OCD Treatment: What to Expect
OCD can make you doubt everything — your memory, your perception, your values, and even your sense of who you are. In our work together, the goal is not simply to reduce symptoms, but to help you feel grounded, confident, and able to trust yourself again.
Many people come to therapy feeling stuck in an endless loop of “what if” questions that seem urgent and impossible to resolve. Treatment helps you step out of that loop by learning to recognize how OCD pulls you away from what you can directly see, sense, and know, and back into imagined scenarios that feel real but are not actually happening.
At its core, this work is based on the idea that your reactions make sense. Your mind is responding logically to something that feels real. There is nothing random or “crazy” about your experience.
As you begin to understand how OCD creates doubt and why certain fears become so sticky, the urgency to respond to that obsessional tug or compulsive pull starts to fade. It’s a little like realizing that the Wizard of Oz is not in fact a wizard, but rather a washed-up magician who created a very convincing illusion of his wizarding prowess. The fear loses its authority because you can see how it was created and that it ultimately has no reality-based substance.
Together, we’ll make sure you are in the driver’s seat and put the OCD-Oz-man in his place.
What Treatment Looks Like
OCD latches onto imagined possibilities:
My hands might be contaminated
I could be a dangerous person and not know it
What if I have a brain tumor?
All of these things are technically possible. But in everyday life, we automatically filter out thousands of irrelevant possibilities because there is no evidence for them. You already have this ability — you use it all day long without noticing.
In OCD, those imagined possibilities start to feel real, urgent, and meaningful. It can feel irresponsible to ignore them, and so you search endlessly for resolution that always seems just out of reach.
In our work together, we slow this process down and look at:
how these doubts formed
what makes them feel real
why they’ve become so sticky
how to return to what you can directly see, sense, and know
As this shift happens, you’ll learn to step out of the “what if” stories and return to what you can directly see, sense, and know. Over time, this restores your ability to trust yourself — your memory, your perception, your values, and your sense of who you are.
Modalities I Use
I am trained in both Exposure and Response Prevention (ERP) and Inference-Based Cognitive Behavioral Therapy (I-CBT), two evidence-based treatments for OCD, and I utilize both in my work with clients. In recent years, my practice has shifted more toward I-CBT because I’ve found that many clients experience it as more intuitive, validating, and accessible — particularly if the idea of intentional exposures has felt like a barrier to starting therapy. It also more directly addresses the underlying processes that drive OCD, often leading clients to a deeper understanding of their OCD and a more lasting sense of confidence in themselves.
ERP is considered the gold standard for OCD treatment and is highly effective. I-CBT offers a different entry point, and research shows that the two approaches lead to comparable treatment outcomes (Aardema et al., 2022). In practice, I’ve found that each can be particularly helpful for different OCD themes and for different people at different stages of treatment. We’ll work collaboratively to tailor our approach in a way that helps you move forward with clarity and confidence.
How ERP and I-CBT Differ In Practice
Below are a few examples of how I-CBT and ERP would approach some common OCD themes:
You have intrusive, violent images or thoughts about bad things happening – getting in your car or even going out for a walk can feel incredibly high stakes when your brain offers a stream of images of harm coming to you or those you love.
I-CBT looks for real-world evidence that something is wrong. In the absence of that evidence, the images that you’re experiencing are understood to be imagined scenarios rather than real threats. All is well, until or unless proven otherwise, and the focus shifts instead to returning your attention to the present moment and lived reality.
With ERP, treatment might involve intentionally bringing up the feared scenario. For example, you might write a script of the worst-case scenario and read it over and over again until it’s no longer as disturbing to have those thoughts or images pop up in your head.
You worry that you may have hurt someone without realizing it. The doubt is intense and convincing, and you feel compelled to check or retrace your steps.
With ERP, you would resist checking or seeking reassurance while allowing the uncertainty about what did or didn’t happen to be present. You might practice responding with “maybe I did stab someone; maybe I didn’t.”
With I-CBT, we would step back and examine how this doubt formed; where did an imagined possibility gain credibility as a perceived threat? We would notice that there is no concrete evidence that anything unusual occurred, and thus there’s nothing to solve. We’d go deeper and consider what makes the possibility of you hurting someone feel so terrifying – what does it say about you that this is something that you deeply fear?
You notice an unusual sensation in your body and immediately worry that it could be something serious. Even after medical reassurance, the doubt returns: What if they missed something? What if this is the beginning of something catastrophic?
With ERP, you would practice refraining from reassurance seeking, researching online, or checking your symptoms, while allowing uncertainty about your health to exist.
With I-CBT, we would trace how your mind moved from perceiving a neutral sensation to a catastrophic conclusion without evidence. We would examine what is actually known versus what is imagined, helping you recognize when OCD takes you out of reality and into a “what if” scenario. The work is in disengaging from the story, and the need to perform compulsions fades when the story loses its pull.