about and considering. But also, I think, at its simplest level, just having the conversation with your client and just being curious about where the tension lies, to open up the conversation, to name it, to have it Identify the patterns, and hopefully get unstuck with your clients.

[Dr. Tori Miller]

And I think what I'm thinking now as well is that I think in the OCD space, we have very, very much embraced the concept of how our role as clinicians is to help our clients sit with uncertainty. But I think we can get caught. I think we can get stuck just saying to our clients over and over, you have to sit with uncertainty. You have to sit with uncertainty. And we can't just keep saying this to our clients over and over again and expect them to just have radical acceptance one day. Oh, oh, accept the uncertainty. Oh, is that what you meant? Accept the uncertainty? I've got it now. I think these conversations are a part of how we get our clients to recognize what that actually means, what it means, you know, to accept, you know, these paradoxes, these challenges. And that's not just about accept that, you know, I could die one day. Well, that. That can only be accepted if we can understand the tension that lies underneath.

[Dr. Celine Gelgich]

Exactly.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

And so we have to be having these conversations. We have to go further than just identifying and then going, well, that's something for you to accept.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

Off you go. Good session. See you next week. Practice sitting with uncertainty.

[Dr. Celine Gelgich]

Because when is anyone really ever accepted anything without knowing why?

[Dr. Tori Miller]

Yeah, that's right.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

Yeah, that's right. And knowing what it would actually. Because I think sometimes I think our clients, when we say this to them, sit with uncertainty. There's a lot of grief and loss that comes with that and a lot of resistance because it's the like. But I don't. I don't want to. And what does. And. And if I accept this uncertainty, all I can see in my future is pain.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

It's just pain and torture.

[Dr. Celine Gelgich]

Yeah. But I think I don't want more of that.

[Dr. Tori Miller]

And I don't want more of that, you know, which is why I keep resisting, which is why I keep engaging these compulsions. But if we can go that. That step further and look at the things that they can gain.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

You know, in terms of being able to attend to other values that they have and to find more balance between these two things. Yes. I think actually gives a really beautiful reason to accept. Because you can.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

Because you can see what you can receive.

[Dr. Celine Gelgich]

Absolutely.

[Dr. Tori Miller]

Or gift yourself.

[Dr. Celine Gelgich]

Exactly. And what you're doing there is you're building a sense of self for your client, which OCD takes away from clients. And when a client can build that sense of self outside of ocd, then life becomes so much more enjoyable.

[Dr. Tori Miller]

Oh, yes.

[Dr. Celine Gelgich]

And so much more beautiful. And they end up carving a life for themselves that they actually want to live.

[Dr. Tori Miller]

Yeah. That they're really proud of.

[Dr. Celine Gelgich]

Yeah. And not one that's stuck in ocd.

[Dr. Tori Miller]

Yeah, yeah, yeah. Let's end it there.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

That was nice.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

That was a nice little wrapper.

[Dr. Celine Gelgich]

I think so.

[Dr. Tori Miller]

I know. Let's go no further.

[Dr. Celine Gelgich]

Otherwise we're gonna end up with a very philosophical discussion. We could be here for hours.

[Dr. Tori Miller]

That was great. Thanks, Elaine.

[Dr. Shoshana Ungerleiter]

Yeah.

[Dr. Tori Miller]

Yeah. That was really interesting.

[Dr. Celine Gelgich]

Thank you.

[Dr. Tori Miller]

Yeah.

[Amazon Pharmacy Narrator]

All right.

[Dr. Celine Gelgich]

Thanks, guys, for watching. We'll catch you next time.

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[Dr. Celine Gelgich]

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