No way! When using exposure-based approaches, we make them graded, meaning they are broken down into manageable steps rather than jumping straight in at the deep end. Together, we create a treatment plan based on a collaborative understanding of your difficulties, and any exposure work is tailored to your own goals and pace.

The aim is not to overwhelm you or force you into situations you are not ready for. Instead, therapy helps you gradually build confidence in facing fears, learning that anxiety is uncomfortable but manageable, and that you can cope without relying on avoidance, checking, reassurance-seeking, or other safety behaviours.

Your treatment plan will be guided by what is important to you and what you would like to be able to do differently in your life—not by what someone else thinks you "should" be able to do.

It can feel really daunting to face your fears or let go of old habits that have helped you feel safe, sometimes for years. As a therapist, I understand this and have a great deal of compassion for how difficult change can feel. It's completely normal to feel nervous about starting therapy, to have questions about the process, or to worry about what might happen if you stop relying on familiar coping strategies.

Some people do experience temporary increases in anxiety when we begin talking about difficult topics or start breaking old patterns. However, therapy should not feel like being thrown in at the deep end.

All behaviour change work is approached as a series of collaborative "controlled experiments". We first take time to develop an understanding of what is keeping the problem going and make sure you have strategies to manage whatever shows up. Together, we then design experiments where you can gradually begin to test out new ways of responding, always with your informed agreement and at a pace that feels manageable.

The goal is not to make you distressed. The goal is to help you build confidence in your ability to cope, so that anxiety and OCD have less influence over your life.

OCD obsessions and intrusive thoughts are typically ego-dystonic, meaning they are inconsistent with your values, beliefs, and sense of who you are. One of the first things we often do in therapy is provide psychoeducation about intrusive thoughts and help normalise experiences that can feel frightening or shameful, including thoughts related to harm, sex, relationships, morality, religion, and other sensitive themes.

As a therapist, I am very familiar with clients asking this question, and the answer is the same regardless of the content of the intrusive thought: thoughts are not actions, intentions, or desires. There is an important difference between having a thought and wanting to act on it.

In fact, thought-action fusion—the belief that having a thought makes it more likely to happen, or is morally equivalent to carrying it out—is one of the most common thinking errors seen in OCD. Therapy can help you learn to relate differently to intrusive thoughts, reducing their impact and helping you break free from the cycle of fear, checking, avoidance, reassurance-seeking, and rumination.

You can read more about types of OCD and thought-action fusion here.

Depression is a word that people don't always connect with. Sometimes low mood resonates better. For people who feel numb, lethargic, disconnected, or stressed out to the point of immobility, shut down can feel like a much better descriptor.

Depression doesn't always look like crying, feeling miserable, or being unable to get out of bed. For some people it shows up as feeling emotionally flat, struggling to enjoy things, feeling disconnected from other people, or finding that everything feels like hard work.

Labels are helpful for some people and less helpful for others. Diagnostic labels can be useful when we're trying to communicate about a pattern of difficulties, particularly when those difficulties have become chronic. At the same time, human beings are dynamic, and we can move in and out of different states throughout our lives. There may be periods where a label fits well, and others where it doesn't fit so neatly.

The main thing is that we develop a clear understanding of what is driving the difficulties you are experiencing. Whether you call it depression, low mood, burnout, shut down, or something else entirely, what matters is identifying the processes that are keeping you stuck so that we can target the right things and help you move forward.

Many people come to therapy feeling stuck in this way. It can be frustrating to know what might help, but still find yourself unable to get started or follow through.

There can be lots of reasons for this. Sometimes anxiety gets in the way and leads to avoidance. Sometimes low mood leaves you feeling exhausted, disconnected, or hopeless. For neurodivergent people, executive dysfunction can also make it difficult to initiate tasks, organise activities, or maintain routines, even when the intention is there.

This is not unusual, and whatever the obstacle is (hello executive dysfunction!), we can usually work together to creatively troubleshoot the problem and find ways to help you engage with treatment. If anxious avoidance is part of the picture, we will formulate this together and work on it directly. If the problem is low energy and feeling disconnected from life, we can explore your personal values and identify small, meaningful steps that feel achievable rather than overwhelming.

Therapy is not about expecting you to suddenly become motivated. It's about understanding what is getting in the way and finding a path forward that works for you.

Anxiety is a normal human emotion, and we need it to survive (sorry!). That being said, anxiety can absolutely become excessive or start taking up more space in your life than you'd like it to.

This can show up in lots of different ways, for example:

• Worrying to the point of becoming preoccupied by what's on your mind (this can sometimes look like being extra prepared for things)

• Having strong physical symptoms that lead you to avoid situations that might trigger them

• Becoming overly concerned by changes in your body and repeatedly checking symptoms or Googling for answers

• Feeling a strong need to seek reassurance from other people or repeatedly sense-check your opinions, decisions, or memories

• Finding yourself stuck in cycles of overthinking, second-guessing, or mentally replaying situations

If you find that anxiety is taking up a lot of your time and energy, or that your thoughts seem to run on a loop in ways that interfere with how you want to live your life, there's a good chance that therapy could be helpful.