OCD & Behavior
Specialist
Serving Maryland, DC, Virginia and Ohio
8000 Locust Mill St, Ellicott City, 21043 | 210-810-3309 | leslieworley@wavesofwisdomtherapy.com
Services
Individual Therapy
One on one therapy sessions to dive into your inner thoughts and intense emotions that are holding you back from living a completely meaningful life.
Individual Therapy includes daily mindfulness, diary cards and examining values.
Group Therapy
These groups are for anyone who wants to reclaim their lives from the cycle of OCD and/or may not feel ready for exposure.
Using Inference Based-CBT and Acceptance and Commitment Therapy, this group is a unique blend of clinical education and treatment as well as the support of peers.
What I Treat: OCD
Understanding OCD
Obsessive–Compulsive Disorder is a condition where the mind becomes caught in cycles of doubt and effortful control. A thought, image, feeling, or sense of “what if” appears, and instead of fading like ordinary mental noise, it feels urgent, something that must be solved, clarified, or prevented. These obsessional doubts can center on nearly anything: safety, morality, contamination, identity, or whether something has been done “just right.”
To ease the uncertainty or emotional discomfort that follows, a person may engage in mental or physical rituals meant to find relief or restore certainty. These rituals: checking, repeating, analyzing, confessing, cleaning, avoiding, or mentally reviewing, can bring momentary calm, but reinforce the mind’s belief that danger or catastrophe is near. Over time, this cycle erodes trust in one’s own senses and creates a life organized around fear rather than meaning.
Common Themes
While OCD can attach to countless topics, the underlying process is consistent: the person mistakes imagination for evidence and treats doubt as an actual threat or danger. Some common themes include:
Every person’s OCD manifests differently. What links these forms is not their content, but their structure—the urgent need to gain certainty in the face of doubt, and the belief that distress must be solved before life can continue.
Examples of Compulsive Strategies to relieve the anxiety or panic:
●Excessive washing or cleaning
●Checking, repeating, or mentally reviewing events
●Reassurance seeking or confessing “just to be sure”
●Avoiding certain people, places, or triggers
●Neutralizing a thought with another thought or ritual
These patterns are ego-dystonic, which means they are at odds with a person’s values and sense of self. The thoughts do not reflect desire or intent, yet the mind insists they must mean something terrible. The more a person tries to reason their way out of doubt, the more convincing it becomes.
How OCD can Feel
Living with OCD often means living with persistent uncertainty. Many people describe feeling haunted by “what if” questions their mind refuses to drop. The emotional toll is heavy: anxiety, guilt, disgust, or exhaustion can accompany every attempt to resist or control these doubts.
OCD can feel like being held hostage by your own mind. Thoughts arrive that you never invited, carrying emotional weight far beyond their content. The harder you try to dismiss or reason with them, the louder they become. Doubt doesn’t ease with reassurance—it multiplies, convincing you that the one question you haven’t answered yet is the one that could undo everything.
It’s not just the anxiety; it’s the constant second-guessing of your perception, memory, and morality. You may look calm on the outside while your mind runs internal checklists, replaying moments for hidden meaning, analyzing every word you said, every sensation in your body, every possibility of danger. The mental effort is relentless.
Many people describe feeling detached from themselves—unable to trust what they feel, what they see, or what they know. Simple decisions can feel monumental. A moment of joy can be interrupted by the mind’s whisper: But what if…?
Over time, the boundaries between thought and truth blur. The world starts to narrow. Conversations, relationships, and passions fade behind the noise of self-monitoring. Even sleep can feel like another battleground where the mind replays the day in search of proof or absolution.
Yet underneath the exhaustion, there is something unbroken—a quiet capacity to notice, to step back, to choose. Recovery doesn’t mean silencing the mind; it means learning that thoughts and sensations don’t need to dictate action. Life expands not when fear disappears, but when you stop waiting for certainty before you begin living again.
A Note from Leslie
One of my core foundations as both a clinician and a person is transparency. I believe in being open about my own lived experience with OCD both to help others feel less alone and to take away the shame that comes with it.
For many years, it was a quiet part of my life, so quiet I didn’t even know what it was. It surfaced in small ways, manageable and familiar. Then a major life event catapulted me into a severe episode that became the most excruciating experience I’ve ever had.
It felt as though something else had taken over my mind, pulling me into a reality that didn’t feel like my own. The world looked different. People looked different. I felt buried under layers of doubt, unsure if I could trust my own perceptions or even recognize what was real. Panic attacks became part of my daily rhythm, and every moment felt unpredictable and frightening.
