ERP (Exposure and Response Prevention) Therapy for Neurodivergent Women in Portland and Washington
Finding Freedom from OCD Through Evidence-Based Treatment Designed for Your Neurodivergent Brain
If you're a neurodivergent woman struggling with OCD, you've likely noticed how your autism or ADHD brain processes obsessive thoughts differently than what traditional therapy models describe. Maybe you've spent years masking your compulsions, turning them inward, or intellectualizing them to the point where even therapists missed what was happening. I understand this experience because I work exclusively with late-diagnosed and self-identified autistic women who are ready to address their OCD through a neurodivergent-affirming lens.
Understanding ERP Through a Neurodivergent Perspective
Exposure and Response Prevention (ERP) remains the gold standard treatment for OCD, but implementing it effectively requires understanding how neurodivergent minds work. In my online practice serving Oregon and Washington state, I've adapted traditional ERP approaches to honor the unique ways autistic and ADHD brains process information, manage sensory experiences, and navigate the world.
Traditional ERP often assumes neurotypical processing styles and coping mechanisms. When working with neurodivergent clients, I recognize that what looks like avoidance might actually be sensory overwhelm, what appears as resistance could be a need for clearer structure, and what seems like overthinking might be your brain's natural tendency toward pattern recognition and detail-oriented processing.
Why Neurodivergent Women Need Specialized OCD Treatment
Many of my clients come to me after years of therapy that didn't quite click. They've been told they're "too analytical" for ERP or that their need for detailed explanations means they're avoiding the work. What these well-meaning providers missed was how autism and ADHD fundamentally change how we experience and process OCD.
For autistic women especially, OCD often intertwines with:
Masking and camouflaging behaviors that hide compulsions from others
Sensory sensitivities that complicate exposure exercises
Executive function differences that affect how we plan and implement response prevention
Pattern-seeking tendencies that can fuel obsessive thinking
Need for predictability that OCD exploits through false promises of control
When you add ADHD to the mix, we also navigate impulsivity that can trigger compulsions, attention regulation that affects mindfulness practices, and emotional dysregulation that intensifies the OCD cycle.
My Approach to ERP: Honoring Your Neurotype While Challenging OCD
In my practice, I've developed an approach to ERP that respects your neurodivergent brain while effectively treating OCD. This means creating exposure hierarchies that account for sensory needs, building response prevention strategies that work with your executive function profile, and using your natural strengths—like pattern recognition and systematic thinking—as tools for recovery.
Building Your Personalized Exposure Hierarchy
Creating an exposure hierarchy with neurodivergent clients requires nuance. I help you distinguish between autism-related needs for routine and OCD-driven compulsions, between sensory accommodations that support you and avoidance behaviors that maintain OCD. Together, we develop a hierarchy that challenges OCD while respecting your neurological needs.
For instance, if you have contamination OCD alongside sensory sensitivities to certain textures, we'll carefully design exposures that target the OCD fear without overwhelming your sensory system. This might mean starting with visual or imaginal exposures before moving to physical ones, or finding creative ways to gradually increase tolerance while maintaining sensory supports in other areas of your life.
Integrating Special Interests and Strengths
Your special interests and neurodivergent strengths aren't obstacles to ERP—they're resources. I help you harness hyperfocus for exposure practice, use special interests as motivators for recovery, and leverage your detail-oriented thinking to track progress and identify patterns in your OCD.
Response Prevention Strategies That Work With Your Brain
Response prevention looks different for neurodivergent folks. While neurotypical clients are told to "sit with discomfort," you might need strategies that engage your systematic thinking or provide sensory input. I help you develop response prevention techniques that could include:
Structured alternatives to compulsions that are neurodivergent-affirming
Sensory tools that provide regulation without becoming compulsive behaviors
Cognitive strategies that leverage your analytical strengths without turning into mental compulsions
Time-based frameworks that work with ADHD time blindness while preventing excessive checking or repeating
Navigating Common Challenges in Neurodivergent ERP
When Autism Traits and OCD Symptoms Overlap
One of the most complex aspects of treating OCD in autistic individuals involves differentiating between autism-related behaviors and OCD compulsions. Repetitive behaviors, need for sameness, and ritualized routines can stem from autism, OCD, or both. In our work together, I help you identify which behaviors serve a regulatory function for your autism and which are driven by OCD-related fear and avoidance.
