Perinatal OCD therapy in Leeds and online

What is perinatal OCD?

Perinatal OCD is obsessive-compulsive disorder that develops or becomes more difficult during pregnancy or after having a baby. When it begins after birth, it may also be described as postnatal or postpartum OCD. Some people experience OCD for the first time during this period. Others have had OCD before, but find that pregnancy, birth or the responsibility of caring for a baby gives it new themes. Although it is most often discussed in relation to mothers, fathers and other new parents can experience obsessional fears about a baby too.

Obsessions are recurring, unwanted thoughts, images, urges or doubts that cause distress. Compulsions are the visible or mental actions used to reduce that distress, obtain certainty or prevent a feared outcome.

Compulsions do not always look like repeated handwashing or checking. They can include avoidance, asking for reassurance, searching online, confessing thoughts, replaying events, checking memories or feelings, praying, counting, replacing a “bad” thought with a “good” one, or trying to work out exactly what a thought means.

Intrusive thoughts themselves are very common. Research suggests that thoughts of accidental harm to a baby are experienced by almost all new mothers, while unwanted thoughts of deliberately causing harm have been reported by nearly half. The presence of a thought is not what determines whether somebody has OCD. The difficulty lies in the meaning attached to it, the distress it creates and the things a person feels driven to do in response.

What can perinatal OCD look like?

OCD can attach itself to almost anything that matters to you. During pregnancy or early parenthood, this often includes responsibility for keeping a baby safe.

You may experience:

• intrusive thoughts, images or urges about deliberately or accidentally harming your baby

• unwanted sexual thoughts or images involving your baby

• fears that you may lose control, act on a thought or discover that the thought says something terrible about you

• worries about contamination, infection, food, medication or passing an illness to your baby

• feeling that your baby could somehow be “polluted” by contact with a particular person, even when the fear is not about dirt or germs

• repeated doubts about feeding, sleeping, health, pregnancy symptoms or medical decisions

• excessive checking of your baby’s breathing, temperature, body or surroundings

• washing or sterilising far beyond ordinary health guidance

• repeatedly researching risks or seeking reassurance from professionals, family or online sources

• avoiding knives, stairs, bathing, changing nappies, preparing food, being alone with your baby or other everyday situations

• mentally reviewing what happened to make sure you did not cause harm

• needing things to feel “just right”, symmetrical, complete or in a particular order

• religious, moral or responsibility-based fears and mental rituals.

The theme can also change. Once one worry feels resolved, OCD may produce another question and ask you to solve that instead.

Why can the thoughts feel so shameful?

OCD tends to target what is most important to you. A person who cares deeply about protecting their baby may therefore be especially distressed by a thought that appears to suggest the opposite.

Many people worry that a therapist will be shocked, judge them or misunderstand what they are saying. Some fear that simply disclosing an intrusive thought will lead professionals to think that their baby is unsafe. This fear can keep people silent and very isolated.

Shame is a powerful social threat emotion. It can make the possibility of being judged, rejected or excluded feel dangerous before anybody has even responded. We can work compassionately with shame and self-criticism while still talking clearly and directly about the OCD.

I am used to talking openly about intrusive thoughts, including thoughts involving deliberate harm, sexual harm, religion, contamination and other themes that people may find difficult to say aloud. My role is to understand the thought in its full context, not react to how shocking its content sounds.

In OCD, these thoughts are usually unwanted, frightening and inconsistent with the person’s intentions and values. This is different from wanting or intending to act on a thought, and it is also different from experiencing psychosis. A careful assessment matters, and I will ask direct but respectful questions so that we can understand what is happening without making assumptions.

Assessment also considers the practical effect of OCD. For example, excessive washing may harm your skin, contamination fears may affect eating or drinking, and avoidance may interfere with ordinary care, closeness or family life. Looking at these unintended consequences helps us address the whole problem, not just the content of a thought.

Understanding the OCD cycle

An intrusive thought may be followed by a frightening interpretation: “What if this means I am dangerous?”, “What if I do not check and something happens?” or “What if ignoring the thought means I agree with it?”

This creates anxiety, disgust, guilt or shame. A compulsion then brings brief relief: you check, wash, avoid, analyse, pray, search or ask for reassurance. Unfortunately, that relief teaches the brain that the thought was important and that the ritual protected you. The next doubt therefore feels even harder to leave unanswered.

