OCD Can Affect Much More Than Worries or Rituals
Who I Work With
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Ages 5–25
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Children • Teens • Young Adults
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Treatment Approach
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Exposure & Response Prevention (ERP)
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Evidence-based Cognitive Behavioral Therapy (CBT)​
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Parent Involvement
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Parents are actively involved when it supports treatment, particularly for younger children and when OCD is affecting family routines.
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​Therapy Options
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​In-Person
Philadelphia's Main Line & Surrounding Suburbs
In-home sessions
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Secure Online Sessions
Pennsylvania & PSYPACT Participating States
(check if your state participates in PSYPACT here)
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Complimentary Phone Consultation
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20-minute phone call
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Speak directly with Dr. Fiona Macphee
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Discuss your concerns and determine whether my approach is the right fit
On This Page
OCD Can Affect Much More Than Worries or Rituals
OCD can affect far more than worries or rituals. It can interfere with school, friendships, family life, sleep, and the confidence to do everyday things.
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The good news is that OCD is highly treatable.
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Using Exposure and Response Prevention (ERP)—a treatment that gradually helps children face feared situations while learning they don't have to follow OCD's rules—and other evidence-based cognitive behavioral therapies, I help children, teens, and young adults build confidence in handling uncertainty so OCD no longer dictates their daily lives.—a treatment that gradually helps children face feared situations while learning they don't have to follow OCD's rules—and other evidence-based cognitive behavioral therapies, I help children, teens, and young adults build confidence in handling uncertainty so OCD no longer dictates their daily lives.
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Treatment is individualized, collaborative, and tailored to each child's developmental stage, strengths, and goals.
Evidence-Based Care with a Personalized Approach
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✔ Exposure and Response Prevention (ERP)
✔ Individualized treatment plans
✔ Parent involvement throughout treatment
✔ Practical strategies that extend beyond the therapy office
Licensed Clinical Psychologist
New York University • Child Mind Institute • University of Pittsburgh Medical Center • Florida International University • University of Washington • Seattle Children's Hospital
PSYPACT Authorized
Meet Dr. Fiona Macphee
If you're looking for treatment for childhood OCD, you're probably not just looking for someone who treats anxiety.
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You're looking for someone who understands OCD specifically—how it affects children differently, how it impacts families, and how to help it get better.
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I'm Dr. Fiona Macphee, a licensed clinical psychologist specializing in evidence-based treatment for OCD and anxiety disorders in children, adolescents, and young adults.
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My treatment approach combines Exposure and Response Prevention (ERP) and other evidence-based cognitive behavioral therapies with a warm, collaborative style that helps young people gradually build confidence while feeling understood and supported.
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Depending on your child's needs, treatment may include individual therapy, parent coaching, school collaboration, real-world sessions where OCD actually occurs, and collaboration with other professionals involved in your child's care.
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Because much of ERP practice happens between sessions, parents are often an important part of treatment—particularly for younger children and when OCD is involving the family through reassurance, accommodations, or rituals.
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For older teens and young adults, treatment may look different. Depending on developmental needs and each family's goals, therapy may involve individual sessions, parent coaching, joint sessions, or a combination of these approaches.
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I'll help determine the level of parent involvement that best supports your child's progress while respecting their growing independence.
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One of the most rewarding parts of my work is watching children discover they are far more capable than OCD has led them to believe.
How OCD Can Affect Everyday Life
One of the most confusing things about childhood OCD is that it doesn't always look the way people expect.
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Many parents picture excessive handwashing or fears of germs. While those symptoms certainly occur, OCD can also involve repeated reassurance-seeking, checking, intrusive thoughts, perfectionism, mental rituals, confessing, or needing things to feel "just right."
Over time, these behaviors often become more frequent and begin interfering with everyday life.
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School attendance may become more difficult. Bedtime routines grow longer. Simple decisions become exhausting. Family outings require more planning, and friendships become harder to maintain.
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For some children, OCD is largely internal. They quietly struggle with intrusive thoughts, anxiety, or mental rituals that others rarely see.
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For others, OCD becomes much more visible. Attempts to interrupt a ritual, tolerate uncertainty, or resist reassurance may lead to intense emotional distress or significant emotional outbursts. What can appear to be defiance, stubbornness, or "bad behavior" is often a child whose OCD has become so overwhelming that they don't yet know another way to cope.
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Whether OCD shows up through obvious rituals and emotional outbursts or through quiet internal struggles, it has a way of gradually asking for more and more of a child's time, energy, and confidence.
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If your primary concern is frequent aggression, emotional outbursts, or oppositional behavior across many situations—not just when OCD is involved—you may also find my Emotional and Behavioral Challenges page helpful.
Exposure and Response Prevention (ERP): The Gold-Standard Treatment for OCD
Exposure and Response Prevention (ERP) is considered the most effective treatment for childhood OCD.
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At its core, ERP helps children gradually face the situations, thoughts, or feelings that trigger OCD while learning not to respond with the rituals, avoidance, or reassurance that OCD demands.
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An exposure simply means gradually practicing something OCD tells your child to avoid or fear. Response prevention means resisting the rituals or reassurance that OCD says are necessary afterward.
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Although rituals and avoidance may provide temporary relief, they actually strengthen OCD over time by teaching the brain that the fear was dangerous and the ritual was necessary.
ERP breaks that cycle.
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With guidance and support, children practice approaching fears in small, manageable steps while discovering something incredibly important:
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They can tolerate uncertainty without listening to OCD.
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Over time, the brain learns that anxiety naturally rises and falls on its own, even without rituals. As confidence grows, OCD gradually loses its influence.
