Get to Know OCD – Episode Summary

Episode: Self-Criticism, OCD, Overthinking, and the Mindset SHIFT That Helps People Heal
Date: June 5, 2025
Host: Dr. Patrick McGrath (Chief Clinical Officer, NOCD)
Guest: John Hershfield (Director, Center for OCD and Anxiety, Shepherd Pratt)

Overview

This episode dives deep into the lived experience of OCD, exploring the cycles of self-criticism, overthinking, and the compulsions that keep people stuck. Dr. Patrick McGrath welcomes John Hershfield—a therapist specializing in OCD who also lives with the condition—to discuss the importance of understanding self-punishing behaviors, the power of mindfulness, and embracing imperfection as a means to healing. The conversation offers insights for those struggling with OCD, their loved ones, and clinicians alike, weaving personal narrative, clinical expertise, and compassionate humor into a rich discussion.

Key Discussion Points and Insights

1. John's Personal and Professional Journey with OCD

• John’s Background ([04:42]–[09:07]):
  • John shares how his own struggles with OCD and involvement in online support groups led him toward a career in therapy.
  • He began by seeking reassurance and advice in Yahoo email groups, which morphed into him supporting others and considering a career change from acting to therapy.
  • The dual perspective of clinician and patient allows him to maintain both “external and internal” awareness of OCD and its rules.
• Family Influence ([13:58]–[17:01]):
  • John reflects on his father’s career as a psychiatrist and the subtle ways it shaped his interests in psychology, though he initially pursued acting.

2. The Myth of OCD as a “Superpower”

• OCD and Achievement ([17:20]–[20:47]):
  • The hosts push back against the myth that OCD drives professional or creative success.
  • John Hershfield ([18:12]):

    "Most of the time when people say OCD helped me, they're talking about character traits that you can have without OCD."

  • They emphasize that resilience and growth come from working through adversity, not from the disorder itself:

    "I don't go around saying, you know, thank God I have OCD. It helped me find my calling." – John Hershfield ([19:56])

• Mindful Gratitude ([21:19]):
  • John notes the only context for gratitude around OCD is if someone adopts a “global, mindful sense of gratitude” for their life as a whole, including challenges.

3. Mindfulness as a Core Practice in OCD Recovery

• Role of Mindfulness ([22:02]–[27:43]):
  • Mindfulness is described as a way of “showing up to the present moment exactly the way it is, without judgment.”
  • Suffering in OCD—and many other psychological conditions—comes from being “lost in thought about the past or the future.”
  • Memorable Quote ([22:42]):

    "Mindfulness for OCD is not separate from mindfulness for everything else… suffering is being caused by being lost in thought about the past or the future." – John Hershfield

  • John explores the unique challenge for OCD: when sufferers notice obsessions, disengaging can feel like a moral risk, compelling further rumination.
  • Mindfulness has personally helped John—and he shares his experiences with silent retreats and meditation.

4. The Power and Pitfalls of Moral Scrupulosity

• Understanding Moral Scrupulosity ([27:43]–[32:41]):
  • John and Patrick discuss moral scrupulosity, where OCD targets a person’s core values and sense of morality, leading even minor perceived infractions to cause outsized distress.

    “For people who struggle… they're kind of viewing moral incongruence… as a kind of contaminant to their sense of self.” – John Hershfield ([28:26])

  • Many OCD subtypes (harm, contamination, relationship OCD, etc.) contain a moral component, making scrupulosity a “catch-all umbrella” for various manifestations.
  • The compulsion to self-criticize or self-punish is highlighted as often overlooked—and counterproductive.

5. Self-Criticism, Self-Punishment, and Compulsions

• Self-Punishment as Compulsive ([36:30]–[38:05]):
  • Many people with OCD see harsh self-criticism as morally necessary:

    "People can get very attached to self-punishment, self criticism, thinking that it's the moral thing to do, when in fact it's the compulsive thing to do." – John Hershfield ([37:21])

  • The hosts challenge the idea that self-punishment leads to positive change, comparing it to ineffective child-rearing strategies.
  • Practicing self-compassion is framed as an exposure exercise for those with deeply rooted self-critical compulsions.
• Memorable Quote ([38:43]):

  "The OCD is giving you exactly what you didn't ask for." – John Hershfield

6. Barriers to Effective OCD Treatment—and When Residential Care Is Needed

• Levels of Care and Missed Opportunities ([39:12]–[43:12]):
  • Many patients reach residential levels of care after lacking tools for emotion regulation or receiving non-specialized, ineffective outpatient treatment.
  • Misdiagnosis, poor diagnostic clarification, and absence of evidence-based care (like ERP) contribute to people needing higher levels of support.

7. Clinical Pearls and the Healing Mindset Shift

• The Value of Suffering ([44:11]–[45:24]):
  • John reflects on questioning the assumption that suffering is always to be avoided:

    "I said something like, well, what's wrong with suffering? And that just stuck with them."

  • Clinicians’ role is often to “hold hope for people when they’re having trouble holding their own hope.”
• Being Human First—Therapy Second ([45:25]–[47:18]):
  • John advises clinicians not to get “so stuck in protocol that they forget therapy is fundamentally about relationships.”
  • Establishing trust and rapport is essential, especially as disclosure itself may be an exposure for someone with OCD.

Notable Quotes

• On Self-Criticism:

  "People can get very attached to self-punishment, self criticism, thinking that it's the moral thing to do, when in fact it's the compulsive thing to do. It's actually feeding the obsession." – John Hershfield ([37:21])

• On Mindfulness:

  "Mindfulness is not an intervention. It's not something you do. It's a perspective you take in which you show up to the present moment exactly the way it is, without judgment." – John Hershfield ([22:42])

• On the Myth of OCD as Superpower:

  "Most of the time when people say OCD helped me, they're talking about character traits that you can have without OCD." – John Hershfield ([18:12])

• On the Nature of Compulsions:

  "The more compulsive you are, whatever the subtype is, the more you are creating a world that's very much like the world you're trying to avoid." – John Hershfield ([34:15])

• On What Makes Treatment Take Off:

  "A lot of what we do is hold hope for people when they're having trouble holding their own hope." – John Hershfield ([44:11])

Timestamps for Key Segments

• John’s personal story and journey into therapy: [04:42]–[09:07]
• OCD and achievement: superpower myth: [17:20]–[20:47]
• Mindfulness and OCD: [22:02]–[27:43]
• Deep dive into moral scrupulosity: [27:43]–[32:41]
• Self-punishment as compulsion: [36:30]–[38:05]
• Levels of care; what leads to needing residential treatment: [39:12]–[43:12]
• Clinical pearls and therapeutic relationships: [44:11]–[47:18]

Memorable and Relatable Moments

• Personal anecdotes about growing up with a psychiatrist father in a literal “barn office” ([14:26]), and John’s transition from acting to therapy.
• Humorous banter about their collaborative work and shared experiences in the field, showcasing the importance of authentic professional relationships.
• Weekly life and writing balance advice for clinicians managing their own mental health.

Takeaways

• The path to healing from OCD is not about moral perfection or punishing oneself into change—it’s about understanding the compulsive nature of self-criticism, using mindfulness to observe thoughts without engagement, and embracing the courage to ask for help.
• Compassion, both from oneself and from clinicians, is crucial, as is holding hope through the darkest moments.
• Seeking specialized care and proper diagnosis early on can prevent escalation, but healing is possible at any stage—with the right support and mindset shift.

For more resources, podcasts, webinars, or to get help, visit NOCD.com.