Podcast Summary: The OCD Stories

Episode #485: "Jonny Say: OCD and the Therapeutic Relationship"

Host: Stuart Ralph
Guest: Jonny Say, UK therapist and co-director at the Intricate Centre for OCD Therapy
Release Date: May 11, 2025

Overview

This episode dives deep into the pivotal role of the therapeutic relationship in OCD therapy, both from the perspective of practitioners and clients. Stuart Ralph and Jonny Say explore how the connection between therapist and client influences treatment outcomes across various modalities (ERP, ACT, CFT), what can get in the way of building this relationship, and how focusing on the relationship itself can facilitate healing, particularly for those stuck in traditional approaches. They share personal anecdotes, insights from research, and discuss the challenges and opportunities within therapeutic alliances.

Key Discussion Points & Insights

The Centrality of the Therapeutic Relationship

• Both Stuart and Jonny agree that beyond techniques like ERP (Exposure and Response Prevention), ACT (Acceptance and Commitment Therapy), and CFT (Compassion Focused Therapy), the therapeutic relationship is the "bedrock of psychotherapy" (03:23).
• A strong therapist-client connection can determine how effective other interventions are ("not wanting to underestimate how important the therapeutic relationship is... it can determine how effective those other components are" – Jonny, 02:43).

Assessing and Attending to the Relationship

• There's often an assumption that a good relationship exists, but it's crucial to check in and explore with clients how connected they feel (04:22).
• Difficulties in connecting may relate to the client's attachment style—anxious or avoidant (07:20).
  • Anxious attachment: Clients may seek excessive reassurance, impacting their ability to engage with therapy independently.
  • Avoidant attachment: Clients may struggle to share or internalize compassion, holding back important information from their therapists.

Quote

"We've got to be humble and honest as clinicians. We're not going to be the right fit for everyone."
— Jonny Say (07:20)

OCD Compulsions as Barriers to Connection

• Compulsions such as excessive reassurance seeking can create walls in therapy sessions, preventing real connection (09:51).
• Sometimes, therapy sessions become "all the OCD," with little of the client's non-OCD self coming into the room (11:13).

Notable Moment

Jonny shares how his supervisor, Nate, asked him to reflect on whether he actually knows his clients beyond their OCD:

"Because of what the OCD is getting in the way, I feel like I don’t actually know you—your hobbies, your interests, what really makes you tick..."
— Recounted by Stuart from Nate's supervision (10:40)

Functional Analytic Psychotherapy (FAP)

• FAP provides tools for directly addressing what's happening in the therapeutic relationship ("...you can name that dependence on others and the sort of insecure attachment, or you can name the avoidance. And then that might open up, like, how is the therapy really going?" – Jonny, 09:10).
• Sometimes, focusing on the relational patterns in therapy can help unlock progress where ERP/ACT have stalled, especially for clients with attachment or trauma histories (15:20).

Quote

"You can use the therapeutic relationship to practice things that are difficult in relationship, and then take that out into someone's life."
— Jonny Say (12:00)

The Power of Validation & Shame Reduction

• A secure, validating therapeutic relationship is essential for building the courage needed for exposures, especially with shame-laden or taboo themes (19:37).
• Being able to share "horrible thoughts we have and the compulsions we do that can be embarrassing" with a supportive therapist is profoundly healing (47:49).

Notable Quote

"The act of revealing oneself fully to another and still being accepted may be the major vehicle of therapeutic help."
— Irving Yalom, quoted by Jonny (47:02)

Personal Experiences: Rupture and Repair

• Both Stuart and Jonny recount moments when minor ruptures occurred in their therapeutic relationships and were successfully repaired, which deepened trust and resilience (26:28–27:08).
• The process of rupture and repair is natural and mirrors all relationships—what matters is being able to acknowledge and address it for mutual growth (34:17).

Quote

"What's... natural is that there are ruptures between therapist and client. What matters is how do we repair those ruptures? Can they be repaired? And a good therapist should help repair them with you."
— Stuart Ralph (26:18)

Therapist Fallibility and Humanization

• Clients sometimes idealize therapists; ACT and FAP encourage therapists to model vulnerability and self-disclosure in service of deconstructing unrealistic expectations and fostering authentic connection (43:37–46:52).
• Self-disclosure normalizes the idea that therapists are also humans with struggles, helping reduce power dynamics and shame.

