The OCD Stories Podcast – Episode #517

Guest: Spenser Gabin
Host: Stuart Ralph
Date: December 21, 2025

Episode Overview

This episode features the return of Spenser Gabin, who originally shared his lived experience of OCD on the podcast in 2018 and now rejoins as a licensed therapist specializing in OCD. Host Stuart Ralph and Spenser discuss Spenser’s personal and professional journey, reflect on Ian O’Brien’s qualitative research into barriers to ERP (Exposure and Response Prevention) therapy, and explore effective approaches to building trust, motivation, and lifelong skills with clients. Throughout, they emphasize the art and science of ERP, the importance of relationships in therapy, and the value of self-disclosure in fostering client growth.

Key Topics & Insights

1. Spenser’s OCD Journey & Becoming a Therapist

[02:51–07:10]

• Spenser recaps his core OCD themes:

  • Health anxieties centered on HIV, mental review of past events (moral scrupulosity), and the challenge of "doing the right thing".
  • “That was my main obsession starting around when I was 19… I fortunately did find treatment rather quickly, which is pretty unusual.” (B, 03:38)

• Discovery and impact of Jonathan Grayson’s book; treatment progress has led to minimal symptoms in recent years.

• Decision to retrain as a therapist in 2019, completing graduate school and obtaining licensure:

  • “I wasn’t really content with the job I was working… went to grad school in 2019 during the pandemic…” (B, 04:38)

• Participating and attending IOCDF conferences, highlighting continual involvement in the OCD community.

2. Reflections on Ian O’Brien’s Research & ERP Dropout Rates

[07:33–13:19]

The Challenge of Dropout in ERP

• Ian O’Brien's research analyzed podcast guests’ stories to understand barriers to engagement and success in ERP.

• Spenser draws parallels between ERP and personal training:

  • You risk overwhelming new clients if you ask too much, too soon, leading to dropout or discouragement.
  • “If someone’s coming in… and you ask them to do a max bench press… you’re probably… going to scare the client off.” (B, 08:26)

• “How can we build someone’s confidence piece by piece vs. just trying to overwhelm?”

• Dropout is under-addressed by clinicians, but Spenser stresses the need to consider how therapy can be more palatable:

  • “The antibiotic analogy: There’s an antibiotic to cure an infection, but if it’s the size of a watermelon and you have to eat it in one bite… not very many are going to take that cure—not because it doesn’t work, but because it’s not palatable.” (B, 11:14)

• Importance of building client confidence, understanding, and trust to support continued engagement with ERP.

ERP as a Lifestyle & Managing Expectations

[13:26–17:58]

• ERP should be integrated as a way of living, much like ongoing physical training, rather than a one-off fix.
• Setting realistic expectations prevents demoralization:
  • “A personal trainer is not going to say… do these workouts for three months, and you’re fit for the rest of your life…” (B, 16:16)
• Clients may misinterpret ERP as a one-and-done solution; therapists must clarify that it requires sustained, lifelong practice.

3. ERP Motivation: Revisiting ‘Why’

[13:26–22:37]

• Emphasizing the client’s ‘why’ for engaging in ERP:
  • Motivation needs to be internal; clients should understand how facing fears will meaningfully improve their lives.
• Concrete example: Overcoming aversion to bungee jumping isn’t helpful if the client doesn’t actually want to bungee jump.
• Stuart and Spenser stress linking exposures to real-life values and aspirations—relationships, freedom, personal growth.
• Stuart shares personal examples of applying ERP skills to public speaking and interviews.
  • “When I feel afraid of something, I lean into it… it becomes a habit almost.” (A, 17:58)

4. ERP, Graduation, and the American Experience

[18:15–21:14]

• Discussion around the terminology of “graduating” ERP:
  • Stuart remarks, “If you graduate ERP, it’s kind of implying you finished ERP when actually… it’s ongoing.” (A, 19:48)
• Spenser notes:
  • “My goal is to teach them the skills so they can do it themselves... But there are going to be triggers that come up… Life is an exposure.” (B, 20:09)
• Life requires ongoing uncertainty tolerance and skill application, not an end-point.

5. ERP’s Impact Beyond OCD: Real-Life Parallels

[21:14–27:46]

• Spenser shares a personal example: Overcoming fear of swimming led to new skills, meeting his wife, and new life experiences:
  • “If I had not really challenged that fear, I wouldn’t have met her… there are downstream effects that can be really positive when we do challenge ourselves.” (B, 23:09)
• Dealing with uncertainty as a skill broadly applicable to life’s unpredictability (pandemic, daily risk vs. rare fears).

