Summary5 min read

Podcast Summary: Get to know OCD

Episode: Why OCD Therapy Did NOT Work The First Time
Host: Dr. Patrick McGrath (NOCD)
Release Date: July 2, 2026

Episode Overview

In this episode, Dr. Patrick McGrath, Chief Clinical Officer at NOCD, explores a common experience among people with OCD: trying therapy without success the first time. Dr. McGrath discusses why this happens, common obstacles, and how listeners can set themselves up for better outcomes if they seek treatment again. With practical insights and encouragement, he emphasizes finding the right therapist, realistic goal-setting, and overcoming barriers such as scheduling, finances, and readiness.

Key Discussion Points & Insights

1. Why OCD Therapy Might Not Work the First Time

Common Barriers to Success
- Taking breaks from therapy is normal and does not signal failure. (00:14)
- Obstacles include finances, misfit between client and therapist, scheduling issues, readiness for therapy, and receiving the wrong treatment approach.

2. Finding the Right Therapist

Specialty Concerns
- Skepticism towards therapists who claim to "specialize" in too many areas:
  "If a therapist says I specialize in 10 or more things, I'd be suspect of that therapist... I don’t think you can be that much of a specialist in that many things." (01:04)
Importance of Appropriate Therapy for OCD
- Warns against generalized "talk therapy" or coping strategies that aren't evidence-based for OCD:
  - Examples: Teaching only safety behaviors, diaphragmatic breathing, muscle relaxation, visualization exercises.
  - These are "ineffective" and an "inefficient use of your time." (02:07)
- Advocates for Exposure and Response Prevention (ERP) therapy as the gold-standard approach.
  "Find a specialist in OCD who really uses exposure and response prevention therapy; then you have found your right match." (02:36)

3. Addressing Treatment Barriers

Scheduling and Therapy Access
- Virtual therapy removes logistical burdens.
- NOCD offers online sessions for added convenience. "Why not just do it from the comfort of your own home or office or wherever you’re at so that it is much more comfortable for you..." (03:54)
Financial Concerns
- Insurance coverage can be a barrier; NOCD offers payment plans, accepts flexible and health spending accounts, and provides documentation for insurance reimbursement. (04:28)

4. Readiness for Therapy

Debunking 'The Right Time' Myth
- Many wait for a "perfect day" to start therapy, but that day never comes.
- Uses a flat tire analogy to illustrate that crises and readiness rarely align on a schedule: "Is there ever a good day to have a flat tire?... You’re going to have a similar kind of reaction to therapy... I would contend this: There’s no great day. There’s no right day other than today." (05:09)
Encouragement to Take Action
- Emphasizes honesty about readiness and open communication with therapists.

5. Goal-Setting in OCD Treatment

Progress over Perfection
- The objective isn’t to eradicate OCD, but to learn how to manage it.
- Cautions against striving for perfection: "The moment you try to do something perfectly, you've already failed at it, right? Because there's no way to be perfect." (06:19)
- Highlights the importance of celebrating small wins and realistic milestones. "Let’s pause for a moment and just kind of relish in what we’ve just done and not just look at it as, ‘ah, well, that was really not a big deal.’ That was a big deal because that's the first step." (07:09)

6. NOCD's Commitment & Getting Help

NOCD Resource Overview
- Free 15-minute consultation calls to discuss needs and goals.
- Matching clients with therapists based on location, payment needs, and insurance.
Encouragement & Call to Action
- Concludes with a strong statement of support: "We know this: OCD doesn't care about you. OCD does not have your best interest at heart, but we do. So check us out at nocd.com and start living the life that you want to live and not the life that OCD wants you to." (08:41)

Notable Quotes

On overly broad therapist specialties:
"If a therapist says I specialize in 10 or more things, I'd be suspect of that therapist... I don’t think you can be that much of a specialist in that many things." (Dr. Patrick McGrath, 01:04)
On ineffective therapy for OCD:
"This is ineffective treatment, it is an inefficient use of your time." (Dr. Patrick McGrath, 02:07)
On readiness and taking action:
"There’s no right day other than today. Today is the day to make the call. Today’s the day to put yourself into what might feel like a risky situation and to try to do something else." (Dr. Patrick McGrath, 05:27)
On progress versus perfection:
"The moment you try to do something perfectly, you've already failed at it, right? Because there's no way to be perfect." (Dr. Patrick McGrath, 06:19)
On NOCD’s commitment:
"OCD does not have your best interest at heart, but we do." (Dr. Patrick McGrath, 08:41)

Timestamps for Important Segments

00:14 — Why people stop therapy, normalizing setbacks
01:04 — How to evaluate therapist credentials and specialties
02:07 — What doesn’t work in OCD therapy (ineffective approaches)
02:36 — The necessity of ERP and finding the right specialist
03:54 — Overcoming scheduling barriers with virtual therapy
04:28 — Financial options and insurance support at NOCD
05:09 — Readiness, the flat tire analogy, and taking action now
06:19 — Dangers of perfectionism in recovery
07:09 — Celebrating small wins and setting realistic goals
08:41 — NOCD’s resources, contact info, and closing encouragement

Summary

This episode provides compassionate, actionable guidance for anyone discouraged by failed OCD therapy. Dr. McGrath stresses that imperfect attempts and pauses in treatment are common. The keys to successful treatment are: finding a true OCD specialist (particularly one using ERP), removing practical barriers (scheduling, finances), realistic goal-setting, and choosing progress over perfection. Throughout, Dr. McGrath’s tone is supportive and direct, aiming to empower listeners to take the next step—reminding them that while OCD may not have their best interests at heart, NOCD does.

