Get to Know OCD Podcast

Episode: Levels of OCD Treatment Explained
Date: September 24, 2025
Host: Dr. Patrick McGrath, Chief Clinical Officer, NOCD
Guest: Lori Johnson

Episode Overview

This episode explores the “levels of care” for obsessive-compulsive disorder (OCD) treatment, clarifying common misconceptions and offering guidance for individuals and families navigating more intensive interventions. Host Dr. Patrick McGrath welcomes clinician Lori Johnson to break down what different treatment settings look like, when higher support may be needed, and practical details about NOCD’s new Intensive Outpatient Program (IOP). Both experts bring decades of direct experience and a supportive, approachable tone as they discuss real-world scenarios, group therapy, insurance hurdles, and the lived journey from acute distress to joyful, independent living.

Key Discussion Points & Insights

1. What Are "Levels of Care"?

[05:11, 05:27]

• “Levels of care” refer to the spectrum of professional support available for individuals with OCD—from weekly outpatient sessions all the way to inpatient hospitalization.
• "A higher level of care really refers to something that requires more support and helps support a person with a different level of functioning." — Lori [00:00, 05:57]
• There are nuanced steps between traditional weekly therapy and hospitalization, often overlooked or misunderstood.

2. Explaining Each Level of Care

[07:33–09:26]

• Standard Outpatient Therapy: 1-2 hours/week; fits those managing daily life with less disruption.
• Intensive Outpatient Programs (IOP): 2-3 hours/day, 4–5 days/week; structured support while maintaining some work or school.
  • "We even had an evening IOP program so that people could come after being at school or after work..." — Dr. McGrath [14:11]
• Partial Hospitalization Programs (PHP): 6 hours/day, 5 days/week; not inpatient but provides immersive, daily therapeutic support.
  • "Sometimes people hear partial hospitalization program and think, do I have to stay at the hospital? And no...they are not stay in the hospital levels of care." — Dr. McGrath [08:21]
• Residential Treatment: 24/7 support; for those unable to function, e.g., can’t work, go to school, or engage in daily life due to OCD.
  • "When it takes over your life to such an extent that you don't live much of your life whatsoever, residential level of care might be the place to go." — Dr. McGrath [10:07]

3. How Decisions Are Made

[12:12, 16:28, 23:26]

• The choice is ideally collaborative: between client and clinical team, always aiming for the least restrictive—and most independent—setting.
• “You have autonomy being a client and being a human. And as long as there are no concerns around safety...the least restrictive level of care is the most appropriate, always.” — Lori [12:12]
• Insurance and local resources often affect what’s accessible.

4. Integration and the Importance of "Stepping Down"

[16:28–17:57]

• Transitioning back into regular life after intensive programs is vital; step-down levels help bridge the gap from structured care to independent living.
• “Integration is a really important part of step down...you get to do this independently because nobody wants to live in a hospital...you want to return back to your life and be able to do this on your own.” — Lori [16:28]

5. Value of Group Therapy

[19:55–21:44]

• Many apprehensive about group settings later find them transformative.
• “Group work can be really transformative...There’s this idea that a lot of people come in and think, man, any other kind of OCD would be better than mine. And you start to learn that no, OCD, no matter what the theme is, interferes in your life.” — Dr. McGrath [19:55]
• Sharing in a group reduces shame and isolation:
  • "I've never really talked about my OCD before in front of a group to other people. I've never really admitted it out loud." — Lori [21:21]

6. Misconceptions and Common Fears about Higher Levels of Care

[00:00, 09:26, 28:52, 31:31]

• People often assume they must be hospitalized when “more support” is recommended, but higher care often means PHP, IOP, or residential—not necessarily hospital lockdown.
• "It can be really scary...our thoughts go to immediately to hospital lock up. Like, I'm losing my autonomy. It does not need to be that way." — Lori [28:52]
• Families and individuals can approach higher support as a conversation, not a failure or loss.

7. Navigating Access and Insurance

[12:12, 14:11, 26:33, 31:31]

• Insurance requirements can determine eligibility and available options (e.g., some require attempts at lower levels before covering residential).
• Geographic disparities: not all states or regions have every level of care.

8. Practical Takeaways & NOCD’s New IOP

[24:43–34:37]

• NOCD’s IOP is a virtual, three- to six-week program presently available in Colorado but expanding.
  • Minimum of 8 ERP sessions required before joining IOP—aimed at those who haven’t improved with standard outpatient ERP.
  • 12 hours/week (Mon–Thur, 12-3pm MST), balancing group and individualized ERP.
• "If you want to learn more about the program, you can head on over to the website at nocd.com/iop and find out more information." — Lori [34:37]
• Focus remains on “returning to a life that’s meaningful for you.”

Notable Quotes & Memorable Moments

• On Autonomy:
  "You have autonomy being a client and being a human. And as long as there are no concerns around safety...the least restrictive level of care is the most appropriate, always." — Lori [12:12]

• On the Group Experience:
  “Group work can be really transformative...any other kind of OCD would be better than mine. And you start to learn that, no, OCD, no matter what the theme is, interferes in your life.” — Dr. McGrath [19:55]

• On Overcoming Fear:
  “Exposure and response prevention is really scary. It is not easy work at all. And sometimes they say to us like, well, I'm already stuck. How are you going to get me through that?...I can't believe you guys believed in me.” — Lori [18:43]

• On Misconceptions:
  "If you hear that you're not doing well, you're like, I'm going to the hospital. Like I had a client once say to me, like, I thought you were going to come in with...people in white coats. That's not how it works." — Lori [09:26]

• Encouragement to Seek Help:
  “Please know this, that if you have OCD, you're not alone and there are people out there looking to help.” — Dr. McGrath [34:37]

Timestamps for Important Segments

• How Levels of Care Work: [05:11–07:33]
• Details on IOP, PHP, and Residential: [07:33–10:07]
• Choosing the Right Level / Insurance Info: [12:12–14:11]
• Integration, Stepping Down, and Returning to Life: [16:28–17:57]
• The Power of Group Therapy: [19:55–21:44]
• Common Questions & How to Know What You Need: [23:26–24:43]
• Overview of NOCD's IOP and Who It's For: [24:43–34:37]
• Final Empowering Messages: [31:31–34:37]

Wrap-Up

The episode demystifies higher levels of OCD care, situating them not as signs of failure but as empowering, stepwise routes to recovery, tailored to life’s practical demands. Dr. McGrath and Lori Johnson stress the profound relief, community, and dignity of appropriate treatment, making clear that hope and autonomy remain central throughout the process. NOCD’s IOP program emerges as an innovative, accessible answer for those needing more than outpatient therapy.

Learn more or take the next step: nocd.com/iop

“This is really about functionality and getting back to a life, a joyous life, sometimes a painful life too, but getting back to life, that's meaningful for you.”
— Lori Johnson [31:31]