Therapy for
Kids & Teens
with OCD
If your child has OCD, you already know this is not “just anxiety” and it is definitely not something they can logic their way out of.
You might be watching your child get stuck in rituals that make no sense to anyone else but feel urgent and necessary to them. You might see them asking the same questions over and over, checking and rechecking, avoiding everyday things, or melting down when they cannot do something “just right.” Maybe their world has slowly started to shrink. School feels harder. Friendships feel complicated. Family life revolves around preventing the next spiral.
You have probably tried reassuring them. You have probably tried reasoning. You might have tried ignoring it. You may have even tried therapy before, only to feel confused about why things did not really change.
OCD is tricky like that. And it requires a very specific kind of help.
I specialize in therapy for kids and teens with OCD because general therapy is often not enough. OCD is not about fear alone. It is about false alarms, rigid rules, and a brain that has learned to demand certainty where certainty does not exist. Treating it properly means working directly with the OCD cycle itself.
This page is here to help you understand what OCD really looks like in kids and teens, why well intentioned strategies often backfire, and what effective treatment actually involves.
What OCD looks like in kids & teens
OCD shows up differently in children than it does in adults, and it often looks different than parents expect.
Some kids have obvious compulsions like hand washing, checking locks, or repeating actions until they feel “right.” Others have mostly mental rituals, which can be much harder to spot. These might include silently repeating phrases, praying in a certain way, reviewing memories, or asking for reassurance in subtle ways.
Many kids with OCD do not say “I am anxious.” Instead, they say things like:
“What if something bad happens?”
“I just need to check one more time.”
“Can you promise me I’m okay?”
“It doesn’t feel right.”
“I can’t stop thinking about it.”
Avoidance is also common. Kids may refuse to touch certain things, go certain places, eat certain foods, or participate in activities they used to enjoy. Teens may become withdrawn, irritable, or perfectionistic. Some kids become very controlling because control feels safer than uncertainty.
OCD often targets what matters most. Family. Safety. Morality. Health. Identity. That is why it feels so intense and personal.
And importantly, OCD is not a parenting problem. It is not caused by something you did wrong. But parents do play a powerful role in helping it get better.
OCD grows through repetition, not reason.
When a child has an intrusive thought or uncomfortable feeling, their brain sends out a false alarm. The anxiety feels urgent and real, even if the fear itself does not make logical sense. To make that feeling stop, OCD pushes the child toward a compulsion. That compulsion might be something visible, like checking, washing, repeating, or avoiding. Or it might be internal, like mentally reviewing, counting, praying, or trying to “figure it out.”
For a moment, the anxiety eases. And that moment is exactly what teaches OCD to come back.
Each time a ritual is done, the brain learns that the fear must have been important and that the ritual was necessary to stay safe. The relief does not last, so the doubt returns, often stronger than before. Over time, the brain demands more rituals, more precision, and more certainty.
This creates a loop that looks like this:
An intrusive thought, image, or urge appears
Anxiety spikes
A ritual or avoidance behavior happens
Anxiety drops temporarily
The brain learns that the ritual “worked”
The cycle repeats
The problem is not that the child is doing something wrong. The problem is that OCD trains the brain through relief. The more the brain learns that rituals reduce discomfort, the more it relies on them.
That is why OCD often gets bigger, louder, and more demanding over time, even when kids and parents are trying very hard to make it stop.
Breaking this cycle does not mean forcing fear away or waiting until anxiety disappears. It means learning how to feel the discomfort without obeying OCD’s rules. That is the foundation of effective OCD treatment.
Why OCD Keeps Getting Worse, Not Better
What Effective OCD Therapy Actually Looks Like
The gold standard treatment for OCD is Exposure and Response Prevention, often called ERP.
ERP is a structured, evidence based approach that helps kids gradually face the things OCD tells them to avoid, without doing the rituals that OCD demands.
This does not mean throwing kids into the deep end. Good ERP is thoughtful, collaborative, and paced carefully. Kids are never forced. They are supported while they do hard things on purpose.
In ERP we work on:
Understanding how OCD operates
Externalizing OCD so it is not “who they are”
Identifying rituals, avoidance, and reassurance seeking
Building an exposure plan that feels challenging but doable
Practicing resisting compulsions in real life situations
Helping parents respond in ways that weaken OCD instead of feeding it
For kids and teens, this work has to be developmentally appropriate. It has to feel respectful. It has to account for school, friendships, family dynamics, and emotional maturity.
