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DURING THE COURSE OF TREATING2 severely or predominantly obsessional people, and of helping other therapists treat them, I have observed some phenomena that have prompted me to reconsider aspects of the classic psychoanalytic model of obsessionalism. In the three patients whose treatment will be delineated here, consistent early developmental factors provided clues to a modified conceptualization of obsessional structure. I believe that this hypothesis concerning the dynamics of obsessional functioning points to ways in which the therapeutic usefulness of the psychoanalytic model can be expanded.
The obsessional patient is often experienced by therapists as particularly irritating. In addition, sometimes the newer therapist—and even the more experienced therapist—finds it difficult to remember that the obsessional's doubting, labyrinthian logic, and apparent lack of movement are not a reflection of insufficient skills in the therapist. I believe that the distance provided by the theory of obsessional development to be presented here may also help the therapist to deal with some of the special problems presented by these patients.
Among my obsessional patients I noted certain similarities of background, especially in what I call the parental style. Although there were variations, each patient had at least one harshly critical parent. The criticism started early in life and had a flailing, arbitrary ring to it from which the child could not escape. The parent's comments usually began with physical appearance, such as: "Your mouth is too small, " "Your nose is too large, " "Your hair is awful."
The criticism persisted, often over school performance (although the children performed well), and ranged over all aspects