OCD is one of the most misunderstood conditions I treat. People joke about it. "I'm so OCD about my desk." "I like things neat, I must have OCD." That's not OCD. OCD is a debilitating condition that traps people in cycles of intrusive thoughts and compulsive behaviours that can consume hours of every day.
If you're reading this, you probably know that already. You know what it's like to have a thought that won't leave you alone. You know the temporary relief of a compulsion and the crushing return of the doubt. You know the exhaustion of living inside your own head.
The good news is that OCD responds well to the right treatment. The key word is "right." Generic talking therapy doesn't cut it. What works is a specific form of CBT called Exposure and Response Prevention. I've used it throughout my 13-year career and the results are consistently strong.
What OCD actually is
OCD has two components. Obsessions are unwanted, intrusive thoughts, images, or urges that cause significant anxiety. Compulsions are the behaviours or mental acts you perform to reduce that anxiety. The compulsion works in the short term, which is why you keep doing it. But it reinforces the obsession in the long term. That's the trap.
The content of the obsessions varies enormously. Some common presentations I work with:
- Contamination OCD involving fears of germs, illness, or contamination leading to excessive washing, cleaning, or avoidance
- Checking OCD involving repeated checking of locks, appliances, or other things driven by doubt and fear of harm
- Harm OCD involving intrusive thoughts about harming yourself or others, despite having no desire or intention to do so
- Pure O where the compulsions are mainly mental, rumination, mental checking, seeking reassurance internally, rather than visible behaviours
- Relationship OCD involving persistent doubt about your relationship or your feelings for your partner
- Religious or moral OCD involving intrusive blasphemous thoughts or extreme moral scrupulosity
- Sexual orientation OCD involving intrusive doubts about your sexuality
- Symmetry and ordering where things need to feel "right" or be arranged in particular ways
Whatever form your OCD takes, the mechanism is the same. And that means the treatment approach is the same.
Why OCD is so often misunderstood
Part of the problem is that OCD has been trivialised by popular culture. But there's another issue. Many people with OCD, particularly harm OCD and sexual-content OCD, are terrified of telling anyone about their thoughts. They believe the thoughts mean something terrible about them.
They don't. Having an intrusive thought about harming someone doesn't make you dangerous. Having an unwanted sexual image flash through your mind doesn't reflect your character. The distress you feel about these thoughts is actually evidence that they go against your values. That's why they're so disturbing. OCD latches onto the things that matter most to you.
If you've been carrying these thoughts in secret, convinced that you're a terrible person, please hear this: you're not. You have OCD. And it's treatable.
How ERP works
Exposure and Response Prevention is the gold standard treatment for OCD. NICE recommends it. The evidence base spans decades. It works.
The principle is straightforward, even if the practice takes courage. You gradually expose yourself to situations that trigger obsessions while resisting the compulsions. Over time, your brain learns that the anxiety reduces on its own without the compulsion. The obsession loses its power.
We build an exposure hierarchy together, a list of triggers ranked from least to most anxiety-provoking. We start at the lower end and work up. Each step builds on the last. I won't ambush you with the hardest thing on your list in session two. We plan every exposure carefully and I make sure you have the skills to manage the discomfort.
Alongside ERP, we work on the cognitive side. OCD involves characteristic thinking errors: overestimating threat, inflating responsibility, believing that thinking something is the same as doing it. Challenging these thinking patterns supports the exposure work and helps prevent relapse.
What treatment looks like
The first session is a thorough assessment. I need to understand your specific OCD profile: what the obsessions are, what the compulsions are, what you're avoiding, and how it's affecting your daily life. This isn't a quick chat. OCD is complex and getting the formulation right matters.
From there, I'll explain the treatment plan and we'll build your exposure hierarchy together. Early sessions focus on understanding the OCD cycle and preparing for ERP. Then we move into active exposure work, both in sessions and between them.
The between-session work is critical. ERP doesn't work in 50 minutes a week. The real change happens in everyday life when you face triggers and resist compulsions on your own. I'll set clear tasks and we'll review them each session.
Most people need 12 to 20 sessions. The biggest factor in how well treatment works is your willingness to engage with the exposures. It's uncomfortable. I won't pretend otherwise. But uncomfortable and effective beats comfortable and stuck.
Pricing and next steps
Sessions cost £60 for 50 to 60 minutes. I offer concessions for military veterans, serving personnel, and blue light workers.
OCD tells you that you can't manage without the compulsions. OCD is wrong. Book a free 15-minute consultation or call me on 07469 870 295.
You can also read about my general CBT approach or how I work with related conditions like anxiety and depression.
