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Leon Salzman, M.D., Treatment of the Obsessive Personality.
New York: Jason Aronson, Inc.
THE PSYCHODYNAMICS OF THE OBSESSIONAL neurosis have been studied and explicated quite thoroughly since Freud's presentation of the Rat Man. Both the typical symptomotology and predominant defense mechanisms employed have been spelled out methodically. Along with the hysterical neurosis it has been seen traditionally as amenable to psychoanalytic treatment, requiring little or no variation in classical technique. Yet, despite all our knowledge and experience with this diagnostic category there is a good deal of pessimism among analysts about achieving a successful outcome when working with an obsessional. "Clinically speaking … it cannot be denied that a major obsessional neurosis is a severe and intractable disorder in which only moderate analytical accessibility prevails." (Glover 1955, p. 205). Why should this be so? Why should work with these patients often be considered laborious, tedious and boring?
Various explanations can be offered. Fenichel (1945) systematically lists several difficulties which he sees as idiosyncratic to the obsessional neurosis. For instance, free association or compliance with "the basic rule" is almost impossible because the patient is always unconsciously censoring irrational thoughts and impulses while striving to be reasonable. The rigid avoidance of emotional experience and a tendency to intellectualize can lead to much talk for talk's sake. Also, the positive value which our culture places on qualities such as punctuality, cleanliness, orderliness, etc. furnishes secondary gains which compound the work of exposing defensive functioning. Furthermore, the obsessional tends to be negativistic