How I work

What happens at each stage from the first call to the last session, how work with children and teenagers differs, and where confidentiality ends.

The free introductory call

The call lasts about 20 minutes and costs nothing. You tell me what has been happening and I tell you whether this is work I do, or whether NHS Talking Therapies, a psychiatrist or another specialist would suit you better. There is nothing to prepare.

The first session

The first session is a standard session. We go through what happens, what sets it off and what you do to make the feeling stop, and I ask about sleep, mood, alcohol, school or work, health and risk. Short questionnaires give a baseline for judging progress. Together we then work out, in plain English, what is keeping the problem going, because two people with the same diagnosis often need different treatment. By the end of the session we talk about what I would recommend and what happens next, where that is already clear; sometimes further assessment is needed first.

Treatment

I use CBT. For OCD the core of it is exposure and response prevention (ERP), in which you gradually face what triggers the fear while not doing the compulsion, and for other anxiety problems it is exposure therapy. Most of the change comes from practising between sessions in real situations, without the things people do to feel safer, such as checking or asking for reassurance. We plan each step together in advance, starting with one that is a stretch but manageable, and the steps become easier with practice.

What happens if progress stalls

We look at why together. Our explanation of the problem may have missed something, in which case we change the approach. Another problem may need dealing with first, or I may help you find a clinician who suits you better.

Endings

Endings are planned. As progress becomes solid, sessions move to fortnightly and then monthly, and we write a summary of what you have learned and what to do if things slip.

How working with children and teenagers differs

I see children of any age. We agree at the outset whether the client is the child or the parents, as in SPACE (Supportive Parenting for Anxious Childhood Emotions), a treatment in which I work with parents only. Young people aged 16 and 17 can contact me and consent for themselves. For a child under 16, the first contact comes from a parent or carer, and we talk about consent together at the start.

With younger children, parents carry out much of the treatment at home. Teenagers set their own targets, and I explain confidentiality in the first session with everyone present.

What I do not do

Confidentiality, and where it ends

What you tell me stays between us, records are kept securely to HCPC standards, and I do not contact your GP or a school, except in these situations. If I believe a child, or an adult at risk, is suffering or likely to suffer significant harm, I have a duty to tell the local authority safeguarding team, or the police in an emergency. Where there is a serious and immediate risk to someone’s life I will contact emergency services, and usually your GP and your emergency contact. A court can require disclosure, and insurers receive limited information such as dates and a broad treatment category. I would talk to you first wherever it is safe to.

Practical details

I work online across the UK and in person in Nottinghamshire, in your own home or at my office in Ravenshead, weekdays, 9am to 5pm. Sessions are 60 minutes and every session is £120. No GP referral is needed. The fees and insurance page has the detail, or you can ask for a free call.

Sources for the course-length figures

• National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management. Clinical guideline CG113 (2011; checked 2020). nice.org.uk/guidance/cg113 (opens in a new tab)
• National Institute for Health and Care Excellence. Social anxiety disorder: recognition, assessment and treatment. Clinical guideline CG159 (2013). nice.org.uk/guidance/cg159 (opens in a new tab)
• National Institute for Health and Care Excellence. Obsessive-compulsive disorder and body dysmorphic disorder: treatment. Clinical guideline CG31 (2005; an update is in development). nice.org.uk/guidance/cg31 (opens in a new tab)
• Pediatric OCD Treatment Study (POTS) Team. (2004). Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder. JAMA, 292(16), 1969-1976. doi.org (opens in a new tab)
• Lebowitz, E. R., Marin, C., Martino, A., Shimshoni, Y., & Silverman, W. K. (2020). Parent-based treatment as efficacious as cognitive-behavioral therapy for childhood anxiety: a randomized noninferiority study of Supportive Parenting for Anxious Childhood Emotions. Journal of the American Academy of Child and Adolescent Psychiatry, 59(3), 362-372. doi.org (opens in a new tab)

Common questions

Written by Dr Daniel O’Rourke, PhD, ABPP, CPsychol, HCPC-registered Clinical Psychologist Last reviewed: September 2026