Therapy Support for OCD: Help With the Anxiety and Shame Alongside ERP

By Clay Klaus-Wade ·

The short answer

If you're doing exposure and response prevention, or ERP, for OCD, you're already doing some of the hardest and bravest work there is in therapy. And yet ERP isn't always the place where everything else gets room: the exhaustion of living with intrusive thoughts, the anxiety that spills into the rest of your life, and, very often, the shame of having thoughts that feel so wrong, so unlike you, that you've never said them out loud to anyone.

That's where I come in. I support people who are doing ERP for OCD and want help with the anxiety and shame OCD can bring. I don't provide ERP myself, and I'm not a replacement for it; I work alongside it.

Start with ERP

I want to be clear about this, because it matters. The International OCD Foundation describes ERP as the most effective, first-line therapy for OCD, and lists certain medications as first-line options as well (IOCDF). The same page is direct that some approaches, including psychodynamic therapy on its own, haven't been found effective as a treatment for OCD itself.

So if you have OCD and you aren't yet working with an ERP-trained clinician, that's the first call to make, and the IOCDF's resource directory is a good place to start. What I offer is something different: a space for the parts of your experience that live around the OCD, held by someone who understands how ERP works and respects it.

Why OCD and shame are so often tangled together

Here's something that surprises a lot of people: almost everyone has intrusive thoughts. In a study spanning 13 countries across six continents, about 94 percent of participants reported having at least one unwanted intrusive thought in the previous three months (Radomsky et al., 2014). Thoughts about harm, sex, religion, contamination, or doubt are a normal part of having a human mind.

What OCD does is grab hold of those thoughts and insist they mean something terrible about you. And because the content of intrusive thoughts is so often taboo, people with OCD tend to carry it in silence for years, sometimes convinced that they're dangerous, broken, or secretly bad. That isn't guilt about something you did; it's shame about who you fear you are, which is a much heavier thing to carry (Tangney et al., 2007).

Shame can also make the work of ERP harder. It keeps people from telling their ERP therapist about the thoughts that scare them most, and it can turn every slip or rough week into more evidence for the story that something is fundamentally wrong with you.

What support alongside ERP looks like

The IOCDF notes that certain additional therapies, including dialectical behavior therapy (DBT) and mindfulness-based approaches, can be helpful when added alongside first-line treatment (IOCDF). In my work with people doing ERP, that might include:

  • Working with shame directly, including the self-criticism that tends to follow intrusive thoughts, using compassion-focused approaches
  • Building skills for the anxiety and distress that show up between exposure sessions, drawing on DBT
  • Making room for the rest of your life: relationships, identity, work, grief, and everything OCD has been crowding out
  • Talking about what it's like to live with OCD, including the loneliness of it, with someone who won't flinch

Just as importantly, here's what I'm careful not to do. Reassurance can feel like kindness, but in OCD it often works like a compulsion, quietly undoing the progress you make in ERP. So I won't analyze the content of your obsessions or tell you that you'd never act on them. With your permission, I'm also glad to coordinate with your ERP therapist, so we're working in the same direction instead of pulling against each other.

Who this is for

This kind of support tends to help people who:

  • Are actively doing ERP, or have done it, and want more space for the emotional side of OCD
  • Feel weighed down by shame, secrecy, or self-judgment about their thoughts
  • Notice anxiety, low mood, or relationship strain that goes beyond what ERP addresses
  • Want a therapist who understands OCD, including less-talked-about forms, and respects the work they're doing in ERP

OCD support at Layered Health

Layered Health is a Philadelphia-based psychotherapy practice opening in Summer 2027. My work is grounded in compassion, attachment, and a deep respect for the parts of ourselves we've learned to hide, and for people living with OCD, those parts are often hiding in plain sight.

If you're doing ERP and want support with the anxiety and shame OCD can bring, I'd love to hear from you.

Contact me

Frequently asked questions

Can I see another therapist while I'm doing ERP?

Yes. Many people work with an ERP therapist for OCD and a second therapist for the anxiety, shame, and other concerns that come with it. It works best when both therapists understand ERP and, with your permission, coordinate so they're not working against each other.

Do you provide ERP for OCD?

No. I don't provide ERP. I support people who are doing ERP and want help with the anxiety and shame OCD can bring. If you have OCD and aren't yet in ERP, the International OCD Foundation's directory is a good place to find an ERP-trained clinician.

Why do intrusive thoughts feel so shameful?

Intrusive thoughts often involve taboo content, and OCD insists they reveal something terrible about you. Research shows that the large majority of people have intrusive thoughts. Having them doesn't mean anything about your character.

Is ERP the main treatment for OCD?

Yes. The International OCD Foundation describes ERP as the most effective, first-line therapy for OCD, along with certain medications. Other therapies are most helpful as additions alongside it.

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