online ERP therapy for adults in missouri & arkansas
OCD keeps demanding certainty. ERP teaches you to stop answering.
Joy Gillespie, MSW, LCSW, is a Missouri-based therapist in St. Charles County specializing in online Exposure and Response Prevention (ERP) therapy for adults with OCD throughout Missouri and Arkansas.
A thought shows up that you would never choose. What if I left the stove on? What if that thought means something terrible about me? Your anxiety rises, and the urge to check, wash, replay, or ask for reassurance feels impossible to ignore. You do it, you feel better for a moment, and then the doubt comes back.
That loop is not a character flaw. It's how OCD works, and you can learn to break that cycle.
the short answers first
What ERP Therapy is
What is ERP therapy?
ERP stands for Exposure and Response Prevention. It is a specialized, evidence-based form of Cognitive Behavioral Therapy (CBT) and the gold-standard psychotherapy treatment for Obsessive-Compulsive Disorder (OCD).
Exposure means gradually facing the thoughts, situations, images, or sensations that trigger your obsessions rather than avoiding them.
Response prevention means learning to resist the compulsions you typically use to reduce anxiety or feel certain, such as checking, washing, repeating, mentally reviewing, or seeking reassurance.
Together, these two components help you learn that you can tolerate uncertainty, experience uncomfortable thoughts and feelings without performing compulsions, and move forward without letting OCD dictate your choices.
ERP isn't about eliminating every unwanted thought or making anxiety disappear immediately. It's about changing how you respond to those thoughts so they have less control over your life.
Does ERP actually work?
Yes. ERP is considered the gold-standard, first-line psychotherapy treatment for OCD, supported by decades of clinical research and recommended by major professional treatment guidelines.
Research has consistently shown that ERP can significantly reduce OCD symptoms, including obsessive thoughts, compulsive behaviors, avoidance, and the time OCD takes away from everyday life.
However, ERP isn't an overnight fix. Treatment involves gradually facing fears, resisting compulsions, and practicing new responses both during therapy sessions and between sessions. Progress looks different for everyone, and some discomfort is part of the learning process.
With consistent practice and the right therapeutic support, you can learn to respond differently to intrusive thoughts, spend less time caught in OCD cycles, and reclaim more freedom in your daily life. If you would like to learn more about ERP, learn about it at International OCD Foundation.
OCD gets quieter when you stop doing what it demands. ERP teaches you how.
The OCD cycle, and how ERP breaks it
how erp works
OCD runs on a loop. A trigger appears: a thought, an image, a sensation, a what-if. Your brain flags it as dangerous, and anxiety, guilt, or a gnawing sense of wrongness rises. To make it stop, you do something.
Every trip around the loop teaches your brain that the thought really was dangerous, and that the ritual is what saved you. So the loop tightens.
Step 1
Trigger
A trigger appears: a thought, an image, a sensation, a memory, or a what-if.
Step 2
Doubt & obsession
Your brain interprets it as threatening or significant, and you get caught in a cycle of doubt, questioning, or uncertainty.
Step 3
Anxiety & distress
Anxiety, guilt, fear, or a gnawing sense that something isn't right begins to build.
Step 4
Compulsion
To get relief or certainty, you do something. You check, wash, confess, mentally replay a memory, search for symptoms, or ask someone whether you are a good person. These are compulsions.
Step 5
Temporary relief
The compulsion may bring a moment of relief. But the doubt eventually returns, and the cycle starts again. Over time, OCD can demand more rituals, more reassurance, and more certainty.
Build a ladder of fears
Together, we create a step-by-step plan for facing the situations that trigger your OCD. We start with the ones that feel less challenging and gradually work toward those that feel more difficult. You're involved in every step of the process, so you know what to expect and help decide where to begin. We start with something that feels challenging but manageable and build from there.
how ERP breaks the cycle
Face one step at a time
We take each step gradually, giving you time to practice before moving on to something more challenging. With each experience, you learn that you can handle uncomfortable thoughts and feelings without turning to compulsions. We decide together when you're ready for the next step. You always have a voice in the process, and we'll make decisions together about what feels like the right next step.
Resist the compulsion
This is where ERP begins to break the OCD cycle. Instead of performing a compulsion to make the discomfort go away, you practice sitting with the uncomfortable thoughts, feelings, or uncertainty without performing a ritual. It may feel counterintuitive at first, but this is where the learning happens: you face the fear, resist the compulsion, and discover that you can handle the discomfort without relying on OCD rituals.
What you learn through ERP isn't that nothing bad will ever happen. No therapist can promise you that. Instead, you learn something much more valuable: you can handle uncertainty and discomfort without relying on rituals to make them go away. You don't need 100% certainty to move forward, and you don't have to let OCD dictate how you live your life. That's the freedom OCD has been keeping from you.
A different kind of therapy
Nothing is sprung on you. Ever.
A lot of people imagine ERP as being pushed into the deep end and forced to face their worst fears. That's not how I approach it.
We work together to plan each exposure. You'll know what to expect before we begin, and we'll move at a pace that feels manageable. You can always speak up if something feels too overwhelming, and we'll adjust the plan together.
