OCD · Solutions Psychiatry
OCD treatment online: ERP and medication, sequenced by one clinician
Obsessive-compulsive disorder responds when exposure therapy and medication are planned together, by the person who hears the whole story. OCD is a specialty here, not a sideline.
Solutions Psychiatry is the full practice: therapy and medication care from one clinician. If you want medication management only, that care has its own home at PsychMed Care.
What OCD actually is
OCD is a loop. An intrusive thought arrives uninvited, a flash of contamination, harm, doubt, or wrongness, and it feels dangerous or morally loaded in a way ordinary thoughts do not. A compulsion follows to neutralize it: washing, checking, reviewing, confessing, researching, seeking reassurance, or running a mental ritual no one can see. The ritual works for a moment, and that moment of relief is what trains the loop to run again, louder.
It is not a preference for tidy desks, and it is not a character flaw. It is a treatable disorder of the brain's alarm and habit systems, and it often carries a heavy load of shame, because the thoughts it produces are exactly the ones a thoughtful person would never choose. Many people hide OCD for years, including from previous therapists, because saying the thoughts out loud feels risky. Here, they are clinical information, and they are heard that way.
OCD also rarely travels alone. Anxiety, depression, insomnia, and tics commonly sit alongside it, and each one changes the treatment plan. That is one reason the evaluation here is unhurried, and why the clinician treating your OCD also manages the whole medication picture rather than a single prescription in isolation.
Presentations
How OCD shows up
Contamination and washing
Fear of germs, illness, or chemicals, with washing, cleaning, or avoidance rituals that grow until they run the day.
Checking and harm fears
Stoves, locks, emails, driving routes, replayed for certainty that never quite arrives, because the disorder moves the goalpost.
Intrusive harm or taboo thoughts
Unwanted images or impulses involving harm, sex, or blasphemy. The thoughts horrify the person having them, which is precisely why they stick.
Relationship and existential OCD
Relentless doubt about a partner, a decision, or one's own identity, with reviewing and reassurance-seeking as the hidden compulsions.
Symmetry, ordering, just-right
Arranging, repeating, and redoing until it feels right, sometimes with counting or tapping patterns layered in.
Pure O, mostly mental
Few visible rituals, hours of invisible ones: analyzing, arguing with the thought, testing reactions, scanning the body for proof.
ERP: the therapy that treats the loop
Exposure and Response Prevention is the gold-standard therapy for OCD, and it is the center of treatment here. The work has two halves. Exposure means approaching the feared trigger on purpose, in planned steps. Response prevention means not performing the ritual that usually follows. Held together, with support, they teach the brain the lesson the loop has been preventing: the anxiety rises, peaks, and falls on its own, and the catastrophe does not arrive.
Done well, ERP is neither flooding nor white-knuckling. You and your clinician build a hierarchy together, from the manageable to the hard, and you always know the next step before you take it. Read more about how ERP works here as part of the wider therapy toolkit, which also includes Internal Family Systems work for the shame and self-criticism that so often wrap around OCD.
Progress is measured, not assumed. The OCI-R, the standard OCD symptom inventory, is rechecked over the course of care, and you can take the free OCI-R screener now for a private baseline before any appointment.
Where medication fits
Medication is the second half of OCD treatment, and sequencing is the whole game. The usual first step is an SSRI, and OCD is not depression with extra steps: doses for OCD commonly run higher than the same drug's depression dose, and a fair trial runs longer before anyone concludes it failed. Judging an OCD medication at four weeks, at a starting dose, is how people collect a list of medicines that "did not work" when they were never really tried.
When a well-run SSRI trial produces a partial response, augmentation is the next conversation: adding a second agent with evidence behind it, rather than abandoning ship and starting over. When a trial truly fails, switching within or across classes is planned, one change at a time, so the result can be read clearly. Medication as the second half of care is described on this site's medication page.
The sequencing advantage here is structural. Your prescriber runs your exposures. A medication change can be timed around ERP milestones, side effects can be weighed against what therapy is surfacing that week, and a plateau gets one integrated explanation instead of two partial ones. When OCD quiets and stays quiet, deprescribing is revisited the same careful way, one step at a time. For medication questions in greater depth, the medication-led conditions are covered at PsychMed Care, run by the same clinician; OCD medication stays on this page because here it is never prescribed apart from the ERP it supports.
The hidden ritual: accommodation
OCD rarely keeps its rituals inside one person. Partners answer the same reassurance question forty times a day. Parents check locks their teenager has already checked. Families quietly reorganize meals, routes, and conversations around the disorder's rules, out of love, and every accommodation buys calm at the price of feeding the loop. Naming that pattern is not blame; accommodation is what caring people do when they have not been shown another move.
Care here looks at accommodation directly. The people around you learn what the disorder is asking of them, and how to step back from rituals gradually and kindly while you step toward the triggers in ERP. When the household stops performing its half of the compulsion, the exposures you do in session stop being undone at home, and progress starts compounding instead of resetting every evening.
What a course of OCD care looks like
OCD treatment is measured in months, not weeks, and anyone who promises otherwise is selling something. The early work is mapping and foundations: understanding your loop, building the hierarchy, and settling the medication question. The middle is the climb itself, exposures rising in difficulty as the lower rungs lose their charge, with the OCI-R rechecked along the way so progress is a trend line rather than an impression.
Setbacks are expected and planned for. Stress, poor sleep, and illness all turn the volume up on intrusive thoughts, and a spike after a good month is the disorder testing the new wiring, not proof the treatment failed. Sessions leave room for exactly those weeks. Later, the cadence widens: maintenance visits, a hierarchy that has become ordinary life, and a medication regimen reviewed for whether every part of it is still earning its place.
Getting started
Starting OCD care here
1. Take the OCI-R
Two private minutes with the standard OCD inventory gives you a baseline number and gives the first conversation a head start.
2. The 60 minute Comprehensive Initial Appointment
Your history, the shape of your loop, what you have tried, and your physical health, plus labs or GeneSight testing if they would change a decision.
3. A plan with both halves
An ERP hierarchy built with you, and a medication decision, start, adjust, or deliberately none yet, made with the therapy plan in view.
4. Measured Follow-up Appointments
Thirty minute visits that track the OCI-R and the rituals' real-world grip, adjusting the exposures and the prescription together.
Comprehensive Initial Appointments are $350 and Follow-up Appointments are $250, with most insurance copays between $0 and $40 and every plan verified before the first visit. When you are ready, book a first visit through the practice site.
One clinician for the whole conversation.
Start with a 60 minute Comprehensive Initial Appointment. Your insurance is verified before the visit, and you leave with a plan, not vague reassurance.