What To Expect In Your First OCD Therapy Session
- azraalic
- Sep 10
- 3 min read
Updated: Sep 15
Starting OCD Therapy: What to Expect
Beginning therapy for OCD can feel like a big step. You might be nervous, wondering what you’ll say or if your therapist will really understand. That’s completely normal. Many people feel the same way before their first session.
Here’s the good news: the first appointment isn’t about fixing everything all at once. It’s about starting to share your story, being heard, and laying the groundwork for change. Just showing up is already a huge step toward feeling better.
What is ERP Therapy?
The main type of therapy for OCD is called Exposure and Response Prevention (ERP). In simple terms, ERP helps you face the thoughts, situations, or feelings that usually set off your OCD and teaches you how to respond differently.
Instead of giving in to the urge to repeat a behavior, check something, or avoid what scares you, ERP helps you sit with the discomfort in a safe and gradual way. Over time, your brain learns that you don’t need rituals to feel okay.
Think of it as re-training your brain:
First, you and your therapist identify your triggers.
You rank them from least stressful to most stressful.
You start small, practicing with the easier triggers.
Step by step, you build confidence and resilience.
ERP is done gently and collaboratively. You’re never pushed into anything extreme. Together, you and your therapist create a plan that matches your needs, whether you’re navigating intrusive thoughts after having a baby, struggling with contamination fears, or stuck in checking rituals that take over your day.
Your First Therapy Session
Your first session is mostly about talking and getting to know each other. You’ll have a chance to explain what’s been going on, how long it’s been happening, and how OCD shows up in your daily life.
Your therapist may ask questions like:
When did your symptoms begin?
What feels hardest to manage?
Do certain times of day or situations make things worse?
What do you try to avoid because of OCD?
This isn’t about judgment. It’s about creating a clear picture of what you’re dealing with so you and your therapist can make a plan together.
You might also get a gentle introduction to ERP, what it is, and what it will look like once you’re ready to begin. But you won’t be asked to do any exposures right away. This session is about comfort, connection, and building trust.
Setting Goals Together
After sharing your story, you and your therapist will start thinking about goals. Maybe it’s wanting to get through the morning without repeating tasks, or reducing urges to check or clean. Over time, goals can grow as you make progress.
The early steps often include:
Learning to notice triggers without reacting automatically.
Practicing response prevention on small things first.
Building tolerance for discomfort gradually.
Reminding yourself that ups and downs are part of the process.
Progress isn’t always a straight line, but each step forward matters.
How to Get Ready for Your First Session
You don’t need to prepare perfectly, but here are a few simple things that can help:
Write down what’s been bothering you most. It’s easier to explain with notes.
Think about what you’d like from therapy. Even “I just want to feel better” is enough.
Bring your questions. Wondering how ERP feels? Nervous about exposures? Ask.
Share past experiences. If therapy hasn’t worked before, say why.
Arrive a few minutes early. Give yourself time to breathe before you begin.
The most important thing? Be honest. If you’re scared, say so. If you’re unsure if something is OCD-related or not, bring it up. A strong working relationship with your therapist starts with open dialogue and trust.
You’ve Already Begun
Your first OCD therapy session doesn’t have to be perfect. You might feel nervous, stumble over words, or cry. That’s completely okay. What matters is that you showed up, and that’s the very first step toward change.
With ERP, you don’t face OCD all at once. You face it slowly, with guidance and support, until your brain learns new patterns. Week by week, you’ll find that things that once felt impossible start to feel manageable.
Reaching out for help is powerful. It means you’re ready to stop letting OCD run the show. You’re ready to try something different. And that’s all you need to get started.
If you’re struggling with intrusive thoughts, anxiety, or repetitive behaviors, you don’t have to face it alone. At Azra A. Kim, LCSW, LMSW, we specialize in ERP therapy for OCD, including intrusive thoughts, contamination fears, and checking rituals. Together, we can take things one step at a time toward a calmer, more hopeful future.