That is where specialization of the therapist matters.
How I Work with Kids and Teens With OCD
I am direct, warm, and honest with kids. I do not talk over them, and I do not treat them like problems to be fixed.
I help them understand what is happening in their brain and why it feels so convincing.
Kids are often relieved to learn that they are not broken. Their brain is just stuck in a false alarm mode.
Sessions are active. We talk, we plan, and we practice. Sometimes we laugh. Sometimes we sit with discomfort together. I meet kids where they are, whether that means sitting on the floor, using metaphors, or tying ERP work to their interests.
For teens, I am especially mindful of autonomy. OCD already takes away so much control. Therapy should not feel like another adult forcing them to do things. We focus on values, independence, and getting their life back from OCD.
Progress does not mean zero anxiety. It means more flexibility, more confidence, and less time spent trapped in rituals.
Parents are not on the sidelines in OCD treatment. You are part of the treatment team.
This does not mean you caused OCD or that you are doing something wrong. It means that small changes in how you respond can make a big difference.
Parent work often includes:
Learning how to recognize subtle compulsions/rituals
Responding to distress without reinforcing OCD
Staying calm and consistent when OCD pushes back
Supporting exposure work at home
This can feel scary at first. Many parents worry that pulling back reassurance will harm their child or damage the relationship. In reality, it often does the opposite. Kids feel more capable when they learn that they can handle discomfort and that you believe in their ability to do so.
I spend time coaching parents through this process so you are not guessing or second guessing yourself.
The Role of Parents in
OCD Treatment
Evidence Based Approaches I Use to Treat OCD
There is no single one size fits all way to treat OCD, especially in kids and teens. What works best depends on how OCD shows up, how old your child is, how involved parents need to be, and what has or has not worked before.
I have formal training in three evidence based approaches for OCD. These are not trends or coping strategies. They are well researched treatments designed specifically for OCD and related anxiety disorders.
Exposure and Response Prevention (ERP)
ERP is the most well known and widely studied treatment for OCD.
In ERP, kids and teens gradually face the things OCD tells them are dangerous or unbearable, while practicing not doing the rituals that OCD demands. Over time, the brain learns that the fear does not need to be resolved and that anxiety can rise and fall on its own.
This work is intentional and structured. Exposures are planned carefully and built step by step. Kids are not forced into situations they are not ready for. Instead, they learn how to approach discomfort with support, confidence, and choice.
ERP helps kids learn:
Anxiety is uncomfortable but not dangerous
Thoughts do not require action
They can tolerate uncertainty
OCD does not get to make the rules
Anxiety goes away even if they don’t do their ritual. They can ride the wave of anxiety.
For many kids and teens, ERP is the backbone of treatment. It directly targets the OCD cycle and helps loosen its grip on daily life.
Inference Based Cognitive Behavioral Therapy (I-CBT)
I-CBT is a newer evidence based approach that focuses on how OCD creates doubt in the first place.
Rather than starting with exposures, I-CBT looks at the reasoning process that leads a child to treat an intrusive thought as a real threat. OCD often pulls kids out of reality and into imagined possibilities, convincing them to trust “what if” scenarios over what they can actually observe.
In I-CBT, we work on:
Identifying how OCD twists logic
Separating imagination from reality
Understanding how doubt gets installed
Rebuilding trust in real world information
Reducing the need to resolve uncertainty through rituals
This approach can be especially helpful for kids and teens who are very stuck in mental rituals, reassurance seeking, or constant analysis. It can also be a good fit for clients who feel overwhelmed by traditional exposure work or who struggle to see their thoughts as intrusive.
This approach. has been shown to be especially useful for people who have tried ERP in the past but it didn’t work, and neurodivergent people.
I-CBT does not ignore anxiety. It helps reduce the power OCD has before anxiety takes over.
Supportive Parenting for Anxious Childhood Emotions (SPACE)
SPACE is an evidence based parent focused treatment for childhood anxiety and OCD.
In SPACE, the child does not need to attend therapy for changes to happen. Instead, parents learn how to respond differently to anxiety and OCD in ways that reduce its hold over time.
SPACE focuses on:
Changing how parents respond to child’s anxiety or OCDCommunicating both
Separating imagination from reality
Understanding how doubt gets installed
Rebuilding trust in real world information
Reducing the need to resolve uncertainty through rituals
Best of all, SPACE doesn’t involve the child at all in treatment. Imagine being able to get all the tools needed to stop your child’s anxiety and OCD through telehealth on your lunch break. It sounds too good to be true, but it’s a real, research-backed treatment that doesn’t interrupt your child’s schedule, make you the enforcer of exposures, or put you in the position of having to make your kid do something different. You simply change your behavior. Click here for more detailed info.
