If you’ve been struggling with intrusive thoughts like “What if I harm my child?” or “What if I’m secretly a pedophile?”, chances are you’ve felt terrified, ashamed, and misunderstood. These thoughts—often referred to as taboo OCD themes—can feel so disturbing that they shake you to your core. And if you’ve tried therapy, you may have been told to “accept the uncertainty that you could be a pedophile” because well, everything is uncertain, right?  But what if that approach hasn’t helped—or has even made things worse? What if we don’t have to accept that we could possibly be a pedophile or murderer- just like people without OCD don’t have to accept this?

This is where Inference-Based Cognitive Behavioral Therapy (I-CBT) offers a gentler, more validating alternative that fosters self trust.

Why “Accept Uncertainty” Doesn’t Work for Everyone

In traditional Exposure and Response Prevention (ERP), the gold-standard treatment for OCD, the goal is to gradually reduce compulsions by accepting uncertainty about feared outcomes. For some people and some OCD themes—like contamination or checking—this approach can be helpful.

But for taboo OCD themes like harm OCD or pedophilia OCD (often referred to as HOCD or POCD), asking someone to “accept that you might be a danger” can feel retraumatizing and deeply misattuned. That’s because these fears often strike at the heart of your identity, values, moral character and often (but not always)- personal trauma history. You’re not afraid of getting sick or making a mistake—you’re afraid you’re secretly a monster.

That’s not a fear you can just sit with. That’s a fear that requires being seen, understood, and therapeutically supported in trusting you are not those awful things. To be clear, I-CBT can be used with any OCD theme, but I have found that it’s especially helpful with the taboo themes where acceptance of uncertainty and exposure do not feel at all accessible. 

Understanding I-CBT: Trusting Your Inner Knowing

I-CBT works from a radically different angle: instead of focusing on uncertainty, it focuses on how the obsessional doubt was created in the first place. Two of the ways this happens is through an over reliance on possibility and irrelevant associations of arbitrary facts that don’t relate to the here and now. Here’s an example:

“Pedophiles do exist- what if I could be one?” (over-reliance on possibility)

“I felt a warm feeling when I held my child—what if that means I’m sexually attracted to them?” (irrelevant association)

“I thought about pushing someone in front of a train—what if that means I want to do it?” (thought-action fusion, irrelevant association) 

These are not evidence-based conclusions. They’re what I-CBT calls “inferential confusions”: moments where your brain substitutes imagination, fear, or a single mental image for trustworthy data.

I-CBT helps you reconnect with what’s actually true about you—your intentions, your desires, your past experiences, and your here and now senses (what you can hear, smell, see, taste and feel).

Inner Sense Data: Your Built-In Compass

One of the most powerful tools in I-CBT is learning to trust your inner sense data—your true intentions, desires, emotions, thoughts and opinions in the here and now context. 

For example, a parent with POCD might know deep down:
➡ “I love my child. I have no desire to harm or sexualize them.”
➡ “I’ve always been caring and protective. I have no history of being violent.”
➡ “These thoughts feel intrusive and scare me, not something I enjoy thinking about”

I-CBT helps you strengthen this inner compass by guiding you to track patterns, intentions, and consistencies in your behavior. Rather than focusing on the content of the thought (which can be endlessly sticky), we focus on the evidence in the here and now- and your values, past experiences, what others know to be true about you.

Desires and Intentions Matter in OCD

Many folks with taboo OCD themes feel devastated because they assume having a thought means they want it to happen. But thoughts and intentions are not the same. And in I-CBT, we emphasize this distinction clearly and repeatedly.

You might be asking yourself, “But what if deep down I do want it?” That doubt is exactly what OCD thrives on—what I-CBT calls a narrative of doubt. It hijacks your values and tells you they can’t be trusted. I-CBT helps you step out of this fear and possibility-based narrative and into a reality-based one, where your long-standing character traits, consistent behaviors, and moral compass are recognized and affirmed.

Reclaiming Trust in Yourself

I-CBT doesn’t require you to accept the unacceptable. It invites you to remember who you are. To look at your history. To reflect on your actual desires, not the intrusive thoughts your brain throws at you. To slowly rebuild trust in your own reality—not the one distorted by obsessional doubt.

If you’ve been struggling with taboo OCD themes and ERP hasn’t felt like the right fit, know this: there are other paths to healing. You don’t have to white-knuckle through uncertainty. You deserve a treatment approach that honors your story, your values, and your truth.

Final Thoughts

Your thoughts are not facts.
You are not your OCD.
You are not a danger because of your intrusive thoughts. 

You are a human being trying to make sense of deeply distressing experiences—and you deserve care that meets you there.

If this resonates with you, you’re not alone. I work with clients in California, Utah, Washington State and Florida (virtually), and in-person in San Diego, offering OCD therapy grounded in compassion, curiosity, and clinical expertise—including I-CBT. Reach out if you’d like support walking this healing path together.