july 2, 2026
OCD therapy in Asheville, NC
If you're looking for OCD therapy in Asheville, this page covers the practical side — how I work, what ERP looks like in session, cost, and how to get started. For the longer story of what OCD is and why so many people don't know they have it, that's here.
the short version
I'm Lindsey Smith, LCSWA, and OCD is one of the core things I treat. I use ERP — Exposure and Response Prevention — which is the treatment with the strongest evidence base for OCD. Not talk therapy that circles the thoughts. Not reassurance, which OCD eats for breakfast. Structured, collaborative work that changes your relationship to the thoughts themselves.
I see clients in person in West Asheville and virtually anywhere in North Carolina. Most of my OCD work happens virtually, and there's a reason that works well — more on that below.
the kinds of OCD I work with
Most of the OCD I see doesn't look like the stereotype. It looks like a person who seems fine and is privately exhausted from managing their own mind. That includes:
- intrusive thoughts — harm, sexual, religious, or "what kind of person would think this" themes
- moral scrupulosity — endless reviewing of whether you did something wrong, said something wrong, are something wrong
- relationship OCD — compulsively checking how you feel about your partner, on a loop (more on that here)
- religious scrupulosity — which often tangles with religious trauma, and it matters to work with someone who can tell them apart
- checking, counting, and ordering — the visible kind, which is real too
- mental rituals — reviewing, neutralizing, silently arguing with the thought. Compulsions nobody can see are still compulsions.
If your version isn't on this list, that doesn't mean it isn't OCD. The content varies endlessly. The mechanism — a thought that feels dangerous, a ritual that buys relief, a loop that tightens — is the same.
what ERP looks like at Monday Counseling
ERP has a reputation problem. People hear "exposure" and picture a therapist making them touch doorknobs while they panic. That's not this.
Real ERP is collaborative. We map how your OCD works — the triggers, the rituals, the reassurance loops — and then we build a plan together, starting with things that feel challenging but doable. You choose the pace. Discomfort is part of the work; being ambushed is not. My job is to help you stay with the uncertainty a little longer than the OCD wants you to, and to not feed the loop while you do it.
Sessions are 50 minutes, weekly to start. Between sessions there's practice, because the work that changes OCD mostly happens in your life, not on my couch. When there's trauma underneath the OCD — and sometimes there is — I'm also EMDR-trained, and the two approaches can work alongside each other.
why virtual ERP works so well
Your compulsions don't live in a therapy office. They live in your kitchen, your car, your group chats. Virtual sessions mean we can do exposures where the OCD lives — checking the stove you were about to re-check, sitting with the email you want to re-read for the fourth time. For OCD specifically, telehealth isn't a compromise. It's often the better tool.
If you're in Asheville, you can also come sit on an actual couch in West Asheville. Both count. You can switch between them.
if you've been managing the loop alone, you don't have to keep doing that. let's talk about what ERP could look like for you.
book a free consultation →who this is for
People who suspect they have OCD but were never diagnosed. People who were diagnosed years ago and told to "manage their anxiety," which didn't touch it. People whose last therapist listened kindly to the intrusive thoughts and offered reassurance — which felt good for a day and made the loop stronger. And people who already know exactly what this is and just want someone who treats it properly.
I work with teens (16+), young adults, and adults, in Asheville and across North Carolina. You don't need a formal diagnosis to start, and I'm not going to make you say the scariest thought out loud in the first session.
common questions about OCD therapy in Asheville, NC
do you offer OCD therapy in Asheville, NC?
Yes. I see clients in person in West Asheville and virtually anywhere in North Carolina, and I'm currently accepting new clients. ERP is the core of how I treat OCD.
will ERP force me to face my worst fears right away?
No. Good ERP is gradual and you're in the driver's seat — we build from things that feel manageable, and you choose what to approach and when. A therapist who pushes you into your worst fear on day one is doing bad ERP. Discomfort is part of the work. Ambush isn't.
what does it cost?
$150 for a 50-minute session (self-pay). I accept Blue Cross Blue Shield NC, Aetna, MedCost, and the NC State Health Plan through a partner practice. HSA and FSA funds work too. The full breakdown is on the therapy cost page.
does ERP work over telehealth?
Yes — and for OCD it has a genuine advantage: exposures happen in the environment where the compulsions live. If you're anywhere in NC, virtual ERP is a real option, not a fallback.
do I need an OCD diagnosis to start?
No. If intrusive thoughts, checking, reassurance-seeking, or mental rituals are eating your time and energy, that's reason enough. A free 15-minute consult is the place to start — you can ask me anything, including "is this even OCD?"