In this in-depth episode of Breaking the Rules, we unpack two commonly confused but fundamentally different clinical presentations: moral scrupulosity (OCD) and Obsessive Compulsive Personality Disorder (OCPD). While they may look similar on the surface—perfectionism, rigid values, intense guilt—the treatment implications couldn’t be more different.

The conversation explores how moral scrupulosity shows up across children, teens, and adults, often hiding beneath “good behaviour,” people-pleasing, over-apologising, and chronic self-monitoring. We also dive into why some clients become stuck in ERP when the underlying issue isn’t OCD at all, but rigidity, control, and ego-syntonic perfectionism associated with OCPD.

This episode is especially valuable for clinicians navigating stuckness, treatment resistance, or confusing presentations—and for anyone who has ever felt trapped by the need to be a “good person.”

💬 Key themes:

• What moral scrupulosity really looks like in OCD
• Why guilt, confessing, and reassurance-seeking are so sticky
• How moral scrupulosity differs from OCPD at a structural level
• Why ERP works for OCD—but often fails for OCPD
• The role of values, culture, religion, and social media pressure
• Common compulsions: confessing, rumination, reassurance, over-apologising
• When rigidity is fear-driven vs personality-based
• How to treat OCPD using schema, ACT, and DBT-informed approaches
• What to do when moral scrupulosity and OCPD co-occur

💡 “OCD hijacks your values and turns them against you.”

🧠 “Good people still have messy thoughts.”

💬 “Rigidity isn’t always anxiety—sometimes it’s identity.”

🔖 Chapters

00:00 Introduction and why this topic matters

02:00 What is moral scrupulosity?

05:30 Why it’s common in kids and teens

08:00 Defining OCPD and why it’s often mislabelled as OCD

11:00 Key differences between OCD and OCPD

14:00 Guilt, confessing, and moral pressure in adolescents

17:00 Social media, cancel culture, and moral anxiety

20:00 Common compulsions in moral scrupulosity

22:00 Psychoeducation vs reassurance

24:00 ERP exposures for moral scrupulosity

27:00 Treating OCPD: flexibility over exposure

30:00 When moral scrupulosity and OCPD overlap

33:00 Differential diagnosis, supervision, and formulation

36:00 Clinical honesty and naming rigidity in the room

#OCD #MoralScrupulosity #OCPD #TherapyPodcast #MentalHealthProfessionals #ERP #Perfectionism #ValuesBasedTherapy #ClinicianSupport #BreakingTheRulesPodcast

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In this thought-provoking episode of Breaking the Rules, the hosts explore how values and paradox show up in the therapy room—especially when working with clients who experience OCD. Drawing from Acceptance and Commitment Therapy (ACT) principles, they discuss how being “fused” with one’s values can keep clients stuck in rigidity, perfectionism, and fear of imperfection.

The conversation dives into the art of helping clients find flexibility between competing values—like control vs trust, safety vs freedom, and perfectionism vs growth—and how learning to hold both truths can open the door to meaningful change. They also unpack how clinicians can use values-based reflection, curiosity, and compassion to move clients beyond “sitting with uncertainty” toward truly living aligned, balanced lives.

💬 Key themes:

• What it means to be fused with thoughts and values

• Common paradoxes in OCD (purity vs imperfection, safety vs health, control vs trust)

• Using values work to build insight and reduce rigidity

• The connection between values, uncertainty, and acceptance

• Why “sit with uncertainty” isn’t enough without context

• Mapping paradoxes and value clashes in therapy

• How building self-concept helps clients reclaim life beyond OCD

🔖 Chapters

00:00 Introduction: Values and Paradox in OCD

02:00 What It Means to Be Fused with Thoughts and Values

05:00 Why Clients Get Stuck in Rigidity

08:00 Common Paradoxes in OCD

11:00 The Cost of Perfectionism and Fear of Imperfection

14:00 Exploring Value Clashes in Therapy

17:00 Building Insight and Flexibility

20:00 Beyond “Sit with Uncertainty”: Context and Meaning

22:30 Rebuilding Self and Identity Outside OCD

#OCD #TherapyPodcast #AcceptanceAndCommitmentTherapy #MentalHealthMatters #ValuesBasedTherapy #ACT #BreakingTheRulesPodcast #ClinicianSupport #OCDRecovery #TherapyTalk #UncertaintyTolerance

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In this powerful and insightful episode, we explore the connection between PTSD and OCD, two conditions that often intersect in complex and misunderstood ways. The discussion dives into how trauma can shape obsessive-compulsive patterns, how compulsions can emerge as coping mechanisms, and why a trauma-informed approach is essential for effective treatment.

