Having therapy with a baby in the room
Getting to an appointment with a newborn is its own obstacle, and it keeps many parents from starting. Online sessions with the baby present, feeding allowed, are how this work actually happens.
Many new parents never get help because getting to it is impossible. An appointment across town means a car seat, a feed timed around the journey, a waiting room with a baby who may or may not cooperate, and childcare if the appointment is one where a baby cannot come. On no sleep. For most people, that is enough to put it off for another month, and then another.
Sessions for new parents are built around exactly that.
The baby can be in the room
Sessions run over secure video, from wherever you are. The baby can be in the room. You can feed during a session, breast or bottle, without pausing anything. You can hold them, rock them, change them. It is genuinely fine if we are interrupted, and we will be, and that is expected rather than tolerated. A session that happens with a baby on your shoulder is a session that happened, and it does the same work as one in a quiet room.
For a lot of parents this is the difference between having therapy and not having it.
Why online suits this theme
There is a second reason online works well here that is not about convenience. Perinatal OCD lives in your home: the bath, the stairs, the cot, the kitchen. The exposures that make up the treatment happen in those places, and in an online session I can be alongside you on the call while you do the first bath without handing over, in the bathroom where it actually happens. In a therapy room we would be talking about your stairs. Online, we are on them.
What a session looks like
Assessment is one or two sessions, at whatever pace the saying needs. If you have never said any of this out loud, you can start with the theme in general terms and fill in the detail over several weeks. Detail helps the treatment; it is not the entry fee.
Then the work: mapping the cycle, the trigger, the intrusion, the meaning it has taken on, and everything you have started doing about it, and withdrawing those compulsions gradually, by agreement, at a pace you set. CBT with exposure and response prevention is the treatment, and it responds as well here as in any other theme. Every step is planned together first. Nothing is sprung on you, and nothing involves your baby coming to any harm; exposure means giving up the safety behaviours, and only that.
Timing around a newborn
Weekly 50-minute sessions are the usual rhythm, and a typical course runs 12 to 16 of them. With a baby, timing is a negotiation with the baby, and we negotiate. Sessions can be scheduled around feeds and naps, and if a week is impossible, it is impossible, and we pick up the next one. The between-session work, which is where most of the change happens, is built around your actual days: small, and possible on no sleep.
During pregnancy
Perinatal covers pregnancy as well as the year after, and this often starts before the baby arrives. There is no reason to wait for the birth. Treatment during pregnancy means the safety behaviours have less time to establish, and the baby arrives to a parent already partway through the work.
Alongside your other care
Where you want it, I am glad to work alongside your GP, health visitor or perinatal mental health team, so that everyone knows what is happening and the care joins up. Assessment also separates OCD from postnatal depression and from postpartum psychosis, which is a medical emergency; if you are unsure which you are describing, contact your GP, midwife, health visitor or NHS 111 today rather than waiting.
Fathers and non-birthing partners get this too, disclose it less, and are just as welcome, with the baby in the room or not.
If the logistics have been the wall, they are lower than they look. There is more on how I treat perinatal and postnatal OCD, and the first conversation can happen with the baby asleep on you.