Podcast Summary: The Hardcore Self-Help Podcast with Duff the Psych

Episode: "A New Approach to OCD: Internal Family Systems w/ Melissa Mose"
Date: November 10, 2025
Host: Dr. Robert Duff
Guest: Melissa Mose, LMFT

Main Theme / Purpose

This episode explores a novel, compassionate approach to treating Obsessive Compulsive Disorder (OCD) by integrating Internal Family Systems (IFS) therapy with traditional evidence-based OCD treatments like Exposure and Response Prevention (ERP). Therapist Melissa Mose, a veteran in OCD work and IFS, shares her personal journey, her clinical innovations, and practical advice for both clinicians and individuals struggling with OCD.

Key Discussion Points & Insights

1. Melissa's Journey to OCD and IFS Therapy

• Personal Background: Started in English, literature, and mythology before entering psychotherapy. Found creative intersections between art, science, and psychology.
  • “I have always had a balance... I don't have issues with science and poetry living in the same room.” (07:31)
• Pivot to OCD: Her daughter's sudden-onset OCD at age 8 was transformative, motivating her to seek out specialized OCD training and eventually focus her career on treating OCD.
  • “My daughter… woke up one day with this really different kind of personality... what we discovered to be a sudden onset ocd.” (11:13)
• Professional Evolution: Experienced both family systems work and depth psychology; her clinical philosophy is eclectic but evidence-based.

2. OCD: Misconceptions, Mechanisms, and Treatment

• Public Misunderstandings:
  • OCD is far more complex than media portrayals. Symptoms go beyond visible compulsions and manifest as nuanced internal struggles.
    • “We don't know what OCD is really. We know that sort of what shows up in TV shows, but it's complex and it shows up in a whole lot of different forms and shades of gray.” (17:05)
• How OCD Works (Negative Reinforcement Loop):
  • Obsessions raise anxiety; compulsions relieve it temporarily, reinforcing the cycle.
    • “OCD is this loop. It's this cycle that is a negative reinforcement loop...” (18:13)
  • Compulsions can range from physical (cleaning, checking) to mental (ruminating, seeking reassurance).
• Subtypes and Progression:
  • Symptoms shift and spread (the “whack-a-mole” phenomenon) if not adequately addressed.
    • “It does spread. If you don't really work on limiting those compulsions… it just gets worse and worse.” (21:59)

3. Exposure and Response Prevention (ERP): Gold Standard OCD Treatment

• Principles:
  • Gradual exposures to anxiety triggers while resisting compulsions; learning through experience that anxiety subsides on its own.
  • Important to start small; not about jumping into the deepest fear:
    • “You don't jump to the top of a really long staircase. You take one step at a time.” (28:23)
• Misconceptions and Cautions:
  • Proper ERP requires expertise—mistakes (like providing excessive reassurance) can reinforce OCD rather than help.

4. Introducing Internal Family Systems (IFS)

• Basic Tenets:
  • The mind comprises “parts” (internal subpersonalities) and a core Self.
  • Parts are often in conflict, mirroring family dynamics; some protect, some manage, some exile vulnerability.
  • The goal: unblending from parts, relating to them with curiosity and compassion, and allowing the Self (centered, calm, connected) to lead.
    • “IFS is this very intuitive... approach where Dick Schwartz, who was the founder, was listening... we have this experience of these internal dichotomies, struggles.” (29:21)
• Differentiation from Other Therapies:
  • Similar in some ways to ACT (Acceptance and Commitment Therapy), especially in “unblending” or “defusion,” but IFS treats parts as agents with needs and agency.

5. Integrating IFS and ERP for OCD

• Rationale:
  • Recognizing obsessions and compulsions as distinct “parts” allows for relational, compassionate treatment rather than solely symptom-focused intervention.
    • “You might have a frantic part that's scanning... So being able to unblend from that rather than just identify with it.” (41:15)
• How It Works Practically:
  • Help clients unblend from obsessional and compulsive parts to access the Self, enabling more effective ERP exposures.
  • Example intervention: Instead of “I am so anxious,” say, “A part of me is really anxious right now.”
• Benefits:
  • Clients develop greater self-compassion, agency, and lasting change.
  • Especially transformative for trauma survivors or those who failed standard ERP alone.
    • “With that access to self, people really do have a whole lot more energy around being able to not do compulsions.” (50:23)

6. Challenges & Cautions in OCD Therapy

• Therapist Mistakes:
  • Providing reassurance or over-engaging with content of obsessions can inadvertently reinforce OCD.
    • “It's very easy to sit and reassure somebody for years... the ways in which our clients get us to reassure them.” (52:19)
• Need for Specialty Training:
  • Essential to work with clinicians truly versed in OCD and ERP to avoid these pitfalls.

