How I work
Inference-based CBT (I-CBT)
A newer treatment for OCD that works on the reasoning behind the doubt — an approach I am trained in and integrate into my work, online across the UK in English or Spanish.
What I-CBT helps with
I-CBT was developed specifically for OCD, and that is what I use it for. It works across themes — contamination, checking, harm, relationship doubt, taboo intrusive thoughts, perfectionism — because it targets the mechanism they share rather than the content of any one of them.
I raise it most often with two groups of people. The first have tried exposure and response prevention (ERP) and could not tolerate it, or did the work and found the doubt came straight back. The second are people whose OCD is almost entirely mental: there is very little to expose themselves to, because the compulsions are arguments happening inside their own head.
A note on evidence, because you deserve an accurate one. NICE recommends CBT including ERP for OCD, and that remains the best-established treatment — it is what I offer first. I-CBT is newer, with a growing body of trial evidence that looks genuinely promising, and it is not yet part of the NICE guideline. I am trained in it and I integrate it into my work; I would not describe it as a replacement for a treatment that is working for you.
If you are unsure which suits you, that is a reasonable thing to bring to a first conversation rather than something to decide alone.
How I-CBT works
I-CBT starts somewhere unusual. Rather than treating an obsession as an intrusive thought to be tolerated, it treats it as a conclusion — one your mind has reasoned its way to, using logic that is sophisticated, internally consistent and applied to the wrong situation.
The idea is called inferential confusion: crossing over from what your senses and common sense are telling you right now into an imagined possibility, and then living as though the imagined one were the real one. You did lock the door — you watched yourself do it — but a story about how you might not have starts to feel more credible than the memory.
So we take the doubt seriously enough to examine how it was built. Where did it come from? What kind of evidence is it made of — general facts, things that happen to other people, personal rules, a chain of what-ifs? Almost always, none of it came from the situation actually in front of you. Once you can see the construction, the doubt stops arriving as a verdict and starts arriving as an argument you are entitled to reject.
The other half of the work is the feared self — the version of you the OCD keeps insisting you might secretly be: careless, dangerous, immoral, negligent. Obsessions cluster around that fear rather than scattering randomly, which is why the themes are so personal. Loosening it takes the fuel away.
In practice this means less exposure homework and more work with reasoning, narrative and attention — noticing the exact moment you leave the here and now, and learning to come back to it. Many people find that easier to start than ERP, though easier to start is not the same as effortless.
What to expect
We start with an assessment of your OCD as it actually is: the themes, the compulsions (including the invisible ones), what you have already tried, and what helped or did not. If ERP has never been offered to you properly, I will say so — it would be poor practice to skip the best-established treatment without discussing it.
If we go with I-CBT, the early sessions are largely about learning to spot the crossover point: the split second where you leave the situation in front of you and enter the obsessional story. That sounds abstract until you catch it live, and then it is very concrete.
Sessions are 50 minutes, weekly at first, and a course typically runs 12 to 20 sessions. Between sessions you keep short records — not exposure tasks, but observations of when and how the doubt is built. Most people find that a very different kind of homework from what they were expecting.
The two approaches are not enemies. It is quite common to work with I-CBT for the reasoning and still use a graded, agreed piece of exposure where avoidance has taken over someone's life. We decide that together, out loud.
Sessions are online by secure video, wherever you are in the UK, in English or Spanish.
Common questions
Is I-CBT instead of ERP? It can be, and it does not have to be. ERP is the best-established treatment and I offer it first; I-CBT is an alternative I am trained in, most often for people who could not tolerate exposure or found the doubt returned afterwards.
Is there evidence for it? There is a growing body of trial evidence and it looks promising, particularly for people who have not done well with exposure. It is not yet part of the NICE guideline for OCD, and I would rather you heard that from me.
Does it mean reassuring myself that the doubt is untrue? No — that would be a compulsion. The work is on how the doubt was built, not on settling its content. Learning that difference is part of the treatment.
Will I have to touch the doorknob / say the thought out loud? I-CBT does not depend on exposure tasks. If avoidance has narrowed your life a great deal we may still agree some graded steps, but nothing happens without your say-so.
Does it work for purely mental OCD? This is where it often fits best, because the compulsions are internal arguments and there is little to expose yourself to.
Can sessions be in Spanish? Yes — I offer therapy in English and Spanish.
Ready to take the first step?
Send an enquiry and Gisela will be in touch within one working day.