Why I Find Providing OCD Treatment to Be Meaningful

Written By Jess Coleman, Ph.D.

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I'm a licensed psychologist providing ERP (Exposure and Response Prevention) therapy for OCD to adults through telehealth in North Carolina, California, and 40+ PSYPACT states — and I want to share why I find treating Obsessive Compulsive Disorder (OCD) to be some of the most meaningful work I do. If you are living with OCD, or wondering whether what you are experiencing might be OCD, I hope this offers a window into what treatment can look like and why I genuinely look forward to this work.

OCD targets what people care about most

One of the first things I share with new clients is something they often already sense but have never heard said out loud: OCD tends to attach itself to whatever matters to a person. A devoted new parent experiences intrusive thoughts about harm coming to their baby. A person who deeply values honesty becomes consumed by doubt about whether they have lied. Someone who cherishes their relationship is flooded with unwanted thoughts questioning it. A person who wants to live ethically is tormented by fears that they are secretly a bad person.

This is part of why OCD is so painful, and it is also part of why I find treating it so meaningful. When someone describes their intrusive thoughts to me, I am not hearing evidence of who they are. I am hearing a map of what they care about. The distress itself is a signal: these thoughts feel unbearable precisely because they clash with the person's values and character.

In my work with clients, naming this early on often brings some relief. Many people have spent months or years believing that their thoughts mean something terrible about them. Being able to say, with clinical confidence, that intrusive thoughts are a symptom — not a reflection of intent, character, or desire — is one of the privileges of this work.

OCD is one of the most treatable mental health conditions

OCD is one of the most treatable mental health conditions. It can feel relentless and permanent from the inside, but from the therapist's chair, the picture can look different: we have decades of strong evidence that evidence-based treatments for OCD work.

Exposure and Response Prevention (ERP), a form of cognitive behavioral therapy, is the gold standard treatment for OCD. Research consistently shows that ERP produces significant reductions in OCD symptoms, and that gains are maintained over time. For people who also take medication, evidence indicates that combining ERP with medication leads to better outcomes than medication alone for people with moderate to severe symptoms.

I find this encouraging and motivating. Clients often arrive believing they will have to manage their intrusive thoughts through sheer willpower forever. Being able to offer a structured, evidence-based path forward, and then watching it work, never stops feeling meaningful. There are few things in my professional life more rewarding than a client telling me they held their baby on the stairs, drove past the school without circling back, or used a kitchen knife to make dinner without engaging in compulsive behaviors like reassurance or avoidance.

The courage I witness in ERP therapy

ERP asks people to do something genuinely hard: to face the situations, thoughts, and uncertainties they fear most, while practicing not doing the compulsions that have felt protective. This takes courage.

People with OCD are often described in our culture through stereotypes — quirky, overly tidy, particular. The reality I see in my practice is very different. I see people who are exhausted from fighting their own minds, who have quietly restructured their entire lives around avoiding feared outcomes, and who still show up to therapy willing to try something different. I see parents who are terrified of their intrusive thoughts choosing to face them so they can be more present with their children. I see clients tolerating enormous uncertainty because they want their lives back.

Witnessing that courage, week after week, is an honor. My role is to design exposures collaboratively, move at a pace that is appropriately challenging but not overwhelming, and never ask clients to do anything unsafe. Their role requires bravery, and they meet me with it. I do not take that for granted.

How my reproductive and medical trauma background shapes my OCD work

My clinical training and research background are in reproductive and perinatal mental health and medical trauma, and this shapes how I treat OCD in ways I have come to value.

OCD frequently shows up during pregnancy and postpartum, when the brain and nervous system are working overtime to protect both parent and baby. Perinatal intrusive thoughts often center on harm coming to the baby, which makes them especially frightening to experience and especially hard to say out loud.

OCD also commonly intersects with health, contamination, and medical themes — fears of illness, doubt about symptoms, compulsive researching and reassurance seeking about health concerns. My background in medical trauma and procedural anxiety helps me distinguish OCD from trauma responses, treat them together when both are present, and understand how medical systems can inadvertently reinforce compulsive checking and reassurance cycles.

Perhaps most importantly, my specialty areas have made me deeply comfortable with taboo intrusive thoughts. Clients often tell me they have never spoken their thoughts aloud to anyone — not partners, not previous therapists — because the content feels too disturbing. Harm thoughts, sexual intrusive thoughts, thoughts that violate a person's religious or moral values: I am comfortable discussing all of them as part of OCD assessment and treatment. Nothing a client shares with me about their intrusive thoughts will shock me, and that steadiness is often the first exposure of treatment: saying the thought out loud.

How I treat OCD: ERP through an ACT lens

ERP is the foundation of my OCD treatment, and I deliver it through the lens of Acceptance and Commitment Therapy (ACT). Research supports both ERP alone and ACT-integrated ERP as highly effective approaches, and for many of my clients, the ACT framework makes exposure work feel purposeful rather than punishing.

In practice, this means we do not do exposures for their own sake. We connect every step of treatment to what the client values and what OCD has taken from them:

  • Mapping out intrusive thoughts, compulsions, and avoidance — and, just as importantly, mapping what a meaningful life would look like without them taking over
  • Practicing willingness to experience anxiety, doubt, and uncertainty, rather than treating those feelings as emergencies that require action
  • Learning to notice thoughts as thoughts — mental activity the brain produces — rather than warnings or truths
  • Facing feared situations in a planned, supported way, while dropping the compulsions that keep the OCD cycle going
  • Taking committed action toward valued roles and activities, even while difficult thoughts and feelings are present

The question that anchors our work is not "How do I make these thoughts go away?" but "What do I want my life to be about, and am I willing to make room for discomfort in the service of that?" In my experience, when exposure is tied to values — being present with your children, staying engaged in your medical care, pursuing the hobbies, relationship, career or family you want — clients find reserves of willingness they did not know they had.

