Podcast Summary:

Get to Know OCD
Episode: The Next Step When Therapy Isn’t Helping Your OCD
Host: Dr. Patrick McGrath (NOCD Chief Clinical Officer)
Guest: Laurie Johnson (Director, Intensive Outpatient Program, NOCD)
Date: October 12, 2025

Episode Overview

In this episode, Dr. Patrick McGrath welcomes Laurie Johnson to discuss what options exist when traditional once-a-week therapy isn’t enough for treating OCD. The conversation centers on understanding the hierarchy of clinical care—ranging from outpatient therapy to intensive programs and residential care—and aims to demystify what happens when more support is needed. The episode introduces NOCD’s Intensive Outpatient Program (IOP) as one such next step, highlighting the importance of matching treatment intensity to individual needs while reducing stigma and misconceptions.

Key Discussion Points and Insights

1. Why Standard Therapy Isn’t Always Enough

• Many people believe weekly one-on-one therapy is their only option—if it “doesn’t work,” they feel stuck.
• More severe OCD may need higher levels of care for adequate support and recovery.

2. The Hierarchy of OCD Treatment Levels

Laurie Johnson outlines (03:00 – 05:00):

• Outpatient Therapy:

  • Traditional weekly therapy sessions.
  • Suited for milder cases or maintenance.

• Intensive Outpatient Program (IOP):

  • Next step up in care if outpatient is insufficient.
  • “You can go to a place in person or virtual...anywhere from three hours a day or more, for anywhere from three days a week or more.” — Laurie Johnson (03:19)
  • Allows participation in regular life while accessing focused treatment.

• Partial Hospitalization Program (PHP):

  • "Despite the name...you may or may not be in a hospital setting, but you still have some autonomy.” — Laurie Johnson (04:10)
  • More treatment hours than IOP, some flexibility in daily schedule, does not require overnight stay.

• Residential and Inpatient Programs:

  • For the most severe cases, especially with safety concerns or significant impairment.
  • "The main difference...is the medical component. Some residentials have a medical component, medication management, etc. Some inpatient programs are more about the risk and have, may have nurses and medical staff.” — Laurie Johnson (04:13)
  • Might involve living at the facility for weeks; inpatient focuses on safety/medical monitoring.
  • Addresses the stigma and fear around “hospitalizations.”

3. How Treatment Levels Are Determined

• Based on functioning and time spent on OCD:
  • “Your job, responsibilities, activities of daily living...if you are engaged in compulsions 10 hours a day, you’re probably not functioning.” — Laurie Johnson (06:30)
• The assessment considers:
  • How much time OCD compulsions take.
  • Whether daily life (work, hygiene, relationships) is compromised.

4. Reducing Stigma and Empowering Choices

• Many fear that advanced treatment means “lockdowns” and giving up all control.
• Real-life care is rarely so restrictive; autonomy is kept wherever possible and appropriate.
• “There's a ton of stigma about hospitalizations, but basically the residential and inpatient are like you’re there, you’re living there...these really aren’t scary either.” — Laurie Johnson (05:37)

5. Encouragement and Options

• One-on-one therapy not working isn’t a dead-end:
  • “Some people will try individual therapy and they'll think it didn't help, and they think that's the end of the road. If that didn't help, there's nothing else. But let's celebrate that we have the opportunity to educate people that there is more available to them.” — Patrick (08:33)
• NOCD is launching its own IOP beginning in Colorado, with plans to expand nationwide to address needs for higher care without unnecessary hospitalization.

Notable Quotes & Memorable Moments

• “OCD knows no boundaries. Everybody knows.” — Laurie Johnson (07:59)

• “We want the least restrictive level of care for you so that you can get better and return back to your normal functioning.” — Laurie Johnson (08:09)

• “Our goal is simple. To make sure that nothing, not OCD, not stigma, not misconceptions, gets in the way of you living the life you want. You deserve to focus on things that bring you joy and meaning. Helping you is just personal to us. It's what we do.” — NOCD Representative (01:18)

Important Timestamps

| Timestamp | Segment | |-----------|-----------------------------------------------------------------| | 02:31 | Levels of care overview begins | | 03:19 | Intensive Outpatient Program (IOP) explained | | 04:10 | Partial Hospitalization Program (PHP) discussed | | 04:46 | Residential and inpatient programs—differences & clarification | | 06:30 | Criteria for determining appropriate treatment level | | 08:33 | Encouragement: treatment doesn’t stop at individual therapy | | 09:10 | NOCD’s new IOP announcement |

Takeaways

• OCD recovery isn’t “one-size-fits-all”—higher levels of care exist for those who need more support.
• Treatment is individualized, with a focus on maximizing autonomy.
• Advanced care options like IOP and PHP bridge the gap between standard therapy and residential/inpatient stays.
• Seeking more intensive care is a proactive, positive step, not a defeat.
• NOCD is expanding access to higher levels of OCD care, starting with IOP in Colorado.

This episode empowers listeners to know that “the next step” exists when weekly therapy isn’t enough—reminding them they have choices and deserve tailored support on their OCD recovery journey.