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TheObsessive&CompulsiveCharacter
TakenfromthebookPsychoanalyticDiagnosisByNancyMcWilliams
EditsbyMichaelMervosh
ForthePSENTrainingProgram
PeoplewithpersonalitiesorganizedaroundthinkinganddoingaboutinWesternsocieties.Pursuingpleasureandattainingpridebythinkinganddoingaresonormativeinoursocietythatwescarcelythinkaboutthecompleximplicationsoftheirbeingsuchesteemedandprivilegedsuccess.Wherethinkinganddoingpropelsomeonepsychologically,inmarkeddisproportiontofeeling,sensing,intuiting,listening,playing,daydreaming,etc,wemayinferanobsessive-compulsivecharacter.Manyhighlyproductiveandadmirablepeopleareinthiscategory.Therearealsopeoplewhoarestronglyinvestedinthinkingyetwhoarerelativelyindifferenttodoing,andviceversa.Obsessiveandcompulsivetendenciesoftenco-existinaperson,butnotethatthisisasomewhatartificialcouplingwithrespecttocharacter.Assymptoms,obsessivethoughtandcompulsivebehaviorscanoccurinanyone,notjustinthosewhoarecharacterologicallyinclined.
• Inobsessive-compulsivedisorders,repetitivethoughtsandirresistibleactionsareego-alien;theydisturbthepersonwhohasthem.Inobsessive-
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compulsivecharacterstructure,theyareego-syntonic;theyareoftenunexaminedbythepersonwhohasthem.
Mostbehaviorthatwetendtoseeaspathologicalisbydefinitioncompulsive:Thedoerseemsdriventoactagainandagaininwaysthatprovefutileorharmful.
DRIVE,AFFECT&TEMPERAMENT“Anal”issuescolortheunconsciousworldsofpeoplewhoobsessandactoncompulsions.Freudobservedthatpeoplehetreatedforobsessionsandcompulsionshadbeenpushedtowardbowelcontrolprematurelyorharshly,orinthecontextofparentalover-involvement.Subjectingyoungchildrentoenemas,andintrinsicallytraumaticprocedure,wasoftenrationalizedtobeinthenameofhygiene.Connectionsbetweenanalityandobsessionalityhavebeensupportedbyresearch.Theexperienceofbeingcontrolled,judged,andrequiredtoperformonschedulecreatesangryfeelingsandaggressivefantasies,oftenaboutdefecation.
• Thebasicaffectiveconflictinobsessiveandcompulsivepeopleisrage(atbeingcontrolled)vs.fear(ofbeingcondemnedorpunished).
• Whatismoststrikinginobsessive-compulsivecharactersisthataffectis
unformulated,muted,suppressed,unavailable,orrationalized.
• Obsessive-compulsivecharactersusewordstoconcealfeelings,nottoexpressthem.
Ifitisseenasreasonableandjustified,angerisacceptabletotheobsessionalperson.Righteousindignationisthustolerable,evenadmired.Shameistheotherfeelingthatcanpenetratedtheaffectless-nessinobsessive-compulsivecharacters.Theyhavehighexpectationsofthemselves,projectthemontoothers,andthenfeelembarrassedtobeseenasfallingshortortheirownstandardsforproperthoughtsanddeeds.
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DEFENSIVE&ADAPTIVEPROCESSES
• Theorganizingdefenseofpredominantlyobsessivepeopleisisolationofaffect;incompulsivepeople,themaindefensiveprocessisundoing.
Higherfunctioningobsessiveindividualsprefermorematureversionsofseparationofaffectfromcognition:rationalization,moralization,compartmentalization,andintellectualization.Finally,peopleofthischaracterstylerelyheavilyonreactionformation;andalso,displacement.
