Lost on Repeat: Prologue

It was a crisp morning in early March of 2012. The hard frost overnight had covered the parking bay. I was reversing back and forth with the car door propped open, struggling to see whether I was between the faint white lines. There had been more traffic than anticipated on the run into town, and I was getting close to being late. The dump of adrenaline was sending my heart rate through the roof. I was becoming increasingly stressed and frustrated.

On the very cusp of slamming the car door shut and driving off, I would still be charged for the session. It would also be a bad first impression.

Hi Gill, sorry for the late notice. The lines in your car park are insufficiently visible. I couldn't park in a way that felt correct, so I drove home, having an epic tantrum like a six-year-old. I hope to see you next week, weather permitting. James.

After a lot of swearing and door handle checking, I pressed the key fob for the fourth time, just in case the car had magically opened in the last twenty seconds—then hurried to the door.

Gill was a cognitive behavioural therapist, and this was my third attempt at psychological therapy. I was in the process of selling my first business and preparing to start a university degree. Under the false impression that the lived experience of mental health issues would harm my career prospects, I sought a private therapist so it wouldn't show on my NHS medical records.

While I've experienced a range of intrusive thoughts over the years, with many compulsions since my early teens, health-related themes were the most common and arguably the most difficult to manage. Health anxiety can often present somewhere between generalised anxiety (excessive worry) and obsessive-compulsive disorder (OCD); mine have always been catastrophic movie-type intrusive thoughts about death and terminal illness. Whether about me, family members, or my dogs, it was generally most active during increased stress or transition periods.

My compulsions have ranged from habitual checking of my body, being on speed dial to the vet, to neutralise persisting fears of my dogs dying in the house while I was out at work. Also, gas poisoning, house fires and the dogs being stolen or killed on the road due to me accidentally leaving the door open. I would repeatedly press light switches and relentlessly check the oven and gas hobs, electrical sockets, doors, windows, and water taps to reduce anxiety around the thoughts.

Although I've been able to reasonably manage OCD over recent years, it has been costly in the past. Not just in terms of my well-being, but it has also impacted my relationships, causing rows and arguments over my need to perform ritual checks of the entire house before leaving to go anywhere. Inevitably, shouting at someone with OCD in the middle of their compulsions, interfering, or entering a room that has been checked will often serve only to contaminate the whole process, meaning that you have to start from scratch. Needless to say, it has caused issues over the years.

Then there's the financial costs. Aside from the nearly one hundred weekly sessions of private therapy, I've broken every door handle and window lock in the house and thrown away mountains of food because I decided it had an odd look about it, despite being in date. Yet, none of it has ever added up logically. Being able to leave the television plugged in, but not the kettle. Leaving the fridge plugged in but not the computer. Taking photos to ensure that things are properly switched off, despite knowing that photos cannot prevent an electrical fire or gas leak if there is an actual fault.

The first therapist I saw when I was diagnosed with OCD at the age of sixteen was a counsellor at my local GP surgery. Typical of teenagers, I didn't speak much. All I remember was that the therapist kept asking me if I loved my parents. He was getting increasingly frustrated with the monosyllabic response. Eventually, he gave me a metaphor for traffic lights and discharged me. Whenever I felt anxious, I was to imagine a red traffic light, then move to amber, then green, all while trying to slow my breathing down.

Safe to say, it did little to curb the intrusive thoughts that developed over the next two years: graphic images of pushing people under trains while waiting on the platform, repeatedly monitoring my vision for signs of a brain tumour, or the urge to crash my car into a tree, once I passed my driving test. And, while having never been suicidal, I spent several months during my early twenties avoiding bridges and multi-storey car parks on the off chance that I might give in to the strange urge to throw myself off the side.

I entered therapy again during my late twenties through the NHS, having around ten sessions. Once again, mostly calming exercises, the STOPP technique, similar to the traffic lights, and worksheets telling me that my thoughts were not facts. None of it touched the sides, but as can be common with perfectionists, I told the therapist it was all marvellous and tremendously helpful. I attended every session with a completed homework sheet, all embellished and written out the night before. I wrote them off as pointless, having tried the techniques only once.

Two decades later, and now a qualified psychologist, I understand that my lack of engagement with the process was partly to blame. Yet, both instances of therapy were focused on the management of generalised anxiety (worry): reassurance seeking and tolerance of uncertainty, as opposed to intervention specifically targeting obsession and compulsion. I also didn't fully understand where I was getting in my own way.

My experience with Gill would be different, to a degree. Although I didn't necessarily appreciate it then, she was absolutely on the ball regarding formulation and intervention.

Sitting next to the window, I realised her room looked out onto the car park. The frost had started to clear in the morning sun, and I could see that I was parked across two spaces, with the white line demarcating the bay running directly underneath the middle of the car. My internal critic starts barking at me. "How the hell did you pass your driving test?" I glanced to the left; I could see a car parked at an odd angle with the bonnet protruding from the space.

My external critic piped up. "What careless and thoughtless person leaves their car abandoned like that? No wonder I couldn't park straight!" Gill noticed me glancing at the car.

[Gill] Oh, that's mine; I couldn't see the line this morning either. Don't worry; the car park is private, and there are always spaces.

[Me] The lines are very faint.

[Gill] They are. Do you struggle when things don't go your way in other aspects of your life?

She was very direct—I liked that about her.

I'm embarrassed that she had seen my morning antics from the window, though. I felt angry and a bit upset. It was the first time in my adult life that anyone had asked me that question. I didn't know why it struck a chord, but it did. I had done a lot of research on OCD over the years, but had never paid much attention to my other quirks.

