Your brain keeps asking a question you can never quite answer enough.
What if I did something wrong? What if I wanted it? What if I’m dangerous? What if I missed something? What if I make the wrong choice? What if this feeling means something?
The problem isn’t that you haven’t thought about it enough.
If You've Been Told to "Just Stop"
You answer it. Check it. Analyze it. Google it. Ask someone. Avoid something. Replay it. Try to finally feel certain.
And for a little while, maybe you do.
Then the question comes back.
You may already know the logic doesn't hold up. You've told yourself to stop the checking, the counting, the pulling, or the picking.
And it didn't work.
Because OCD and body-focused repetitive behaviors aren't problems of willpower.
These patterns can be difficult to interrupt, even when you understand what is happening and genuinely want something to change. Trying harder, judging yourself, or reasoning with the pattern usually isn't the missing piece.
You might recognize
- Intrusive thoughts that spiral no matter how hard you try to think your way past them
- Compulsions or rituals that bring a moment of relief, followed quickly by shame
- Pulling or picking that happens almost on autopilot, sometimes before you even notice you started
- Exhaustion from managing this alone, quietly, maybe for a very long time
I'm not going to tell you to just stop. I want to understand what's driving the pattern so we can treat the process that's actually keeping it going.
A little education: what's actually happening
It helps to understand what's actually going on underneath, so let's slow down together for a moment.
OCD
OCD isn't a personality trait or a quirk about liking things a certain way. It's a nervous system caught in a certainty-seeking loop.
A thought shows up, your brain flags it as dangerous or unbearable, and a compulsion (checking, counting, seeking reassurance, avoiding) promises relief. It works, briefly. Then the loop resets, often stronger than before.
BFRBs
BFRBs work in a similar way, but through the body. Hair-pulling, skin-picking, and related behaviors often serve as a way to regulate overwhelming feelings, tension, or sensory needs, even when the behavior itself brings shame afterward.
Neither is a character issue. OCD and BFRBs can overlap in lived experience, but they involve different mechanisms, and they often call for different approaches.
If You're a New or Expecting Parent: This Might Sound Familiar
Perinatal OCD is common, rarely talked about, and often terrifying to admit out loud.
What this can sound like
If you're pregnant or postpartum and having intrusive, unwanted thoughts about harm coming to your baby, thoughts that horrify you, that you'd never act on, that make you afraid to be alone with your own child:
Please hear this clearly and gently: that is not a sign you're a dangerous parent.
It's often a recognizable, treatable pattern called perinatal OCD, and you are far from alone in experiencing it, whatever kind of family you're building, whatever path brought you to parenthood.
What often travels with it
You might also notice compulsive checking, reassurance-seeking, or avoiding your baby out of fear of the thoughts themselves. These symptoms are treatable, and for most people, simply naming them accurately, with warmth instead of alarm, is the first real relief they feel in a long time.
Learn more about perinatal care
A thought is not a confession.
OCD often targets the things that matter most to you. That can make intrusive thoughts feel especially convincing, shameful, or dangerous.
You may be terrified that having the thought says something about your character, your intentions, your sexuality, your relationship, your morality, or what you might do.
Intrusive thoughts do not automatically tell us what you want.
What we actually work with
I am interested in what happens after the thought appears: the checking, mental review, avoidance, reassurance, testing, comparison, confession, or attempts to finally feel certain.
You do not have to prove to me that you are a good person before we can begin working with what is happening.
If your concern involves recurring sexual behavior rather than unwanted intrusive thoughts, the Sexual Health & Compulsive Behaviors page may be a better place to begin.OCD and trauma can both be present. They are not the same thing.
Sometimes a person has a trauma history and OCD. Sometimes a traumatic experience intensifies an obsessive theme. Sometimes the urge to analyze a thought as trauma becomes another way of trying to finally make it make sense.
I do not assume every intrusive thought is secretly about trauma.
We treat what is actually happening, not what we think should be happening.
If trauma is part of the picture, we can work with it carefully. If the problem is primarily an OCD cycle, I do not want trauma processing to become another form of rumination, checking, or certainty-seeking.
This distinction is important.
How We Work
We don't have to argue with every thought.
For many clients, the exhausting part is not the first thought. It's everything that happens afterward.
Inference-Based CBT
I may use Inference-Based CBT to help us understand how obsessional doubt gets constructed and where you leave what is actually happening in front of you for an imagined possibility.
ERP
ERP may also be useful when appropriate, especially when avoidance and compulsive responses have narrowed your life.
The goal is not to make you love uncertainty or never feel anxious.
It’s to help uncertainty stop making every decision for you.
How ERP and I-CBT Pacing Actually Works
If you've heard ERP horror stories, about being thrown straight into the scariest exposure on day one, that's not how this works here.
Exposures are built gradually and collaboratively, starting with what's genuinely manageable for you and moving up only as you're ready, and never a moment before.
You have a say in the pace. This isn't something done to you.
The same goes for I-CBT. We start by examining the reasoning behind the doubt itself, never by pushing you into anything overwhelming before you're truly ready.
BFRBs
Sometimes your hands are moving before you've consciously decided anything.
Skin picking, hair pulling, rubbing, biting, or other body-focused repetitive behaviors can become deeply automatic.
Maybe there is an urge. Maybe a sensation feels "not right." Maybe you are bored, focused, stressed, dissociated, trying to smooth something, searching for completion, or realizing after the fact that you've been doing it for twenty minutes.
The behavior is usually doing something for you, even when it costs you afterward.
We want to understand what happens before, during, and after the behavior.
Treatment may include Habit Reversal Training, awareness work, environmental changes, competing responses, COM-B informed strategies, and attention to emotional or trauma-related factors when those are genuinely part of the picture.
What This Looks Like
This work is structured and active, not open-ended venting.
We'll get specific about your triggers and patterns early, and I'll ask you to do some of the harder work between sessions, because that's genuinely what moves the needle with OCD and BFRBs.
I'll also tell you when I think something isn't working. Being compassionate doesn't mean continuing with an approach that isn't helping.
Who This Is For
People come to this work with different histories, identities, relationships, beliefs, and reasons for wanting things to change. This may be a fit if:
- Adults with OCD who have done "regular therapy" and are still looping
- People with trichotillomania, skin picking, and other BFRBs
- New and expecting parents navigating perinatal OCD
- Clients who want direct, behavior-based work, met without flinching or judgment
You can tell me what the thoughts actually say. The content of an intrusive thought does not tell me who you are.
The goal isn't to finally become 100% certain.
It's to have more of your life available even when certainty doesn't show up.
Certainty + mental loops
- spending less time reviewing the same question
- asking for less reassurance
- making decisions without needing them to feel perfectly right
- allowing a thought to exist without treating it like evidence
Attention + avoidance
- returning attention to what is actually happening in front of you
- having more freedom around situations you have been avoiding
BFRB urges + shame
- noticing a BFRB urge earlier
- having more options before automatically acting on an urge
- experiencing less shame about having a brain or body that does these things
We are not trying to make you careless. We are trying to help doubt, urges, and intrusive thoughts take up less authority in your life.
You're Not "Just" Anxious or "Just" a Habit
Reach out and tell me what's been happening. We can start by figuring out what process is actually driving it and what kind of treatment makes sense. That may include ongoing therapy, an intensive, or another service depending on what you need.