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

Episode Summary

Episode: Why revisiting a parent’s own childhood can help them as a new parent
Hosts: Dr. Celin Gelgec & Dr. Victoria Miller
Guest: Dr. Bianca Mastromano
Date: April 28, 2025

Brief Overview

In this episode, Dr. Celin Gelgec and Dr. Victoria (“Tori”) Miller sit down with clinical psychologist Dr. Bianca Mastromano to explore why revisiting a parent’s own childhood and emotional history can play a crucial role in supporting new parents—especially those navigating OCD and other mental health concerns during the perinatal period. Drawing on clinical experience and personal reflections as parents, the conversation spotlights trauma-informed, preventative approaches, the challenges of breaking intergenerational cycles, and practical insights for clinicians supporting families.

Key Discussion Points & Insights

1. Dr. Bianca Mastromano’s Journey into Perinatal Psychology

• Bianca’s Background:
  • Started in forensic psychology, originally interested in law ([02:22]).
  • Became disheartened by high rates of reoffending and sought preventative work.
  • Discovered “Tuning into Kids” program: Supports parents in reflecting on their own childhood and learning emotion-focused parenting ([03:40]).
  • Progressed to earlier interventions—now working mainly with soon-to-be and new parents, including infant mental health ([04:59]).
• Quote:
  • “I did heaps of therapy. I sorted my stuff out before I had kids. So, like, we’re good to go. And then this baby comes and it’s like this little trap door appears and it’s like, there’s all this other stuff there.” – Bianca ([05:41])

2. The Emotional Terrain of Becoming a Parent

• Plasticity of Early Development:
  • Change can be rapid with infants/toddlers; impact of intervention is tangible.
• Parents' Self-Reflection:
  • Many parents encounter new or resurfacing emotional challenges with the arrival of their child, despite previous therapy or personal work ([05:41], [07:23]).

3. Parental Reflective Functioning

• Core Concept:
  • Parental reflective functioning is a parent’s capacity to reflect on both their own and their child’s internal experiences ([08:39]).
  • This skill is highly protective for mental health and parent-child connection.
• Challenges:
  • Parents often worry about causing emotional harm—especially those with trauma histories.
  • Intrusive thoughts are normal, but emotional intrusive worries (“am I traumatizing my child?”) are often overlooked.
• Quote:
  • “The fact that parents are reflecting on this is such a positive sign… It’s so protective if parents are simply seeing their children, holding them in mind.” – Bianca ([08:39])

4. Emotional Overload, Perfectionism, and Parental Anxiety

• Unrealistic Standards:
  • Social media, pop psychology, and rigid “cycle breaker” narratives reinforce perfectionistic expectations ([11:50], [13:31]).
  • Fear of children experiencing “bad” emotions leads to overprotection or avoidance of boundaries ([14:43]).
• Quote:
  • “Our job is to help our kids feel their feelings, not to protect them from their feelings.” – Celin ([15:14])

5. The Paradox of OCD and Parenting

• OCD Complicates Reflection:
  • Parents with OCD face unique struggles: intrusive thoughts, doubts about harm, heightened responsibility, and compulsions for certainty ([17:24]–[18:13]).
  • OCD-related burnout and sleep deprivation are especially common ([18:13]–[21:49]).
  • Perfectionism around routines (e.g., sleep) can become debilitating, with parents sacrificing self-care or flexibility.
• Loss of Presence:
  • Compulsions (e.g., excessive research, hypervigilance) can paradoxically make parents less present with their child ([22:26]–[23:27]).
  • “In an attempt to protect the child… sometimes you can end up not being tuned in or actually experiencing time with the child, because you’re so worried or frantically researching or engaging in compulsions to protect the child. And it’s just torturous.” – Victoria ([23:03])
  • The “false security blanket” of OCD: seeking certainty but missing the partnership, playfulness, and flexibility of parenting ([23:27]–[24:43]).

6. Reframing Success in Parenting

• Letting Go of One-Size-Fits-All:
  • Many parents seek the perfect strategy to guarantee a “good” child, but emotional ups and downs are normal and important ([24:43]–[26:12]).
  • “What does it mean for something to work? Is that a child who’s just calm all the time?” – Bianca ([26:09])
• Cycle Shifting vs. Breaking:
  • Bianca prefers “cycle shifting” rather than “cycle breaking” to reflect the gradual evolution of family dynamics, not a black-and-white rupture with the past ([13:31]).

Notable Quotes & Memorable Moments

• On Hidden Triggers of Parenthood:
  • “You think you have dealt with stuff and then buttons get pushed and you’re like, I thought I had dealt with this or it shows up in a different way.” – Dr. Celin ([08:13])
• On Parental Doubt & Intrusive Thoughts:
  • “Parents are often caught off-guard by the fears that they notice around emotionally damaging their children.” – Bianca ([10:42])
• On Absurd Standards:
  • “You must hold your calm all the time… But I mean, you’re human also.” – Celin ([11:50]–[11:59])
• On Playfulness and Presence:
  • “There’s no present moment, awareness. There’s no playfulness—which is so important—flexibility, which is so important in each of those moments.” – Celin ([23:27])
• On the Repetitive Search for Certainty:
  • “Losing time researching, trying to find that certainty around what choice they should make, losing touch with what their value system is for themselves, and disconnecting from their own sense of self, just paralyzing the searching.” – Victoria ([21:52])

Timestamps for Key Segments

• 02:22–05:38 — Bianca’s background: from forensic to perinatal psychology
• 05:41–08:13 — Impact of parenthood on emotional health and self-reflection
• 08:39–13:31 — Parental reflective functioning, trauma, and anxiety in parenting
• 14:43–15:14 — Debunking “protecting from bad emotions”; focus on emotion coaching
• 16:32–18:13 — Exposure work for parents (especially those with OCD) and children
• 18:13–21:49 — Burnout, self-sacrifice, and sleep issues in parents with OCD
• 22:26–24:43 — Loss of presence, paradox of OCD-driven parenting behaviors
• 24:43–26:30 — The fallacy of “one right way” & cycle-shifting vs. cycle-breaking
• 26:30–26:59 — Diagnostic delays and OCD surfacing in the perinatal period
• Conclusion – Next episode will continue the conversation ([26:59])

Final Thoughts

This episode provides clinicians with an in-depth look at the interplay between parents’ own childhood experiences, the challenges of perfectionism, and the distinctive obstacles faced by new parents—particularly those with OCD. Realistic, compassionate reflection is encouraged, as is a shift away from black-and-white, all-or-nothing thinking about breaking cycles or achieving perfect parenting.
The discussion is rich with clinical insights and normalizes the emotional messiness of parenting, while affirming the value of curiosity, flexibility, and self-compassion in both clinicians and parents.