What OCD actually looks like (often, not what people expect)

A lot of the people I see with OCD do not know that is what it is. The common picture — handwashing, light switches — is real but narrow. The pattern underneath shows up in many forms:

  • Intrusive thoughts about harm, sexuality, religion, contamination, or “what if I…”
  • Mental rituals — silently arguing with the thought, neutralising, replacing.
  • Reassurance-seeking — needing someone to confirm, again and again, that it is not what you feared.
  • Checking — physical, mental, online research, scanning conversations afterwards.
  • Avoidance — places, people, content, that might trigger the thought.

The thoughts vary; the cycle is consistent. The cycle is what CBT works on.

How we would work

Most evidence-based CBT for OCD includes a form of Exposure and Response Prevention (ERP) — the careful, gradual practice of being with the trigger without doing the compulsion. We build it together, slowly, in collaboration. ERP is uncomfortable but well-tolerated when done properly, and it is the part of the work that most reliably ends the cycle.

We start with a free 15-minute call, then one to two sessions to map your specific version of the loop. From there the work is skill-by-skill:

  • Cognitive work. Understanding how the OCD mechanism actually operates, and why fighting the thought makes it stronger.
  • Behavioural experiments. Testing the predictions OCD is making, in small, manageable steps.
  • Response prevention. Reducing the compulsions one by one, starting with the easiest. The cycle weakens once it stops being fed.
  • A different relationship with intrusive thoughts. Not stopping them — everyone has them — but stopping the response that makes them stick.

Most people work with me for between twelve and twenty sessions for OCD. The work continues into your week between sessions, and that homework is usually where the change actually lands.

Why online works well for OCD

For OCD specifically, online sessions have an advantage many people do not expect: we work where your OCD lives. Exposure and response-prevention work can be set up around your real-world triggers, in your real-world environment, with practical homework that bridges the gap between session and life. The transitions that often make in-person therapy feel separated from the rest of the week — the journey home, the change of context — are gone. You finish a session and the work is right there in your own space, where it needs to be done.

Fees and the next step

Free 15-minute consultation. Single sessions £80 (50 minutes). Block of five sessions £350. Sessions are over secure video. Full fees and booking information.