Frequently Asked Questions About OCD Therapy
How does ERP actually work? Will I have to do the things I’m afraid of?
ERP involves gradually facing feared situations in a controlled, supportive way, but we always go at your pace. If you fear contamination, we might start by touching something mildly “dirty” together in session before working up to bigger challenges. If you have intrusive thoughts about harm, we might use imaginal exposure (writing scripts or visualizing scenarios) rather than physical actions. You’re always in control, and we customize every exercise to your specific fears and comfort level.
My compulsions are mostly mental (counting, praying, or repeating phrases in my head). Can you still help?
Absolutely. You may have heard the term “Pure O” (purely obsessional OCD) to describe OCD where compulsions aren’t visible. While this term has become popular online and in mental health discussions, research shows it’s actually a misconception. Clinical studies confirm that all forms of OCD include both obsessions and compulsions—the compulsions in “Pure O” are simply mental or covert rather than observable behaviors like handwashing or checking locks. As noted in research published in Expert Review of Neurotherapeutics and Psychology Today, what appears to be purely obsessional OCD actually involves hidden compulsions such as mental review, reassurance-seeking, checking your thoughts or feelings, thought neutralization, or avoidance of triggering situations.
Many people don’t realize they have these mental compulsions because they’re not visible to others. Our therapists are highly experienced in identifying and treating these hidden mental rituals, including those involving aggressive, sexual, or religious intrusive thoughts that patients often feel ashamed to discuss. ERP works by helping you resist these mental compulsions just as we would physical ones. The fact that your compulsions are hidden doesn’t make them any less real or any less treatable.
Will I have to tell you about all my intrusive thoughts, even the really disturbing ones?
Understanding your specific obsessions helps us create an effective treatment plan, but we go at your pace. Many clients find it’s actually a relief to finally talk about thoughts they’ve been hiding, especially when they realize their therapist has heard similar thoughts from many other OCD clients and won’t judge them. What feels shocking or shameful to you is familiar territory for us, and sharing these thoughts is an important part of breaking OCD’s power over you.
How long does OCD therapy typically take?
Most clients see significant improvement within 12 to 20 sessions using ERP. However, OCD that’s been present for many years or involves multiple subtypes may take longer. Research on outcomes from over 3,500 OCD patients treated with video teletherapy using ERP found that treatment improvements were relatively similar for those with mild, moderate, and severe OCD symptoms, with the average treatment lasting about 11 weeks. This study, published in the Journal of Medical Internet Research, demonstrated that severity matters less than you might think; even severe OCD can respond well to evidence-based treatment.
Some clients achieve their goals in a few focused months, while others benefit from ongoing support as they tackle different aspects of their OCD. The important takeaway is that effective treatment is possible regardless of how long you’ve been struggling or how severe your symptoms feel right now.
Can OCD really go away, or will I always struggle with it?
With effective ERP therapy, many people experience substantial or complete remission of symptoms. The goal isn’t to eliminate every intrusive thought (everyone has them), but to change your relationship with these thoughts so they no longer control your life. You’ll develop lifelong skills, and if symptoms return during stressful times, you’ll know how to manage them. In fact, research published in the International Journal of Neuropsychopharmacology found that a significant proportion of people with OCD achieve long-term recovery, not just short-term relief, showing that recovery is a realistic and attainable outcome for many.
What if I’ve had OCD for years or my symptoms are really severe?
Length of time with OCD does not prevent recovery. Clinical research published in Depression and Anxiety followed adults with OCD for 10–20 years and found that the duration of illness was not linked to long-term outcome—meaning even people who had struggled for decades could still improve or recover. Similarly, work in the International Journal of Neuropsychopharmacology emphasizes that the prognosis for OCD is often more hopeful than many believe, with a substantial number of people reaching remission over time. And while severe symptoms can feel overwhelming, they don’t mean recovery is out of reach. In fact, many people with severe OCD are especially motivated to change, which can actually work in their favor. We’ll meet you where you are and help you build momentum step by step.
I tried therapy before and it didn’t work. How is this different?
If your previous therapy focused mainly on talking about your OCD or trying to “think differently” without doing exposure work, that may be why it didn’t help. ERP is fundamentally different: it’s action-based and directly targets the cycle of obsessions and compulsions. Many of our clients found relief with ERP after years of other therapies that didn’t address OCD specifically.
Which of your therapists have the most experience with OCD, and how do I find the right fit?
Ten of our therapists specialize in OCD treatment, each bringing different strengths and areas of focus. When you call for your complimentary consultation, we’ll ask about your specific OCD symptoms and what you’re looking for in a therapist. We can then match you with someone whose expertise aligns with your needs, whether that’s someone who specializes in a particular OCD subtype, someone who speaks Spanish or Polish, or someone with a specific therapeutic style. Our goal is to connect you with the right therapist from the start so you feel comfortable and confident in your treatment.
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