7. IFS for OCD: State of the Field and Resources

• Growing Interest, Not Yet Fully Evidence-Based:
  • Rising curiosity among clinicians, more trainings, but limited formal research to date.
    • “There's very little research because it was developed clinically… There's promising research.” (58:24)
• Melissa Mose’s Work:
  • Author of a clinician-focused book (“Self-Led ERP”) with a workbook for general audiences forthcoming.
    • “Self-Led ERP is really what I'm doing... I ended up with something called Slurpee.” (60:15)
• Starting Points for Individuals:
  • Turn inward, notice internal parts, especially critical or skeptical ones; externalize and welcome them, inspired by “Inside Out.”
    • “The idea of if you were to cast that character in a play... what would it look like on stage? And that's like the ultimate externalization.” (66:47)
  • Invitations to seek self-compassion and small steps even in the face of discomfort.

8. Advocacy and Access

• Community Work:
  • President of the SoCal affiliate of IOCDF; focused on training clinicians, early identification, and access to evidence-based care.
• How to Find Resources & Therapists:
  • Contact Melissa via her website (melissamosmft.com or ifsforocd.com) for support or referrals.
  • She is building a network for clinicians and individuals interested in IFS for OCD.

Notable Quotes & Memorable Moments

• On IFS and OCD Hope:
  • “There is stuff out there that tells people that OCD isn't curable and it's the wrong message. You can have your life back. You can get better from this. No matter how far gone you feel like you are... there is a way through this.” –Melissa Mose (74:50)
• On Self-Compassion and Change:
  • “When you have access to yourself while you're doing an exposure, it makes all the difference.” –Melissa Mose (48:09)
• On Recognizing OCD Complexity:
  • “Symptoms go way beyond visible compulsions; OCD often masquerades in subtle, internal forms… It's definitely complex.” –Melissa Mose (17:05)
• On Family and Systems Approach:
  • “My training, my boots on the ground training was in family work... when you're working with teenagers, you're inevitably working with a whole family system.” –Melissa Mose (09:06)
• Movie Analogy for IFS:
  • “It was an IFS trainer that was consulting on [Inside Out]. It actually is based on IFS.” –Melissa Mose (68:37)

Recommended Resources from the Episode

• For Clients:
  • “ACT for OCD” by Marisa Mazza
  • Jon Hershfield’s “Mindfulness Workbook for OCD”
  • iocdf.org for information and resources
• For Clinicians:
  • Melissa’s website: ifsforocd.com
  • “Self-Led ERP” (Book)
  • Upcoming workbook (in development)
• Further Training & Support:
  • OCD SoCal Conference (ocdsocal.org/conference) – Annual event with expert speakers

Timestamps for Important Segments

• Melissa describes daughter's sudden onset OCD: (11:13)
• Breaking down ERP and its rationale: (24:19–28:33)
• IFS explained and contrasted with other therapies: (29:21–36:41)
• Applying IFS to OCD cycles and treatment: (41:15–46:21)
• Success stories of integrating IFS with ERP: (48:06–51:40)
• How to start exploring IFS (practical tips): (63:08–68:28)
• Movie “Inside Out” as illustration of parts: (68:28–69:14)
• Hope and encouragement for those struggling: (74:50–76:56)

Conclusion

This conversation provides hope and practical direction for those suffering from OCD, and a nuanced framework for clinicians seeking gentler, deeper ways to foster genuine recovery. Melissa Mose’s integration of IFS with ERP highlights the importance of both evidence-based protocols and compassionate acknowledgment of the person’s internal landscape. The message: OCD is treatable, recovery is possible, and every part of you is welcome in the healing process.