My role is to guide, encourage, and support you as you take steps outside your comfort zone, not to push you beyond what you're ready to handle. ERP isn't about forcing yourself to face your fears. It's about learning, one step at a time, that you can handle uncertainty and discomfort without letting OCD make the decisions for you.
inside an ERP session
What an ERP session actually looks like
ERP sessions are active and practical. We plan, practice together, and review what you're learning along the way. The work doesn't stop when our session ends; you'll have opportunities to practice new responses in your everyday life, too. Here's what a typical session looks like.
We start with the week you actually had
We check in on your practice since our last session: what you tried, where OCD pushed back, and what you noticed. No judgment if the week went sideways. The information is what matters, and it helps us decide where to focus next.
01
02
We choose the next step together
From your exposure hierarchy, we choose an exposure for today: something challenging but manageable. You'll know what it involves and why we're choosing it before we begin. We make the decision together, and you'll have a voice in the process.
03
We do the exposure in session
You face the trigger with me there: touching a surface, reading feared words aloud, or leaving a message unreviewed. Because we meet online, you can practice in the places where OCD actually shows up in your life. I'll coach and support you in real time.
04
You practice resisting the compulsion
This is the response prevention half. Instead of checking, washing, or seeking reassurance to make the discomfort go away, you practice allowing the urge to be there without acting on it. The goal isn't to make anxiety disappear. It's to learn that you can handle uncomfortable thoughts, feelings, and uncertainty without relying on compulsions.
05
We close with a plan for the week
We talk about what you learned and set small, specific practices for the days ahead, sized to fit real life. You'll know what to practice, why it matters, and how it connects to the work we're doing together.
A note on session length
Some exposures need more room than a standard session allows, especially early in treatment. Extended ERP sessions are available and prorated based on my regular session rate, so we can give the work the time it needs.
Myth vs. Reality
What people often get wrong about ERP
ERP is sometimes misunderstood. Many of the things people fear about it describe flooding or poorly delivered therapy, not thoughtful, well-paced ERP. Here are some common misconceptions and what you should know.
the myth
“ERP means facing my worst fear all at once.”
Reality: No. ERP is typically gradual and collaborative. We start with exposures that feel challenging but manageable, using a hierarchy we build together based on how distressing different triggers feel to you. We work toward more difficult exposures as you develop confidence and skills. You are never simply thrown into your worst fear.
the myth
“I have to feel ready and unafraid before I start.”
Reality: You don't have to feel ready or confident to begin. Most people start ERP with some fear or hesitation. We start with manageable steps and build from there. You don't need to feel fearless; you just need to be open to trying something different, one step at a time.
the myth
“Exposures will make my anxiety worse permanently.”
Reality: ERP can feel uncomfortable, and anxiety may temporarily increase as you face situations you've been avoiding or learn to resist compulsions. But the goal isn't to make anxiety disappear during every exposure. It's to learn that you can tolerate discomfort and uncertainty without relying on compulsions. With practice, OCD can become less controlling, even when uncomfortable thoughts or feelings still show up.
the myth
“ERP is just white-knuckling it with willpower.”
Reality: ERP isn't about gritting your teeth and enduring distress. It's about learning through experience that you can face uncertainty and uncomfortable feelings without performing compulsions. Each exposure gives you an opportunity to respond differently to OCD rather than following its demands.
the myth
“ERP is only for contamination and hand-washing OCD.”
Reality: Hand washing is just one visible example. ERP can help with many OCD presentations (more about that below). Although the themes differ, these presentations often involve obsessions, distress, and compulsive attempts to find relief or certainty. ERP addresses those patterns.
the myth
“ERP will get rid of my intrusive thoughts completely.”
Reality: Unwanted thoughts are a normal part of being human. ERP doesn't promise to eliminate intrusive thoughts or give you an empty mind. Instead, it helps you change how you respond to them, so a thought can show up without dictating what you do next. You can notice it and get on with your day without giving into the compulsion. ERP is about building tolerance toward intrusive and unwanted thoughts without getting pulled into the OCD cycle.
What ERP can help with
ERP treats OCD in all its forms
OCD can take many forms, targeting the things that matter most to you. Whether your compulsions are visible or happen entirely in your mind, ERP helps you change how you respond to obsessive thoughts, uncomfortable feelings, and uncertainty.
01
Contamination OCD
ERP helps you gradually face fears about germs, illness, and contamination without relying on washing, cleaning, or avoidance rituals.
02
Harm OCD
ERP helps you respond differently to unwanted thoughts about harming yourself or others without getting caught in mental reviewing, confessing, avoiding, or seeking reassurance.
03
Relationship OCD
ERP helps you step out of the cycle of analyzing your feelings, comparing your relationship, and repeatedly seeking reassurance about whether your partner or relationship is right for you.
04
Just-right OCD
ERP helps you resist the urge to repeat, arrange, reread, or redo things until they feel right, learning to tolerate the discomfort of leaving things imperfect or unfinished.
05
Scrupulosity (Moral or Religious OCD)
ERP helps you face fears about sinning, offending God, or being a bad person without relying on repeated prayer, confession, or reviewing your intentions for certainty. Treatment respects your faith and personal values.