What kept me tethered was the same foundation I have always used in my clinical work; my training in Acceptance and Commitment Therapy and Dialectical Behavior Therapy. Those principles helped me stay connected to life even as my mind unraveled. They gave me the structure to keep showing up for the things I valued: my family, my dogs, my friends and my work.
It was through my own treatment with an OCD specialist, using approaches like Inference-Based CBT, Acceptance and Commitment Therapy, and ERP, that I began to find my footing again. I still live with OCD. Obsessional doubts still show up. I just now know how to control the volume… And you can too.
What I Treat: Eating Disorders
At Waves of Wisdom Therapy, we work from a Contextually Focused DBT framework: a model that blends the mindfulness, acceptance, and values work of ACT with the structure and emotion regulation tools of DBT. This approach helps clients understand why eating disorder behaviors make sense in context and how to move toward a more flexible, compassionate relationship with food, the body, and emotion. This means learning to hold pain gently while building new patterns of living. Our work is experiential, collaborative, and paced with care. Together, we explore what your behaviors are trying to protect, and how to honor those needs through actions that build a life that feels meaningful.
Eating disorders often begin in ways that make sense within a person’s life context. Sometimes as a focus on health, appearance, or control, and other times as a way to manage painful emotions or uncertainty. Whatever the initial reason, these behaviors can gradually take on a life of their own, becoming rigid, consuming, and disconnected from what truly matters.
Eating Disorders
Restriction and Anorexia
Restriction often begins with the intention to feel safe, disciplined, or in control and gradually evolves into a system that feels impossible to escape. Food rules multiply, hunger cues are silenced, and self-worth becomes entangled with perfection and deprivation. In therapy, we explore what restriction is protecting you from. From the emotions, fears, or relational dynamics underneath. Using acceptance-based and DBT-informed tools, clients learn to honor the underlying needs (safety, identity, belonging) without relying on avoidance. We practice small acts of flexibility, reintroducing food variety, loosening rules, rebuilding trust in the body’s natural cues. All in service of what truly matters: vitality, connection, and peace.
Binge Eating
Bingeing is often the body’s and mind’s response to deprivation, both physical and emotional. It can bring temporary relief or numbness from distress, only to be followed by guilt, shame, and renewed promises of control. From a contextual lens, bingeing is not a failure of willpower but an understandable attempt to regulate overwhelming emotion. Therapy focuses on increasing awareness of cues (hunger, emotion, loneliness), building tolerance for discomfort, and reclaiming self-compassion in moments of perceived “loss of control.” We work toward a relationship with food where nourishment replaces punishment and eating becomes part of living, not escaping.
Binge–Purging Patterns
When binge episodes are followed by purging, fasting, or over-exercising, it creates a false sense of balance, control restored after chaos. These cycles often reflect deep fear: fear of change, of losing control, of being seen. In treatment, we gently disentangle the function of these behaviors. Clients learn to experience fullness, guilt, and emotional intensity without turning against the body. We practice mindful awareness of urges, distress tolerance, and values-based decision-making. Over time, the body becomes an ally rather than an enemy to manage.
Purging Without Bingeing
Some clients purge after ordinary meals or small amounts of food, often driven by anxiety, shame, or sensory discomfort. In these cases, purging functions as an emotional release, an attempt to rid the self of internal distress, not just food. We approach this work with compassion and precision. Through emotion regulation and mindfulness-based skills, clients learn to experience fullness and emotion without needing to purge them. We replace punishment with care, using willingness and body-based grounding to restore safety in the present moment.
Unhealthy Relationships with Food and Body
Many people live in a gray area between clinical diagnoses where food is a daily negotiation, exercise is tied to guilt, and body image dictates mood. This spectrum of disordered eating still carries deep pain and deserves care. Therapy focuses on helping clients understand what their relationship with food is communicating. We explore how avoidance, rules, or rigidity function in their lives, and how to reclaim flexibility, enjoyment, and belonging. Clients learn to build a relationship with food that is responsive rather than reactive, one guided by values, connection, and compassion.
While OCD and Eating Disorders are the core specialties at Waves of Wisdom Therapy, our clinicians are also trained and experienced in working with:
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Self-harm behaviors
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Trauma-related distress
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Anxiety, depression
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Challenges that can accompany neurodivergence, including Autism.
In truth, trauma, whether big, small, chronic, or subtle, shows up in some form for most clients we see. Much of the work here involves gently uncovering those roots and learning new ways to respond to the pain beneath them, building a life guided by meaning rather than avoidance.
