As a registered psychologist based in Sydney CBD, I work with people experiencing OCD across a wide range of presentations — contamination, harm, taboo thoughts, relationship OCD, and pure-O. Sessions are available in-person at my Elizabeth Street practice or via telehealth anywhere in Australia, with Medicare rebates available through a Mental Health Treatment Plan.

What OCD Actually Is

Most people experience unwanted or strange thoughts from time to time.

For people with OCD, the problem isn’t the presence of these thoughts — it’s how much meaning they’re given, and the distress that follows.

OCD often involves intrusive thoughts, images, or urges that feel deeply upsetting, disturbing, or completely at odds with one’s values. These thoughts can be about contamination, harm, morality, sexuality, or responsibility. Despite how vivid they feel, they say nothing about who you are as a person.

Despite many common misconceptions across popular culture and social media, OCD is not about cleanliness, order, or being “Type A.”

At its core, OCD involves:

• intrusive thoughts or doubts that trigger anxiety

• intense discomfort or moral distress

• attempts to neutralise or reduce that distress

• temporary relief followed by repetition

The cycle continues because the brain learns that anxiety must be resolved immediately.

Intrusive Thoughts Are Normal

Intrusive thoughts are a normal part of human experience. The difference in OCD lies in how those thoughts are interpreted.

People with OCD tend to believe:

• having a thought makes it significant

• having a thought means something about them

• uncertainty must be eliminated

• distress must be resolved now

• thoughts must be controlled

These beliefs turn passing mental events into ongoing threats.

Common Forms of OCD

Contamination OCD

Fear of germs, illness, or being “tainted,” often leading to washing, cleaning, or avoidance behaviours.

Harm OCD

Intrusive thoughts or images of hurting oneself or others — despite having no desire to act on them.

Forbidden or Taboo Thoughts

Obsessions involving sexuality, religion, morality, or socially unacceptable themes, often accompanied by intense shame.

Mental Compulsions

OCD doesn’t always involve visible behaviours. Many people engage in:

• mental checking

• reassurance-seeking

• reviewing memories

• arguing with thoughts

• repeating phrases or rituals internally

Because these compulsions reduce anxiety briefly, they strengthen the cycle.

Why OCD Persists

OCD is maintained by a feedback loop:

1. An intrusive thought occurs

2. Anxiety spikes

3. The thought is judged as dangerous or meaningful

4. Compulsions are used to reduce anxiety

5. Relief occurs briefly

6. The brain learns the thought was a threat

Crucially, attempts to suppress or get rid of thoughts tend to increase their importance, not reduce them.

OCD and Shame

Many people with OCD feel ashamed of their thoughts, especially when they involve harm, sexuality, or morality. This often leads to secrecy and avoidance — delaying effective treatment.

In reality, the content of intrusive thoughts usually reflects what matters most to the person, not hidden desires or intentions..

When It’s Worth Getting Support

It may be helpful to seek professional support if:

• intrusive thoughts feel constant or distressing

• you feel compelled to neutralise or check

• reassurance only provides temporary relief

• avoidance is growing

• shame or fear stops you from talking openly

How I Help With OCD

OCD is one of the most treatable psychological conditions. My approach to working with clients in therapy experiencing OCD, is focused on the following evidence-based principles:

• understanding how OCD operates (psycho-education)

• changing the relationship to intrusive thoughts (cognitive restructuring)

• gradually facing feared experiences without neutralising rituals (exposure response and prevention)

• reducing compulsions and safety behaviours

• increasing tolerance of uncertainty

This work is challenging at times, but highly effective when done in a structured, compassionate way.

Therapy is not about forcing exposure or overwhelming clients — it’s paced, collaborative, and guided by readiness.

Frequently Asked Questions

• Is OCD only about cleanliness and checking? No — this is one of the most common misconceptions about OCD. While contamination and checking presentations are well known, OCD covers a much wider range including harm obsessions, taboo and sexual thoughts, religious and moral scrupulosity, relationship OCD, and purely mental compulsions with no visible behaviour at all. Many people with OCD go undiagnosed for years because their presentation doesn't match the stereotype.

• What is ERP and how does it work? Exposure and Response Prevention (ERP) is the gold-standard psychological treatment for OCD. It involves deliberately encountering situations or thoughts that trigger obsessional anxiety, and resisting the urge to perform compulsions. This teaches the brain that the intrusive thought is not actually dangerous, and that anxiety can be tolerated without neutralising. ERP is always paced collaboratively and never involves forcing someone into overwhelming situations.

• How many sessions does OCD treatment take? OCD typically requires more sessions than other anxiety presentations. Focused ERP treatment often runs 20 or more sessions, particularly for more entrenched presentations. Complex or long-standing OCD may require longer work. Progress is reviewed throughout and the pace is always guided by what feels manageable.

• Does Medicare cover psychology sessions for OCD? Yes. With a Mental Health Treatment Plan from your GP, you're eligible for Medicare rebates on individual psychology sessions. Your GP can arrange this before your first appointment.

• What is Pure-O? Pure-O refers to OCD presentations that appear to involve obsessions without obvious physical compulsions. In practice, most people with Pure-O do engage in compulsions — they are simply mental rather than behavioural, such as reassurance-seeking, mental reviewing, or thought suppression. These mental compulsions maintain the OCD cycle in exactly the same way physical compulsions do.

• Is telehealth available for OCD treatment? Yes. ERP-based OCD treatment has good evidence for telehealth delivery. Sessions are available Australia-wide. For some presentations, telehealth can actually facilitate exposure work in the client's own home environment, which is clinically useful.

Related Services

If OCD is part of a broader pattern, you may also find these pages relevant:

• Anxiety — OCD is classified as an anxiety-related condition and frequently co-occurs with generalised anxiety and social anxiety

• Depression — the shame and exhaustion of living with OCD commonly leads to depression

• Addiction — some people use substances to manage OCD-related distress, particularly when the condition has been undiagnosed or untreated for a long time

• Trauma & PTSD — trauma and OCD can co-occur, particularly where intrusive memories are being misidentified as obsessional thoughts

If you'd like to discuss your situation and whether therapy might help, please get in touch here, or by using the form below.