OCD asks for complete certainty. Pregnancy and parenting cannot provide it. Therapy helps you step out of the repeated search for certainty and become more able to make reasonable decisions while doubt is present.

Why challenging the thought is often not enough

People with OCD often already understand that their fear is unlikely or irrational. Trying to debate every thought can turn into another form of rumination, while repeatedly reassuring yourself that everything is safe can strengthen the need for further reassurance.

Relaxation can be useful in wider life, but it can also become a safety behaviour if it is used each time to cancel a thought or make an exposure feel safe.

We will still consider beliefs, interpretations and thinking patterns. The main change, however, comes from learning to respond differently when the thought, feeling or doubt appears.

CBT with exposure and response prevention

CBT with exposure and response prevention, usually shortened to ERP, is the psychological treatment recommended by NICE for OCD.

Exposure means gradually approaching a situation, thought, image, feeling or uncertainty that OCD has taught you to fear. Response prevention means choosing not to carry out the compulsion, avoidance or safety behaviour that would usually follow.

ERP may sound frightening, but it should be planned, collaborative and manageable. I will not expect you to begin with your hardest fear, and exposures are not introduced as surprises. A simple hierarchy can help us choose a manageable starting point, but it is not a rigid ladder and is not always necessary. Each behavioural experiment is linked to your individual understanding of the problem, and what you learn helps us decide the next step.

ERP never involves putting you or your baby at genuine risk. It does not mean ignoring medical advice, safe-sleep guidance, ordinary hygiene or reasonable infant care. Using relevant professional guidance where needed, we agree what appropriate care looks like and then identify the additional checking, cleaning, avoidance or rules that OCD has added.

Depending on your individual formulation, therapy might involve:

• completing ordinary baby care without reviewing it repeatedly afterwards

• leaving a room after one reasonable safety check instead of returning again and again

• allowing an intrusive thought to be present while continuing with what you were doing

• delaying or dropping reassurance seeking, online research or mental checking

• practising contact with a feared word, image or situation without neutralising it

• asking a partner not to answer the same reassurance question repeatedly.

We can practise exposures together during face-to-face or video sessions. Between sessions, you will know clearly what you are working on and why. After appointments, I share practical resources, examples and agreed exercises so that you are not left trying to remember everything on your own.

Imaginal exposure

Some OCD fears cannot, and should not, be recreated in real life. In these situations, imaginal exposure can be very effective.

This may involve developing a carefully agreed written or recorded narrative that brings you into contact with a feared possibility or uncertainty. You then practise reading or listening to it without analysing, reassuring yourself or carrying out another mental ritual.

Imaginal exposure is not about persuading you that the worst outcome will happen, making an unacceptable event seem acceptable or overwhelming you. It is a structured way to help your mind learn that a frightening thought can be present without needing to be solved or neutralised.

I am comfortable using imaginal exposure when it is clinically appropriate and will prepare for it with you carefully.

What if ERP feels too difficult?

Finding ERP difficult does not mean that you are failing therapy. It usually tells us that there is something important we need to understand.

For example, you may believe that not responding to a thought means agreeing with it, that feeling anxious is itself dangerous, or that you must do everything possible to prevent even a very unlikely harm. You may also be exhausted, low in mood, frightened of being judged or placing all responsibility for safety on yourself.

Alongside ERP, therapy may therefore include:

• clear psychoeducation about intrusive thoughts, anxiety and the body’s threat response

• an individual formulation of what keeps your OCD going

• Theory A and Theory B work to examine what problem really needs to be solved

• behavioural experiments to test predictions and learn from experience

• work on inflated responsibility, including a responsibility pie chart where helpful

• compassion-focused work with shame, self-criticism and feelings of being a “bad” parent

• mindfulness, defusion and attention-training skills to notice thoughts and return to the present

• support with motivation, mood and making between-session work realistic.

These approaches support ERP rather than replacing it. Mindfulness, for example, is used to help you notice a thought without becoming absorbed in it, not to make the thought disappear or prove that you are safe.

In Theory A and Theory B work, Theory A sets out the danger that OCD says must be prevented—for example, “I might harm my baby”—while Theory B asks whether the main problem is fear, preoccupation and loss of confidence. We compare the evidence, what each theory asks you to do and what may happen if you continue living by it. This can make the purpose of ERP much clearer before you begin an experiment.

