How Toni Spera found her way to OCD specialty care, and built a career at NOCD that fits her life
Before she specialized in treating obsessive-compulsive disorder (OCD), Toni Spera would work with people who had OCD but weren’t getting the care they needed.
As the Clinical Director at an Inpatient Mental Health and Substance Use Program in upstate New York, she saw a steady stream of people come through with conditions her program was built to treat. But every so often, someone would arrive with untreated or undertreated OCD and Spera would realize her team, focused on dual-diagnosis care, simply wasn’t equipped to help.
Finding a place to specialize
That gap piqued her curiosity. She started researching, trying to understand a condition her program kept encountering but couldn’t fully treat. That search led her to come across NOCD, and she decided to apply to join the team. Once she joined as a therapist, she went through the NOCD’s comprehensive training program which reshaped her understanding of OCD from the ground up.
“The short answer is everything changed”, she says of how her perspective and understanding of OCD evolved. She joined NOCD with in her words, “maybe a little better than a layperson’s understanding [of OCD]” — enough to know the basics, not enough to grasp how far OCD can reach. “I didn’t realize how expansive OCD can be, in that it can attack virtually anything that is of meaning or of value to the person,” she says. “I certainly didn’t realize how debilitating it can get” — pointing to its ranking as one of the ten most disabling conditions in the world.
As she started treating OCD using exposure response prevention (ERP) — the most effective treatment for the disorder — Spera found it wasn’t only effective and impactful, but also left room for a surprising amount of creativity during sessions.
Spera found it wasn’t only effective — it left room for surprising creativity.
“There is an endless opportunity to be creative with ERP while adhering to an evidence-based structure,” Spera says. She’d done exposure work before joining NOCD, but nothing that gave her this kind of range. In one session, she found herself holding her own previously worn and unwashed clothing, pulled from her dirty laundry pile, while her member did the same as a means to work through a contamination fear. In another, she helped a Member with emetophobia build a convincing stand-in for vomit out of frozen peas, cat food, and a cracked egg so they could practice seeing “vomit” and not be overwhelmed by it when it happens in real life.”It really gives the therapist and the Member an opportunity to put their heads together and come up with unique, and sometimes fun, ways to challenge the fear,” she says.
That mix of structure and creativity is what makes moments like this one possible: Spera once worked with a Member who had severe POCD — pedophilia-themed OCD — that made it nearly impossible for them to be alone with their own child without overwhelming fear. “I’ll never forget the day that they told me all about being able to be alone with their child, and being able to hold their child in a really normative way,” she says, “without letting the OCD dictate how they interacted.” For Spera, it’s a clear example of the impact ERP can have — giving someone their life back, and the ability to do the things they love and value most.
The tools behind the impact
That impact on Members doesn’t happen in a vacuum — it’s shaped by the environment Spera works in day to day, and the tools and technology NOCD has built to support clinicians in doing that work.
Coming from what she calls “a bit of a dinosaur” of a medical record system, Spera was struck by how intuitive NOCD’s platform is by comparison, and how specifically it’s built around ERP itself. She also points to the tools that keep her connected to Members between sessions — messaging, community chats, group access — as something that changes how she practices. “It can be three o’clock in the morning and my Member can shoot me a message to say, this is what’s happening for me right now,” she says. “It offers the opportunity for me to get a little bit more insight into what’s happening between sessions.”
As someone drawn to data, she also values how NOCD collects measurement-based information on symptoms and uses it to inform treatment planning — a way to know, concretely, whether a Member is getting the symptom relief they’re looking for, and to pivot when they’re not.
When asked what she’d want people to know about her work, Spera keeps it simple: “I love the opportunity to help people find their own sense of freedom, and I feel blessed that I get to do that every day.”
If this is the kind of impact and support you’re looking for in your next role, we’d love to connect. Explore therapist opportunities at NOCD
