How I see this presentation
OCD is a presentation I see consistently in practice, and one where the specific training of the therapist makes a material difference to outcomes. Exposure and response prevention (ERP) is the evidence-based treatment; not all therapists offering CBT are trained in it. What I see in the consulting room is unwanted intrusive thoughts, images, or urges across a wide range of content: contamination, checking, harm, symmetry, taboo material. The shared mechanism is the way rituals reinforce the original distress over time. Most people have been managing it privately for years, often with a significant sense of shame, before naming it in a clinical setting.
How I tend to work with it
The evidence-based lead for OCD is Cognitive Behavioural Therapy with exposure and response prevention (ERP). The early work is formulation: mapping how the obsessions and compulsions are maintaining each other for you. The exposure work is then introduced collaboratively and paced carefully, with hierarchies agreed in advance and reviewed as we go. Where intrusive thoughts carry particular weight, cognitive work on the meaning of the thoughts sits alongside the behavioural work. CBT with ERP is the NICE-recommended treatment for OCD, and for most presentations it is the approach that produces lasting change. ERP is uncomfortable by design; that is not a warning, it is the mechanism. The structure, agreed hierarchies, and reviewed pace are what make it clinically manageable.
What a course might look like
Sessions are 50 minutes, typically weekly. ERP work tends to settle into a steady rhythm once the early formulation is in place, and progress is reviewed every four to six sessions. A course of CBT with ERP for a defined OCD presentation often falls between twelve and twenty sessions, though this is not a fixed rule. The framework varies per person and is agreed openly.
Next step
If what you have read here fits what you are experiencing, getting in touch is straightforward. Henry responds to all enquiries personally, typically within one working day. An initial call carries no commitment.
If you have been researching for a while and want to ask a question before booking, a brief enquiry is the right place to start.