Notable Quote

"I’m proud of my recovery... but we’re all flawed humans... I’ll smash down any sense that I’m not a struggling human and having difficulties, too."
— Jonny Say (45:19)

Practical Barriers: Children and Therapy Coercion

• When children or adolescents are forced into therapy by caregivers, lack of willingness can impede relationship-building; sometimes, the best decision is to pause therapy until the child is ready (35:34).
• For adults coerced into therapy by others (family, doctors), directly addressing ambivalence and resistance relationally can sometimes open the door to meaningful engagement (36:21).

Relational Outcomes: Taking Healing Beyond the Room

• Therapeutic gains are internalized—clients often remember how therapists made them feel rather than details of treatment protocols (25:22).
• A secure therapeutic alliance supports clients in reengaging with relationships outside of therapy, which fosters overall recovery and happiness, supported by extensive research such as the Harvard Study on Adult Development (16:50).

Notable Quote

"People will forget what you said, they'll forget what you did, but they will never forget how you made them feel."
— Maya Angelou, referenced by Stuart (25:22)

Pets as Therapeutic Relationships

• The restorative power of relationships extends to animals, who provide unconditional positive regard and support during tough times (48:23–48:42).

Memorable Moments & Notable Quotes (with Timestamps)

• "We're not going to be the right fit for everyone."
  — Jonny Say (07:20)
• "Because of what the OCD is getting in the way, I feel like I don’t actually know you."
  — Stuart, recalling Nate's supervision (10:40)
• "The act of revealing oneself fully to another and still being accepted may be the major vehicle of therapeutic help."
  — Irving Yalom as quoted by Jonny (47:02)
• "You get courage from other people... the courage is contagious."
  — Jonny Say (19:37)
• "I've internalized that grace, that compassion, that belief that I'm not a bad person is all there."
  — Stuart Ralph (27:45)
• "Sure, Jonny, everyone gets up in the morning and does a shit."
  — Jonny’s therapist, offering lighthearted normalizing acceptance at a key therapeutic moment (29:40)
• "Relationships are the thing that make us most happy... and then when you’ve got OCD... your mind’s just throwing you intrusive thoughts the whole time..."
  — Jonny Say (41:15)
• "ACT is for self-disclosure if it's in service of the client."
  — Stuart Ralph (44:13)
• "To think with our clients, not for our clients."
  — Paul Gilbert, referenced by Jonny (46:46)

Timestamps for Important Segments

• 02:02 – Introduction to the role of therapeutic relationships in OCD therapy
• 07:16 – Challenges in forming therapeutic bonds (attachment styles, barriers)
• 10:40 – OCD as a barrier to getting to know clients as people
• 11:54 – Using values and interests in session to strengthen the alliance
• 15:20 – FAP as a relational approach when ERP/ACT stall
• 19:37 – Shame and validation in taboo and "difficult" OCD content
• 25:22 – What clients remember most: The feeling of being cared for (Maya Angelou quote)
• 26:18 – The importance of rupture and repair in therapy
• 29:40 – Jonny’s anecdote: Therapist’s light-hearted acceptance
• 34:17 – How past relational wounds can amplify small mistakes in therapy
• 35:34 – Children forced into therapy: limits of the relationship
• 36:21 – Addressing resistant/adult clients directly
• 41:00 – Reinforcing change and courage through genuine therapist pride
• 47:02 – Irving Yalom quote on acceptance and full self-revelation
• 48:23 – Pets as sources of unconditional positive regard

Conclusion

This episode offers a rich, practical, and deeply human exploration of the therapeutic relationship’s critical role in OCD treatment. Stuart and Jonny underscore the interplay between clinical approaches and the interpersonal fabric of therapy, illustrating how healing is most powerfully delivered and received within real, courageous, and sometimes imperfect human connection.

For further learning:

• FAP training on May 16th (details in the show notes)
• Related episodes: "ICDM Pets" with Emily Hemmending, "Just Call Me Steve" with Dr. Steven Phillipson

Final Word:

"If you have a therapeutic relationship that helps you reconnect out in the world after the impact of OCD on relationships, I think... that's so helpful."
— Jonny Say (43:20)