How We Treat
Acceptance and Commitment Therapy (ACT)
Learning to Make Space for Pain in Life.
Acceptance and Commitment Therapy (ACT) is a modern, evidence-based approach that helps people build lives guided by values rather than ruled by struggle.
ACT begins with a simple truth: pain is part of being human. The goal isn’t to erase discomfort, but to learn how to relate to it differently: with awareness, flexibility, and self-compassion. So that suffering no longer stands between you and the life you want to live.
Instead of fighting or avoiding painful thoughts, emotions, and memories, ACT teaches you how to make space for them while staying connected to what matters most. Using mindfulness and acceptance skills, you learn to notice internal experiences as they come and go, without getting tangled in them or letting them decide your next move.
What “Acceptance” Really Means
Acceptance in ACT doesn’t mean giving up or liking what hurts. It means dropping the exhausting battle with what’s beyond your control, and choosing to turn your energy toward living fully, even in the presence of pain. It’s an intentional stance, a way of saying, I can feel this and still keep moving forward.
Through practice, you begin to approach difficult experiences with curiosity instead of judgment, allowing room for healing, growth, and self-kindness.
The “Commitment” Piece
Commitment is about action. Taking deliberate steps toward what truly matters to you.
ACT helps you clarify your personal values: the people, causes, and experiences that make life meaningful. From there, you learn practical ways to act in alignment with those values, even when fear, doubt, or pain shows up.
When behavior starts to reflect what you care about, life begins to feel richer, steadier, and more intentional. We shift from chasing happiness to creating a life that feels like meaning-filled.
The Heart of ACT: Psychological Flexibility
At its core, ACT builds psychological flexibility, the ability to stay present and responsive, no matter what thoughts or feelings arise.
You learn to pause, notice, and choose, rather than react automatically or get stuck in mental loops. Through mindfulness, metaphor, and experiential exercises, ACT strengthens your capacity to experience life fully with joy, pain, and everything in between, while continuing to move in the direction of meaning and purpose.
What to Expect in Therapy
In sessions, we’ll look at what’s been keeping you stuck in struggle and explore how to approach your experiences with greater openness. Together, we’ll identify your core values, develop mindfulness and acceptance tools, and create concrete actions that move you toward the life you want to build.
You don’t need to be “fixed.” You’re not broken. You’re just stuck. ACT helps you start moving with the pain you carry.
Inference-Based Cognitive Behavioral Therapy (I-CBT)
A New Way to Understand OCD
Inference-Based Cognitive Behavioral Therapy (I-CBT) is a modern, research-supported approach for treating Obsessive-Compulsive Disorder.
Instead of focusing on fear, anxiety, I-CBT looks at how obsessional doubt begins in the first place. It helps people see how the mind can drift from what’s real and observable into imagined possibilities that feel just as true.
With OCD, the issue isn’t uncertainty itself, it’s that false sense of doubt that starts when imagination takes over as if it were evidence which starts the obsessional process. I-CBT teaches you how to recognize that process, return to direct experience, and rebuild trust in your own senses and reasoning.
How Obsessional Doubt Takes Hold
When OCD is active, it can feel like something isn’t quite right, even when everything looks fine.
You might know you locked the door or know you don’t want to harm anyone, yet still feel unsure. That’s because your attention has shifted from what you can see or remember to what you can imagine might have happened instead.
When imagination starts to feel as convincing as reality, I-CBT calls this pattern inferential confusion. The result is obsessional doubt: a strong, uncomfortable sense that something could be wrong, even when there’s no real evidence that it is.
Learning to Trust Reality Again
I-CBT helps you notice the exact moment your mind moves from reality into imagination. Through guided exercises, you learn how to track that shift, understand what keeps the doubt alive, and return to what’s actually happening in the present.
This approach by itself doesn’t rely on exposure or reassurance. Instead, it focuses on understanding. Seeing thoughts for what they are: stories created by the mind, not proof of danger.
What the Research Shows
I-CBT has been studied for over two decades and is shown to be highly effective for OCD. Clinical trials find outcomes similar to traditional exposure-based therapies, with strong symptom reduction and high satisfaction among participants.
Because I-CBT works through reasoning and awareness rather than exposure to anxiety, many people find it a more approachable, especially those who prefer understanding their thought process.
