Psychodynamic psychotherapy for obsessive-compulsive disorder

Obsessions and compulsions are intrusive thoughts, impulses, and actions that cannot be suppressed, even though those affected recognize them as nonsensical. The point prevalence is one to two percent, and the lifetime risk is two to three percent.

The first choice is cognitive behavioral therapy with exposure and response prevention. For depth psychology-based psychotherapy (TP), there is insufficient evidence of efficacy. People with obsessive-compulsive disorder may first consider behavioral therapy. In addition, high doses of selective serotonin reuptake inhibitors (SSRIs) are used over an extended period of time.

In classical compulsion, there is an underlying conflict: forbidden impulses, whether sexual, competitive, or self-assertive, clash with a conscience that is experienced as alien and directed against the self. Reaction formation and isolation of affect (transformation into its opposite; separation of thought and feeling), as well as undoing, keep this conflict unconscious. These are defense mechanisms.

The situation is different in cases of severe structural disorders. Here, the ritual provides stability and protects against a sense of inner disintegration. Interpretations that focus on conflict can then have a destabilizing effect. What is needed are supportive interventions that strengthen structure.

This distinction determines the course of treatment, and it also determines the prognosis: The first form can be treated much more successfully using psychodynamic methods than the second.

Obsessive-compulsive disorders begin early in life, are chronic in nature, and are difficult to treat with any approach. For many people with the disorder, the neurobiological component is likely greater than the psychoanalytic tradition has long been willing to acknowledge.

Out of shame, obsessions and compulsions are often kept secret for years. Simply bringing them up is the most important step.

Behavioral therapy remains the first line of treatment, and I’ll help you find it. I am psychodynamically trained and provide online counseling; I do not treat obsessions or compulsions. In counseling, we sort out what is on the table right now.