07
Pure O and Mental Compulsions
ERP also addresses compulsions that happen entirely in your mind, such as replaying memories, analyzing feelings, mentally reviewing events, or trying to neutralize unwanted thoughts. You can learn to experience intrusive thoughts without engaging in mental rituals.
06
Responsibility OCD
ERP helps you reduce excessive checking and the need to feel completely certain that you haven't made a mistake, overlooked something, or caused harm.
Not sure which type of OCD you’re experiencing?
Learn more about the different forms of OCD and how they show up here:
Questions answered
Frequently asked questions on ERP Therapy
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There isn't a set number of sessions that works for everyone. The length of ERP therapy depends on several factors, including the severity of your OCD, how many areas of your life it affects, your treatment goals, and how consistently you practice between sessions.
Some people begin noticing meaningful changes within a few months, while others benefit from a longer course of treatment. We'll regularly review your progress and adjust your treatment plan as needed. The goal isn't to rush through a predetermined number of sessions but to help you develop skills you can continue using beyond therapy.
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Absolutely! ERP can be effectively delivered through secure video sessions. In fact, online therapy can offer unique opportunities to practice exposures in the environments where OCD actually shows up, whether that's your home, your kitchen, your workplace, or your everyday routines.
During online sessions, we can work through exposures together in real time, and you'll also practice new responses between sessions. I provide online ERP therapy to adults physically located in Missouri or Arkansas at the time of their appointments.
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Absolutely. ERP isn't just for visible compulsions like hand-washing, checking, or repeating behaviors. It also addresses mental compulsions, which are common in what's sometimes called Pure O.
Mental compulsions can include replaying memories, analyzing your feelings, mentally reviewing conversations, trying to prove an intrusive thought wrong, or repeatedly seeking certainty in your mind. ERP helps you recognize these patterns and practice allowing unwanted thoughts and uncertainty to be present without engaging in mental rituals.
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No. You can participate in ERP therapy without taking medication. ERP is an evidence-based psychological treatment for OCD and can be used on its own or alongside medication, depending on your needs and preferences.
Some people benefit from combining ERP with medication prescribed by a healthcare provider, while others choose therapy alone. If you're currently taking medication, we can consider how it fits into your overall treatment. Medication decisions should be discussed with your prescribing provider.
The International OCD Foundation recognizes ERP as a first-line psychological treatment and notes that it can be combined with medication when appropriate.
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Not necessarily. You don't have to arrive with a formal OCD diagnosis to start a conversation about ERP. If you're experiencing unwanted, repetitive thoughts, compulsive behaviors, mental rituals, or ongoing difficulty tolerating uncertainty, we can discuss what you're experiencing and whether ERP may be appropriate.
During our initial conversations, we'll explore your symptoms, how they're affecting your life, and what kind of treatment might best fit your needs.
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That's okay. Learning to resist compulsions takes practice, and it doesn't always happen perfectly. If you find yourself performing a compulsion during or after an exposure, it doesn't mean you've failed or that ERP isn't working.
We'll look at what happened, identify what made the situation difficult, and use that information to guide future practice. Even small changes, such as delaying a ritual, resisting part of it, or recognizing a mental compulsion, can become opportunities for learning.
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Having tried ERP before doesn't necessarily mean it can't help you. There can be several reasons treatment may not have been effective, including exposures that weren't adequately tailored to your OCD, mental compulsions that went unaddressed, difficulty practicing between sessions, or treatment that wasn't sufficiently focused on response prevention.
We can explore what your previous experience was like, what did and didn't help, and what might need to be different this time. Your treatment should be individualized to your symptoms, needs, and goals.
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ERP is typically structured around regular sessions, often weekly, with opportunities to practice between appointments. The frequency of sessions depends on your symptoms, treatment goals, availability, and how much support you need.
Because practicing between sessions is an important part of ERP, you'll have specific exercises to work on in your everyday life. We'll find a rhythm that supports consistent progress while fitting into your schedule.
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Yes. Although ERP is the foundation of OCD treatment, I sometimes incorporate Internal Family Systems (IFS) to support the exposure process.
For some people, parts of them may feel afraid, hesitant, or resistant to facing situations that trigger their OCD. For example, one part may believe that checking is necessary to keep loved ones safe, while another part wants to break free from the OCD cycle.
Using IFS, we can explore and better understand these internal conflicts rather than simply pushing past them. This can help reduce resistance and build greater willingness to engage in exposure work.
IFS does not replace ERP. Instead, it can complement ERP when appropriate, helping us address what's happening internally while continuing to work toward responding differently to OCD.
therapy from where you are
Online ERP Therapy in Missouri & Arkansas
You can receive specialized OCD treatment without having to travel to an office or commute to appointments.
I provide online ERP therapy for adults who are physically located in Missouri or Arkansas at the time of their appointments. All sessions take place through secure video, so you can access therapy from the privacy and comfort of your own space, wherever you are in either state.
taking the first step
Interested in ERP therapy?
Schedule your FREE 30-minute consultation to ask questions, share what you've been struggling with, and explore whether ERP therapy may be a good fit for you.