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February 16, 1959. SOME TECHNICAL ASPECTS CONCERNING THE ANALYSIS OF OBSESSIVECOMPULSIVE PATIENTS. William G. Niederland, M.D.
Many technical difficulties in the treatment of patients with severe obsessional neuroses are created by the copiousness of communication, the ruminative type of association, the meticulous and narrative mode of describing daily activities and of elaborating intellectually on them, as well as the sometimes rapidly emerging depressive or paranoid substructure for which the obsessional ritualistic system is a defense. Most of these difficulties are not insurmountable if we pay particular attention to the analysis of the transference, particularly the negative.
Three clinical examples are presented to illustrate these points. In each, the obsessional elaboration was interrupted by an interpretation of the patient's anxiety within the transference. In the third case the emergence of a paranoid delusional system in statu nascendi was interrupted and analyzed through interpretation of the transference, permitting successful continuation of the analysis to its conclusion by standard technique. In each case emphasis was placed on ferreting out and analyzing the negative transference. Another technical procedure, briefly discussed, and found particularly useful in some cases of obsessional neurosis, is the analysis of sounds (preverbal or nonverbal) emitted by the patient. A case is presented to illustrate the condensation of thoughts and feelings expressed in a single sound.