CognitiveDefensesAgainstDrives,Affects&Wishes
• Obsessive-compulsiveindividualsidealizecognitionandmentalthinking.Theytoconsignmostfeelingstoadevaluedrealmassociatedwithchildishness,weakness,lossofcontrol,disorganization,anddirt.Theyarethusatagreatdisadvantageinsituationswhereemotions,physicalsensations,andfantasyhaveapowerfulandlegitimaterole.Peoplewithobsessivecharactersareofteneffectiveinformal,publicrolesyetoutoftheirdepthsinintimate,domesticones.Althoughtheyarecapableoflovingattachments,theymaynotbeabletoexpresstheirmoretenderselveswithoutanxietyandshame.Consequently,theymayturnemotionallytonedinteractionsintooppressivelycognitiveones.Theytendtolapseintosecond-personlocutionsthatareself-distancing.“Well,youfeelkindofpowerlessinthosesituations.”Theprevalentmisconceptionoftheschizoidpersonasunfeelingmaybebasedonobservationsofregressedobsessionalpeoplewhohavebecomewoodenandrobotic,sodeepisthegulfbetweentheircognitionandemotion.Becausethedistancebetweenanextremeobsessionandadelusionisslight,moredisturbedobsessionalpeopleborderonparanoia.
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BehavioralDefensesAgainstDrives,Affects&WishesUndoingisthedefiningdefensemechanismforthekindofcompulsivitythatcharacterizesobsessiveandcompulsivesymptomsandcharacterstructure.Compulsivepeopleundobyactionsthatgavetheunconsciousmeaningofatonementand/ormagicalprotection.Compulsivitydiffersfromimpulsivityinthataparticularactionisrepeatedoverandoverinastylizedandsometimesescalatingway.Compulsiveactionsalsodifferfrom“actingout”,strictlyspeaking,inthattheyarenotsocentrallydrivenbytheneedtomasterunprocessedpastexperiencesbyrecreatingthem.Compulsiveactivityisfamiliartoallofus.Whateverone’scompulsivepatterns,thedisparitybetweenwhatonefeelsimpelledtodoandwhatisreasonabletodocanbeglaring.
• Compulsiveactivitiesmaybeharmfulorbeneficial;whatmakesthemcompulsiveisnottheirdestructivenessbuttheirdriven-ness.
Compulsiveactionsoftenhavetheunconsciousmeaningofundoingacrime,which,inmostinstances,thecompulsiveperson’scrimesexistmainlyinfantasy.
• Compulsivebehavioralsobetraysunconsciousfantasiesofomnipotentcontrol.Thisoftenderivesfrombeliefsthatoriginatedearlyinlife,beforethoughtsanddeedsweredifferentiated.IfIthinkmythoughtsanddeedsaredangerous,thattheyareequivalenttopowerfulactions,Iwilltrytorestrainthemwithacomparablypowerfulcounter-force.
ReactionFormationTheincessantrationalityoftheobsessionalpersoncanbeseenasareactionformationagainstasuperstitious,magicalkindofthinkingthatobsessionaldefensesdonofullysucceedinobscuring.Byinsistingonsomuchcontrol,oneisoutofcontrolineverysignificantway.
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• Reactionformationisadefenseagainsttoleratingambivalence.
Peoplewhoarestronglypre-occupiedwithbeinguprightandresponsiblemaybystrugglingagainstmorepowerfultemptationstowardself-indulgencethanmostofusface.
RELATIONALPATTERNSINOBSESSIVE&COMPULSIVECHARACTERSThischaracterarisesfromthosewhohavehadparentalfigureswhosethighstandardsofbehaviorandexpectearlyconformitytothem.Thischaracterislikelytohavehadcaregiverswhotendedtobestrict,andconsistentinrewardinggoodbehaviorandpunishingbadbehavior.Whencaregiversareunreasonablyexacting,orprematurelydemanding,orcondemnatorynotonlyofunacceptablebehaviorbutalsoofaccompanyingfeelings,thoughts,orfantasies,theirchildren’sobsessiveandcompulsiveadaptationscanbemoreproblematic.Fromanobject-relationsperspective,whatisnotableaboutobsessiveandcompulsivepeopleisthecentralityofissuesofcontrolintheirfamiliesoforigin.Examples-Amotherwhofeedsherchildonaschedule,demandednapstobetakenatparticulartimes,inhibitedspontaneousmotoractivities,prohibitedmasturbation,insistedonconventionalsex-rolebehaviors,punishedloosetalk,etc.Thefrequencyofhaving‘contaminationfears’inobsessionalpeopleisrelatedtoseparationanxietythatiscreatedbyparentalover-involvementandover-protection.Over-protectiveparentsgetinthewayofayoungchild’stakingsmallrisksthatarenecessarytodevelopasenseoftheboundaryofself,andaccountsfortheomnipotent,magicalthinkingfoundinobsessiveandcompulsivepeoplewholackthisboundary.
