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The idea of intrapsychic conflict is at the heart of analytic thinking about psychology. In a way that makes it a hard thing for an analyst to discuss: talk about practically anything from a psychoanalytic point of view, and you find you're talking about conflict. Worse, talk about neurosis from the point of view of conflict and it is practically a tautology; the fact of intrapsychic conflict and the compromise solutions it invites are precisely what define the thing we call neurosis.
So I realized, in taking on the topic of “conflict in the neuroses,” that I needed a way to limit my focus. I began by thinking about instances in my practice where the notion of intrapsychic conflict provided not just the general underpinning to my thinking about a patient, but where it actually made a radical difference in how I approached a patient and the kind of treatment plan the patient and I developed.
Several patients came to mind, and as I thought about what they had in common, I realized that each of them had come to see me expressing a version of the same problem. Each was