We had the opportunity to sit down with two of our licensed therapists, Jenny Estes and Nicole Brunn, to discuss in-depth “what is obsessive compulsive syndrome?” Specifically, we discussed what challenges they see kids with OCD facing in Palo Alto, San Jose, and Menlo Park. They also shed light on the types of treatment options that are most helpful including Exposure and Response Prevention (ERP) and Acceptance and Commitment Therapy (ACT). Finally, we discussed Palo Alto Therapy’s exciting upcoming launch of an OCD Intensive Outpatient Program for families who need a little bit of extra support.
What OCD Looks Like for Children in Silicon Valley and the SF Bay Area
OCD among children frequently presents with specific obsessions that can be particularly challenging. These are unique to each child, but our therapists tell us that there are some common OCD types that they regularly see among the kids and teens in their offices. Therapists across the nation see these as well, of course, but they may manifest uniquely in Northern California.
Jenny and Nicole highlighted five common OCD types observed in the area:
- Contamination OCD – Fear of germs and contamination.
- Harm OCD – Intrusive thoughts of causing harm or magical thinking (e.g., “if I don’t perform a ritual, something bad will happen”).
- Morality OCD – Persistent fears of being “good” or “bad,” sometimes influenced by environmental messages around ethics or social expectations.
- Just Right OCD – The need for things to be arranged or performed in a specific way, leading to repetitive “checking” behaviors.
- Social Media OCD – Anxiety around posting online and fear of social rejection or “cancellation.”
These obsessions often reflect the values and societal pressures surrounding Silicon Valley children. Stressors from the push for academic and extracurricular excellence to navigating the online landscape, can amplify these compulsive anxieties.
The Impact of Social Pressure on OCD
In highly competitive educational regions like the Bay Area, children are often affected by unspoken societal pressures to excel. Jenny says,
“Even when parents are very laid back and aren’t sure why their kids are so stressed, striving for success is just something that’s in the air here.”
This can manifest as an (impossible) pursuit of perfection which may exacerbate OCD symptoms. Nicole explains how the broad adaptation of social media has heightened the issue:
“Kids have always compared themselves to others. With social media, they’re not just competing with the 24 kids in their own class anymore. They’re competing with hundreds and thousands of other kids online.”
In such an environment, kids often feel extreme levels of stress. This may show up as a social media compulsion, taking dozens of selfies before feeling that one is “just right” enough to post. However, it can also trigger symptoms that may seem unrelated. In a culture that rewards excellence, OCD rituals can provide a temporary sense of control, even though they ultimately worsen anxiety.
What Is Obsessive Compulsive Syndrome At Different Ages?
Obviously, kids change a lot from year to year. Your kindergartener doesn’t have the same interests or concerns as your middle schooler. Naturally, the symptoms of OCD also change with time. Or as Nicole puts it, “the symptoms attach to different themes.”
For example, morality OCD might show up in a grade school child as a fear that they’re a bad kid because they know they’re supposed to recycle their bottles but they threw one in the trash. On the other hand, a teenager might obsess over accidentally misgendering a peer.
Jenny, who typically works with older kids, says that gender and sexuality concerns are common among California children with OCD. There are so many layers to OCD and it makes you question yourself in multiple ways. So, when new themes and challenges come up for kids, such as addressing their own sexuality, the symptoms of OCD often manifest as well.
The Surprising Way that OCD Stigma Shows Up
We asked Jenny and Nicole what their OCD clients share about their experiences of stigma. These days, there are portrayals of people with OCD in popular media. We are increasingly open about discussing mental health, particularly in the Bay Area. So are children with OCD able to be themselves without feeling as much stigma as the children of a decade or two ago?
Yes. And no.
Both therapists emphasized that the portrayals of OCD in the media are often limited. Children whose OCD symptoms don’t match a specific vision might not feel able to share their experiences.
Moreover, it has become common to use mental health language incorrectly in our everyday language. The therapists share:
“Teens might make casual references such as “I am so OCD about doing my homework perfectly.” It’s a humble brag that doesn’t recognize the distress of true OCD experiences. As a result, children who do have serious disruptions and difficulties because of OCD may feel unseen, misunderstood, and trivialized.”
OCD Therapy Helps Children With All Types of OCD
Therapists tailor therapy sessions to the specific client and their situation. However, there are some common OCD therapy options that have been proven effective. Our therapists have a foundation in Cognitive Behavioral Therapy (CBT). However, there are different types of CBT, and our therapists stressed that it’s critical to include exposure therapy and tie treatment to a person’s core values.
Effective Approaches in OCD Therapy: ERP and ACT
This exchange with Nicole and Jenny offers insight into combining modalities for OCD therapy:
Jenny: “Sometimes a client comes in and says that they have already tried CBT and it hasn’t worked.”
Nicole: “Right, because traditional CBT involves talking about the thoughts, which often just causes the problem to grow.
