OCD therapy for adults in Bromley

What is OCD?

Obsessive-compulsive disorder, OCD, is a condition in which unwanted, intrusive thoughts, images or urges drive repeated actions carried out to reduce the anxiety those thoughts create. It is treatable, and it affects adults from every background.

The thoughts are known as obsessions and the actions as compulsions, and those actions can be mental as well as physical. OCD has nothing to do with simply preferring things tidy or organised.

The pattern tends to repeat itself in a fairly predictable shape. An intrusive thought appears, anxiety rises sharply, a compulsion is carried out to bring relief, and that relief fades within minutes or hours, so the cycle starts again. Over months or years this can take up a significant part of a person’s day and start to shape decisions about work, relationships, routines and even where someone chooses to live. Many people with OCD recognise, at some level, that their thoughts are unlikely or out of proportion, which can make the condition harder to explain to other people rather than easier.

Symptoms of OCD

Symptoms of OCD fall into two broad groups, obsessions and compulsions, though the balance between the two varies from person to person.

Obsessions are thoughts, images or urges that arrive uninvited and cause real distress. They might involve fears about contamination or illness, doubts about whether a door was locked or an appliance switched off, worries about accidentally causing harm to someone or thoughts that clash sharply with a person’s own values and sense of self. Compulsions are the responses to those obsessions: washing or cleaning, checking, counting, arranging objects in a particular order, seeking reassurance from other people or running through a mental script to try to cancel a thought out. Some compulsions are visible, such as repeated handwashing or checking a lock several times before leaving the house. Others happen entirely inside someone’s head, which can make them far harder for family, friends or colleagues to notice.

A useful marker for when OCD is present, rather than everyday worry, is time and interference. Occasional intrusive thoughts are common and do not, on their own, indicate a disorder. OCD is generally diagnosed when obsessions and compulsions take up an hour or more of the day, or when they get in the way of work, study or relationships.

Common themes in OCD

OCD can attach itself to almost any subject a person cares about, but a number of themes come up often in practice. Contamination fears can lead to excessive washing or cleaning, sometimes to the point of sore skin or an exhausting daily routine. Checking themes tend to centre on locks, switches, taps, appliances or written work, with the checking itself often failing to bring lasting certainty. A need for symmetry, order or things feeling ‘just right’ can make ordinary tasks slow and effortful. Some people experience intrusive thoughts about harming themselves or people close to them, despite having no wish whatsoever to act on those thoughts. Others describe unwanted sexual or blasphemous thoughts that feel completely at odds with who they are, or persistent doubts about a relationship that no amount of reassurance ever seems to settle for long.

Whatever the specific theme, the shame that comes with it is often strikingly similar. People frequently put off seeking help for years because the content of a thought feels too difficult to say out loud to anyone, including a partner or a doctor. In our experience, the theme itself has little bearing on how well a person responds to treatment. The underlying pattern, an anxious thought followed by a compulsive response, tends to respond to the same structured approach whatever the subject matter happens to be.

How therapy can help

Compulsions and avoidance are what keep OCD going over time. Each time a ritual is completed or a feared situation is avoided, the brain learns, briefly, that the danger was real and that the response was necessary to stay safe. Therapy works by interrupting that cycle so that anxiety is allowed to rise and fall on its own, without a compulsion doing the work of bringing it down.

The National Institute for Health and Care Excellence recommends cognitive behavioural therapy, including a specific technique called exposure and response prevention, as a first-line psychological treatment for OCD. For some people, a GP or psychiatrist may also discuss medication, usually a type of antidepressant, as an option alongside therapy. We do not prescribe medication ourselves, but we can help you think through what might be worth raising with your GP if that route seems relevant to your situation.

Our approach

Sessions take place online with adults across Bromley and the surrounding area, using secure video software from wherever suits you best, whether that is home, a private room at work or somewhere else quiet. Assessment comes first: understanding your specific obsessions and compulsions, how they developed, and what has helped or not helped before, ahead of agreeing together what therapy will focus on and how quickly to move.

We work with adults living in Bromley, Beckenham, Chislehurst, Shortlands, Bickley, Hayes and Petts Wood, and with people further across south east London who would rather meet from home than travel into central London for an appointment. Working online means geography matters less than fit between therapist and client, and it also means no one has to say a difficult thought out loud in a waiting room before a session has even started. We will update this site as the practice develops.

What does OCD therapy involve?

Treatment usually begins with mapping out the specific obsessions and compulsions involved, then building a hierarchy of situations ranging from manageable to most difficult. Exposure and response prevention involves facing a feared situation, image or thought gradually, while deliberately resisting the compulsion that would normally follow it. This is done at an agreed, gradual pace rather than all at once, and always with your say over what gets worked on first and when.

Between sessions, there is usually some practice to carry out: noticing an urge as it arises, delaying a compulsion for a set period or sitting with a difficult thought rather than immediately acting on it. Progress with OCD is rarely a straight line, and a difficult week is a normal part of the process rather than a sign that therapy is not working. The number of sessions someone needs varies considerably from person to person, depending on how long symptoms have been present, how many themes are involved, and how much everyday life has been affected.

Frequently asked questions

Some of the questions people most often ask before starting OCD therapy are answered below.

When to seek help

It is worth speaking to someone if compulsions or rituals are taking up an hour or more of your day, if avoidance is starting to shrink the scope of your life, or if intrusive thoughts are causing distress that does not ease with time. You do not need a formal diagnosis before getting in touch, and there is no theme too small, or too difficult, to bring to a first conversation. If you are in crisis or having thoughts of harming yourself, contact 999, NHS 111 or the Samaritans on 116 123.