Obsessive Compulsive Disorder (OCD)

What this might look like

OCD can look very different from person to person. It isn't always about cleanliness, germs, or having things arranged in a particular way.

You might recognise some of these experiences:

• Unwanted thoughts, images or urges that keep coming back
• Worrying about what an intrusive thought might mean about you
• Repeatedly checking things, even when you know you've already checked
• Needing things to feel "just right"
• Repeating actions, words or routines until they feel safe or complete
• Mentally reviewing conversations or events to make sure you haven't done something wrong
• Frequently seeking reassurance from other people
• Avoiding situations, people or objects that trigger uncomfortable thoughts
• Feeling responsible for preventing something bad from happening
• Spending a lot of time trying to achieve certainty about something you can't ever feel completely sure about

OCD can be exhausting. You may even recognise that your fears or rituals don't entirely make sense, while still feeling unable to stop responding to them.

How Louise works with this

Louise uses Cognitive Behavioural Therapy (CBT), including Exposure and Response Prevention (ERP), when working with OCD. ERP is an established psychological treatment for OCD.

OCD often becomes caught in a cycle. An intrusive thought, feeling or situation creates anxiety or uncertainty, and you do something to make that discomfort go away — perhaps checking, avoiding, seeking reassurance, performing a ritual, or trying to work the problem out in your head.

That response might bring some relief in the short term. Unfortunately, it can also strengthen the cycle and make it harder to tolerate the same uncertainty the next time it appears.

Therapy involves understanding your particular OCD cycle and gradually learning a different way of responding.

With ERP, you work collaboratively and progressively towards facing situations, thoughts or feelings that OCD has taught you to fear, while reducing the compulsions or safety behaviours you would normally use to feel better.

This isn't about suddenly confronting your biggest fear or being forced to do something you're not ready for. The work is planned together and approached gradually.

Over time, the aim is to help you become more able to experience uncertainty and uncomfortable thoughts without needing to perform a compulsion to make them go away.

What if my OCD is mostly in my head?

Not all compulsions are easy to see.

Some people experience what are sometimes described as mental compulsions. You might spend significant amounts of time:

• Reviewing memories to check what really happened
• Analysing whether a thought means something about you
• Mentally repeating words or phrases
• Trying to replace a "bad" thought with a "good" one
• Checking how you feel about something
• Trying to prove to yourself that something isn't true
• Repeatedly asking yourself, "But what if...?"

Because these behaviours happen internally, it can sometimes be difficult to recognise them as part of OCD.

Treatment can involve learning to notice these less-visible compulsions and gradually reducing the need to engage with them. ERP protocols address mental rituals and neutralising strategies directly, not just visible, physical compulsions.

But what if my intrusive thoughts are horrible?

Intrusive thoughts can involve subjects that feel frightening, shameful or completely at odds with who you believe yourself to be.

Sometimes this makes people afraid to tell anyone what they're thinking.

You may worry that your psychologist will be shocked, judge you, or believe that having the thought means you secretly want it to happen.

You don't need to arrive at therapy ready to disclose everything at once.

We can take time to understand what's happening and talk about difficult experiences at a pace that feels manageable.

Is my OCD serious enough for therapy?

You don't need to wait until OCD has completely taken over your life before seeking support.

Some people spend hours each day performing rituals. For others, OCD is much less visible — they may continue working, parenting, studying and socialising while experiencing significant distress internally.

If intrusive thoughts, checking, reassurance seeking, rituals or avoidance are causing distress, taking up significant mental space, or getting in the way of the life you want to live, it may be worth seeking support.

You also don't need to be certain that what you're experiencing is OCD before making an appointment. Assessment can be part of the process.

Medicare rebates

If you have a Mental Health Care Plan from your GP, you may be eligible for Medicare rebates on psychology sessions. Louise accepts clients with a Mental Health Care Plan and can work with you on a schedule that suits your situation.

Sessions are available in-person in Alderley, Brisbane, or via telehealth across Australia.

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