Podcast Summary: Get to Know OCD

Episode: How I Went From Not Knowing OCD to Treating It Every Day
Host: Dr. Patrick McGrath (B)
Guest: Alessandro Rosati, LCSW (A)
Release Date: April 5, 2026

Episode Overview

This episode features a candid conversation between Dr. Patrick McGrath (NOCD's Chief Clinical Officer) and Alessandro Rosati, a licensed clinical social worker at NOCD. The discussion centers on Alessandro’s personal and professional journey—from minimal exposure to Obsessive-Compulsive Disorder (OCD) in graduate school, to becoming a skilled OCD specialist at NOCD. The episode explores the transformative training, unique support systems, and the robust, collaborative culture that define working at NOCD, while also offering insights into effective OCD therapy and the realities of telehealth.

Key Discussion Points & Insights

1. Therapist Background and Training Gaps

[00:32 - 02:00]

• Alessandro describes a typical therapist's education: foundational work in Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT), but little meaningful exposure to Exposure and Response Prevention (ERP) or OCD-specific treatment.
• Even personally experiencing OCD and Body-Focused Repetitive Behaviors (BFRBs), Alessandro was unaware of what these were until joining NOCD.
• Quote:

  "OCD wasn't really talked about other than like a paragraph in the DSM...I had OCD as well as BFRBs, but didn't really know what they were. So until I came here. So very, very interesting to go from not knowing anything to becoming a specialist..." — Alessandro [02:00]

2. The NOCD Support System and Therapist Growth

[03:14 - 04:09]

• NOCD offers continual case consultations (20+ hours per week), access to senior staff, and a collaborative Slack environment.
• This daily access to expertise helps therapists feel supported and competent, especially when facing complex or atypical OCD presentations.
• Quote:

  "I just feel so supported and held by you all. And you definitely make me feel like I'm not alone, especially if there's a crisis or if there's anything that I don't understand very well..." — Alessandro [03:35]

3. OCD Subtypes and Therapist Self-discovery

[04:29 - 06:58]

• Many clinicians, even after formal training, hold misconceptions about OCD—seeing it primarily as hand-washing or straightening behaviors.
• Alessandro realized post-joining NOCD that OCD can present as harm or taboo obsessions, relationship anxieties, and more.
• Therapists sometimes retrospectively identify past misdiagnosed or mishandled OCD cases in their histories.
• Quote:

  "At first I didn't realize that OCD could morph into other themes like harm OCD and taboo themes, even though I myself had had those thoughts." — Alessandro [04:29]
  "You're not the first therapist who joined us who, after joining us, realized, well, shit, I have this too..." — Dr. McGrath [04:42]

4. Transformative Nature of NOCD’s Training

[04:53 - 05:43]

• NOCD’s approach emphasizes creativity in ERP and incorporates Acceptance and Commitment Therapy (ACT) principles.
• Learning cognitive diffusion and ACT allowed Alessandro to change their relationship to distressing thoughts and help members do the same.
• Quote:

  "The treatment, although it seems quite shocking at first, ends up becoming quite creative as, as a modality." — Alessandro [04:53]

5. Addressing Misconceptions and Regrets in Practice

[06:58 - 07:59]

• Both Dr. McGrath and Alessandro addressed the common regret therapists feel when they realize, in hindsight, they could have better served past clients with OCD-specific knowledge and treatment.
• This highlights the widespread lack of OCD training in graduate programs.

6. NOCD’s Mission and Treatment Philosophy

[07:59 - 09:40]

• NOCD's mission is to provide life-changing, evidence-based care—correcting the failures and potential harm from unsuitable or outdated approaches (like talk therapy, safety behaviors, and avoidance).
• ERP is framed not as avoidance of distress but as building tolerance and resilience.
• Quote:

  "It's not about learning how to soothe through those situations. It's about building the strength and resilience to get through hard things." — Alessandro [08:35]

7. Specialized Support for Complex Cases

[09:40 - 10:28]

• NOCD offers specialized consultations for comorbidities such as eating disorders, hoarding, BFRBs, and tics.
• Therapists are empowered to navigate complex cases through collaborative problem-solving.

8. Opportunities for Therapist Growth and Input

[11:05 - 12:15]

• Therapists at NOCD are encouraged to provide feedback, run consultations, and move into leadership or innovation roles.
• Quote:

  "My goal also is to, to continue developing as a supervisor. And I've gotten that opportunity. So I think NOCD really cares about helping people feel like they're, you know, growing and changing with the company because the company's constantly changing." — Alessandro [11:05]

9. Rigorous Hiring, Training, and Evidence-Based Practice

[12:30 - 14:33]

• Entry to NOCD involves rigorous interviewing, structured training, mock sessions, and ongoing education.
• Alessandro views this as a positive differentiator in preparing therapists for real-world cases.
• Quote:

  "I wish that more companies did that level of training. In fact, that is what I sought when I was in grad school is like, I need a good training program." — Alessandro [13:28]

10. Culture of Recognition and Community

[14:33 - 17:21]

• NOCD rewards excellence (e.g., trips to Cabo, New Orleans company celebrations).
• Despite being a telehealth company, Alessandro emphasizes a strong sense of community through Slack, virtual consults, conferences, and team activities.
• Quote:

  “Actually, I feel like I know my coworkers way better than I did when I worked in a facility because we are constantly in communication…" — Alessandro [14:53]
  “It was almost like we were having days of exposures like every single day, and we got to do them together…” — Alessandro [16:13]

11. Embracing Technology in Therapy

[17:21 - 19:18]

• Technology fosters ongoing therapist-member communication, supports ERP between sessions, and strengthens therapeutic rapport.
• Telehealth is described as more dynamic and accessible than traditional models.
• Quote:

  “We can communicate with our members and inspire them to do homework in between session. It's, it's not so closed off and sterile...” — Alessandro [18:17]

12. Advice for Prospective NOCD Therapists

[19:18 - End]

• Alessandro encourages therapists considering NOCD to remain open-minded about rigorous training and tech-driven practice, assuring that the support and personal growth opportunities are invaluable.
• Quote:

  “I was skeptical and I was like, oh, but it's a tech company and you. And I don't know, I was, I was hesitant... However, once I got involved in the level of training and felt really supported...I was all in.” — Alessandro [19:30]

Notable Quotes & Memorable Moments

• "You definitely make me feel like I'm not alone, especially if there's a crisis or if there's anything that I don't understand very well, because OCD sometimes takes shape in very strange ways..." — Alessandro [03:35]
• "All we want to do is grow that to more and more people having an opportunity..." — Dr. McGrath [15:50]
• “It was almost like we were having days of exposures like every single day, and we got to do them together…” — Alessandro [16:13]
• “So that's another added benefit. So I think just open your mind to the idea. If you're scared about the training process and how rigorous it is, I encourage you to stick with it because it will help you grow as a therapist. It will push you and make you uncomfortable and honestly, that's, that's a good thing.” — Alessandro [19:30]

Takeaways

• NOCD’s clinical environment is uniquely collaborative and supportive, providing both the structure and flexibility necessary for therapist growth and excellent patient outcomes.
• Therapists are empowered through education, real-time support, and opportunities for advancement, including innovation and leadership pathways.
• OCD treatment, especially ERP, is not adequately taught in most graduate programs—creating a "second education" experience for new therapists at NOCD.
• The integration of technology is a core strength, enhancing efficacy, rapport, and accessibility in OCD treatment.
• Recognition and team-building are core cultural elements, with NOCD prioritizing its therapists' sense of value and belonging.

For those interested in applying or learning more about careers at NOCD, visit nocd.com and check out their careers page.