Obsessionality, Communication and Mis-Communication*

This paper is an account of the first 2 years of therapy with an adolescent boy whom I shall call Leonard. He was referred to the clinic, aged 16, for compulsive, obsessional behaviour which affected his whole functioning and was having a particularly crippling effect on his school work. Having been a “straight A” student, he was now re-sitting exams in order to attain the standard required to enable him to go on to more advanced studies. Initially I saw him 3 times a week but in the 2nd year this was reduced to twice weekly. This is not a theoretical paper and there is no theoretical overview; it is a clinical account of the process of the therapy. As implied by the title, the focus is on the changing nature of the communication, its relation to the obsessionality and the way these changes and fluctuations parallel the development of the therapy.

Leonard's thinking processes had come to a virtual standstill due to the setting up of an obsessional system designed to spare him any experience of psychic pain. The material thus offers an opportunity to chart his gradual emergence from the stranglehold of obsessionality into the freer regions of creative thinking and “true” - i.e. meaningful communication.

At the start Leonard's obsessionality was pervasive and all-encompassing, contaminating any contact between us. It was thus a powerful communication through which I learned a great deal about the quality of his relationship to his objects and about the objects themselves.

Quite early on it became apparent that Leonard's internal world was dominated by a bullying taskmaster; an internal dictator who imposed rituals and compulsions in exchange for “protection” from worries and anxieties. The price for this was heavy, namely the paralysis of all thinking processes; a kind of mental constipation.

The start of therapy was particularly difficult for Leonard. He was very tense and nervous - unable to tolerate even the slightest p