The Next Step When Therapy Isn’t Helping Your OCD

Summary

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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

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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.

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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.

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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)

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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 |

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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.

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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.

Transcript

[Laurie Johnson]

Foreign.

[NOCD Representative]

Whether you realize it or not, you probably know someone with obsessive Compulsive Disorder or maybe you love someone with ocd. And if those two don't fit, you might be the person with obsessive Compulsive disorder. Because of this, OCD awareness is so personal for all of us. We hope that raising awareness will bring hope to everyone and their friends and their families who are affected by Obsessive Compulsive Disorder. When we recognize what OCD really is, it offers us a couple of options. We can see the signs in ourselves and others much quicker that can help to end a great deal of suffering. NOCD is the world's leading OCD treatment provider. And I'm honored to lead a team of licensed clinicians who are specially trained to accurately diagnose OCD and and provide the treatment of choice, exposure and response prevention so that we know that we can give people the lives that they want to live and help them not live the lives that OCD wants them to live. In addition to that, for ocd, it means applying the work that we do to other conditions that often come along with obsessive compulsive disorder, such as body focused repetitive behaviors, tics hoarding, anxiety disorders, mood conditions, trauma, and even body dysmorphic disorder. If any of these are things that are affecting you or your loved ones or family, know that help is available. If you're looking for help, you can check us [e-mail] that's no c d dot com. Our goal is simple. To make sure that nothing, not ocd, not stigma, not misconceptions, gets in the way of, 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. Hi everyone.

[Patrick]

Welcome to another one of our fun Sunday drops. So good to have all of you here. And I get questions all the time about severity and OCD and levels of care and boy, it just so happens no CD is looking at. Yeah, developing an intensive outpatient program in IOP And Laurie Johnson, the director of.

[NOCD Representative]

That, here with me today to talk.

[Patrick]

Very specifically about these levels of care and severity of ocd. Hi, Laurie, how are you?

[Laurie Johnson]

Hi, I'm great. Thanks for having me, Patrick.

[Patrick]

So what do you think? What kind of levels of care do you see people, you know, really needing when they have more significant OCD than can be taken care of in a one to two hour a week individual therapy session?

[Laurie Johnson]

Absolutely. It's a great question and I think we'll kind of briefly cover some of the levels of care, but not really go into depth of, that's fine. But they range from, I think people think, okay, I'm really severe, I need to go to the hospital. Like, I'm gonna, I'm gonna have to do a residential program and some, something's easier, know something's happening for me and my whole life's going to be uprooted. And there are different levels of care that allow us to kind of bump up from outpatient psychotherapy. So you go up to the next level and there are different little nuances in different areas and different kinds of programs. So this next level is intensive outpatient program. And it is exactly what it says, intensive outcation. That means you are still involved in your life. You can go to a place in person or virtual for a certain amount of time. Anywhere from three hours a day or more, for anywhere from three days a week or more. The next level beyond that is a partial hospitalization program. And partial hospitalization, despite the name, hospitalized, being in there, you may or may not be in a hospital setting, but you still have some autonomy. It just bumps up the amount of hours that you're spending in that you're.

[Patrick]

Not staying overnight, you're not staying overnight.

[Laurie Johnson]

You may have lunch breaks or split session days. You're just really trying to integrate the skills that you're learning into your life. Perfect. Next bump up is residential and inpatient. There's really the main difference between residential and inpatient is the medical component. Some residentials have a medical component, medication management, etc. And some inpatient programs are more about like the, the risk and have, may have nurses and medical staff.

[Patrick]

Yeah, I really don't, I don't even know that I could name a inpatient program for OCD at this point. I think they're all residential. Someone might go inpatient if they have ocd, if they're feeling, say, suicidal or a risk to self or others. And sometimes we know that OCD takes on those kind of themes. Right. And people may be so scared or overwhelmed that they try to check themselves into that. And sometimes the hospitals will say, you know, you're, you have ocd. You, here's the level of care you really need. And they'll send you to a residential or an IOP or php, even though your OCD may tell you the only safe place for you to be is in a locked unit on an inpatient unit where there's monitoring of you 24 hours a day, seven days a week. Right.

[Laurie Johnson]

And I think that's what people think treatment is. Right. Treatment is like you're going to be locked down and doctors are going to be watching you and you're like hooked up to all these machines. No, there's like a lot of autonomy within this. So yes, you are correct. Inpatient would apply for someone who has some safety and risk concerns that are co occurring, aren't unheard of. And that doesn't mean that you're sicker than any other person. No. Or that you're worse off or anything. There's a ton of stigma about hospitalizations, but basically the residential and inpatient are like you're there, you're, you're living there, whether for a temporary period of time, a known amount of time, 30 days, 60 days, sometimes as minimal as two weeks. That's not our preferred stance as providers, but your insurance covers what it covers. And these, these really aren't scary either. Right. Just as with a person who's an outpatient, therapy or residential, like you need the help that you need and that is what it is. So those programs are more intense. They're 247 and someone's there supporting and watching you and you know, just like helping. You're involved in groups and other processing and a ton of exposure and response prevention, which we all know can be a painful plight of needing to rip that band aid off and do that work. So in general, those are the level of care and, and based on which level you're assessed for or recommended for placement for is really based on a couple of different things. Is your functioning in your life. So that's your job, your responsibilities, your activities of daily living, which self and hygiene and other components that help you be a human in your life and engaged in your life. The other is the amount of time that you are spending. So for a person with OCD, they may be engaged in compulsions anywhere from two hours a day to 10 hours a day and that goes back to functioning. If you are engaged in compulsions 10 hours a day, you're probably not functioning.

[Patrick]

Very well or more or more. Yep.

[Laurie Johnson]

It doesn't. OCD knows no boundaries. Everybody knows. So if based on the amount of time that you're spending is also kind of correlated with the level of functioning that you may or may not have. So intensive outpatient is the first level of care because we want the least restrictive level of care for you so that you can get better and kind of return back to your normal functioning.

[NOCD Representative]

Well, I just think that it's great that people can learn that there are.

[Patrick]

Multiple levels of treatment. Right. That 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. And we hope that they will take advantage of those things that are available to them because they can be very, very helpful. So we hope you get out of this. To everyone watching that you have options for treatment that go above and beyond that individual therapy level if it's something that you need. And NOCD is excited to be starting an intensive outpatient program that will run three hours a day, four days a week, starting in Colorado. And we're going to be building that across the country will be our plan over time. So we're thrilled to have you here, Laurie, to start that up with us. Thank you very much. Glad to be able to introduce you to all of my friends out there who watch our Sunday drops and look forward to continuing to work together with you on the development of the programs.

[Laurie Johnson]

Thanks, Patrick.

[NOCD Representative]

Thank you, everyone.

[Patrick]

We'll see you again soon.