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Many families begin noticing meaningful improvement within three to six months of consistent treatment, although every child and every situation is different.
What Therapy Looks Like
No two children experience OCD in exactly the same way, and therapy shouldn't look the same for every child either.
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Treatment is active, collaborative, and individualized. Rather than simply talking about anxiety each week, we work together to help your child build the confidence and skills needed to respond differently to OCD—both in therapy and in everyday life.
Understanding OCD
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Children first learn how OCD works and why rituals, reassurance, and avoidance keep the cycle going.
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Understanding the cycle helps children begin recognizing OCD as something they can respond to differently—not something they have to obey.
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Learning to Respond Differently
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Using Exposure and Response Prevention (ERP) and other evidence-based cognitive behavioral strategies, children gradually practice approaching situations that trigger OCD while learning not to respond with the rituals, avoidance, or reassurance that OCD demands.
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Each step is carefully planned, individualized, and adjusted based on your child's readiness so they can build confidence through experience.
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Parent Coaching & Family Support
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Because much of ERP happens between therapy sessions, parents often play an important role in helping children practice new skills in everyday life.
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For younger children, parent coaching is typically an essential part of treatment. You'll learn how to recognize when OCD is pulling the family into its cycle, respond in ways that support your child's progress, and confidently guide ERP practice between sessions.
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For teens and young adults, the level of parent involvement depends on your child's developmental needs, treatment goals, and preferences. Some families benefit from parent coaching or occasional joint sessions, while others are most successful with therapy that is primarily individual.
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Real-World Practice
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Some of the most meaningful progress happens outside the therapy office and where OCD actually occurs.
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When appropriate, we'll practice approaching real-life situations that trigger OCD—at home, at school, or in the community—while learning to respond without following OCD's rules.
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These real-world sessions are available throughout Philadelphia's Main Line and surrounding suburbs when clinically appropriate.
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School Collaboration
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When OCD begins affecting attendance, learning, or participation, collaboration with teachers and school staff can help create consistency between home and school.
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Together, we can develop practical strategies that support your child's progress across settings.
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The Goal of Treatment
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The goal of treatment is to reduce OCD symptoms while helping children get back to living the life they want to live.
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As treatment progresses, many families notice that daily routines become easier, reassurance becomes less necessary, and children become increasingly willing to face situations they once avoided.
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Children begin returning to school with greater confidence, participating in activities they had stopped doing, enjoying time with friends and family, and discovering they are capable of handling uncertainty without following OCD's rules.
When Weekly Therapy Isn't Enough
While many children make excellent progress through weekly therapy, some benefit from a more concentrated treatment approach.
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Extended sessions provide additional time to practice new skills, work through more challenging situations, and build momentum that can be difficult to achieve within a traditional therapy session.
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Because OCD often shows up outside the therapy office, intensive treatment may also include practicing skills in real-world settings where OCD actually occurs.
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Together, we'll determine whether weekly therapy or a more intensive format is the best fit for your child's needs and goals.
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Intensive treatment may be especially helpful when:
✓ OCD is significantly interfering with daily life.
✓ School attendance has become difficult.
✓ Previous therapy hasn't led to the progress your family hoped for.
✓ Your child would benefit from extended practice and support.
Frequently Asked Questions
Are parents involved in treatment?
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It depends on your child's age, developmental stage, and treatment goals.
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For younger children, parents are typically an essential part of treatment because they help support ERP practice between sessions and learn how to respond when OCD involves the family.
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For teens and young adults, treatment may be primarily individual, may include occasional parent sessions, or may involve more active parent participation when it supports treatment. Together, we'll determine the approach that best fits your child's needs while supporting increasing independence.
How long does treatment usually take?
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Every child is different.
Many families begin noticing meaningful improvement within three to six months of consistent treatment, although the overall length of therapy depends on your child's symptoms, goals, and progress.
Do you provide online therapy?
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Yes.
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I provide secure telehealth throughout Pennsylvania and in PSYPACT participating states where I am authorized to practice.
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For families in Philadelphia's Main Line and surrounding suburbs, treatment may also include real-world sessions at home, school, or in the community when clinically appropriate.
Do you prescribe medication?
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As a licensed psychologist, I don't prescribe medication.
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Exposure and Response Prevention (ERP) is considered the first-line treatment for OCD and is highly effective for many children.
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When medication may be beneficial, I'm happy to collaborate with your child's pediatrician or psychiatrist to coordinate care.
What happens during the complimentary phone consultation?
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During our 20-minute phone call, we'll discuss the concerns that brought you here, answer your initial questions, and determine whether my practice is the right fit for your family.
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If it seems like a good match, we'll talk about the next steps for scheduling an intake evaluation.
Do I need an OCD diagnosis before contacting you?
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Not at all.
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Some families contact me after their child has already been diagnosed with OCD, while others simply know that something doesn't seem right.
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If you're unsure whether your child's symptoms reflect OCD, another anxiety disorder, or something else entirely, I can help. Depending on your child's needs, I may recommend beginning treatment or completing a psychological evaluation to clarify the diagnosis and guide treatment planning.
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We'll discuss your concerns during the complimentary phone consultation and determine the most appropriate next step for your family.
Ready to Take the Next Step?
If OCD has begun taking over your child's life, effective treatment can help.
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A complimentary phone consultation is an opportunity to discuss your concerns, ask questions, and determine whether my approach is the right fit for your family.
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Together, we'll talk about what's been happening, what treatment might look like, and the next steps toward helping your child spend less time listening to OCD and more time living the life they want to live.
Looking for help with ADHD, anxiety, emotional outbursts, or executive functioning? Explore my other specialty areas.
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