Exposure and Response Prevention (ERP)
Learning to Face What Feels Unbearable
Exposure and Response Prevention (ERP) is a specialized, evidence-based treatment for Obsessive-Compulsive Disorder (OCD). It’s considered the gold-standard approach and is supported by organizations like the American Psychiatric Association (APA), the National Institute for Health and Care Excellence (NICE), and the World Health Organization (WHO).
ERP is a form of Cognitive Behavioral Therapy (CBT) that focuses on action rather than analysis. It helps you face the fears, images, or thoughts that trigger anxiety without engaging in the compulsive behaviors that temporarily relieve it. Over time, this teaches your brain something powerful: you can experience fear, discomfort, and uncertainty, and still be okay.
How ERP Works
OCD runs on a cycle: anxiety rises, a compulsion brings temporary relief, and then the doubt returns stronger. ERP breaks that cycle by gently and gradually helping you do the opposite of what OCD demands.
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Exposure: You intentionally face the situations, thoughts, or sensations that trigger your anxiety or obsessional doubt.
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Response Prevention: You resist the urge to perform the compulsion or ritual that usually follows.
Through repeated practice, your nervous system learns that anxiety peaks and then naturally fades on its own. This process, called habituation, helps retrain your brain to see that feared situations or thoughts are not dangerous and that you don’t need rituals or avoidance to feel safe.
What to Expect in ERP Therapy
ERP is collaborative, structured, and paced carefully.
Together, we’ll start by understanding your symptoms and developing a plan that fits your goals. We’ll create a hierarchy of activating events, starting with situations that bring mild discomfort and slowly moving toward more challenging ones.
During sessions, I’ll guide you through each step while helping you manage the anxiety that arises with mindfulness, grounding, and compassion. Between sessions, you’ll practice exposures in your everyday life to keep building confidence and flexibility.
ERP is challenging work, but it’s not about forcing yourself through fear, it’s about learning that you can feel uncomfortable and still move toward freedom. Every step you take rewires your brain to trust that you are capable, resilient, and safe.
How ERP Fits Within Broader Treatment
ERP can stand alone or be combined with other evidence-based approaches.
At Waves of Wisdom Therapy, ERP is often integrated with Acceptance and Commitment Therapy (ACT) and Inference-Based CBT (I-CBT)—approaches that focus on mindfulness, reasoning, and values-based living. Together, these methods create a well-rounded process for understanding the nature of OCD, relating differently to thoughts, and reclaiming your life from fear.
WOW’s Special Blend of I-CBT, ACT, and ERP for OCD
Building a Life That Matters More Than OCD
At Waves of Wisdom Therapy, treatment for OCD is about learning how to live meaningfully with the presence of obsessional doubts. We will learn how to make room for the full range of human experience without being pulled under the current of the OCD cycle.
All of the work we do is grounded in Acceptance and Commitment Therapy (ACT). ACT reminds us that pain is inevitable, but suffering is optional. We can’t control our thoughts or emotions, but we can choose how we respond to them, and in doing so, move toward a life guided by purpose, presence, and self-compassion.
From this foundation, we integrate two powerful, evidence-based methods: Inference-Based Cognitive Behavioral Therapy (I-CBT) and Exposure and Response Prevention (ERP) in order to help you understand and change the patterns that keep OCD alive.
Using I-CBT: Returning to the “Here and Now”
I-CBT helps you recognize the moment your mind drifts from reality into imagination: the “what if” world where obsessional doubt is born.
With ACT as the through-line, we approach this process with gentle acceptance: acknowledging that anything is possible, while grounding firmly in what is actually happening right now.
This work rebuilds trust in your senses and reasoning. It teaches you to see thoughts for what they are: stories of the mind, not proof of danger, and to anchor yourself in the here and now with steadiness and clarity.
Using ERP: Leaning Into the Distress
ERP helps you face the thoughts, images, or situations that OCD tells you to avoid. The response prevention part means resisting the urge to perform a ritual or compulsion, even when anxiety rises.
This is where ACT comes in. Instead of trying to eliminate discomfort, we practice leaning in and feeling the distress fully, allowing it space, and discovering that you can manage it without giving in to OCD’s demands.
In doing so, you begin to experience freedom to live your life in a way that matters even when distress shows up.
All Together Now
These approaches create a balanced, flexible way of healing from a life stunted by OCD.
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ACT helps you open up to experience instead of fighting it.
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ERP helps you practice courage in the face of fear.
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I-CBT helps you return to reality when imagination pulls you away.
This blend is working together to change your relationship with OCD. The goal is to build a life that feels authentic, purposeful, and peaceful even when your mind tries to convince you otherwise.