We began piecing things together over the first few sessions, starting with the A5 writing pad resting on her lap. By session three, Gill was stretching across a corporate-sized presentation board. The competing schemas of chaos and order are laid out in neatly drawn boxes, circles and arrows, like a map of the London underground. A combination of hypercritical, rigid and unrelenting standards and a healthy side plate of fearing harm and illness. I was officially knighted as a truly compulsive and obsessive person.

And, like many people with similar schemas, the only problem I could see from my perspective was the cycle of distressing, intrusive thoughts and relentless checking.

Gill was an experienced and intuitive therapist who helped me make sense of things. She recommended a combined treatment approach involving in vivo (with the therapist) exposure tasks to the most feared outcome of my thoughts. This involved digitally recording my imagined demise from a terminal brain tumour right up to the point of my funeral. My homework task was to repeat the exposure by listening to the recording at regular intervals during the week without engaging with compulsions. Commonly known in therapy circles as exposure and response prevention (ERP).

She also recommended combining this with eye movement desensitisation and reprocessing (EMDR). This was not typically offered on the NHS for OCD, given the evidence base being mostly anecdotal outside of treatment for post-traumatic stress disorder (PTSD). Still, she had seen better results with her previous patients when combining the treatment approaches.

True to my well-established patterns, I told Gill that this all sounded great and that I could understand her rationale. What I didn't tell her was that I knew I was not symptomatic of PTSD, and from what I had read online, ERP was the gold standard; it had a well-established evidence base. I wanted that—thank you!

In retrospect, I wish I had listened to her, but at the time, I was still under the false belief that I always knew best.

I recorded the exposure tasks during our sessions while maintaining emotional detachment and making intellectual connections. I would play the recordings during the week on loudspeaker while searching for support worker roles to keep me financially afloat while studying. I rationalised that I was too busy to take the time out. Although technically distracted, I wasn't engaging in my usual compulsions.

That was okay, though?

Obviously not!

Eventually, I started my university course and, combined with a part-time job and lack of affordability due to the significant drop in income, I ended treatment abruptly. I sent Gill an email, telling her how much better I felt and that her approach was life-changing. I'm pretty sure she saw through it.

So why am I telling you all this? More to the point, why did I decide to write a whole book about it?

As you have likely gathered by this point, obsession and compulsion have been part of my life for as long as I can remember and also involve a large part of my clinical work.

Following a significant career change in 2012, I began the long and uncertain path into applied psychology training. I started treating people with OCD clinically in 2016. Initially, at a low intensity, before moving into specialist psychotherapy as my career developed.

I also have over forty years of personal lived experience of compulsion and obsession, starting at the age of seven with a preoccupation with things needing to feel balanced. Over time, this evolved into tasks needing to be done to an excessive and unsustainably high standard.

I've seen five different psychotherapists over the years, each of whom has leaned into various theories. I found therapy both helpful and unhelpful. Different approaches provided unique benefits, but no single model or technique has ever proven to be a silver bullet. Psychological treatment for OCD, perfectionism and demanding internal standards can also be quite tricky for both the client and the therapist. Yet, the variety of approaches helped me bring different pieces together, eventually shifting my perspective, which then allowed me to shift gears.

Technically speaking, I no longer meet the clinical criteria for an obsessive-compulsive disorder. But I am still very much a compulsive and obsessive person. It is simply the case that it no longer dictates my life or generates the same degree of anxiety it once did. Yet, the tendency to check things and the demanding standards still hum in the background. When I say “hum,” they can fire up like the engines of a Boeing 747 taxiing for takeoff, given the right conditions.

If you're wondering whether the rest of the book will be some life coaching-type pitch: "How I set myself free from OCD." It's not, and I did not. What I have learned to do is to recommission the small bombs of anxiety that trigger it and, over the years, have learned to drain the power from it. And no, it's not as simple as it sounds.

Of course, my experiences are not universal. OCD manifests in varied ways, and each person's journey is different. In my clinical work, I'm careful to bracket off my experiences so that I don't filter treatment through my personal lens. Although lived experience can be helpful to some degree in therapy, there is also a risk that it can skew the focus away from the person's individual experiences or lead to assumptions based on subjective leaps.

During the first chapter, I provide a basic outline of the current clinical understanding of OCD and obsessive-compulsive personality traits and how the lines between what is classed as a problem can often be quite blurred. However, the book is not about mental disease and illness; it's about real people, real lives, and what it is actually like to lose yourself and live life constantly on repeat.

The aim is to provide an honest reflection from a perspective that seeks to bridge the gap between clinical treatment and lived reality from both sides of the clinic room. The stories about my personal life and therapy experiences are all true. My family members have kindly provided their perspectives with consent to share these. However, any descriptions or references to patients in my clinical practice have been entirely fictionalised to ensure confidentiality. The therapists I've worked with have also been anonymised to protect their identities.

My own story is the primary case study that runs throughout, and I take a light-hearted view, which sometimes gets a little dark. Having worked with a lot of people with OCD over the years, I fully recognise that it is typically anything but light. However, I wanted to approach this book with honesty and integrity; it also has a bit of swearing in it—it's about real life. Hopefully, it will feel relatable in some ways and help to normalise similar or shared experiences.

At the very least, you will have an opportunity to analyse the shrink for once.

Lost on Repeat: Compulsive Obsessive People (2025)

Quirky in tone, occasionally funny, sometimes bleak. 300 pages.

Available in:
Paperback | Hardback | Kindle | Kindle Unlimited