Jenny: “Talking about the problem, constantly thinking about the problem, doesn’t solve the problem. Incorporating the exposures through ERP is the key. That’s what makes OCD therapy different from talk therapy for depression or anxiety.”
So, a therapist might combine CBT with ERP but as long as exposures are part of the OCD treatment plan, they can work with other modalities as well. Dialectical Behavior Therapy (DBT) is often paired with ERP to great success.
So is Acceptance and Commitment Therapy (ACT)
ERP also works very well in combination with ACT therapy.
Jenny: “I use ACT a lot. It’s a learning model so it helps people change both their mindset and their actions.”
Nicole: “I use ACT most of the time as well. It is values-based so exposures aren’t just random.”
Jenny: “Some clients come in and they say, I don’t want to do exposures. I’m forced to face exposures all day and it makes things worse. That’s mostly because they aren’t working with a therapist to coach them through the mindset that makes it possible to learn to tolerate the exposures. Just exposure to a thing you fear isn’t enough. Exposures for the sake of exposures aren’t helpful and may even be harmful.”
Nicole: “So it’s helpful for clients to identify their values then choose exposures that help the person live more of their values.”
Jenny: “Exposures can feel scary, but doing them allows you to live a bigger life. If they’re tied to what you value, you are excited to use the therapy to have that bigger life.”
But what do values look like for young children with OCD?
With this type of OCD therapy, you aren’t just habituating your behavior. Instead, you’re learning. That learning generalizes so that if OCD symptoms manifest again later, even in a different way, you have the internal ability to work through them. A child, teen, or even an adult might work through their challenges and end therapy only to have the OCD symptoms come back a few years later during a time of transition. Sometimes it only requires a couple of sessions to bring that learning back to the forefront and help to alleviate symptoms.
What Does ERP Look Like For Kids and Teens with OCD?
We asked Nicole and Jenny whether they find that in-person or virtual therapy is better for kids. Nicole shares that she finds in person therapy better for younger kids. Both have also noticed that many kids and teens prefer in-person therapy these days because they already spend so much time online. Having taken many online classes, they feel like it’s work. Going to an office creates a different container for the sessions. Additionally, sometimes the act of going to the office brings about natural exposures that the child and therapist can then work through.
Jenny is currently a telehealth-only therapist and, although she agrees that in-person can be better for young kids, she utilizes a variety of tools online that can be effective. Interactive online tools, games, and videos are useful. Additionally, it’s possible for kids to do exposures at home while on a video call. For example, the therapist may have a parent bring over a backpack that the child didn’t want to touch because “it’s dirty” and can work with them on tolerating touching it.
How Long Does OCD Therapy for Kids Take?
This is one of the first questions that parents often ask at the beginning of therapy. As Jenny says, “I wish I had an answer.” Like with all types of therapy, it depends on a wide variety of intersecting factors.
But both Nicole and Jenny agree that parental engagement in the treatment process often accelerates progress. Active participation in sessions, understanding the process of ERP, and supporting exposure tasks at home can make a significant difference in a child’s recovery.
Sometimes, children will meet with a therapist once a week for a few months and that’s it. At other times, families may need more intensive support.
Launch of Intensive OCD Therapy
Palo Alto Therapy is introducing Intensive OCD Therapy to address a growing need in the community for comprehensive, structured support. Traditional weekly therapy sessions can be limiting, especially for those with severe OCD symptoms who feel “stuck” in their progress. Families who are overwhelmed and may be considering residential treatment for their child may choose intensive therapy instead, allowing the child to remain in the home while getting extra support.
Intensive OCD Therapy is an 8-12 week program designed to provide intensive support while allowing for continuity of care. During the program, children will see their therapist once per week, work with exposure coaches in and out of the home once per week, and parents will attend a virtual weekly session. Sometimes family sessions occur.
A unique aspect of Palo Alto Therapy Intensive OCD Therapy is its continuity of care.
Current clients who need additional support can transition into the program without starting over with a new therapist, a process that often leads to setbacks. Similarly, new clients can enter the program at a higher level of care and, once stabilized, transition to regular weekly sessions, avoiding the disruption of referrals to a new program.
This model fosters a strong, ongoing therapeutic relationship, allowing therapists to fully monitor progress and adjust treatments as needed. This continuity is essential for OCD clients, who can experience spikes in symptoms during stressful or transitional periods, and who benefit from consistent, long-term care.
As Jenny points out,
“Most people don’t want to switch therapists if things are working, not just because of the relationship but also because it’s overwhelming. They don’t want to start over and tell their whole story again and try to show someone how to understand them if they already have their person who gets it.”
The therapist benefits as well, because there are more people on the team to provide support but the therapist can still see all of the changes made during Intensive OCD Therapy. They don’t have to start over with the client because the client isn’t going away and returning again.
Contact us today with your questions about OCD therapy or to find out more about the launch of Intensive OCD Therapy. You can learn more about licensed California therapists Jenny Estes here and Nicole Brunn here