Contextually-Focused DBT (C-DBT)
At Waves of Wisdom Therapy, I use a C-DBT–informed approach when working with self-harm behaviors and eating disorders. “Informed” means the treatment draws from all the principles, skills, and structure of Contextually-Focused DBT which includes mindfulness, distress management, emotion regulation, and values-based action. This happens within an individual therapy setting rather than a full DBT program. If your evaluation suggests that a higher level of care is needed, I’ll connect you with a comprehensive C-DBT program that includes group therapy, phone coaching, and team consultation.
Making Sense of Chronic Emotional Pain
Contextually-Focused Dialectical Behavior Therapy, or C-DBT, is a modern approach that combines the mindfulness and behavioral skills of DBT with the acceptance and values-based focus of ACT. It’s guided by Dr. Paul Holmes’s Chronic Distress Model, which helps us understand why emotional pain can become so persistent and how to begin shifting out of it.
Other DBT programs are heavily focused on “skills building.” C-BDT helps you make sense of your pain, recognize patterns that no longer serve you, and reconnect to a sense of belonging and living a life of purpose.
The Foundation: Mindfulness and Context
C-DBT starts with mindfulness, not as a way to control thoughts or emotions, but as a way to see them clearly and respond with awareness instead of reactivity.
We explore how your behaviors make sense in the context of your life story, relationships, and environment. When you see your patterns in context, as responses to invalidating or oppressive experiences, you can begin to loosen their hold.
You don’t have to “fix” your emotions; instead, you learn how to experience them safely, understand what they’re trying to communicate, and respond in ways that move you closer to what matters.
The Chronic Distress Model
The Chronic Distress Model explains how emotional pain often comes from feeling like you don’t matter, like your needs or voice have been dismissed or overlooked. When this happens repeatedly, it creates a cycle: we swing between trying to prove our worth and collapsing into the belief that we have none.
C-DBT helps break that cycle. Through mindfulness, acceptance, and compassionate exploration, we begin to see these patterns as attempts to protect ourselves, not signs of weakness. From there, we build new ways of relating to ourselves, to others, and to the world that restores a genuine sense of belonging.
The Three Core Processes
C-DBT moves through three overlapping phases of healing:
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Awareness (“Consciousness-Raising”)
You’ll begin by increasing awareness of how your attempts to cope: self-criticism, withdrawal, perfectionism, over-pleasing, have been shaped by a history of not feeling seen or valued. This awareness is the first step toward change.
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Freedom From
Together, we work on separating old coping patterns from the emotions or memories that trigger them. Through experiential exercises, exposure, and mindful emotional work, you begin to see that your feelings and your behaviors are not the same thing.
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Freedom To
As reactivity lessens, space opens for choice. Here, we focus on commitments and values—what gives your life meaning—and on building behaviors that support them. Freedom “to” is about creating, connecting, and living intentionally, not reactively.
The Heart of C-DBT
At its core, Contextually-Focused DBT is about understanding, not judging; accepting, not resigning; and moving toward meaning, not away from pain.
It invites you to see your distress as something that makes sense—and then to practice responding differently, with awareness, self-compassion, and purpose.
Fees & Insurance Information
Insurance
I am an Out-of-Network Provider
This means I do not bill insurance directly. Many people choose this option because it allows us to focus fully on your care, without restrictions or limitations that insurance companies sometimes impose.
That said, you may still be able to receive partial reimbursement from your insurance company for our sessions. To make the process as simple as possible, I provide a simple superbill with an itemized receipt covering the necessary codes and details that you can submit to your insurance for reimbursement.
Healthcare Benefits
How to Check Your Out-of-Network Benefits
• Call the number on the back of your insurance card (usually labeled "Member Services" or "Behavioral Health").
• Ask:
o Do I have out-of-network mental health benefits?
o What percentage of the session fee is reimbursed?
o If they need "billing codes", you can use these: 90781, 90834 & 90837
o Do I need to meet a deductible first, and if so, how much remains?
o How do I submit a superbill for reimbursement?
Why Check
People are often surprised at how much their insurance reimburses, sometimes covering a significant portion of session costs. Even if you have a deductible, once it's met, reimbursement rates can be higher than expected. If you're unsure, don't let the insurance process discourage you. Many people find that once they've asked a few questions and submitted a superbill, the process is smoother than they imagined.
Fees
Individual sessions
• 50 minute $200
• 75-80 minute $225
Group therapy
• 60-75 minutes $60