What meaningful recovery from OCD looks like

Recovery from OCD does not usually mean never having another intrusive thought. Intrusive thoughts are a universal human experience; nearly everyone has them. Recovery means the thoughts lose their power. They become background noise rather than alarms. The urge to check, avoid, research, or seek reassurance quiets significantly, and the time and energy OCD consumed gets redirected back into a person's actual life.

Clients sometimes grieve during treatment — for the years OCD took, for experiences they missed, for the version of parenthood or partnership or young adulthood they wanted. I do not rush past that grief or reframe it. It deserves room. And alongside it, I get to watch people reclaim things: sleeping when the baby sleeps, going to the appointment without weeks of dread, holding their child without a ritual first, trusting themselves again.

That reclaiming is why I find this work meaningful. OCD treatment is one of the places in psychology where the change is often visible and life-altering — and where the client's own courage and perseverance deserves the credit.

When to seek support

It may be time to reach out for OCD treatment if you notice that:

  • Intrusive thoughts feel frequent, distressing, or out of control
  • You are spending significant time checking, avoiding, mentally reviewing, researching, or seeking reassurance
  • Anxiety or rituals are interfering with sleep, work, caregiving, relationships, or daily tasks
  • You are avoiding situations, places, or people because of your thoughts
  • You feel ashamed of your thoughts or afraid to say them out loud

You do not need to be in crisis to seek support. If OCD is taking up more of your life than you want it to — even if you are still functioning, even if others cannot tell anything is wrong — that is reason enough.

If someone is experiencing thoughts of self-harm or suicide, immediate support is needed. In the U.S., calling or texting 988 connects to the Suicide and Crisis Lifeline. If there is imminent danger, call 911 or go to the nearest emergency room.

If any of this resonates, and you're wondering if therapy with a specialist might help, I'd be glad to connect. You can reach me through my contact form or at contact@drjesscoleman.com.

Telehealth OCD therapy in North Carolina, California, and PSYPACT states

I provide specialized, evidence-based OCD treatment through secure telehealth to adults located in North Carolina, California, and more than 40 PSYPACT states. Telehealth is well suited to ERP, because it allows us to practice exposures in the real environments where OCD shows up: your kitchen, your car, your baby's nursery, your home office. If you are searching for an ERP therapist or OCD specialist who works with adults online, you can reach out through my contact form or email me at contact@drjesscoleman.com to schedule a free consultation call.

Frequently Asked Questions

What is the most effective therapy for OCD?

Exposure and Response Prevention (ERP) is the gold standard, evidence-based treatment for OCD. Decades of research show that ERP significantly reduces OCD symptoms and that improvements are maintained over time. I provide ERP through an Acceptance and Commitment Therapy (ACT) lens, which research supports as an equally effective approach that many clients find meaningful and sustainable.

Do you only treat OCD related to pregnancy and postpartum?

No. While I have specialized expertise in perinatal OCD, I treat OCD across themes and life stages in adults, including harm, contamination, health, relationship, moral and religious (scrupulosity), and sexual intrusive thought themes. My reproductive and medical trauma background informs my work, but it does not limit who I work with.

Will you be shocked or alarmed by my intrusive thoughts?

No. I am comfortable discussing all types of disturbing intrusive thoughts as part of OCD assessment and treatment, including thoughts about harm, sexual content, and thoughts that violate your values. Intrusive thoughts are symptoms of anxiety, not reflections of your character or intentions, and saying them out loud to a therapist who understands OCD is often the first step in taking their power away.

Can OCD really be treated through online therapy?

Yes. ERP translates very well to telehealth, and in some ways it is an advantage: we can practice exposures directly in the environments where your OCD shows up, rather than in an office. Sessions are held through a secure, HIPAA-compliant platform for adults in North Carolina, California, and 40+ PSYPACT states.

How long does ERP therapy take?

ERP is typically a structured, time-limited treatment rather than open-ended therapy. Research protocols commonly range from roughly 12 to 20 sessions, and many adults notice meaningful change within the first few months of consistent work. Length varies with symptom severity, how long OCD has been present, and how much practice happens between sessions.

Will treatment make my intrusive thoughts go away completely?

The goal of OCD treatment is not to eliminate intrusive thoughts, because intrusive thoughts are a normal part of the human mind. The goal is to change your relationship with them so they lose their urgency and stop dictating your behavior. Most clients find that as compulsions decrease, the thoughts themselves become quieter, less frequent, and far less distressing.

How do I know if what I'm experiencing is OCD or ordinary worry?

Ordinary worry tends to focus on realistic, everyday concerns and shifts with circumstances. OCD involves intrusive thoughts or images that feel unwanted and out of character, paired with repetitive behaviors or mental rituals — checking, avoiding, reviewing, reassurance seeking — aimed at reducing distress or preventing feared outcomes. An assessment with a therapist who specializes in OCD can clarify the difference, and I am glad to help with that.

Further Reading

Jess Coleman, Ph.D.
Next

Why I Love Practicing Acceptance and Commitment Therapy: Reflections From an ACT Therapist