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OCD and telehealth psychology in Sydney: ERP via video, what to expect, and how to find a psychologist

OCD is one of the most misunderstood mental health conditions — and one of the most treatable with the right approach. If you are living with OCD in Sydney and considering telehealth, this guide explains what OCD actually involves, how the gold-standard treatment (ERP) works, and whether telehealth is a good fit.

What is OCD?

Obsessive-compulsive disorder (OCD) is a condition characterised by two interlocking features: obsessions and compulsions.

Obsessions are recurrent, intrusive, unwanted thoughts, images, urges, or doubts that cause significant distress. They are unwanted — people with OCD typically find them distressing and ego-dystonic (inconsistent with their values, character, and how they see themselves). Common obsession themes include:

• Contamination (germs, disease, chemical contamination, bodily fluids)
• Harm (fear of harming others or oneself, either accidentally or deliberately)
• Intrusive sexual or violent images or thoughts
• Doubt about whether actions were completed correctly (Did I lock the door? Did I turn off the stove?)
• Symmetry, exactness, and "not just right" experiences (things not feeling in the right place, order, or arrangement)
• Religious or moral scrupulosity (fear of having sinned, blasphemous thoughts, moral failures)
• Relationship OCD (intrusive doubt about whether one loves a partner, or whether a partner is trustworthy)
• Existential obsessions (preoccupation with the nature of reality, consciousness, existence)

Compulsions are repetitive behaviours or mental acts performed in response to the distress caused by obsessions, with the goal of reducing anxiety or preventing a feared outcome. They are not performed for pleasure. Compulsions can be:

• Behavioural: handwashing, cleaning, checking (locks, appliances, doors), arranging or ordering objects, repeating actions, seeking reassurance from others
• Mental: reviewing events in the mind, mental counting or repeating, praying, substituting "good" thoughts for "bad" ones, mental arguments against the obsessive thought

The defining feature of OCD is the cycle: intrusion leads to distress, compulsion temporarily reduces distress, but the relief is brief and the intrusion returns — often more intensely, and more broadly triggered over time. The compulsion does not resolve the problem; it maintains it.

OCD is not just about cleaning and checking

The media image of OCD tends to focus on hand-washing and symmetry. These are real presentations, but OCD is far broader. Some presentations are particularly misunderstood:

"Pure O" (OCD without obvious compulsions)

"Pure O" refers to OCD presentations where the compulsions are primarily mental rather than visible behavioural acts. The person performs mental rituals (reviewing, reassuring themselves, mental argument, thought suppression) rather than physical rituals. This is still OCD; the compulsions are internal. "Pure O" is somewhat a misnomer — there are always compulsions; they are just not visible to an outside observer.

Harm OCD

Harm OCD involves intrusive thoughts, images, or urges related to harming oneself or others — for example, a parent having intrusive thoughts about harming their child, or a person having intrusive images of stabbing someone while holding a knife. These thoughts are deeply distressing precisely because they are inconsistent with the person's values and character. Having these thoughts does not mean a person is dangerous or likely to act on them. Harm OCD is not the same as genuine homicidal ideation; a psychologist experienced with OCD will understand this distinction.

Intrusive sexual thoughts

Intrusive sexual obsessions can involve thoughts or images about sexuality (including sexual orientation OCD — "HOCD" — intrusive doubt about one's sexual orientation, experienced as ego-dystonic by the person regardless of their actual orientation), or intrusive thoughts of a sexual nature about children or others. Again, the distress caused by these thoughts, and their ego-dystonic quality, are what characterise them as OCD rather than desire.

How is OCD treated? Exposure and Response Prevention (ERP)

Exposure and Response Prevention (ERP) is the gold-standard psychological treatment for OCD, with the most extensive evidence base of any psychological intervention for this condition. It is a form of CBT specifically adapted to the OCD cycle.

ERP works on the core mechanism of OCD: it breaks the cycle by exposing the person to the feared stimulus or thought (exposure) while deliberately refraining from the compulsion (response prevention). Over repeated practice, the anxiety that arises from the obsession diminishes as the nervous system learns that the feared outcome does not occur, and that anxiety can be tolerated without performing the compulsion.

