Get to Know OCD: Why Specialized Therapy Is Essential for OCD

Host: Dr. Patrick McGrath (NOCD’s Chief Clinical Officer)
Date: October 26, 2025

Episode Overview

In this episode, Dr. Patrick McGrath delves into why it is crucial for people with OCD to seek out specialized therapy, specifically highlighting the importance and effectiveness of Exposure and Response Prevention (ERP). Drawing from his 26 years in the field, Dr. McGrath discusses the pitfalls of general therapy for OCD, explains the mechanics behind ERP, and emphasizes the necessity of finding well-trained, specialized therapists.

Key Discussion Points and Insights

1. The Necessity of Specialized OCD Therapy

• Specialized Training Matters
  Dr. McGrath stresses that effective treatment for OCD isn’t something every therapist can provide:

  “Does your therapist actually have specialized training in obsessive compulsive disorder? … Not just because on a popular website they clicked off a box that says that they know how to treat OCD.” (01:43)

• He encourages listeners to ask therapists about their credentials and experience with OCD, emphasizing that a one-off webinar or checklist is not enough.

• Why General Therapy Falls Short
  General therapists might focus on relaxation or coping strategies, which are insufficient—and sometimes counterproductive—for OCD:

  “A general therapist might approach OCD thinking, how can I help this person to calm down as quickly as possible…This would be the sign of somebody who isn’t specialized in treating obsessive Compulsive Disorder.” (09:29)

2. What Is ERP and Why Is It the Standard? (Exposure and Response Prevention)

• Breaking Down ERP
  ERP is a two-part process:

  • Exposure: Purposefully facing the thoughts, images, or urges that are uncomfortable (obsessions).
  • Response Prevention: The key step—helping the individual not perform compulsions or safety behaviors in response.

  Dr. McGrath is clear: exposure alone doesn’t cure OCD. Many people with OCD are constantly exposed to their obsessions, but the compulsions are what keep OCD alive.

  “Exposure therapy is not the answer…The most curative aspect…is the response prevention aspect. And what is response prevention? It’s the elimination of the compulsion and other safety behaviors…” (05:19)

• ERP in Practice He likens therapy to gradually entering a pool, not being thrown in:

  “I look at treatment not as throwing you deep into the deep end of the pool… I’m going to stick a toe in the water and see how it feels… just I’m going to build up to doing all of the things that I need to do to eventually move into the deep end of the pool and figure out how to float and then how to swim.” (06:38)

3. Key Misconceptions about OCD Treatment

• Living with Uncertainty Dr. McGrath highlights that the world is inherently uncertain, and part of ERP is helping people learn to live with discomfort and possibility rather than seeking absolute certainty:

  “The goal of ERP is to help people learn that they can live with discomfort, they can live with uncertainty. I bet not one person…lives a life of absolute certainty.” (10:16)

• OCD’s Trap: Possibility vs. Probability
  A major cognitive distortion in OCD is treating possibilities as probabilities:

  “In the world of OCD, possibility does equal probability. And OCD says if it’s possible, it’s highly probable. And we better do a compulsion just to make sure, just in case.” (13:10)

4. Everyday Examples & Memorable Moments

• Pink Elephant Paradox
  Dr. McGrath demonstrates how trying to avoid certain thoughts increases their occurrence, using the classic pink elephant example:

  “The moment I tell you not to think of a pink elephant, you’re pretty much guaranteed to think of it.” (16:42)

  “Our brains kind of work in this paradox. The more we don’t want to think of something…the more we will. And the more we accept that it’s there, the less it will actually bother us.” (17:33)

• Concrete Exposure Example
  He shares a humorous real-time exposure:

  “I hope the ceiling crashes on me while filming this. We’ll see. I will do no compulsion or safety behavior to try to stop that from happening.” (15:12)

5. Goals and Takeaways for Listeners

• Find a True Specialist Dr. McGrath's key advice is to make sure your therapist is genuinely trained in ERP and OCD:

  “If you’re not confident in the person that you’re working with that they know what OCD is, or that they’re going to do good exposure and response prevention therapy, it is okay to check around to find somebody that does specialize in it.” (08:36)

• Treat OCD, Not Just its Subtypes You don’t need a therapist specializing in a particular OCD subtype—find an OCD specialist who knows ERP inside and out:

  “ERP is the treatment for OCD regardless of what the subtype is. So you don’t need to find a specialist in a subtype. You need to find a specialist in obsessive compulsive disorder.” (18:55)

• Live the Life You Want The ultimate goal:

  “You can handle the world in its glorious uncertainty and its absolute unpredictability, and know that you can live your life the way that you want to and not the life that OCD wants you to. And that’s always my hope for everyone.” (20:27)

Notable Quotes & Moments

• “If you want OCD to stick around, do more compulsions. If you want OCD to go away, do less compulsions. That’s really the key…” (05:54)
• “Just because we think something doesn’t make it true. Just because we have an urge about something doesn’t cause us to do it.” (15:33)
• “Possibility does not equal probability. However, in the world of OCD, possibility does equal probability.” (13:38)

Key Timestamps

• 01:43 — Importance of specialized training for OCD
• 05:19 — ERP explained: exposure and response prevention
• 06:38 — Therapy as gradual exposure, not “throwing you in the deep end”
• 09:29 — Differences between general and specialized therapy
• 10:16 — Learning to live with uncertainty
• 13:10 — OCD’s confusion of possibility vs. probability
• 15:12 — Therapist models exposure in real-time (ceiling example)
• 16:42 — The pink elephant thought experiment
• 18:55 — ERP as the universal treatment for OCD subtypes
• 20:27 — Therapy goal: living your own life, not OCD’s

Final Thoughts

Dr. McGrath encourages listeners to be proactive:

• Seek therapists who truly understand OCD and practice ERP
• Be cautious of general therapy approaches or therapists lacking specific OCD expertise
• Embrace uncertainty and resist OCD’s compulsions

For further support, Dr. McGrath reminds listeners that NOCD specializes in OCD, related conditions, and even broader mental health issues.

Learn more at nocd.com.

This summary captures the main content and spirit of Dr. McGrath’s deeply knowledgeable and encouraging discussion on the necessity of specialized therapy for OCD.