OCD is one of the main areas of my clinical work. Most of the people I see with OCD have lived with it for years before getting in touch. Often they have already tried therapy that didn't quite address it. Many function well at work while spending hours a day on checking, analysing, seeking reassurance or mentally reviewing, sometimes in ways nobody around them has noticed.

The treatment with the strongest evidence for OCD is Cognitive Behavioural Therapy that includes exposure and response prevention (ERP). That is the approach I use, adapted to the person and to the way their OCD actually operates.

What OCD actually looks like

OCD has two parts. Obsessions are unwanted thoughts, images, urges or doubts that feel alarming and hard to dismiss. Compulsions are anything done to reduce the anxiety, prevent a feared outcome, or get a sense of certainty that things are alright.

Some compulsions are visible: washing, checking locks and appliances, arranging, asking the same question again. Many are not. These are some of the most common things I see:

Each of these brings short-term relief. Each one also teaches the brain that the thought was dangerous and needed dealing with. That is the loop that keeps OCD going, and it is what treatment targets. Reassurance seeking deserves particular attention, because it is so common and so easily mistaken for something helpful: see Why reassurance keeps OCD going.

Common forms of OCD I work with

The content of OCD varies enormously, and people often worry that their particular version is unusual or too shameful to describe. In practice, the themes tend to fall into recognisable patterns:

It helps to know that these are not separate conditions needing separate treatments. The theme differs, but the mechanism underneath is the same: an intrusive thought gets treated as meaningful and threatening, and the person responds with something that brings temporary relief and longer-term entrenchment. ERP works on that mechanism. What changes from person to person is how the work is designed, not the underlying principles.

Having an intrusive thought about harm, sex, children or blasphemy does not mean you want it, or that you are at risk of acting on it. In OCD, the thoughts that stick are usually the ones that go most against a person's values. That is why they are so distressing.

How CBT with ERP works

ERP involves gradually and deliberately approaching the thoughts, situations and uncertainty that OCD tells you to avoid, while not performing the compulsions that would normally follow. Over time, this allows the brain to learn something it can't learn while the compulsions are still running: that the anxiety passes on its own, and that you can carry doubt without having to resolve it.

Treatment begins with a detailed assessment and formulation: understanding the particular obsessions, compulsions, avoidance and beliefs that keep the cycle going for you.

From there, therapy focuses on changing the patterns that maintain OCD. This may include ERP, work on beliefs around responsibility and certainty, and addressing less obvious compulsions such as mental reviewing and reassurance seeking.

The work is collaborative and tailored to the way your OCD actually operates. What matters is not simply knowing what ERP is, but understanding which patterns need to change and how to approach them safely and effectively.

For a fuller account of what sessions involve, see How ERP therapy for OCD works.

What ERP is not

People are sometimes put off by what they have heard about exposure therapy, so it's worth being clear. ERP is not about being forced into your worst fear, and it is not about proving that your thoughts are false or getting a guarantee that nothing bad will happen. Seeking that guarantee is usually part of the problem. Good ERP is planned together, graded, and explained at every step. It asks a lot of you, but it shouldn't feel like something being done to you.

It is also different from general talking therapy. Spending sessions analysing the content of obsessions, or reassuring someone that they are a good person, can feel helpful in the moment but tends to feed the cycle. Part of my job is to notice when therapy itself is becoming a compulsion.

How long does treatment take?

This depends on how severe the OCD is, how long it has been present, how many areas of life it affects and how much practice is possible between sessions. Sessions are 50 minutes and usually weekly. We review progress together at regular points, so you always have a clear sense of where things stand rather than committing to an open-ended course.

Online or in person

Most of my sessions are online, by secure video, across the UK, and ERP works well online. I also see people in person on Thursdays at Re-Mind The Body Therapy Centre, 260a Kilburn Lane, London W10 4BA, about five minutes' walk from Queen's Park station. For some forms of OCD, such as contamination fears or checking at home, working by video can actually be an advantage, because exposures can take place where the OCD happens.

Questions people often ask

Will you be shocked by my thoughts?

No. Thoughts about harm, sex, children, sexuality, religion or relationships are common in OCD, and I hear them regularly. Many people tell me they have never said their thoughts out loud before. Being able to describe them to someone who recognises exactly what they are is often the first real relief.

Do I need a diagnosis before getting in touch?

No. Many people aren't sure whether what they are experiencing is OCD. The assessment will clarify that, and if I think something else is going on, I'll tell you.

What about medication?

I don't prescribe. Some people find medication helpful alongside CBT, and some come to therapy already taking it. If you are considering it, that is a conversation to have with your GP or psychiatrist, and CBT with ERP can be combined with it.

Is this the right service for you?

I work with adults (18 and over) on a private, self-pay basis. CBT with ERP in weekly outpatient sessions suits most people with OCD. If, at assessment, I think you would be better served by a different level of care or a different approach, I will tell you and explain why.

If you are a GP, psychiatrist or another clinician considering a referral, the information for referrers sets out what I offer and how to get in touch.

Further reading on OCD