When “Anxiety” Gets Weird — Why OCD Often Gets Missed in Trauma Therapy
“What if I have OCD?” a client once asked me.
Internally, I sighed.
At the time, OCD felt like the newest TikTok-driven mental health trend — another label being over-applied to anxiety. Externally, I did what I had been trained to do. I went through the DSM-5 criteria, confirmed that what the client was experiencing fit better with a diagnosis of Generalized Anxiety Disorder, reassured them (sigh) that they didn’t have OCD, and we moved on with session.
Fast forward about a year.
Thanks to some personal experiences and deeper professional exposure, my understanding of OCD expanded — and suddenly, things that hadn’t made sense before clicked. I found myself returning to that earlier conversation and realizing the client might have been right.
I remember saying, “I wonder if you were right. I wonder if this could be OCD. Would you be open to exploring that together?”
There was also an apology and repair. I had missed something important.
“Weird Anxiety” — Wait..
As I began learning more, I noticed a pattern that I suspect many trauma-informed therapists encounter.
Clients would come into session with intense anxiety. We’d explore history, work with parts, process memories, build insight and self-compassion. By the end of session, they often felt calmer and clearer.
Then they’d come back the next week just as distressed.
They weren’t “resistant.”
They weren’t avoiding the work.
They weren’t lacking insight.
If anything, they were thoughtful, highly reflective, and deeply motivated.
What I had come to lovingly refer to as “weird anxiety” was, in fact, OCD.
OCD often masquerades as generalized anxiety, trauma responses, or relational insecurity — especially in high-functioning, insight-oriented clients. The distress isn’t primarily driven by fear in the body or unresolved memory networks. It’s driven by doubt.
“What if I missed something?”
“What if this means something about me?”
“What if I can’t ever be sure?”
Clients can understand where the fear comes from and still feel completely hijacked by it.
This is where many trauma-informed approaches quietly stall.
IFS helps us understand parts, but OCD doesn’t resolve simply by unburdening emotion.
EMDR can bring relief, but obsessional doubt often reconstitutes itself.
Insight brings understanding — not resolution.
That doesn’t mean these approaches are wrong. It means OCD requires something additional.
Making a Clinical Shift
I sought out supervision and learned how to properly assess for OCD using the Y-BOCS II. Almost immediately, my entire practice shifted.
I know “transformative” is an overused word — but in this case, it’s accurate.
Suddenly, patterns I had been working around for years made sense. Clients I had felt quietly stuck with were finally moving forward. Many times, just the validation of a diagnosis was relieving in and of itself.
As I explored different treatment approaches, I came across the work of Melissa Mose, and it opened up a whole new world. Melissa was talking about treating OCD using Internal Family Systems (IFS) — not in a way that bypassed the disorder, but in a way that honored both the emotional system and the structure of OCD.
I joined one of her consultation groups that met four hours a month and was struck by her depth of knowledge and clinical wisdom. In those groups, I was introduced to Inference-Based CBT (I-CBT) — a model that conceptualizes OCD not as an anxiety disorder, but as a disorder of reasoning and inference.
I completed training in I-CBT and began integrating it into my work right away. The results were striking.
What I-CBT lacked, IFS provided.
What IFS couldn’t fully address, I-CBT clarified.
Together, they fit beautifully.
Why Consultation is Essential in OCD Treatment
OCD can be uniquely disorienting for therapists.
It often:
Pulls clinicians into subtle reassurance or analysis
Activates over-responsibility
Creates confusion about whether treatment is “working”
Leaves even experienced therapists doubting themselves
This is why consultation matters so much when working with OCD — not just for technique, but for orientation and support.
Having a place to slow down, reality-check conceptualizations, and think collaboratively prevents therapists from getting pulled into the disorder’s logic.
About OCD Consultation with Me
I now exclusively use IFS and Inference-Based CBT to treat OCD. Most of my clients move from severe Y-BOCS II scores to non-clinical ranges by the end of the 12-module I-CBT curriculum.
I created my OCD consultation cohort for therapists who:
Work with OCD or suspect it’s showing up more than they realized
Are IFS-informed and want to apply parts work responsibly with OCD
Are curious about I-CBT as a non-exposure-based approach
Want thoughtful, relational consultation rather than rigid protocols
If you’ve been sensing that something about your “anxiety” cases doesn’t quite fit — you’re probably not wrong.
OCD often reveals itself not when therapists fail, but when they’re paying close attention. If you’d love to have community in this process, I’d love to have you join us in a cohort this year! Details are available here, and I’d love to answer any questions for you!
Consultation as Community: Why EMDR Therapists in Private Practice Need More Than Training
Most EMDR therapists don’t go into private practice anticipating the loneliness that can follow. We’re drawn to this work because it’s meaningful, relational, and deeply human. We value autonomy and depth, and many of us leave group settings or agencies hoping for more alignment and freedom.
What often surprises people is how quietly isolating private practice can become.
There’s no team meeting to process a heavy session.
No colleague down the hall to ask, “Have you seen this before?”
No shared container for holding the emotional weight of trauma work.
For a while, continuing education and advanced trainings can fill that gap. Learning something new can feel energizing and grounding. But eventually, many therapists realize that what’s missing isn’t more information or techniques or protocols - it’s community.
Consultation Is More than Case Collaboration
EMDR consultation is often framed as a place to get answers, guidance, or reassurance about clinical decisions. And it is totally that - and - when consultation happens with the same group of people over time, it becomes something else entirely.
