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Why Psychoanalysis May Not Be the Right Treatment for OCD

Certain processes may exacerbate obsessions and compulsions.

Key points

  • Analyzing one's OCD obsessions for hours may make those obsessions seem more real.
  • Anecdotally, psychoanalysis may address why patients have obsessions and compulsions but not how to manage them.
  • Cognitive Behavioral Therapy and Exposure and Response Prevention Therapy can successfully treat OCD.

The famous Sigmund Freud was a neurologist and the founder of psychoanalysis. Psychoanalysis is a clinical method that aims to treat psychological conditions by uncovering unconscious conflicts, thoughts, feelings, desires, and memories within the person.

Once these elements are uncovered, they are then brought to the sufferer’s conscious awareness. This process is done through various techniques, such as dream interpretation, free association, parapraxes, and inkblots.

With regards to those diagnosed with OCD, I recommend not using psychoanalysis as the treatment modality. The OCD sufferer is already compulsively trying to “figure out” or “get to the bottom of” the obsession. The OCD sufferer will not benefit from spending an extra hour or two per week analyzing, and attempting to unearth the inner conflicts and desires that they have.

For me, this is considered two extra hours a week engaging in compulsions. Analyzing obsessions with one's analyst may reinforce the obsession, thereby making the obsession seem more “real.”

I feel this can make the OCD so much worse, and the sufferer is investing time and money into it. Indeed, many sufferers look forward to going to psychoanalysis because they are getting the reassurance and answers their OCD is craving. This “relief” will not last long and soon the doubt will set back in. Instead, this population needs to be facing the dreaded not knowing, and uncertainty.

Most OCD sufferers look forward to their sessions with their analyst. Years ago, I had a client, diagnosed with OCD, when he was a child. I met him when he was 32 years old. He explained that he had been treated by the same "analyst" for 10 years. He stated that he never had a period of time in those 10 years where he would say his compulsions were less, or his functionality was improved. In fact, he described his symptoms as becoming more severe and "torturous" over the years.

He stated that he "looked forward" to his bi-weekly sessions with his psychoanalyst. Sometimes, if he was having a very OCD triggering week, he would request his sessions to be 120 minutes, instead of 60. I asked him what they would do in those 120-minute appointments. He explained they would "dig in" and "try to figure out why" he kept doing the compulsions. I asked if he ended up figuring out why he did his compulsions. He stated that he knew exactly why he was doing what he was doing. However, as you can see, it did not stop him from doing the behaviors.

This client decided to begin in a treatment program called RIP-R, while he never discussed why he was doing his unproductive and compulsive behaviors, he did learn all the techniques and skills he needed in order to "fight back" and reduce the number of compulsions he was doing. He very quickly began accepting uncertainty instead of analyzing it. He was able to function better and become less controlled by his obsessions in less than six months.

janeb13 / Pixabay
Source: janeb13 / Pixabay

Therefore, I feel cognitive behavioral therapy, specifically ERP or RIP-R is the best way to help an OCD sufferer get into recovery. Both behavioral orientations help a client begin to see the obsession as “not real” by having them resist compulsive behaviors.

So, it is sometimes unnecessary to really understand “why” you have OCD and "dig in and explore" your obsessions in order to get into recovery. To quote Sigmund Freud, "sometimes, a cigar is just a cigar.”

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