The speakers unpack the challenges of working with co-occurring trauma and OCD, emphasizing flexibility, creativity, and compassion in clinical work. From ERP integration to managing dissociation and building client insight, this conversation offers a nuanced understanding of how clinicians can hold both trauma and OCD safely in the therapy room.

💬 Key themes:

• How trauma can trigger or intensify OCD symptoms

• Compulsions as coping mechanisms for post-traumatic stress

• Why ERP and trauma therapy can complement each other

• The importance of trauma-informed care in OCD treatment

• Recognizing and managing dissociation during therapy

• Building client insight and resilience through psychoeducation

• Empowering clinicians to work confidently with trauma and OCD

🔖 Chapters

00:00 Understanding PTSD and OCD

02:55 The Interplay of Trauma and OCD

05:42 Navigating Treatment Challenges

08:53 Integrating ERP with Trauma Therapy

11:55 Building a Trauma-Informed Approach

14:54 Fluidity in Therapeutic Techniques

17:49 Empowering Clinicians to Address Trauma

23:44 Conclusion and Encouragement for Clinicians

#PTSD #OCD #TraumaInformedCare #ERP #MentalHealthPodcast #TherapyTalk #ClinicianSupport #TraumaRecovery #OCDTreatment #CopingMechanisms #TherapyForTrauma

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In this insightful episode, we explore the concept of parental accommodation — the well-intentioned ways family members and loved ones may unknowingly reinforce OCD behaviours. Drawing from the research of Professor Eli Liebowitz (Yale) and real-world clinical experience, the hosts unpack how accommodation develops, why it’s so hard to stop, and how families can begin to make meaningful change.

From checking, reassuring, or adapting routines “just to keep the peace,” to facing meltdowns, fear, or guilt when setting limits — this conversation goes deep into what it means to hold boundaries with compassion. You’ll hear about ERP therapy, the SPACE model, and practical ways clinicians and parents can work together to reduce accommodation and empower recovery.

💬 Key themes:

• What “parental accommodation” means and how it maintains OCD

• Why well-meaning reassurance can make symptoms stronger

• The difference between anxiety disorders and OCD

• Supporting children, teens, and adults through distress safely

• Helping parents tolerate their own emotions and model resilience

• How reducing accommodation can rebuild connection and trust in families

• Managing clinician fears around self-harm threats and safety planning

🔖 Chapters

00:00 Introducing the topic: Parental Accommodation and OCD

02:00 What it means to accommodate and why we do it

05:00 How everyday reassurance turns into OCD reinforcement

08:00 Fear, meltdowns, and why it’s hard for families to stop accommodating

11:00 Emotions, modelling, and learning to tolerate discomfort

14:00 The SPACE model and clinician guidance

17:00 Working with parental fear and client safety

21:00 Reducing accommodation step-by-step

25:00 Supporting families when clients resist change

26:40 Why it works — even if the client isn’t in therapy

#OCD #ERP #ParentalAccommodation #MentalHealthPodcast #TherapyTalk #FamilyTherapy #SPACEModel #OCDRecovery #ClinicianSupport #ParentingAndMentalHealth #EmotionalRegulation

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The perinatal period is one of the most vulnerable—and transformative—times in a parent’s life. In this episode, we explore the challenges of perinatal mental health, with a particular focus on OCD and how intrusive thoughts can impact new parents during this stage.

