The primary purpose of this study was to examine the role of motivation in the treatment of individuals hospitalized for severe OCD, specifically, the extent to which an individual’s motivation for treatment and motivational orientation (intrinsic or extrinsic motivation) predict OCD treatment response. The sample consisted of 142 individuals diagnosed with severe treatment-refractory OCD participating in an intensive treatment program. Patients completed a measure assessing overall motivation and motivational orientation at admission (TSRQ), and measures assessing depressive severity (BDI) and OCD symptom severity (Y-BOCS) at admission and discharge. Hierarchical multiple regression analyses were performed in which admission levels of overall motivation, intrinsic motivation, and extrinsic motivation were examined as predictors of OCD treatment response when controlling for length of treatment and baseline levels of OCD and depressive symptoms. Results indicate that a high initial level of extrinsic motivation was associated with poorer treatment outcome when controlling for other variables. Furthermore, findings suggest intrinsic motivation appears to have an interactive effect with OCD symptom severity, such that a high level of intrinsic motivation at the outset of treatment may predict positive treatment outcome when OCD symptoms are more severe. Overall initial level of motivation was not found to be a significant predictor of OCD treatment outcome. Treatment implications and suggestions for future research are discussed.