Michelle Puerner, LCSW

Over 95% of my caseload meets criteria for OCD or an OC-related condition. For the past six years, I have treated an average of 28 individuals per week with OCD across a wide range of presentations, including harm, taboo, somatic, contamination, moral, relationship, and body-focused OCD, as well as comorbid eating disorders, tics/Tourette’s, Functional Neurological Disorder, and trauma. I have extensive experience treating taboo and sexual-themed OCD, including intrusive sexual thoughts and moral obsessions. My work centers on evidence-based ERP, grounded in functional analysis and flexible, process-informed care for complex cases. I also provide supervision and consultation for clinicians.

I treat OCD in the context of anxiety disorders, eating disorders, mood disorders, Tourette’s and tic disorders, ADHD, and Functional Neurological Disorders. OCD remains the organizing target, with ERP at the center of treatment. Co-occurring concerns are understood functionally, looking at how each one feeds into the OCD loop. I weave in ACT, I-CBT, DBT-informed skills, and metacognitive work to support emotion regulation, motivation, and flexibility without backing away from exposure. Care is sequenced to reduce interference and risk so progress can happen across domains without losing focus or fragmenting treatment.

I’ve been a licensed therapist for nearly 15 years and have been using ERP in my work since 2018, with a focused specialization in OCD and related disorders over the past six years. I carry a high-volume OCD caseload and have pursued advanced training in ERP, ACT, I-CBT, Metacognitive Therapy, CBIT, and SPACE-based family work. I’m a trained Family Well-Being Consultant through When a Loved One Won’t Seek Mental Health Treatment and use SPACE-informed models, including Failure to Launch and ARFID frameworks. My approach is grounded in functional thinking and flexible, real-world application.

I practice in rural Montana and serve individuals and families across multiple states via telehealth, helping bring specialized OCD care to communities with limited access to specialty services. My caseload includes children, adolescents, and adults from a wide range of socioeconomic, racial, and cultural backgrounds, including clients of color and Native clients in rural settings. I have extensive experience working with individuals involved in the court system and those impacted by institutional stressors. I regularly work with neurodivergent and LGBTQ+ clients and provide affirming, grounded care that is responsive to context while staying anchored in evidence-based OCD treatment.

I have worked in a wide range of systems, including the Veterans Administration and the Montana State Prison, serving individuals impacted by trauma, poverty, disability, and institutional stress. My current practice is based in rural Montana and serves clients across multiple states via telehealth, many from underserved or isolated communities. I regularly work with clients of color, Native clients, court-involved individuals, neurodivergent clients, and LGBTQ+ individuals. My approach emphasizes cultural humility, respect for lived experience, and adapting evidence-based OCD treatment to each person’s social, cultural, and systemic context.