Beyond Symptom Management: How ISTDP Helps with OCD

For many people with OCD, the symptoms are exhausting. You know your thoughts aren’t rational. You’ve tried to stop the compulsions.

You may have done thought-challenging, exposure work, even breathing exercises. And for a while, they may have helped.

But the thoughts still return. The rituals persist. The anxiety doesn’t let up.

This doesn’t mean you’ve failed. It likely means the root cause hasn’t yet been reached.

That’s where Intensive Short-Term Dynamic Psychotherapy (ISTDP) offers something different. Not just symptom management, but a deeper understanding of why the cycle keeps going, and how to finally break free.

What Is OCD, Really?

OCD (Obsessive-Compulsive Disorder) is more than being neat or needing things arranged a certain way. It’s a condition where intrusive thoughts, obsessions, trigger intense anxiety, and compulsive behaviours develop in an attempt to relieve that anxiety or prevent imagined harm.

From an ISTDP perspective, these symptoms are not just irrational habits. They’re unconscious defensive strategies, ways the mind protects you from experiencing deeper emotional conflicts that may have once felt overwhelming or dangerous.

The obsessive thoughts and compulsions often serve as a distraction or a substitute for feelings that couldn’t be safely felt, such as anger, guilt, grief, or longing, often connected to early attachment experiences.

Why Traditional OCD Therapy Doesn’t Always Work

Therapies like CBT or ERP (Exposure and Response Prevention) tend to focus on reducing symptoms through behavioural exposure or cognitive restructuring. These approaches can be helpful, and for some people they bring meaningful relief.

However, for others, the improvement doesn’t last, or the symptoms resurface in new forms. That’s often because the underlying emotional conflicts driving the symptoms haven’t been addressed.

In ISTDP, we understand that many of the compulsions and obsessions are not just patterns of behaviour, but part of a larger internal system designed to keep painful emotions out of conscious awareness.

If someone grew up in an environment where certain feelings, especially anger, sadness, or desire, were met with rejection, punishment, or neglect, the mind may have developed elaborate ways of avoiding those feelings. OCD can be one such system.

How ISTDP Approaches OCD Differently

Rather than focusing solely on resisting compulsions or challenging thoughts, ISTDP works to identify and resolve the unconscious emotional processes that create and sustain the symptoms.

In this approach, we look very closely at the moment-to-moment signals in your thoughts, body, and anxiety responses. We explore how defences such as mental rituals, overthinking, doubting, and compulsions function to block access to painful emotional material.

An essential part of the work involves learning to recognise how your nervous system is discharging anxiety, through muscle tension, mental agitation, or physical symptoms and helping you build the capacity to stay with difficult emotions without needing to avoid or suppress them.

Over time, this allows the unconscious system that’s producing the symptoms to reorganise, making the compulsions less necessary.

Two Examples of How This Can Work

One woman came to therapy after years of struggling with obsessive fears and repetitive checking. Previous therapy had helped her resist the rituals, but the anxiety always returned.

Through ISTDP, it became clear that her compulsions were protecting her from rage and grief linked to early experiences in her family. As she gradually accessed and worked through those buried emotions, her anxiety dropped, and the compulsions began to ease, not through willpower, but through resolution.

Another man who had spent most of his adult life managing contamination fears and ritualised handwashing discovered in therapy that his compulsions gave him a false sense of control in the face of unresolved emotional pain.

He had grown up with a neglectful and emotionally unpredictable parent, and hadn’t been able to express his anger or sadness safely. Once he was able to access and process these feelings directly in therapy, his anxiety reduced, and the compulsive behaviours began to lose their grip.

These were not changes that came from learning new techniques or strategies. They were the result of helping the person face and feel emotions they had previously been unable to tolerate.

Why OCD Can Be So Persistent

OCD is often misunderstood as irrational or random, but it usually serves a protective function.

It may distract from painful emotional truths, shield against guilt or shame, or create a false sense of control in situations where the person once felt helpless.

As long as the underlying conflicts remain unconscious, the compulsions tend to persist, regardless of how much effort is put into resisting them.

ISTDP helps bring this hidden emotional reality into focus. The goal is not to overwhelm the person or pathologise their defences, but to build the internal strength and capacity to experience what was once too much.

As the emotional conflicts are resolved, the internal system can reorganise itself and the symptoms often lose their purpose.

You’re Not Alone And There Is a Way Through

If you’ve been living with OCD and feel like nothing has worked, it doesn’t mean you’ve done anything wrong.

It may simply mean that therapy hasn’t yet reached the root.

ISTDP offers a focused and compassionate way forward,

helping you feel what couldn’t be felt in the past, so your mind no longer needs to protect you in ways that keep you stuck.

If you’re ready to try a different kind of therapy for OCD, you can learn more about how I work here, or get in touch here.

I offer online therapy across the UK and Europe, as well as in-person sessions in Nottingham.