5 - Psychodynamic approaches to OCD

Summary

Introduction

Much of the theorising found in psychodynamic approaches tends to pay close attention to the detail of individual patients. This makes it difficult to review thoroughly the whole of the psychodynamic literature on OCD, and in what follows no attempt to do this will be made. To the extent that generalisations across individual patients are possible from this perspective, furthermore, one finds psychodynamic theorists offering a number of different accounts of OCD. It seems unlikely that each of these is intended to apply to a different subgroup of OCD patients, and these accounts thus stand instead as alternative, and perhaps also incompatible, approaches to the disorder.

Given these points, the present discussion will take the following course. Firstly, some of the psychodynamic accounts of OCD that have been offered will be briefly outlined, the emphasis being on exposition rather than criticism. Following this, a single case discussion presented by Malan (1979) will be critically discussed at some length, along with some of Malan's comments concerning psychodynamic theory and therapy. There are two justifications for concentrating critical comment on Malan's case discussion. Firstly, and as already noted, much psychodynamic theorising takes into account the detail of individual patients and is therefore also best discussed with reference to such details. This does not, of course, mean that all of the points raised by any given case will be irrelevant to the evaluation of psychodynamic accounts of other cases, and indeed, it is suggested that some of the themes raised by the case discussion to be considered here (for example, the nature of symbolisation and the role of the unconscious) would be central to many psychodynamic discussions.