It becomes relational.
You don’t have to reintroduce yourself each month.
You don’t have to explain your practice context from scratch.
You get to follow up on cases without completely introducing it as new.
You get to know other clinicians on a deeper level.
Over time, trust builds. The conversations deepen. The group develops a shared language. Consultation shifts from “What should I do?” to “How do I want to practice, and who do I want to be while doing this work?”
That’s EMDR consultation as community.
Why Community Matters
EMDR therapy, and trauma work in general, asks a lot of clinicians. We keep track of multiple cases that are all in different phases, maybe using different protocols. Many of us are integrating other modalities and tracking parts, relationship dynamics, childhood memories.
We hold intense material. We witness suffering and transformation. We sit with uncertainty.
Doing that work in isolation increases the risk of burnout, self-doubt, and over-responsibility. Not because therapists aren’t capable — but because this work was never meant to be done alone.
A consistent EMDR consultation community helps distribute the weight.
It offers:
A place to normalize stuckness
A container for uncertainty and ethical nuance
Support for the therapist’s nervous system, not just their skillset
A reminder that you are part of something larger than your solo office
A place to celebrate WINS in community
My EMDR Consultation Cohort
When I started these EMDR cohorts, it was primarily to simplify the certification process and offer an affordable path to certification. As I’ve run the groups over the last two years they have grown into something so surprising and beautiful - a community of colleagues who helped each other, laughed together, and helped one another grow.
This is a small, consistent EMDR consultation cohort for therapists in private practice that meets monthly over the course of six months (with the option to join for the year!) It’s designed for EMDR therapists in private practice who want:
Ongoing relational support
A stable group of peers
Space to think together, not perform
A place where clinical growth and sustainability are equally important
Yes, this cohort can count toward EMDR certification hours. But that isn’t the heart of it. The heart is connection — building a community where EMDR therapists don’t have to carry their work alone.
What has helped you stay connected in private practice? Share in the comments!
If you’ve been craving something more relational, more consistent, and more human than one-off trainings, consultation as community may be exactly what you’re looking for - reserve your spot today!
Y-BOCS II Nerd Alert 🧠 (why I’m changing the severity thresholds)
This week I was updating a Y-BOCS II score for a client who is officially in remission from OCD (yay!), when I glanced down at the scoring thresholds in the PDF I give to consultees. I noticed something that didn’t sit right with me: I had “8–15 = mild symptoms,” but in practice I’ve been treating 12–14 and below as remission/subclinical.
So I had a moment of, “Wait… how can something be ‘mild OCD’ and ‘in remission’ at the same time?”
That sent me into a little research spiral with our best friend, Chatty G, and here’s what I found: I wasn’t totally making stuff up - the ranges I had in my handout were:
0–7 subclinical
8–15 mild
16–23 moderate
24–31 severe
32–40 extreme
40–50 “severe debilitation”
That’s basically the old/original Y-BOCS (0–40) bands — which are all over the internet — and then I stretched them up to 50 because the Y-BOCS II goes to 50 (each item is 0–5 now, not 0–4). So what I had was a reasonable clinician adaptation, not nonsense. I suspect I found this online somewhere, but in true ADHD form, I cannot be sure!
But… the Y-BOCS II doesn’t actually come with official severity cutoffs.
The manual tells us how to score it (sum items 1–10, 0–50) but it never gives us “this is mild, this is moderate.” So most of us just kept using the old Y-BOCS language and pretended it fit. (Guilty 🙋🏻♀️)
Then I found a 2025 paper that finally does what we wanted it to do: it proposes empirically derived severity benchmarks specifically for the Y-BOCS II. That paper basically says: let’s make severity fit the 0–50 scale, and let’s put remission at the bottom where it belongs. Then they tested it, and based on their research they recommend these categories:
0–14: subclinical / remission
15–21: mild
22–34: moderate
35–50: severe
This lined up exactly with what I was already doing clinically — using 14 and below as “we’re out of the OCD woods.” It also lines up with broader OCD outcome work that uses Y-BOCS remission in that same neighborhood.
So I’m updating my scoring guide to match that version.
New Language:
Y-BOCS-II (10 items, 0–5 each; total score 0–50). Severity bands based on recent Y-BOCS-II psychometric work (2025):
0–14 = subclinical / remission
15–21 = mild
22–34 = moderate
35–50 = severe
Note: earlier versions of this handout adapted the original Y-BOCS (0–40) bands to a 0–50 scale; this version reflects empirically derived Y-BOCS-II benchmarks.
I strongly encourage you to download the new version here!
Things I Think You’ll Love
It matches how we talk to clients. If someone is 12 or 13, we call that “pretty much in remission,” not “still mildly OCD.”
It’s actually tied to recent data, not just inheritance from the 1989 version. Y’all know I prefer the YBOCS II over the YBOCS primarily because it assess for avoidance compulsions - this allows us to use empirical research without missing out on the avoidance assessment.
TLDR - The Y-BOCS II goes 0–50, but the old severity bands we all used were for the 0–40 version. A 2025 paper finally offered severity ranges that actually fit the 0–50 scale, so I’m updating my handout to match.
Thanks for trusting me to keep evolving the tools I share with you — I want them to match what the current research is actually saying, and as I always say - I am learning right along side you!