Therapy for OCD

Most people picture OCD as tidiness, hand-washing and straight edges. That is the version that made it into films, and it is a large part of why people who have OCD can spend years not knowing it.

What OCD actually is, is a doubt you cannot close. An unwanted thought, image or urge arrives — the obsession — and instead of passing through the way thousands of thoughts a day do, it snags. It seems to mean something about you, or about what might happen, and it seems to demand an answer.

So you answer it. You check, you wash, you replay the memory, you research it, you ask someone to tell you it is fine, or you avoid the situation altogether. That is a compulsion, and it works — the anxiety drops, sometimes within seconds. The relief is the problem. It teaches your brain that the threat was real and that acting on it was what saved you, so the next time the thought arrives it arrives louder, and needs a little more answering to settle.

Intrusion, meaning, compulsion, relief, return. That loop is the whole condition, and it is why arguing with the content never gets anywhere: the thought is not the problem, and the answer was never going to hold. Treatment targets the loop.

This comes up in a lot of first sessions, and there is almost always an explanation that is not "OCD is untreatable" or "I am the difficult one".

Sometimes the OCD was never named. Themes that don't involve washing or checking — intrusive thoughts about harm, sex, religion or identity — get handled as anxiety, as depression, or as material for open-ended talking therapy. Talking about an obsession at length is not neutral. It is very often the compulsion, performed out loud, with a professional.

Sometimes the mental compulsions were missed. The visible rituals stopped, the OCD carried on internally, and the treatment was recorded as finished.

Sometimes ERP was the right treatment delivered too fast, or without enough explanation of why it works, so it amounted to being asked to white-knuckle through distress for no clear reason. Stopping was a sensible response to that, and it is not the same thing as ERP not working for you.

And sometimes exposure genuinely isn't the right fit. That is what inference-based CBT (I-CBT) is for — it works on the reasoning that makes an obsessional doubt feel credible in the first place. If ERP has failed you before, or you already know you would not do it, say so in the first session rather than the sixth.

A typical course runs 12–16 weekly sessions. We start with a thorough assessment (1–2 sessions), agree clear goals, and review progress openly as we go. Many clients notice meaningful change within the first six sessions.

Do I need a diagnosis before I start? No, and you don't need a GP referral either. Most people arrive describing what they do rather than naming a condition. Working out together whether this is OCD is part of what the first sessions are for — and if it isn't, I will say so and point you somewhere more useful.

What if all my compulsions are in my head? That is still OCD, and it is a large part of what I treat. Replaying memories, analysing what a thought means about you, checking how you feel, researching, seeking reassurance — those are compulsions, they are just silent ones. The treatment is the same and it works just as well.

Can OCD be treated without exposure therapy? Yes. ERP is the front-line recommendation and usually what I would suggest first, but it is not the only route: NICE also supports cognitive therapy for OCD, and I-CBT works on the reasoning behind the doubt rather than through exposure. If you already know you would not do ERP, say so at the start — it changes the plan, not whether you can be helped.

I'm too ashamed to say my thoughts out loud. Can I still come? Yes, and at whatever pace that needs. Some people start with the theme in general terms and fill in the detail over several weeks. I have worked with harm, sexual, religious and identity themes for years — you will not shock me, and the content of an intrusive thought has never once told me anything about the person having it.

Does online ERP work as well as in person? Yes — research consistently shows online ERP matches in-person outcomes, and practising exposures in your own environment can even help.

Do you work with all types of OCD? Yes. The themes on this page are the common ones, not a list of what qualifies — if yours isn't there, it is still treatable and the approach doesn't change.

Is OCD curable? "Cure" is a slippery word for any anxiety condition. What a good course of treatment reliably produces is intrusive thoughts that turn up, mean very little and pass — the way they do for everyone else. Most people finish able to handle a flare-up themselves rather than needing to come back.

Can sessions be in Spanish? Yes — I offer therapy in English and Spanish.