If you're considering therapy for OCD or similar difficulties, the assessment session is where we start to make sense of your specific patterns and build a plan that fits your situation.

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It's important that this isn't just a tick-box exercise. It's a detailed conversation about your OCD, your life, and what treatment might look like for you specifically. Here's what we'll cover, typically in a 60-minute session.

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You can read more about my general assessment approach here and how I work with OCD here.

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Understanding Your OCD Patterns

 

We'll start by discussing the specific obsessions and compulsions that are affecting your life right now.

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Obsessions: What intrusive thoughts, images, doubts, or fears are dominating your mind? Contamination fears, harm thoughts, relationship doubts, existential concerns, or something else entirely?

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Compulsions: What do you do to try to manage these obsessions? This might be visible behaviours like checking, washing, or arranging. It might be mental compulsions like rumination, mental reviewing, or trying to replace "bad" thoughts with "good" ones. It might be avoidance, reassurance seeking, or Googling.

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Impact: How is OCD affecting your daily life? Your relationships, your work, your ability to do things you value? Understanding the real-world impact helps us prioritise what to tackle first and incorporate treatment with getting you back up and running.

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Understanding Your Context

 

OCD doesn't exist in a vacuum. We'll discuss the broader context of your life, past and present.

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Relationships: Who's in your life? How are your relationships affected by OCD? What impact might other people have on your OCD, for better and for worse?

 

Work and responsibilities: What are your current stressors? How is OCD interfering with work or studies?

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Activities and values: What have you stopped doing because of OCD? What matters to you that OCD is preventing?

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Recent life events: Has anything changed recently? New job, relationship changes, loss, illness? OCD patterns love to seduce us during times of stress!

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Exploring Your History

 

Understanding where your OCD came from helps us work out what's maintaining it now.

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Early relationships: What was your relationship like with parents or caregivers? Were emotions allowed? Was there criticism, high standards, or unpredictability?

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Significant life events: Were there traumas, losses, illnesses, or other experiences that shaped how you see the world?

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Key OCD traits: Do you have patterns of magical thinking (believing your thoughts can cause events)? Inflated sense of responsibility (feeling it's your job to prevent all harm)? Intolerance of uncertainty (needing to be absolutely sure)? Perfectionism? These underlying beliefs often fuel OCD.

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When it started: When did OCD first show up? What was happening in your life at that time?

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Understanding Your Strengths and Skills​

 

Assessment isn't just about problems. We'll also discuss what's already working.

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Past therapies: Have you tried therapy before? What helped? What didn't? This tells us what to build on and what to avoid repeating.

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Current strategies: What do you already do that helps, even a little? These are strengths we can develop further.

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Support system: Who supports you? What resources do you have?

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Resilience: How have you coped with difficulties in the past? What are your existing strengths?​

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Clarifying Your Goals

 

We'll discuss what you're hoping to achieve through therapy.

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Values based goals: Rather than just "stop having intrusive thoughts" (which isn't always realistic or helpful), we'll explore what you want to be able to do. What kind of life do you want to live? What activities, relationships, or experiences do you want to reclaim from OCD?

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For example:

• "I want to be able to leave the house without checking multiple x"

• "I want to spend time with my children without constant fear"

• "I want to go to work without needing reassurance from my partner"

• "I want to sleep without rituals dominating my evening"

 

 

My Formulation: Making Sense of Your OCD

 

At the end of our assessment (which may take one or occasionally two sessions for complex presentations), I'll share my understanding of what's happening for you. This includes:

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What your OCD looks like: The specific patterns, themes, and mechanisms which might be keeping it going.

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What's maintaining it: The compulsions, avoidance, and underlying beliefs that inadvertently feed the cycle.

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Where therapy might help: Specific recommendations about which treatment approaches would be most helpful for your situation.

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I'll explain this verbally during the session, and I can provide a written summary if that's helpful.

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Read examples of various OCD formulations here

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What Happens After Assessment

After an assessment, you'll have:

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Clarity: A clearer understanding of your OCD patterns and what's maintaining them.

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Options: Specific recommendations about treatment approaches that fit your situation.

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No pressure: There's no obligation to continue therapy with me. The assessment stands alone as valuable information about what you're dealing with.

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A decision to make: You can decide whether the approach I've suggested makes sense for you, whether now is the right time, and whether we feel like a good fit.

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Some people book in for ongoing therapy immediately. Others take time to think about it. Others decide to try the recommendations independently first. All of these are completely fine.

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