This approach is especially helpful when kids are resistant to therapy, burned out, or too overwhelmed to engage directly in treatment. It can also be powerful alongside ERP or I-CBT, helping parents align their responses with the goals of treatment.
SPACE is not about being strict or withholding support. It is about changing the environment around OCD so it no longer gets reinforced.
How These Approaches Work Together
These approaches are not mutually exclusive. Many families benefit from a thoughtful combination.
Some kids start with ERP. Others benefit from I-CBT first to loosen OCD’s grip on doubt. Some families begin with SPACE to reduce accommodations and create momentum at home.
Treatment is collaborative and tailored. The goal is not to follow a rigid protocol, but to use the right tools at the right time so OCD loses power and your child gains confidence.
What Progress Really Looks Like
OCD treatment is not about becoming fearless. It is about becoming flexible.
Progress might look like:
A child going to school even when anxiety shows up
A teen choosing not to ask for reassurance
A family dinner without rituals
A shorter meltdown instead of a long one
A kid saying “This is OCD” and doing the hard thing anyway
Setbacks happen. That does not mean treatment is failing. It means OCD is trying to regain ground. We plan for that and adjust as needed.
The goal is not perfection. The goal is freedom.
OCD often shows up alongside other challenges. Generalized anxiety, panic, depression, perfectionism, tics, and sensory sensitivities are common.
Some kids with OCD also struggle with self harm thoughts or intrusive thoughts about harm, even when they have no desire to act on them. These thoughts can be terrifying for kids and parents alike. They are also a very common part of OCD.
Part of my work is helping families understand the difference between intrusive thoughts and actual risk, and responding in ways that reduce fear rather than escalate it.
Treatment is tailored to the whole picture, not just a diagnosis on paper.
OCD, Anxiety, and Other Overlapping Concerns
If You Are Wondering Whether This Is the Right Fit
If your child has OCD, or you suspect they might, you deserve clear answers and effective support. You deserve a therapist who understands OCD deeply and treats it directly, not one who accidentally reinforces it.
You also deserve hope.
Kids and teens can and do get better with the right treatment. Their brains are flexible. Their capacity for bravery is often much bigger than they realize.
If you are ready to stop tiptoeing around OCD and start helping your child build a bigger, fuller life, therapy can be a powerful next step.
You do not have to figure this out on your own.
Common Questions and Worries Parents have about OCD Therapy
If you are feeling unsure, overwhelmed, or hesitant, you are not alone. Most parents arrive with a long list of questions and a quiet fear of making things worse. These are some of the concerns I hear most often.
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This is one of the most common worries, and it makes sense.
Exposure does not mean forcing a terrified child into their biggest fear. Good OCD treatment is flexible, paced, and responsive to where a child actually is.
If a child is not ready for traditional ERP, that does not mean therapy is off the table. In those cases, we may start with approaches like I-CBT or SPACE.
I-CBT helps kids understand how OCD creates false doubt before anxiety fully takes over. By strengthening their ability to recognize OCD thinking, many kids feel more grounded and less overwhelmed, which can make exposure work feel more doable later.
SPACE allows parents to make meaningful changes without requiring the child to participate directly. This is especially helpful for kids who are resistant, exhausted, or shut down. As accommodations decrease and confidence increases at home, OCD often loses intensity on its own.
Exposure is a powerful tool, but it is not the only door into treatment.
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Yes, and I say that gently and honestly.
OCD does not live only in the therapy room. Real progress happens when new skills are practiced in daily life, in small and manageable ways.
That does not mean homework packets or overwhelming assignments. It means thoughtful, realistic steps that fit into your family’s routine. Sometimes that looks like practicing an exposure. Sometimes it looks like changing how a question is answered. Sometimes it looks like doing less rather than more.
I work closely with families to make sure between session work feels supportive, not punitive or unrealistic. You will always understand the why behind what you are doing.
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I am not a general therapist who also treats OCD. OCD is a primary focus of my work.
That means I am trained specifically in evidence based approaches designed for OCD, including ERP, I-CBT, and SPACE. Sessions are structured with intention, not just supportive conversations that leave families unsure what to do next.
I work directly with the OCD cycle. We name it. We map it. And we make a plan to weaken it.
