OCD Therapy for Neurodivergent Women in Portland & Washington State
When Your Brain Won't Stop Negotiating With Itself
If you're reading this, you probably know that feeling all too well – the endless mental loops, the "what-ifs" that multiply like rabbits, and that persistent sense that something terrible will happen if you don't perform certain rituals or think certain thoughts. For neurodivergent women, especially those of us who are autistic or AuDHD, OCD can feel like another layer of complexity in an already intricate neurological landscape.
I get it. As a neurodivergent therapist who specializes in OCD treatment, I understand how exhausting it is when your brain feels like it's constantly running threat-detection software in the background. And I know how OCD can cleverly disguise itself within autistic traits, making it harder to identify and address
Understanding OCD Through a Neurodivergent Lens
OCD (Obsessive-Compulsive Disorder) isn't just about washing your hands repeatedly or keeping things organized – though it certainly can manifest that way. It's a complex anxiety disorder that creates a cycle of intrusive thoughts (obsessions) and behaviors or mental acts (compulsions) that temporarily relieve the distress those thoughts cause.
For autistic women and AFAB folks, OCD often looks different than the stereotypical presentations. Your OCD might show up as:
Endless rumination about social interactions (did I say the wrong thing? Did I offend them?)
Mental reviewing and checking of past conversations or events
Intrusive thoughts about your identity, relationships, or moral character
Compulsive research or information-seeking to achieve "certainty"
Rigid rules about "right" and "wrong" ways of thinking or feeling
Perfectionism that goes beyond typical autistic attention to detail
What makes this particularly challenging is that many of us have spent decades masking our autistic traits, developing elaborate systems to appear "normal." When OCD enters the picture, it can hijack these systems, turning helpful routines into prison-like compulsions.
The Intersection of Autism and OCD
Here's something that might resonate: distinguishing between autistic repetitive behaviors and OCD compulsions can feel impossible sometimes. Both can involve routines, rituals, and specific ways of doing things. The key difference? Autistic repetitive behaviors typically feel regulating and satisfying, while OCD compulsions are driven by anxiety and never quite provide lasting relief.
I work with women who are navigating this exact intersection. Many of my clients discovered their autism in their 30s, 40s, or 50s – often after their own child was diagnosed or during perimenopause when executive function challenges became impossible to mask. Now they're trying to untangle which behaviors serve them and which ones are keeping them stuck.
The overlap creates unique challenges:
Sensory sensitivities can fuel contamination fears
Need for predictability can morph into rigid OCD rules
Pattern recognition can lead to magical thinking and superstitious behaviors
Justice sensitivity can intensify moral and scrupulosity OCD themes
Social processing differences can amplify relationship-focused obsessions
My Approach: Evidence-Based Treatment That Actually Works
I specialize in two highly effective, evidence-based treatments for OCD: Exposure and Response Prevention (ERP) and Inference-based Cognitive Behavioral Therapy (I-CBT). These aren't your typical "just think positive" approaches – they're structured, proven methods that actually retrain your brain's response to obsessive thoughts.
Exposure and Response Prevention (ERP)
ERP is considered the gold standard for OCD treatment. It involves gradually facing the situations that trigger your obsessions while resisting the urge to perform compulsions. I know that might sound terrifying, but here's the thing – we go at your pace, and I'm with you every step of the way.
For neurodivergent clients, I adapt ERP to account for:
Sensory needs and accommodations
Processing differences
The need for clear, concrete explanations
Energy management and autistic burnout prevention
Inference-based CBT (I-CBT)
I-CBT is a newer approach that focuses on the reasoning processes behind OCD. Instead of just exposing you to fears, we explore how OCD convinces you to doubt reality and trust imaginary stories instead. This approach particularly resonates with my analytical, detail-oriented clients who want to understand the "why" behind their OCD.
I-CBT can be especially helpful for:
Pure-O (primarily obsessional) presentations
Clients who struggle with traditional exposure exercises
Those with strong imagination and creativity (hello, autistic pattern-recognition!)
People who've tried ERP before without full success
What Therapy Actually Looks Like With Me
Let's be real – starting therapy can feel overwhelming, especially if you've had experiences with therapists who didn't understand neurodivergence. Here's what you can expect when working with me:
Getting Started
I offer a free 15-minute consultation where we can chat about what's bringing you to therapy and whether we might be a good fit. No pressure, no judgment – just a conversation to see if my approach aligns with what you're looking for.
If we decide to move forward, our intake session involves:
A comprehensive review of your history (yes, including that late autism realization)
A holistic assessment that considers all aspects of your life
Collaborative goal-setting for therapy
Discussion of how OCD shows up specifically for you
Our Ongoing Work
Once we've established care, our sessions focus on:
Understanding Your OCD: We'll map out your specific OCD patterns, identifying triggers, obsessions, and compulsions. For neurodivergent folks, this often means untangling OCD from autistic traits and figuring out what serves you versus what restricts you.
Building Your Toolkit: I'll teach you specific techniques from ERP and I-CBT, adapted for your neurodivergent brain. We'll practice these together until they feel natural and accessible.
Real-World Application: We'll work on applying these tools to your actual life – whether that's managing OCD while parenting, working in demanding professional environments, or navigating relationships.
Integration and Identity: Beyond symptom reduction, we'll explore how to integrate this work with your understanding of yourself as a neurodivergent person. This isn't about "fixing" you – it's about giving you more choice and freedom.
Why This Matters for Late-Diagnosed Autistic Women
If you're in that "Oh, I have autism – now what?" phase, adding OCD treatment might feel like one more thing on an already full plate. But here's what I've learned: addressing OCD can actually make the autism integration process easier.
When OCD is running the show, it's hard to distinguish between:
What's autism (and potentially helpful)
What's masking (and potentially draining)
What's OCD (and definitely not serving you)
By treating OCD, many of my clients find they have more energy to explore their authentic autistic selves. They can keep the routines that regulate them while letting go of the compulsions that exhaust them.
For Parents and Professionals
I work with many women who are balancing demanding careers or parenting (or both) while managing OCD and navigating their neurodivergent identity. OCD can be particularly cruel in these contexts, latching onto fears about:
Being a "good enough" parent
Professional competence and impostor syndrome
Moral concerns about work-life balance
Perfectionism in all areas of life
My approach acknowledges the real constraints and pressures you face. We're not aiming for a life without stress (unrealistic), but rather developing ways to manage OCD that fit within your actual life circumstances.
Online Therapy That Works With Your Life
All my sessions are conducted online, which means:
No commute time eating into your already packed schedule
The comfort of being in your own sensory-friendly environment
Flexibility to schedule around work and family obligations
Access to specialized care regardless of where you are in Portland or Washington State
Taking the Next Step
I know reaching out can feel vulnerable, especially if you've spent years masking and managing on your own. But you don't have to figure this out alone. OCD is highly treatable, and with the right approach – one that honors your neurodivergence rather than pathologizing it – you can find relief.
If you're ready to explore OCD treatment that actually understands the neurodivergent experience, I invite you to reach out. We can discuss scheduling, answer any questions you have about my approach, and see if we might be a good therapeutic fit.
Your brain might be complex, but that doesn't mean you're broken. Sometimes we just need the right tools and support to work with our neurology rather than against it. I'm here when you're ready to start that journey.