Breaking free from the OCD cycle with ERP therapy
ERP therapy is a specialized, evidence-based approach that I use to help people break free from the exhausting cycle of obsessive-compulsive disorder. If you've spent years trapped in repetitive thoughts and rituals that consume your time and energy, you're not alone—and more importantly, there's a path forward that doesn't require you to white-knuckle your way through every anxious moment. As a therapist in Philadelphia who specializes in working with LGBTQ+ individuals and those navigating complex identities alongside mental health challenges, I've witnessed the profound transformation that happens when someone finally learns to respond differently to their OCD.
ERP therapy stands for Exposure and Response Prevention, and it represents a fundamentally different way of relating to the intrusive thoughts and compulsive behaviors that characterize OCD. Rather than fighting against your mind or trying to suppress unwanted thoughts, ERP teaches you to gradually face your fears while learning to resist the compulsive behaviors that have kept you stuck. This approach isn't about eliminating anxiety entirely—it's about building a new relationship with discomfort so that OCD no longer controls your daily life.
Understanding the OCD Cycle
Before diving deeper into how ERP works, it helps to understand the cycle that keeps OCD going. OCD operates on a feedback loop that can feel impossible to escape. It typically begins with an intrusive thought, image, or urge that triggers intense anxiety or distress. These obsessions can take countless forms—fears about contamination, worries about harm coming to loved ones, doubts about whether you locked the door or turned off the stove, concerns about your identity or relationships, or disturbing thoughts that feel completely contrary to who you are as a person.
When these obsessions arise, the anxiety they generate feels unbearable. Your brain desperately searches for relief, and that's where compulsions enter the picture. Compulsions are the behaviors or mental rituals you perform to neutralize the anxiety. You might wash your hands repeatedly, check things over and over, seek reassurance from others, mentally review situations to make sure nothing bad happened, or avoid certain places, people, or activities that trigger your obsessions.
Here's the cruel irony of OCD: the compulsions that seem to help in the moment actually make everything worse in the long run. Each time you perform a compulsion and experience temporary relief, you teach your brain that the obsession was a legitimate threat that required a response. This strengthens the OCD cycle and makes it more likely that similar obsessions will trigger even more intense anxiety next time. Over time, the compulsions tend to expand and escalate, demanding more and more of your time and energy while providing less and less relief.
How ERP Therapy Interrupts This Cycle
The genius of ERP lies in its direct approach to breaking this self-reinforcing cycle. Instead of continuing to feed the OCD through avoidance and compulsions, ERP systematically teaches your brain a new response. The process involves intentionally exposing yourself to the thoughts, situations, or objects that trigger your obsessions while simultaneously resisting the urge to perform compulsions.
When I work with someone using ERP, we don't just dive into their biggest fears on day one. The approach is gradual, collaborative, and carefully paced to build confidence and mastery. Together, we create what's called a fear hierarchy—a ranked list of situations that trigger OCD symptoms, from mildly uncomfortable to intensely distressing. We start with exposures that feel challenging but manageable, and we only move up the hierarchy as you build skills and confidence.
During exposures, something remarkable happens. When you face a feared situation without performing your usual compulsions, your anxiety will initially rise. This is expected and completely normal. However, if you stay in the situation long enough without ritualizing, your brain eventually learns that the feared outcome doesn't occur, and your anxiety naturally decreases through a process called habituation. Over time, with repeated practice, the situations that once triggered overwhelming anxiety begin to lose their power.
What Makes My Approach to ERP Different
While ERP follows certain evidence-based principles, the way I practice it is anything but cookie-cutter. I believe that effective therapy must honor the whole person, including their identity, their values, and their unique life circumstances. This is especially important when working with LGBTQ+ individuals, whose experiences with OCD may intersect with their identity in complex ways.
For queer and trans folks, OCD can sometimes latch onto aspects of identity, sexuality, or gender. I've worked with people whose OCD generated intrusive doubts about their sexual orientation, their gender identity, or the authenticity of their relationships. Traditional OCD treatment that doesn't understand the nuances of LGBTQ+ experience can inadvertently cause harm by failing to distinguish between genuine identity exploration and OCD-driven doubt.
My approach integrates ERP with other therapeutic modalities I offer, including Internal Family Systems (IFS) and psychodynamic perspectives. This integration allows us to address not just the behavioral patterns of OCD, but also the underlying emotional experiences and the various parts of you that may be involved in the OCD cycle. Some people find that combining ERP with IFS helps them develop more self-compassion during the challenging work of facing their fears.
I also bring an art therapy background to my practice, which can be valuable for people who process experiences more effectively through creative expression than through talk alone. Whether we incorporate visual art, creative writing, or other expressive modalities depends entirely on what resonates with you and supports your healing.