I also work closely with parents. I help you understand how OCD operates in real life and how small shifts in your responses can make a meaningful difference at home. You are not left guessing or trying to piece things together between sessions.
With kids, I meet them at their level and earn trust first. With teens, I respect autonomy and avoid power struggles. Therapy is collaborative, not something done to them.
Most importantly, I am honest. I will tell you what is likely to help, what may not, and what the process realistically looks like. OCD treatment works best when everyone understands the goal and the path forward.
Families often tell me that therapy finally makes sense and that they feel less alone and more confident in how to support their child.
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In most cases, yes. Parents are involved in the majority of sessions, especially for younger kids and tweens.
This is not because your child cannot do the work. It is because OCD treatment is more effective when parents understand what is happening and how to respond outside of session. When parents and therapist are aligned, kids make faster and more sustainable progress.
With teens, parent involvement often looks different. Teens usually have more individual time in session, with parents joining periodically to check in, adjust plans, or problem solve together. I am thoughtful about balancing a teen’s need for privacy with the reality that parents are still a key part of treatment.
If a child or teen strongly prefers not to have a parent present for part of the session, we talk about that. Therapy should feel safe and respectful, not forced.
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This is another very common concern.
Effective OCD treatment does involve facing discomfort, and that can mean anxiety increases temporarily before it decreases. That does not mean therapy is harming your child. It means the OCD cycle is being challenged.
We move at a pace that prioritizes safety, consent, and trust. Kids are supported in learning that anxiety can rise and fall without needing to be fixed immediately. Over time, confidence grows and anxiety takes up less space.
I monitor this closely and adjust as needed. Treatment is not about pushing through at all costs. It is about building resilience in a way that lasts.
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Many families come to me after trying therapy that was supportive but not OCD specific.
OCD requires targeted treatment. Without it, sessions can unintentionally turn into reassurance or coping skills that provide short term relief but do not change the cycle.
Trying again with an OCD specialized approach is not starting over. It is building on what you already know, with tools designed specifically for this problem.
When should we reach out for help?
You do not need to wait until OCD takes over your child’s life completely.
Many parents reach out when they notice that:
Rituals or avoidance are increasing
School, sleep, or friendships are being affected
Family life is starting to revolve around anxiety
Reassurance and accommodations keep growing
Your child feels stuck, frustrated, or exhausted
You are constantly second guessing how to respond
You also do not need to have a perfect diagnosis or use the “right” words. If something feels off, or if what you are doing is no longer working, that is enough reason to ask for support.
Early, targeted treatment can prevent OCD from becoming more entrenched and can make the path forward feel much more manageable for both you and your child.
Taking the Next Step
If you are reading this and recognizing your family, trust that instinct.
OCD is treatable. Kids and teens can learn to live full lives without anxiety running the show. With the right support, the right tools, and a thoughtful plan, things can shift in meaningful ways.
Reaching out does not mean you are committing to anything yet. It means starting a conversation, asking questions, and figuring out what support might look like for your child and your family.
You do not have to navigate OCD alone.
A Note About Taboo or Scary OCD Thoughts
One of the reasons families hesitate to reach out for help is fear.
OCD can involve thoughts that feel disturbing, confusing, or completely out of character for a child or teen. These might include intrusive thoughts about harm, sexuality, morality, religion, illness, or losing control. Parents often worry about what these thoughts mean, or whether saying them out loud could make things worse.
These thoughts are a common part of OCD.
Intrusive thoughts are not desires, intentions, or warning signs. They are unwanted mental noise that targets what a person cares about most. The more alarming the thought feels, the more OCD grabs onto it.
Many kids with OCD are deeply distressed by these thoughts and go to great lengths to neutralize them. They may avoid certain people or places, confess things they have not done, ask for reassurance, or mentally review situations to make sure they are “safe” or “good.” The fear is about the thought itself, not about acting on it.
I want parents to know this clearly: having intrusive thoughts does not mean your child wants to hurt anyone or themselves. It does not mean something is wrong with their values, character, or identity.
Talking about these thoughts in the right therapeutic context does not make them stronger. Avoiding them often does.
OCD thrives in secrecy and shame. Treatment brings these thoughts into the light in a careful, respectful way so they lose their power. Kids are often relieved to learn that what they are experiencing has a name, a pattern, and a path forward.
If your child is carrying thoughts they are afraid to say out loud, that is not a reason to avoid reaching out. It is often the strongest reason to do so.