In the first few sessions, we’ll explore what brings you to therapy and complete a structured assessment to better understand your experience with OCD. This includes the Y-BOCS, a gold standard clinical interview that helps us identify the specific obsessions and compulsions you’re dealing with—because OCD can look very different from person to person.

Once we have a clear understanding of your OCD patterns, we’ll work together to create an exposure hierarchy—a step-by-step plan of situations, thoughts, or triggers that bring up anxiety. These are organized from least distressing to most challenging, so we can approach them gradually and intentionally.

This hierarchy becomes our roadmap for treatment. It ensures that we’re moving at a pace that feels manageable, while still helping you make meaningful progress. Each step is designed to build your confidence and show you that you can handle discomfort without relying on compulsions or avoidance.

In this phase, we begin actively practicing exposures based on the hierarchy we’ve created. This means gradually and intentionally facing the thoughts, situations, or sensations that trigger anxiety—starting with more manageable steps and building up over time. During exposures, the focus isn’t on getting rid of anxiety, but on learning that you can tolerate it without needing to respond in the usual ways. I’ll guide and support you through this process, helping you stay with the discomfort and notice how it changes on its own. Over time, these repeated experiences help retrain your brain, so the anxiety becomes less intense and less controlling, and you feel more confident facing what used to feel overwhelming.

ERP involves daily “homework”, so that you can practice and apply what we’re working on in real life. This homework involves completing exposures, resisting compulsions, and noticing how your anxiety changes over time.

You might practice facing a specific fear, sitting with uncertainty, or choosing not to respond to urges in the usual way. This homework is a critical part of progress, as they help your brain learn through experience—not just in session, but in your day-to-day life.

We’ll plan these together so they feel manageable and relevant, and you’ll have clear guidance on how to approach them.

As you build confidence, we’ll gradually move up your exposure hierarchy, taking on more challenging fears step by step. Each exposure builds on the last, helping you strengthen your ability to tolerate discomfort and resist compulsions.

We’ll also adjust and expand the hierarchy as needed, adding new situations or refining steps based on your progress. Repetition is key here! By practicing exposures multiple times, your brain continues to learn that anxiety is manageable and doesn’t need to be “fixed.”

Over time, what once felt overwhelming becomes more manageable, and you gain a growing sense of confidence and freedom in situations that used to feel difficult.

As you make progress, we’ll shift our focus to maintaining your gains and preparing for the future. This includes reviewing everything you’ve learned about OCD—how it shows up for you, what keeps it going, and how to respond effectively using ERP skills.

We’ll make sure you feel confident recognizing early signs of OCD and know exactly how to handle them, so you can stay on track even after therapy ends. The goal is for you to become your own best therapist—equipped with the tools, insight, and confidence to manage OCD independently.

By the end of treatment, OCD may still show up from time to time, but it won’t have the same power over you—and you’ll know exactly what to do when it does.