What to Expect When Starting ERP with Me
The journey begins with a free 20-minute phone consultation where we can discuss what's bringing you to therapy and determine whether we might be a good fit for working together. This conversation gives you a chance to ask questions and get a sense of my approach before committing to anything.
If we decide to move forward, our first session focuses on getting to know you and your specific experience with OCD. I'll ask about what symptoms you're experiencing, how OCD is affecting your daily life, what has motivated you to seek help now, and what your hopes are for recovery. I'll also explain more about how ERP works and what you can expect from our work together. These initial sessions are truly about feeling things out and making sure our therapeutic relationship feels right for you.
Once we've established a foundation, we begin the active work of ERP. This involves building your fear hierarchy, learning about the OCD cycle and how it operates in your specific case, and beginning gradual exposures. I meet with clients weekly for one-hour sessions, though some people benefit from longer sessions or meeting more frequently, especially during intensive phases of ERP work.
Between sessions, there is homework. This is a crucial part of ERP—the real change happens through the practice you do in your daily life. Homework typically involves monitoring your obsessive thoughts and compulsive behaviors, noticing patterns, and practicing exposure exercises while resisting compulsions. I'll send you specific assignments and sometimes journal prompts to support your progress. The homework isn't busy work; it's where the transformation takes root.
The Courage Required for ERP
I want to be honest with you: ERP is challenging work. It requires you to deliberately face the things that frighten you most and to sit with discomfort rather than seeking immediate relief. This goes against every instinct that OCD has trained into you. Many people initially wonder if they can really do this, if they're strong enough, if the anxiety will be too overwhelming.
What I can tell you from my experience is that the people who engage in ERP consistently surprise themselves with their own courage and capacity. The anxiety you fear is temporary and manageable, even when it doesn't feel that way in the moment. And on the other side of that discomfort lies freedom—the freedom to live your life according to your values rather than according to OCD's demands.
ERP is also deeply empowering because it puts you in the driver's seat of your own recovery. Rather than depending on external reassurance or avoidance strategies, you develop internal resources and confidence in your ability to handle whatever thoughts or feelings arise. Many people describe completing ERP as one of the most challenging and rewarding experiences of their lives.
OCD in the LGBTQ+ Community
OCD doesn't discriminate—it affects people across all identities and backgrounds. However, LGBTQ+ individuals may face unique challenges when it comes to OCD and its treatment. Beyond the specific ways OCD might target aspects of identity, there's also the reality that many therapy spaces haven't felt safe or affirming for queer and trans people.
Finding a therapist who truly understands your experience matters. You shouldn't have to educate your therapist about basic aspects of LGBTQ+ life or worry that they might pathologize your identity rather than your OCD symptoms. When you work with me, you can trust that I understand the difference between genuine identity exploration and the doubt and distress that OCD generates. I'm deeply committed to providing affirming care that honors who you are while helping you break free from OCD's grip.
As a queer person with a trans partner, I have personal insight into the LGBTQ+ community that goes beyond professional training. This lived experience shapes my practice and my understanding of the complex ways that identity, mental health, and life circumstances intersect.
Life After ERP
One of the most beautiful aspects of ERP is witnessing what becomes possible when OCD loosens its hold. People reclaim hours of their day that were previously consumed by rituals. Relationships improve as the need for reassurance decreases. Career and creative pursuits flourish without the constant interference of intrusive thoughts. The world expands as previously avoided situations become accessible again.
Recovery from OCD isn't about never having another intrusive thought—that's not realistic or even desirable. Rather, recovery means that when intrusive thoughts arise, they no longer derail you. You recognize them for what they are, allow them to pass without engaging in compulsions, and continue living your life. The thoughts may still show up, but they no longer have power over you.
Many people also find that the skills they develop through ERP extend far beyond OCD. Learning to tolerate uncertainty, sit with discomfort, and act according to your values rather than your fears proves valuable in countless life situations. ERP doesn't just help with OCD—it builds psychological resilience that serves you throughout your life.
Taking the First Step
If you're reading this and recognizing your own experience with OCD, I want you to know that reaching out for help is itself an act of courage. OCD thrives on secrecy and shame, often convincing people that their thoughts are too disturbing to share with anyone. Breaking that silence by contacting a therapist is already a step toward freedom.
I offer specialized ERP therapy for OCD at my Philadelphia practice, with options for both in-person and online sessions. Whether you're in Philadelphia or elsewhere in Pennsylvania, I'd welcome the opportunity to discuss how I might support you in your recovery journey.
Recovery is possible. The cycle can be broken. And you don't have to do it alone.
To schedule a free 20-minute consultation and learn more about working together, please reach out through my website. I look forward to connecting with you.
Frequently Asked Questions About ERP Therapy
How long does ERP therapy typically take to see results?
