Psychodynamic-supportive psychotherapy: Two case reports of obsessive disorder

Introduction: While it is true to say that people are complicated, that complication does not come by chance. Psychodynamic theory, as an approach that undertakes to explain the psychic structure of persons as a whole, has a long tradition in the study of personality disorder's pathology, etiology, and therapy. In addition, psychoanalytic theory of instincts, ego psychology, object relationships, and self psychology, do offer us different ways not only to help our patients realize apparently inexplicable ironies and paradoxes that happen in their lives but also transform their weaknesses into strengths.

Background: Nowadays, the range that covers the spectrum of obsessive disorders is under question. Thus, it is believed that obsessive disorders can be treated as continuity: on one side, there are the "strict" compulsive disorders. On the other side, there are other disorders that are characterized by egosyntonic obsessions, yet poor recognition, which can conduct to dangerous behavior. Between these above-mentioned disorders, there are the so-called "mixed" conditions33. However, obsessive personality disorder is not the usual background of obsessive- compulsive disorder.

Furthermore, it is suggested that impulsiveness and compulsiveness could also relate to an emotional disorder. The high percentage of comorbidity found in other disorders of the obsessive spectrum, the available genetic data, and the effectiveness of the SSPIs suggest this emotional diastase, which is also claimed for borderline disorders33.

In addition, obsessive-compulsive disorder is included in the obsessive spectrum33,34 along with depression, eating disorders35, bodydysmorfic disorder, Olfactory Reference Syndrome/ORS, Impulse Control Disorders, Trichotillomania, Tourette syndrome, but also Schizophrenia, delusional disorders, and other psychotic conditions. Such a dimensional model, even if more complicated than the axial one, provides the general context for further research, as well as for better understanding and treatment.

Purpose: In this essay, which deals with obsessive personality, we aim at: a) looking into how people are using logic and action setting their emotions, perception, imagination and artistic creativity aside in order to protect themselves from internal conflicts. As a consequence, they can be emotionally safe and high self-esteemed, b) indicating diagnostic but also therapeutic problems caused by multipathology, which are commonly arisen while therapeutic process is in progress, and c) giving a dimensional diagnose as an answer to various questions that can arise in some cases who had already been diagnosed as "obsessive-compulsive disorder."

Materials and Method: We report two cases (one of a man and the other of a woman) that had been diagnosed to be suffering from "obsessive - compulsive disorder" during the first year of Dynamic Supportive therapy. The two patients have been selected on account of the resistance of their symptoms and the inefficient co-operation with their previous therapists. We present the basic strategies of Dynamic Supportive therapy, according to bibliography47, and the step-by-step practice of this therapy during one year. We emphasize on the therapeutic goals set, the difficulties encountered and the achievements accomplished at the end of this time.

Results: Even if these are our preliminary results, many of them agree with the findings of other studies: a) Obsessive neuroses can include characteristics from other types, like the hysteric, paranoid, schizoid, and depressive one; yet it is described better using the term "Obsessional disorganization of life"48; b) both case histories reveal that the complexity of psychopathology begins before the age of eighteen. Moreover, the dynamic-supportive therapy of these cases supports the suggestion that the "constant type of the internal experience" in personality disorders is both a unique and an individualized uninterrupted procedure, c) in personality disorders, transference and counter-transference reactions are usually intensive49. The clinician is asked to bear his or her anxiety until the psychotherapeutic process reaches that point where impulsiveness for action decreases, and on the other, he ought to help the patient express emotions like anger and criticism about therapy or even the therapist himself. In this way, isolation can progressively stop from being the common egosyntonic coping style38.

Key words: Obsessive-compulsive disorder, obsessive personality, psychodynamic-supportive psychotherapy.