This distinction matters because attempting to eliminate autism-related regulatory behaviors through ERP would be harmful and ineffective. Instead, we focus on targeting the fear-based, OCD-driven behaviors while preserving and even strengthening the routines and repetitive behaviors that genuinely support your autistic nervous system.
Managing Perfectionism and High Achievement
Many late-diagnosed autistic women have spent decades perfecting the art of appearing "normal" through relentless perfectionism and high achievement. When OCD enters the picture, it often hijacks these coping mechanisms, turning them into exhausting compulsions around work, relationships, or personal standards.
In our ERP work, I help you untangle performance-based compulsions from genuine values and goals. We explore how to maintain high standards in areas that matter to you while releasing the OCD-driven need for impossible perfection. This often involves examining how masking has shaped your relationship with achievement and creating new definitions of success that honor your authentic neurodivergent self.
Addressing Internalized and Hidden Compulsions
Neurodivergent women often develop internalized compulsions that go unnoticed by others—and sometimes even by themselves. Mental reviewing, cognitive checking, and internal reassurance-seeking can be especially prevalent among those who've learned to mask their OCD. These hidden compulsions require modified ERP approaches that address the internal landscape of OCD.
I use specialized techniques to help you identify and prevent these mental compulsions while respecting your tendency toward internal processing and reflection. This might include developing awareness practices tailored to your processing style, creating external representations of internal processes, or using somatic approaches that help you notice and interrupt mental compulsions through body awareness.
The Integration Process: Beyond Symptom Reduction
For my clients, ERP isn't just about reducing OCD symptoms—it's about integration and identity development. As you progress through treatment, we explore what it means to be a neurodivergent person with OCD who's reclaiming their authentic self. This integration process often involves:
Redefining your relationship with uncertainty while honoring your autistic need for predictability
Developing self-compassion for both your OCD struggles and your lifetime of masking
Creating sustainable routines that support your neurodivergent needs without feeding OCD
Building authentic connections as you unmask and share your true self with others
Why Online ERP Works Well for Neurodivergent Clients
Conducting ERP through online sessions offers unique advantages for neurodivergent individuals. You can engage in treatment from your own sensory-friendly environment, eliminating the stress of commuting and navigating new spaces. The online format also allows for creative approaches to exposure exercises, using screen sharing, virtual tools, and the ability to practice in your actual living environment where many compulsions occur.
The convenience of online therapy also means we can schedule sessions at times that work best with your energy levels and daily rhythms, whether that's accommodating ADHD medication schedules, working around sensory overload periods, or finding windows when your executive function is at its peak.
Starting Your ERP Journey
Beginning ERP as a neurodivergent person requires a therapist who understands both OCD treatment and neurodivergent experiences. In our initial consultation, we'll discuss how your autism or ADHD intersects with your OCD symptoms, your previous therapy experiences, and your goals for treatment. During the intake session, I conduct a comprehensive assessment that looks at your OCD within the context of your entire neurodivergent experience, including sensory profile, executive function, social communication style, and masking history.
From there, we create a treatment plan that adapts ERP principles to your unique brain while maintaining the evidence-based foundations that make this treatment effective. This personalized approach ensures that you're not trying to force yourself into a neurotypical treatment model but rather engaging in ERP that's designed for your neurodivergent mind.
Ready to Begin?
If you're a neurodivergent woman ready to address your OCD through specialized ERP treatment, I invite you to reach out. Whether you're in Portland, elsewhere in Oregon, or anywhere in Washington state, my online practice provides accessible, neurodivergent-affirming OCD treatment that honors who you are while helping you break free from OCD's grip.
Contact me today to schedule your free 15-minute consultation. Together, we'll explore whether ERP in my practice aligns with your needs and goals. You deserve OCD treatment that understands and respects your neurodivergent experience while providing the evidence-based intervention that actually works.