The timeline for ERP varies depending on the severity of your OCD, how consistently you practice between sessions, and other individual factors. Many people begin noticing changes within the first few weeks of active exposure work, though substantial improvement typically occurs over three to six months of consistent treatment. Some people continue therapy longer to address additional concerns or to solidify their gains, while others feel ready to transition to maintenance work relatively quickly. I work with each person to determine the right pace and duration for their unique situation.
Will ERP make my anxiety worse before it gets better?
During individual exposures, you will experience temporary increases in anxiety—that's actually part of how ERP works. By staying in the anxious situation without performing compulsions, you teach your brain that the anxiety will naturally decrease on its own. However, this doesn't mean your overall quality of life gets worse during treatment. Most people find that even as they're doing challenging exposure work, they're also experiencing relief from the constant burden of compulsions. The temporary discomfort during exposures is in service of lasting freedom.
What if my intrusive thoughts are too disturbing to share with a therapist?
This concern is incredibly common among people with OCD, and it's one of the reasons many people delay seeking treatment. OCD often generates thoughts that feel shameful, disturbing, or completely contrary to your values and identity. I want to assure you that there is nothing you could share that would shock me or change how I view you. OCD thoughts are not reflections of your character or desires—they're symptoms of a treatable condition. Creating a safe space where you can speak openly about your experience, without judgment, is fundamental to my practice.
Can ERP therapy be combined with other therapeutic approaches?
Absolutely. In my practice, I often integrate ERP with other modalities including Internal Family Systems (IFS), psychodynamic therapy, and art therapy. This integrated approach allows us to address not only the behavioral patterns of OCD but also the emotional experiences and internal parts involved in the cycle. Some people find that IFS helps them develop self-compassion that supports ERP work, while others benefit from creative expression as part of their healing process. The combination depends entirely on what serves you best.
Is ERP effective for all types of OCD?
ERP has been shown to be effective across all subtypes of OCD, including contamination fears, harm obsessions, relationship OCD, sexual orientation or gender identity OCD, religious or moral scrupulosity, perfectionism, and checking compulsions. The specific exposures are tailored to your particular symptoms, but the underlying principles remain the same regardless of what your OCD latches onto. During our work together, we'll design exposures that directly address your specific obsessions and compulsions.
What's the difference between ERP and regular talk therapy for OCD?
Traditional talk therapy that focuses primarily on exploring the meaning of thoughts or processing past experiences typically isn't effective for OCD and can sometimes make symptoms worse. ERP is a specialized, behavioral approach specifically designed to treat OCD by changing your response to obsessive thoughts. Rather than analyzing why you have certain thoughts or trying to reason them away, ERP helps you build tolerance for the thoughts while eliminating the compulsive behaviors that maintain the cycle. This behavioral change is what creates lasting improvement.
How is online ERP therapy different from in-person sessions?
Online ERP therapy is highly effective and follows the same principles as in-person work. Many exposures can be conducted just as well through video sessions, and having sessions in your own environment can sometimes be advantageous for practicing real-life exposures. Some exposures might require creativity in an online format, and we work together to design practices that fit your situation. I offer both in-person sessions in Philadelphia and online sessions throughout Pennsylvania, and we can discuss which option might work best for you.
What happens if I can't resist doing a compulsion during an exposure?
Learning to resist compulsions is a skill that develops over time—it's not something most people can do perfectly from the start. If you engage in a compulsion during an exposure, it's not a failure; it's information about where you are in the process. We might adjust the difficulty of the exposure, develop additional strategies for managing the urge, or simply acknowledge that building this capacity takes practice. The goal is progress, not perfection, and setbacks are a normal part of the recovery journey.
Can ERP help with OCD that focuses on my identity or relationships?
Yes, ERP is effective for OCD that targets aspects of identity, including sexual orientation, gender identity, and relationship concerns. These subtypes of OCD can be particularly distressing because they create doubt about things that feel core to who you are. As an LGBTQ+ affirming therapist, I'm skilled at distinguishing between genuine identity exploration and OCD-driven doubt. We work together to address the OCD symptoms while honoring and supporting your authentic self, whatever that looks like for you.
How do I know if I have OCD versus just being an anxious person?
While anxiety and OCD share some features, OCD is characterized by the specific cycle of intrusive, unwanted obsessive thoughts followed by compulsive behaviors or mental rituals performed to reduce the distress. If you spend significant time each day dealing with repetitive thoughts you can't shake and feel compelled to do certain things to feel okay, OCD may be present. During our initial sessions, I conduct a thorough assessment to understand your symptoms and determine the most appropriate treatment approach. If you're unsure whether OCD is the right fit, I encourage you to schedule a consultation so we can explore your experience together.