When safety has taken over almost every parenting decision, an “ideal parent” pie chart can also be helpful. Keeping a baby safe matters, but so do warmth, play, connection, flexibility and helping a child gradually become independent. The exercise helps us make room for the kind of parent you want to be, rather than allowing OCD to define good parenting as preventing every possible risk.

Involving partners or family

OCD often draws other people into its rules. This is sometimes called family accommodation.

Your partner may check the hob for you, repeatedly confirm that you have not harmed the baby, take over a task you now avoid, answer the same question in different ways or follow cleaning rules to prevent distress. This support is understandable and usually comes from care, but it can unintentionally keep OCD going.

With your agreement, a joint appointment can help a partner or family member understand the OCD cycle and learn how to support your progress without becoming part of a compulsion. The aim is not simply to tell your partner to stop reassuring you, and it is not for somebody else to police your behaviour. We agree what encouragement and practical support will look like while helping you reduce reassurance seeking. We can also protect some family time and conversation from being taken over by OCD.

Therapy that fits around pregnancy and a new baby

There is no single correct way to complete CBT. Some people like monitoring forms, written formulations and detailed worksheets. For somebody who is sleep-deprived or caring for a new baby, that amount of paperwork may feel impossible.

We will use what is genuinely helpful. Between-session exercises can be built into situations that already occur during the day, and written work can be kept as simple as it needs to be. In online appointments, I can share examples, diagrams and resources on screen as we work. Progress comes from practising a different response, not from completing perfect worksheets.

Most ERP can be completed successfully in the clinic or online. For clients in or near Leeds, an occasional home-based session may sometimes be agreed where it is clinically useful and practical, although this is not usually necessary.

Later in therapy, we can prepare a relapse-prevention plan for times when OCD may find new material, such as sleep disruption, changes in your baby’s development or a future pregnancy.

A practical Theory A and Theory B worksheet

I have created a simple worksheet that helps you place the two explanations side by side: what OCD says the problem is, and what the wiser part of you thinks may really be happening.

The prompts help you consider the evidence for each theory, what you would need to do if it were true and what the longer-term consequences might be if you continued living your life according to it. We may use the worksheet in therapy to clarify a behavioural experiment, and you can also download it here as a starting point.

Download the Theory A and Theory B worksheet

My experience of working with OCD

I am a BABCP-accredited Cognitive Behavioural Psychotherapist and an EMDR therapist, with over nineteen years of experience in mental health and fourteen years since qualifying in CBT.

I spent around ten years working in NHS IAPT, now called NHS Talking Therapies. During this time, I developed substantial experience in assessing and treating OCD alongside other common mental health difficulties.

Since 2022, I have worked in a specialist NHS perinatal mental health service in Leeds. Perinatal OCD, intrusive thoughts, anxiety, shame and the wider transition to parenthood form an important part of my clinical work. I have also completed specialist training in Cognitive Behavioural Therapy for Perinatal OCD with the Oxford Cognitive Therapy Centre.

Although I am trained in EMDR, CBT with ERP is the main treatment I offer for OCD because it has the more established evidence base and is the psychological treatment recommended for this difficulty. I would not routinely replace ERP with EMDR. In selected cases, where a traumatic memory or a vivid catastrophic image is clearly maintaining the problem or making ERP difficult to engage with, we may consider carefully formulated EMDR-informed work alongside the OCD treatment. If OCD occurs alongside birth trauma, depression or another problem, we can consider the full picture and agree which difficulty needs attention first.

I have a particular interest in this area of therapy. I value helping people speak about thoughts they may have kept secret, understand why OCD has become so convincing and begin doing ordinary things again without being governed by its rules.

Perinatal OCD therapy appointments

I offer:

• face-to-face appointments in Chapel Allerton, Leeds

• online therapy across the UK

• therapy in English or Polish

• appointments for self-funding and eligible Bupa pr pther insurance clients.

The first 50-minute appointment is an assessment and treatment-planning session. We will discuss the thoughts or situations troubling you, the responses that follow, how the problem affects your life and what you would like to change.

You do not need to disclose every detail in your first message or arrive knowing whether the problem is definitely OCD. You can simply say that you are experiencing intrusive thoughts or repeated checking, reassurance, avoidance or rituals. We can begin there.

Further appointments are arranged if we both agree that I am the right therapist for you. Sessions usually take place weekly or fortnightly.