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What makes it difficult to cure an obsession is the fact that it is a defense. The patient is afraid to lose it; if he does, he longs for it or he replaces it with another one. He constantly endeavors to improve its rationalization, so that nobody can take it away from him.
The interpretation of the obsession is without therapeutic result; what must be reached is the cause of the underlying anxiety. The patient, wavering between right and wrong, acts as though he tried to do what is certainly right in the public eye. Therefore, he wants to do more than well to insure his doing well enough. Hence, the scruple and constant control. Such notions of right and wrong are absolute and play a part in the normal thinking of the child.
In obsessional patients anxiety is related to sex and aggression, both forbidden. An interesting case history illustrates this theoretical survey.