If you’re considering starting or returning to OCD therapy, Dr. McGrath’s guidance offers hope, clarity, and practical steps forward.

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[00:00]
A
So you've tried therapy for OCD once and felt it didn't work. Should you try it again? Let's talk about that. First of all, taking break from therapy is common and it can happen for lots of reasons. It's not necessarily a sign of failure. But there are steps that you can do to get back to more manageable life and experience. Experience is, and that could be making sure that the therapy you do is the right therapy. So why did you stop? Right. What needs to be different this time? Some of the common barriers could be things like finances, therapists fit, scheduling, readiness, and even finding the right treatment. Right. There's a couple of websites out there that list therapists that they go on and they click off all these buttons and say that they specialize in all of these things. And I'm here to tell you right now, if a therapist says I specialize in 10 or more things, I'd be suspect of that therapist. Right. I, I'm a little, I'm a little wary of somebody who, who can have that many specialties and works with everybody from 2 year olds to 95 year olds. Oh, and also is an expert in seven different kinds of treatment modalities too. I mean, this, this frightens me slightly when I see that, because I don't think you can be that much of a specialist in that many things. But unfortunately people put that out there. And so you go on and you see these folks and you think, oh look, they specialize in this thing and what do they do? A general talk therapy for ocd. And they probably teach you things like safety behaviors, they teach you how to do diaphragmatic breathing and muscle relaxation and 5, 4, 3, 2 ones and closed eye visualizations and all of these types of things. This is ineffective treatment. It is an inefficient use of your time. What do we want to make sure you actually do? You find a specialist in OCD who really uses exposure and response prevention therapy, I would contend then you have found your right match. And, and I think you will be more excited to try therapy again when you do this. Right. So if you're looking for a therapist, and let's say it didn't fit last time, well, you ought to be able to talk to somebody in an intake department to say, here's the kind of therapist I want, we can do that for you here at nocd. By the way, scheduling virtual. Very convenient. We offer virtual therapy here at nocd. So if that's something that would be much better for your schedule than having to pack up the family, drive to an office, leave the kids in the lobby while you're in the therapy session. All these things that you have to do. Why not just do it from the comfort of your own home or office or wherever you're at so that it is much more comfortable for you to be in the place that you need to be? Maybe finances is an issue, right? Well, insurance could be helpful for ocd, but maybe that's not always the case that you have it. Or maybe you have a high deductible or copay. At nocd, we offer payment plans. You can use your flexible spending or your health spending accounts. We'll even give super bills that you can do to turn into your insurance on the back end. And maybe you're not feeling quite ready for therapy at this point in time. Now, let me talk about that for a second. This is one of my favorite topics. Is there ever a good day to have a flat tire? I've never met someone who said that there was, right? Most people are like, oh, why does it have to happen today? Of all the days, why today? That's the kind of way that we think about things. You're going to have a similar kind of reaction to therapy. Ah, today's not the best day for it. Maybe, maybe tomorrow will be a better day. But today's not the right day. I would contend this. There's no great day. There's no right day other than today. Right? Today is the day. Right? So today is the day to make the call. Today's the day to put yourself into what might feel like a risky situation and to try to do something else, to try to do something different. You should be able to be honest with your therapist about where you're at so that they can help you. You ought to set realistic goals with them about progress, not perfection. Right? We're not here to get rid of ocd. We're not here that you will never have an intrusive or unwanted thought, image or urge ever again. That's setting you up for fail. One of the things I love to say to people is the moment you try to do something perfectly, you've already failed at it, right? Because there's no way to be perfect. There's eight and a half billion people on the planet. It means every one of them looks at what you did and says, wow, that was perfect. Even if you're in golf and you hit a hole in one, you may think, perfect shot, but the person you're playing against who just lost to you is like, that sucked it isn't about trying to be perfect in this situation. It's about trying to move forward and make progress. We're going to celebrate small wins. The way that we can is by looking at what we've done and just saying, all right, nice job. That was great. Do you want to do more? Sure. Okay. Can you do more? Yeah, we'll get to there. But let's pause for a moment and just kind of relish in what we've just done and not just look at it as, ah, well, that was really not a big deal. I still need to do this. That was a big deal because that's the first step into getting to that. Right. So it's a big deal. Our therapist can help you to get back on your treatment journey. If that's something you're looking forward to. Reach out to us@nocd.com or download the NOCD app and you can reach out to our care team through either of those options, where they will have a free 15 minute call with you and you can chat with them about what you're looking for in therapy, what kind of therapist you're looking for. They'll help to set you up. They'll match you based on insurance, payment needs, what state you're in, anything that we need to do to be sure that you're getting the right care. We want to assist you in getting that care because we know this OCD doesn't care about you. OCD does not have your best interest at heart, but we do. So check us out@nocd.com and start living the life that you want to live and not the life that OCD wants you to.