Structured ERP for Adults with OCD
Obsessive-Compulsive Disorder is one of the most treatable conditions in adult mental health, when it gets the right treatment. Exposure and Response Prevention (ERP) is the first-line psychological treatment and has the strongest evidence base for OCD across every symptom cluster. Most people who complete ERP experience substantial and durable improvement.
Our clinicians deliver ERP as it was designed: structured, protocol-based, and adapted to the specific symptom clusters and mental compulsions the client presents with.
Common Presentations We Work With
- Contamination and cleaning: fears of germs, illness, or contamination with washing, avoidance, or elaborate decontamination rituals.
- Checking: intrusive doubts followed by repeated checking, reviewing, or reassurance-seeking.
- Symmetry, ordering, "just-right": driving arranging, counting, or repeating actions until they feel correct.
- Taboo or intrusive thoughts: unwanted aggressive, sexual, or religious content paired with mental rituals to neutralize.
- Health / somatic OCD: intrusive fears of illness with body-checking and reassurance-seeking.
- Relationship OCD (ROCD): intrusive doubts about a relationship or partner with compulsive analyzing.
- Mental-compulsion presentations ("Pure O"): mostly internal rituals, rumination, mental reviewing, silent praying.
Our Approach
ERP is a structured protocol, typically 12 to 20 weekly sessions. Treatment starts with a detailed map of your specific obsessions, feared outcomes, and compulsions (including mental ones, which are often missed). From there we build an exposure hierarchy and work through it collaboratively.
Modern ERP integrates inhibitory learning principles, rather than "waiting for the anxiety to come down," the goal is to build new learning that the feared outcome does not follow and that you can tolerate uncertainty. This has improved treatment durability and reduced dropout.
For clients with taboo intrusive thoughts, we work with imaginal exposure and cognitive strategies that block mental ritualizing. For clients whose OCD has been present for a long time, we also address the shame, depression, and identity effects that come with years of hidden symptoms.
If you are already working with a psychiatrist on medication (SSRIs are the first-line pharmacotherapy for OCD), we coordinate with your prescriber.
Who This Is For
This program is appropriate for:
- Adults with diagnosed OCD or a strong suspicion of OCD who have not yet had ERP
- Clients whose prior therapy did not include ERP, or included it in a way that missed mental compulsions or reassurance-seeking
- Clients on SSRIs looking for the psychotherapy component of a combined treatment plan
- Clients navigating OCD alongside depression, generalized anxiety, or other conditions
Getting Started
An initial consultation will include a review of your symptom history, prior treatments, and current functioning. From there, your clinician will map the specific presentation and outline what an ERP plan would look like for you.
This page describes our general approach. Treatment is individualized. For severe or treatment-resistant OCD, we can discuss specialist referral options.