OCD: The Psycho-dynamic Perspective
Introduction
A psycho dynamic approach attempts to explain the effects of obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) in terms of extreme, inadequate efforts to resolve potential dangers caused by violent or sexual impulses and impaired information retrieval. This viewpoint offers useful insight into the
emotional understanding of people with such conditions. The psycho-dynamic model may be
very useful in recognizing what patients are doing with their manifestations
and establishes a clinical partnership that encourages more evidence-based
strategies.
Psycho-dynamic treatment/therapy for OCD
Obsessive-compulsive disorder (OCD) is a chronic disorder majorly consisting of recurrent obsessions and uncontrolled compulsions. Recent studies have shown that, OCD is more common than previously assumed. However, there are no scientific or evidence-based psycho-dynamic theories in existence.
New findings
Research have stated certain points with respect to the manual-guided approach for psycho- dynamic therapy in analyzing patients suffering from OCD- Short-term psycho-dynamic therapy (STPP)- Current clinical diagnosis and recent findings in psycho-dynamic perspective for OCD:
- Treatment consists of twelve modules based on Luborsky 's supportive-expressive therapy. The psychiatrist links the patient's OCD symptoms to his / her expectations with the (expected) responses of others. This approach helps people recognize their history of distress and OCD responses. It translates their symptoms into interpersonal (internal and external) relationships.
- The Core Conflictual Relationship Theme (CCRT) is the expressive (interpretive) element of Somatic Experiencing (SE) therapy. SE therapy can be expected to improve patients' understanding of their conflicts, reduce OCD symptoms and help them develop more adaptive behaviors. It can also help them gain better understanding and awareness of their symptoms and a sense of control (i.e., not being helpless towards OCD).
The formation of a stable collaborative relationship is
perceived to be the core components of the intervention's supporting factor.
Luborsky has formulated a number of principles to establish a secure
alliance. E.g. to convey a sense of understanding and acceptance, or to
recognize the growing ability of the patient to work on his or her problems in
the same way as the therapist does.
In order to adopt a treatment specifically to OCD, the principles have integrated disorder-specific treatment elements which have been indicated to be
clinically helpful for the same. They include, for example:
- Difference in thought and behaving (e.g., "If you have romantic impulses against these young people, that does not imply that you have personally, committed adultery").
- Mitigating rigid super-ego (consciousness) typical of OCD patients. (enabling patients to fulfill their super-ego demands; not suppressing patient's sexual desires or impulses. etc)
Other components include: (a) informing patients regarding
the illness and diagnosis; (b) resolving ambivalence and establishing
nursing objectives; (c) promoting inner dialogue; (d) discussing (potential)
non-response and resistance; and (e) concentrating on termination and relapse
prevention.
Limitation to Psycho-dynamic Approaches in understanding OCD
- Negligence to biological factors- Although there is strong psychological evidence for this technique, it may ignore any biological components that may be associated with this scenario. Basically, when it comes to addiction, genetic or biological susceptibility to this matter can be difficult to ignore.
- Not widely acceptable- A lot of people don't find this the right way to solve the problem at hand. This is because others may find it hard to believe that their behavior and thoughts can be influenced by their subconscious.
References:
- https://oxfordmedicine.com/view/10.1093/med/9780190228163.001.0001/med-9780190228163-chapter-7
- https://psycnet.apa.org/record/2017-43726-007
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5032496/
- https://psychotherapy.psychiatryonline.org/doi/pdf/10.1176/appi.psychotherapy.2009.63.3.245
- https://onlinelibrary.wiley.com/doi/pdf/10.1002/wps.20339
All mental illnesses can be understood by looking deep into the patient’s subconscious but the psycho-dynamic approach too has criticisms. One of the key strengths of this approach is that it recognizes the importance of psychoanalytic treatment for distress and manifestations. It makes strategic observations that provides a framework on personality.
ReplyDeleteThe weakness of the approach is that Freud’s theories are subjective (researcher bias) rather than scientific which is not observable due to analysis of the unconscious. It is often criticized for being too deterministic, sexist, reductionist and generalized. There is no evidence-based psycho-dynamic treatment for OCD but this approach is essential to optimizing the understanding of the illness. It enhances the sense of control within the patients that their growing ability to work on their problems are similar to the therapist’s method.
This is very well written and very informative. I learnt a lot. Well don, great job!!
ReplyDeleteTreatment using pscho-dynamic approach might be less but Psychodynamic approach becomes important to understand how OCD originated in individuals. Childhood trama can lead to OCD which can be understood through psychotherapy. Moreover Freud mentions that fixation in the Anal stage can lead to development of OCD in adults.
ReplyDeleteThe article is very informative and tries to understand both positives of the approach. This approach attempts to understand the symptoms of OCD in terms of excessive, maladaptive efforts to cope with perceived dangers posed by aggressive or sexual impulses and in terms of distorted information processing and rigid cognitive styles that are intolerant of ambiguity. All in all, the article is a great piece work on the psycho dynamic approach on OCDs.
ReplyDeleteThe Psychodynamic perspective provides valuable insights to subjective experiences of patients with OCD and related disorders. It is also believed that unresolved fixations in the anal stage of development can enable a person to have obsessions and compulsions, to channelise their sexual and aggressive impulses. However, it is not a reliable approach, as psychodynamic therapy fails to understand major symptoms of OCD. Many researchers are of the opinion that the psychodynamic psychotherapy has become redundant in treating OCD patients.
ReplyDeleteThe psycho analytical approach certainly helps in getting perspective and insight into understanding OCD. But, it does not provide any research-based treatment for the disorder. Moreover, the source of psychodynamic studies i.e., the research done by Sigmund Freud in itself is flawed and has been criticized several times for multiple reasons.
ReplyDeleteIn spite of this, getting another perspective when studying a mental illness is never harmful, but researchers need to be mindful when drawing conclusions, especially in the field of OCD and other disorders since it's an extremely sensitive issue to be dealing with.