6. Values-Based Exposures and ACT Integration

[27:46–30:04]

• Both discuss integrating ACT principles—helping clients connect exposures to personal values.
• Example: Overcoming contamination fears to move freely and connect socially, not simply to “touch the door handle”.

7. Therapeutic Alliance: Building Trust

[32:38–37:59]

• The critical importance of trust:

  • “That’s a basic principle of psychotherapy. We have to have a strong alliance... They have to feel understood. That’s a critically important piece.” (B, 32:38)

• Manuals may push for quick immersion in ERP; real-life effectiveness depends on trust, rapport, and human connection.

• “If the therapist cares… I want to work hard for them… it can be motivating for the client.” (A, 34:15)

• Parallel drawn between effective teachers and effective therapists: Relationship and perceived investment drive effort and openness.

8. Self-Disclosure as a Therapeutic Tool

[41:54–45:55]

• Stuart asks about Spenser’s approach: Spenser prefers to disclose lived experience judiciously when trust has been established.

  • “Disclosing too early can come off wrong… but later, when there’s trust… it can be really healing.” (B, 42:01)

• Some clients have found and valued Spenser’s original podcast story before working with him.

• Stuart sometimes notes his lived experience of OCD early on, especially with teens, to reduce shame and open dialogue.

  • “There’s nothing you could tell me that I’ve not thought myself… I say that to let you know, you don’t need to be embarrassed or ashamed in here.” (A, 44:17)

• Both agree self-disclosure can powerfully normalize, provided it’s client-focused and not excessive.

9. Adherence, Self-Efficacy, and Setting Up for Success

[49:40–54:01]

• Spenser draws another lesson from personal training: Adherence matters more than initial effort; long-term success requires ongoing engagement.

• Building self-efficacy is key:

  • “One struggle I’ve had… is sometimes overestimating what the client is ready to do… if the client doesn’t think they can do the exposure, they probably won’t do it, and that can be demoralizing.” (B, 51:16)

• Therapist’s role is to cultivate early, manageable successes, bolstering momentum and confidence.

• Stuart encourages clients to communicate openly about their comfort with exposures, highlighting that this dialogue is itself an act of courage.

Notable Quotes & Memorable Moments

• On making therapy approachable:

  "That to me is the art of being… a good therapist in general, but also a good OCD therapist is… we know ERP works… but the part that really is more of an art form is how do we get the client to actually see that, believe in it, believe in themselves."
  — Spenser (11:36)

• On linking exposures to motivation:

  "If someone doesn’t really understand how in the big picture this is going to improve their life… they’re not likely to want to do it… They’re not going to be really internally driven to stay with it when it gets hard."
  — Spenser (15:23)

• On ERP as a lifestyle:

  "ERP really should become almost like a lifestyle. It's a daily practice, not something that you sort of… do for 60 minutes of therapy once a week and then the rest of the week you do your compulsions."
  — Spenser (16:36)

• On the therapist–client relationship:

  "There has to be trust in the room…You can really do a lot, but if the alliance isn’t there, you’re going to run into problems."
  — Spenser (32:38)

• On self-disclosure:

  "I do… The timing of that is incredibly important… Disclosing at the right time can be really, really healing."
  — Spenser (42:01)

Important Timestamps

• 02:51 – Spenser summarizes his OCD history and career switch to therapy.
• 07:33 – Reflections on Ian O’Brien’s research and ERP dropout rates.
• 11:14 – The 'watermelon' antibiotic analogy for making ERP palatable.
• 15:23 – Emphasizing personal motivation (the “why”) in ERP.
• 16:36 – ERP as long-term lifestyle, not a one-off cure.
• 18:15 – Discussing American terminology around “graduating” ERP.
• 23:09 – Spenser shares a personal example of swimming, fear, and meeting his wife.
• 32:38 – Building trust and alliance in therapy.
• 42:01 – Self-disclosure and its impact on therapy.
• 49:40 – The importance of adherence, self-efficacy, and incremental progress.

Conclusion

Spenser Gabin’s journey from OCD sufferer to specialist therapist highlights the hope and practical guidance available for those seeking recovery. Central themes from this episode include the necessity of motivation rooted in clients’ real-world values, the importance of trust in the therapeutic relationship, the role of self-disclosure in combating stigma, and the understanding that ERP is not a graduation event but a life skill to be maintained. For therapists, it’s a reminder that therapy is as much about artful relationship-building as it is about delivering evidence-based protocols.

For listeners:
This episode offers compassionate, real-world perspectives for anyone navigating ERP, whether as a client, loved one, or therapist-in-training.