Our speakers discuss the role of psychoeducation, the importance of therapeutic trust, and how clinicians can best support parents navigating overwhelming thoughts and fears. We also examine the value of bringing babies into therapy, collaborative care, and the crucial reminder that intrusive thoughts do not define someone’s ability to be a loving, capable parent.

💬 Key themes:

• Why the perinatal period heightens vulnerability
• The role of OCD and intrusive thoughts in early parenting
• Using psychoeducation to normalize and reduce shame
• Building rapport so clients feel safe to share difficult thoughts
• The potential benefits of including babies in therapy sessions
• Collaborative care and supporting parents holistically

🔖 Chapters

00:00 Introduction to Perinatal Mental Health and OCD

02:50 Understanding Vulnerability in the Perinatal Period

05:47 Therapeutic Approaches for Clinicians

08:47 The Importance of Psychoeducation

11:45 Building Rapport and Trust with Clients

14:50 Managing Intrusive Thoughts in Therapy

17:49 Collaborative Care and Support Systems

20:51 Incorporating Babies in Therapy Sessions

23:45 Creating a Supportive Environment for New Parents

#PerinatalMentalHealth #OCD #IntrusiveThoughts #NewParents #MaternalHealth #TherapyTalk #ParentingSupport #MentalHealthAwareness #Psychoeducation #ClinicianSupport

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This honest and reflective episode takes listeners inside the therapy room—where clinical learnings, vulnerability, and growth unfold in real time.

Ms Catherine McGrath (Clinical Team Lead and Senior Psychologist) sharea hard-earned lessons from working with OCD clients using ERP (Exposure and Response Prevention), and open up about the emotional toll, missed opportunities, and the courage it takes to keep learning.

From the power of self-compassion to the importance of holding space and involving parents in the therapeutic process, this conversation is a valuable reminder that clinicians don’t need to be perfect to be effective—they just need to keep showing up.

💬 You’ll hear about:

• The real struggles clinicians face in ERP therapy
• Why reflecting on mistakes leads to better outcomes
• How client emotions are best met with presence, not perfection
• The impact of including parents in treatment plans
• Why being kind to yourself is not optional—it's essential

🔖 Chapters

00:00 Introduction to Clinical Learnings

02:59 The Courage to Learn ERP

05:57 Missed Opportunities in Therapy

08:57 The Importance of Holding Space

11:47 Navigating Client Emotions

15:12 Involving Parents in Therapy

17:42 Reflecting on Hard Lessons

21:01 Self-Compassion in Clinical Practice

23:47 Summary and Closing Thoughts

#ClinicalPractice #TherapyTalk #MentalHealthMatters #OCDTherapy #ERP #SelfCompassion #TherapistReflections #ClientEmotions #InvolvingParents #TherapyPodcast #MentalHealthProfessionals

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In this episode, we explore the often misunderstood world of Meta OCD—a subtype of obsessive-compulsive disorder where the obsession becomes the diagnosis itself. Clients plagued by questions like "Do I really have OCD?" or "Is this the right treatment?" can become trapped in a mental loop that stalls progress and fuels perfectionism, self-doubt, and avoidance.

We discuss how Meta OCD complicates therapy, disrupts client engagement, and challenges traditional treatment methods. From moral scrupulosity to obsessive intellectualization, this conversation is a must-listen for anyone working in mental health, or for those navigating OCD themselves.

💬 Key insights:

• What is Meta OCD and how does it differ from other forms?
• How perfectionism and compulsions manifest in subtle ways
• Why traditional OCD treatments may fall short for these clients
• The double-edged sword of reassurance in therapy
• How to foster self-worth and celebrate small wins

🔖 Chapters

00:00 Understanding Meta OCD

02:31 Defining Meta OCD and Its Implications

04:57 The Impact of Meta OCD on Treatment

07:59 Navigating Client Engagement and Reassurance

10:14 Perfectionism and Its Role in Meta OCD

12:24 The Challenge of Self-Identification

15:51 Recognizing and Addressing Meta OCD in Therapy

22:02 The Limitations of Manualized Treatments

#MetaOCD #OCDRecovery #MentalHealthPodcast #TherapyTalk #Perfectionism #MentalHealthMatters #TherapistTools #ClientEngagement #ObsessiveCompulsiveDisorder #Scrupulosity #TherapyTechniques

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In this insightful episode, we explore the tangled web of health anxiety, OCD, and death anxiety, unpacking how these psychological disorders often overlap and feed into each other. From obsessive thought patterns and compulsions to the deep-rooted fear of mortality, our speakers dive deep into the inner workings of anxiety disorders and what makes treatment so complex—and so crucial.