How ERP is structured

1. Assessment and psychoeducation. The psychologist first conducts a thorough assessment of the obsessions and compulsions, their triggers, the distress they cause, and their impact on daily life. Psychoeducation about the OCD cycle — how compulsions maintain obsessions — is a core early element. Understanding this mechanism is often experienced as a significant relief by people who have been confused about why their symptoms have persisted despite their efforts to control them.
2. Building the exposure hierarchy. A list of feared situations, objects, thoughts, or triggering contexts is constructed collaboratively, ordered from lowest to highest distress. Exposures begin at a manageable level and progress upward as the person's ability to tolerate distress grows.
3. Exposure practice with response prevention. Exposures are conducted during sessions and practised between sessions. The person intentionally contacts the feared stimulus and then refrains from performing the compulsion. The discomfort that results is tolerated — not suppressed, but experienced and allowed to pass naturally. Over repetitions, the discomfort diminishes as habituation or inhibitory learning occurs.
4. Cognitive components. While ERP is primarily a behavioural treatment, cognitive components — including addressing overestimation of threat, inflated responsibility, and intolerance of uncertainty — are typically woven into the work.
5. Generalisation and relapse prevention. Later sessions focus on maintaining gains, applying ERP skills to new obsessions as they arise, and building a realistic plan for managing future episodes.

Can ERP for OCD be delivered via telehealth?

Yes — and for many OCD presentations, telehealth is not just a viable alternative to in-person treatment; it is a natural fit.

Most OCD-related distress is triggered in the person's own environment: their kitchen, bathroom, bedroom, car, or workplace. Contamination OCD may involve specific objects in the home. Checking compulsions often involve appliances, locks, or light switches at home. Harm OCD may be triggered by knives, scissors, or other common household items. When sessions occur via video in the person's home, the therapist has direct access to the actual environment where the obsessions and compulsions occur — which can be highly useful.

Research on telehealth-delivered ERP for OCD has found that outcomes are comparable to in-person ERP for a range of presentations. It is worth noting that some exposure tasks will require the person to be in a specific physical environment that neither they nor the therapist is in — for example, touching a public bathroom surface, or entering a specific location. For these, the therapist guides the preparation and debriefs afterwards, as they would with between-session exposure homework in any format.

Some presentations and some people will be better served by in-person ERP — particularly where very severe symptoms require more immediate support, or where intensive formats (such as daily sessions) are needed. A psychologist can advise you on what suits your situation.

Finding the right psychologist for OCD in Sydney

OCD is one of the presentations most frequently mismanaged in general mental health practice. Psychologists without specific ERP training sometimes use general CBT or supportive approaches that — while well-intentioned — can inadvertently maintain OCD (for example, by reassuring the person about their intrusive thoughts, which functions as a compulsion). When looking for a psychologist for OCD, it is worth being specific about the treatment approach.

Things to look for and ask:

• Do you use ERP for OCD, and is it the primary approach? ERP is the evidence-based treatment. Some psychologists use CBT but not ERP specifically; this distinction matters.
• What does treatment typically involve session to session? A psychologist experienced with OCD should be able to explain the exposure hierarchy, response prevention, and what the homework between sessions looks like.
• Have you worked with [the specific presentation]? OCD varies considerably in form. If you have harm OCD, sexual obsessions, or "Pure O," asking about specific experience with those presentations is reasonable.
• AHPRA registration. Any practitioner calling themselves a "psychologist" must be registered. Verify at ahpra.gov.au.

You can browse our directory of telehealth psychologists for OCD and anxiety in Sydney to find practitioners with relevant experience who offer telehealth across NSW.

Medicare and the cost of OCD psychology in Sydney

To access the Medicare rebate for psychology, you need a Mental Health Treatment Plan (MHTP) from a GP or psychiatrist. This provides access to up to 10 rebated sessions per calendar year. The Medicare rebate is $98.95 per session for a registered psychologist, or $145.25 for a clinical psychologist, from 1 July 2025.

Telehealth sessions attract the same rebate as in-person sessions. See our full guide to psychology costs and Medicare rebates and our guide to getting a Mental Health Treatment Plan.

OCD can sometimes require more than 10 sessions per year for a meaningful course of ERP, particularly for moderate-to-severe presentations. It is worth discussing with your GP or psychologist whether a new MHTP can be issued in the next calendar year, or whether other funding options are available.

Frequently asked questions