IN person and telehealth

OCD & ERP Therapy

intrusive thoughts • compulsions • avoidance

OCD often attaches itself to the things people care about most: morality, relationships, sexuality, harm, religion, health, identity. Some people hide symptoms because the thoughts feel shameful, irrational, or dangerous.

REACH OUT TO LEARN MORE

What OCD Actually Feels Like

Many people think OCD is about cleanliness or visible rituals. In reality, OCD is more often experienced as chronic doubt, hypervigilance, and becoming mentally stuck in loops that are difficult to let go of.

OCD Can Attach to Anything

OCD often centers around morality, relationships, sexuality, religion, identity, health, or responsibility. Intrusive thoughts are usually distressing precisely because they conflict with the person’s values. Therapy focuses on changing the relationship to fear and uncertainty so that life no longer revolves around compulsive patterns.

The Search for Certainty

OCD often creates an exhausting need to feel completely certain about thoughts, feelings, memories, intentions, or decisions. The more someone tries to eliminate doubt, the more consuming the cycle usually becomes.

Compulsions Are Not Always Visible

Compulsions can include checking, reassurance seeking, rumination, mental reviewing, emotional monitoring, avoidance, or trying to “figure out” what thoughts mean. Many people with OCD spend hours trapped in rituals that are almost entirely internal.

collaborative therapy

How ERP Works

  • Understand how OCD operates through fear, compulsions, avoidance, and the search for certainty. Treatment is collaborative and gradual, not about forcing people into overwhelming situations. Therapy may focus on reassurance seeking, mental rituals, compulsive checking, perfectionism, hyper-responsibility, and intolerance of uncertainty.

  • ERP begins by identifying the intrusive thoughts, fears, situations, or sensations that trigger anxiety and avoidance. The goal is to understand the cycle clearly rather than simply reacting to fear automatically.

  • Together, we create a step-by-step hierarchy of feared situations, starting with manageable challenges before moving toward more difficult exposures. This helps therapy feel structured, gradual, and collaborative rather than overwhelming.

  • Mindfulness skills help people notice intrusive thoughts, uncertainty, and anxiety without getting pulled into compulsions or mental rituals. The goal is not to eliminate thoughts, but to change the relationship with them.

  • Exposure exercises involve intentionally approaching feared situations while resisting compulsions, reassurance, checking, avoidance, or mental rituals. This is where new learning begins to replace fear-based habits.

  • ERP works through repetition, consistency, and gradual progression over time. As confidence grows, exposures expand into more difficult situations and daily life becomes less organized around fear and avoidance.

A Unique Approach to ERP

Many people spend enormous amounts of energy attacking themselves internally. Shame, and fear of what thoughts “mean” often become part of the disorder itself. My approach integrates Exposure and Response Prevention (ERP) with principles from Compassion Focused Therapy (CFT), originally developed for people struggling with shame and chronic self-criticism.

This does not mean reassurance or “positive thinking.” It means helping people develop the capacity to respond to fear and uncertainty without collapsing into self-hatred and panic. This approach can be especially helpful for people struggling with:

an Image of the Sky with Sparse Clouds

frequently asked questions

  • One of the most painful parts of OCD is the fear that thoughts reflect hidden desires, intentions, or moral truths about the self. In OCD, intrusive thoughts are often distressing precisely because they conflict with the person’s values, identity, or sense of safety. Therapy focuses on changing the relationship to uncertainty and compulsive meaning-making rather than trying to achieve perfect certainty about thoughts.

  • Exposure and Response Prevention (ERP) can work very effectively through telehealth. Because OCD often becomes intertwined with a person’s daily routines, home environment, relationships, devices, reassurance patterns, and avoidance behaviors, online therapy can sometimes allow treatment to happen more directly within the contexts where symptoms actually occur.

    Virtual therapy can also make specialized OCD treatment more accessible for people who may not have an ERP-trained clinician nearby. During sessions, we may work on identifying compulsive patterns, building exposure hierarchies, reducing reassurance seeking and avoidance, and practicing new ways of responding to uncertainty and intrusive thoughts in real time.

    Some people initially worry that online therapy may feel less personal or less effective than in-person treatment. Research suggests that ERP delivered through telehealth can still lead to meaningful improvement for many people struggling with OCD and anxiety disorders.

    I provide online OCD and anxiety treatment for adults located in states where I am licensed to practice.

  • No. ERP is collaborative and individualized. Therapy does not involve overwhelming people or forcing exposures before they are ready. The goal is to gradually build the ability to tolerate uncertainty, discomfort, and intrusive thoughts without relying on compulsions or avoidance.

  • I work with many forms of OCD and anxiety, including:

    • harm OCD

    • sexual intrusive thoughts

    • pOCD

    • scrupulosity

    • relationship OCD

    • contamination fears

    • health anxiety

    • perfectionism and chronic doubt

    • reassurance seeking and mental compulsions (Pure O)

  • Many people with OCD spend years hiding symptoms out of fear of being judged or misunderstood. Intrusive thoughts can involve themes that feel frightening, taboo, or morally threatening. Therapy is approached from a radically non-judgmental perspective focused on understanding the OCD cycle rather than evaluating people based on the content of thoughts.

  • The length of treatment varies depending on several factors, including symptom severity, avoidance patterns, level of insight, readiness for change, and what else is happening in a person’s life outside therapy. Prior therapy experience, consistency with treatment, and whether supportive people in the person’s environment are willing to participate in the treatment process can also influence progress.

    ERP is an active treatment that often requires practicing new responses to fear, uncertainty, and compulsive urges outside of sessions. Many people begin noticing meaningful improvements as they become less trapped in compulsive cycles and avoidance patterns.

    While every situation is different, a common timeframe for seeing significant progress is often somewhere between 3 and 6 months of consistent treatment.

3 Million adults live with ocd in the us. you are not alone.

This screening tool is designed to help identify common OCD symptom dimensions, including intrusive thoughts, compulsions, checking, contamination fears, taboo thoughts, and mental rituals.

TAKE THE QUESTIONNAIRE