OCD Therapy London
What is OCD? Understanding Obsessions, Compulsions and an Integrative Approach to Treatment
Approx. 750+ words | Keywords: OCD therapy London, ERP therapy London, ACT therapy for OCD, psychodynamic OCD therapy
Obsessive-compulsive disorder, often shortened to OCD, is frequently misunderstood. In everyday language, OCD is sometimes used to describe neatness, perfectionism or a preference for order. Clinically, however, OCD is much more distressing and complex. It involves intrusive thoughts, images, urges or doubts that feel unwanted and difficult to dismiss, alongside compulsions that are used to reduce anxiety, neutralise threat, or gain a temporary sense of certainty.
Obsessions can attach themselves to almost any theme. Some people experience contamination fears or checking concerns. Others struggle with intrusive thoughts about harm, morality, sexuality, relationships, religion, identity, health, or existential questions. The content can vary enormously, but the structure of the problem is often similar: a thought appears, it feels threatening or meaningful, anxiety rises, and the person tries to do something internally or externally to make the anxiety go away.
Compulsions are not always visible. They may involve washing, checking, repeating or reassurance-seeking, but they can also involve mental acts such as rumination, reviewing memories, checking feelings, neutralising thoughts, or trying to work out whether a thought is “true”. This is important because some people do not recognise their experience as OCD precisely because their compulsions are happening privately in the mind.
Exposure and Response Prevention, known as ERP, is widely recognised as a first-line psychological treatment for OCD. ERP involves gradually approaching feared situations, thoughts, sensations or images while resisting the usual compulsive response. The aim is not simply to “get used to” anxiety, but to learn that distress can be tolerated, uncertainty can be lived with, and compulsions are not necessary in order to be safe.
NICE guidance recommends CBT that includes ERP for OCD, either alone or in combination with medication depending on severity and individual need.
At the same time, ERP can be difficult. Some clients find exposure work frightening, shaming or too abrupt if it is not carefully paced. Research has found a weighted mean dropout rate of around 14.7% in ERP trials for OCD, which shows that many people do complete and benefit from ERP, but also that a meaningful minority disengage. When someone struggles with ERP, it can be too easy to describe them as “treatment resistant”.
That phrase may obscure something clinically important: the treatment may not yet have fully understood the person, the function of the symptom, or the relational meaning attached to letting go of compulsions.
This is where Acceptance and Commitment Therapy, or ACT, can be particularly useful. ACT does not ask the client to prove that thoughts are irrational or to remove uncertainty completely. Instead, it helps the person change their relationship to thoughts. A thought can be noticed as a thought, rather than treated as a command, warning or confession.
This is especially helpful when OCD is dominated by rumination and mental compulsions, because the struggle is often not with an external object but with the demand for absolute internal certainty.
A psychodynamic perspective can add another important layer. From this viewpoint, OCD is not only a disorder of faulty threat detection, genetics or an overactive amygdala. Those biological and cognitive elements may be relevant, but they may not tell the whole story. Symptoms can also be understood as meaningful attempts to manage conflict, shame, guilt, aggression, dependency, sexuality, loss or relational fear.
A compulsion may be destructive in the present, but it may also once have served a psychological purpose: to protect the self from feelings that seemed unbearable or unacceptable.
This does not mean abandoning ERP. Instead, psychodynamic thinking can support ERP by making the work more human. If the therapist understands what the symptom means, what it protects against, and how it functions in the client’s relationships, behavioural change may become more tolerable. For example, a client whose OCD centres on responsibility may not only fear harm; they may also carry a deeper relational position of needing to be blameless, good, or beyond reproach.
Exposure work can then be held within a richer understanding of the self, rather than treated as a technical exercise alone.
My perspective is that OCD is not simply random noise. The content may be irrational in one sense, but the intensity of the obsession often points to something emotionally significant. The aim of therapy is therefore twofold: to reduce the compulsive cycle through evidence-based approaches such as ERP and ACT, while also exploring the deeper meaning, relational patterns and emotional conflicts that may underlie the symptoms.
In this way, treatment can address both what keeps OCD going and why this particular form of suffering may have developed.
I offer OCD therapy in London Bridge and online across London, including Soho, Shoreditch and Islington. My approach integrates ERP, ACT and psychodynamic therapy, creating space for both structured behavioural change and deeper psychological understanding.
References
- International OCD Foundation (n.d.) How do I stop thinking about this? What to do when you’re stuck playing mental ping-pong. Available at: https://iocdf.org/
- NICE (2005, reviewed 2024) Obsessive-compulsive disorder and body dysmorphic disorder: treatment. Clinical guideline CG31. London: National Institute for Health and Care Excellence.
- Ong, C.W., Clyde, J.W., Bluett, E.J., Levin, M.E. and Twohig, M.P. (2016) ‘Dropout rates in exposure with response prevention for obsessive-compulsive disorder: What do the data really say?’, Journal of Anxiety Disorders, 40, pp. 8–17.