Therapy for fear of losing control
CBT and ERP for the dread that you might suddenly act on an impulse — and the self-monitoring it drives. With a BABCP-accredited OCD specialist, online across the UK, in English or Spanish.
Does this sound familiar?
You are on a station platform and the thought arrives: what if I jumped. You are driving and it is: what if I turned the wheel. In a silent church, a lecture, a hospital ward — what if I shouted something obscene. Holding a knife in your own kitchen, standing at a window with a child, at the top of a staircase. It lasts a second, and the second afterwards is horror.
So you start defending against yourself. You stand further back on the platform, or grip the wheel harder, or take the longer route. The knives get moved, or you stop being the one who cooks. You avoid being alone with people you might hurt, or being in places where an outburst would be unthinkable. And underneath all of it runs a constant self-monitoring: checking whether you still feel in control, testing the grip, watching for the moment it slips.
The monitoring is what makes it worse. Attention aimed at your own control makes control feel precarious, in anybody. It is the same effect as thinking hard about swallowing, or about walking down stairs — nothing was wrong with it until it was being watched.
The urge to jump from a height, sometimes called the call of the void, is reported by roughly half of people who have never had a mental health problem in their lives. What makes it OCD is not having the thought. It is what happens next: the meaning it takes on, and everything you start doing to make sure. This is a recognised theme, it sits close to harm OCD, and it is treatable.
How I treat it
The treatment is CBT with Exposure and Response Prevention (ERP), which NICE recommends for OCD. We are not going to try to establish that you are safe. Every time you have established it, it has expired within the hour, and the establishing is what we are actually treating.
We map the cycle first: the trigger, the intrusion, the meaning it has taken on, and the whole safety apparatus that follows — the standing back, the gripping, the moving of objects, the avoidance, and above all the self-monitoring. Each of those tells your brain that the danger was real and that you only got through it because you were vigilant. We withdraw them gradually, by agreement, and your brain gets the chance to learn what it has never been allowed to test.
Early on we usually spend a session on how intrusive urges actually work, because the mechanism itself is reassuring in a way that reassurance is not. Thoughts and actions run on different systems. The horror you feel is not evidence of danger — it is evidence that the thought is landing on somebody it is profoundly at odds with, which is precisely why it stuck to you and not to the person next to you on the platform.
Then we get the ordinary things back: the platform, the kitchen, the drive, the quiet room, being alone with the people you love without a guard posted.
What to expect
We start with one or two assessment sessions to understand how your OCD works and what you have stopped doing because of it. A typical course runs 12–16 weekly sessions of 50 minutes, with practical work between them. Every exposure step is planned together first and paced by you — you are never handed a situation you have not agreed to.
Part of assessment is telling apart an intrusive urge you find horrifying from genuinely wanting to harm yourself or someone else. Those are different things needing different responses, and separating them is routine work rather than an interrogation. If it is the second — if you are actually thinking about ending your life, or you believe you might act — say so, in the first email if you like, and we deal with that first.
Sessions run over secure video across the UK and worldwide, or in person at Sanctuary Therapy Centre in Prestwich and Hebden Bridge, in English or Spanish.
Common questions
Does having these urges mean I might act on them? Notice that answering that is exactly what the OCD is asking for, and that no answer has held yet. What is worth knowing is the mechanism: intrusive urges of this kind are extremely common, they attach to whatever a person would find most abhorrent, and the distress you feel is a measure of the distance between the thought and you.
Is this the same as suicidal thoughts? No, though it is often mistaken for them, including by professionals. An intrusive urge to jump horrifies you and you want it gone; suicidal thinking involves wanting, however ambivalently, to die. If you are experiencing the second, that needs a different response and you should say so straight away — including in an initial email.
How is this different from harm OCD? Mostly by emphasis. Harm OCD usually centres on hurting a specific person; this theme centres on your own control giving way — an impulse arriving that you cannot stop, whether that is jumping, shouting, swerving or lashing out. The treatment is the same and plenty of people have both.
Should I keep avoiding platforms and knives to be safe? Avoidance is the compulsion here, and it is the main thing keeping this going — every time you step back, the fear gets confirmed. We will dismantle it, but deliberately and in an order you agree to, not by you forcing yourself onto a platform edge this weekend.
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.