💬 We discuss:

• The blurred lines between health anxiety and obsessive-compulsive disorder
• How death anxiety often lies beneath our fear of illness
• Why reassurance-seeking can trap us in cycles of fear
• Coping strategies and evidence-based treatment approaches
• How therapists can help clients rediscover meaning beyond their mental health challenges

Whether you’re a clinician, someone living with anxiety, or simply curious about the human mind—this conversation will challenge your understanding and offer a fresh perspective on mental wellness.

🔖 Chapters

00:00 Understanding Health Anxiety and OCD

06:01 The Intersection of Health Anxiety and Death Anxiety

12:03 The Complexity of Health Anxiety and OCD

18:43 Treatment Approaches for Health Anxiety and OCD

24:22 Living Beyond Anxiety: Finding Meaning in Life

#HealthAnxiety #OCD #MentalHealthMatters #TherapyTalk #AnxietyTreatment #DeathAnxiety #CopingWithAnxiety #IntrusiveThoughts #MentalWellness #PsychologicalDisorders #AnxietyAwareness #MeaningBeyondAnxiety

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In this episode, we dive deep into the world of Exposure and Response Prevention (ERP)—the gold standard treatment for Obsessive-Compulsive Disorder (OCD)—through a clinical and ethical lens.

We unpack the delicate balance between challenging clients and protecting their autonomy, exploring how therapeutic trust, client consent, and collaborative exposure tasks shape the success of ERP. This conversation asks the tough questions: How far is too far in exposure therapy? And what happens when fear is no longer the enemy, but the doorway to healing?

💬 Key themes:

• The role of informed consent in exposure therapy
• Building trust and safety in the therapeutic relationship
• Understanding OCD beyond the symptoms
• Why a collaborative approach is more effective than a prescriptive one
• Recognizing when a therapist's anxiety enters the room too

🔖 Chapters

00:00 Introduction to ERP and Client Concerns

02:46 Understanding OCD and Its Impact

05:53 The Role of Trust in Therapy

08:53 Navigating Exposure Tasks Collaboratively

11:51 Ethics of Exposure Therapy

14:54 Client Consent and Collaboration

17:38 Managing Anxiety During Exposure

20:45 The Importance of Client Agency

23:44 Conclusion and Key Takeaways

#ERP #OCDTreatment #ExposureTherapy #TherapyEthics #ClientConsent #MentalHealth #TherapyPodcast #TherapeuticTrust #CollaborativeCare #AnxietySupport #OCDRecovery #EthicalTherapy

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With suicide remaining a leading cause of death for people aged between 15-44 in Australia, clinicians in the OCD space need to ask the question: How do we differentiate between suicidal ideation and obsessive intrusive suicidal thoughts?

In this episode, we discuss how to work with a client when they come to you with suicidal thoughts, why it is critical to take all mentions of suicide seriously, and how to determine whether a person with OCD is presenting with suicidal ideation consistent with wishes to die or whether it's intrusive suicidal OCD.

This episode contains discussions about suicide. If you find this episode distressing and would like more support, please seek help from your local healthcare provider. If you're in Australia, you can call Lifeline on 13 11 14 at any time.

Resources and links:

• Lifeline website
• Webinars, books, and training by Melbourne Wellbeing Group
• OCD training workshops by Dr Celin Gelgec
• OCD focused supervision for healthcare professionals with Dr Celin Gelgec

Connect:

• https://www.melbournewellbeinggroup.com

This show is produced in collaboration with Wavelength Creative. Visit wavelengthcreative.com for more information.

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