Anotherkindoffamilybackgroundhasbeenassociatedwithobsessiveandcompulsivepersonalities.Itisthepolaroppositeoftheover-controlling,moralisticambiance.
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Somepeoplefeelsobereftofclearfamilystandards,sounsupervisedandcasuallyignoredbytheadultsaroundthem,thatinordertopushthemselvestogrowup–theyholdthemselvestoidealizedcriteriaofbehaviorandfeelingsthattheyderivefromthelargerculture.Thesestandards,sincetheyareabstractandnotmodeledbypeopleknownpersonallytothechild,tendtobeharshandunbufferedbyahumanesenseofproportion.Manytherapistsfoundthatpatientswiththeharshestsuperegoshadbeenthemostlaxlyparented.
• Havingtomodelone’sselfafteraparentalimagethatoneinventsbyone’sself,especiallyifonehasanintense,aggressivetemperamentthatisprojectedontothatimage,cancreateobsessive-compulsivedynamics.
THEOBSESSIVE-COMPULSIVESELFIntrojectivelyorientedobsessiveandcompulsivepeople:
• Aredeeplyconcernedwithissuesofcontrolandmoralrectitude.
• Equaterighteousbehaviorwithkeepingaggressive,lustful,andneedypartsoftheselfunderstrictcontrol.
• Tendtobeseriouslyreligious,hard-working,self-critical,anddependable.
• Haveself-esteemthatcomesfrommeetingthedemandsofinternalized
parentalfigureswhoholdthemtoahighstandardofbehavior.
• Worryalot,especiallyinsituationsinwhichtheyhavetomakeachoice,andtheycanbeeasilyparalyzedwhentheactofchoosinghasmomentousimplications.
Paralysisisoneofthemostunfortunateeffectsofthereluctanceofobsessionalpeopletomakeachoice.Theyhaveatendencytopostponedecisionmakinguntiltheycanseewhatthe“perfect”(guiltanduncertaintyfree)decisionwouldbe.
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Theclient’sfearofmakingthewrongdecisionandthetendencytocasttheprocessofdecidinginpurelyrationalisticterms(listsofprosandcons)canseducethetherapistintoofferinganopinionaboutwhichchoicewouldbepreferable.Ifatherapistenterstheclient’sdecision-makingweb,theclientwillsimplyandimmediatelyrespondwithcounter-arguments.(Yesbuts.)The“yes,but”stanceisanefforttoavoidtheguiltthatinevitablyaccompaniesdecisiveaction.Instandardneuroticfashion,theirhabitualover-zealousnesstopreservetheirautonomyorsenseofagencybyavoidingaction,intheend,servestodisableit.
Wheretheobsessivepersonpostponesandprocrastinates,thecompulsivepersonspeedsahead.Compulsivepeoplejumpintoactionbeforeconsideringalternatives.
• Thecompulsiveperson’srushtoactionhasthesamerelationshiptoautonomyastheobsessiveperson’savoidanceofaction.
Instrumentalthinkingandexpressivefeelingarebothcircumvented,toavoidtherealizationthatheorsheisactuallymakingachoice.
• Choiceinvolvesresponsibilityforone’sactions,andresponsibilityinvolvestoleranceofnormallevelsofbothguiltandshame.
• Non-neuroticguiltisanaturalreactiontoexertingpower,andavulnerability
toshamecomeswiththeterritoryoftakingdeliberateactionthatcanbeseenbyothers.
Again,rememberthatobsessivepeoplesupporttheirself-esteembythinking;compulsiveone’sbydoing.
• Obsessiveandcompulsivepeoplefeartheirownhostilefeelingsandsufferinordinateself-criticismoverbothactualandpurelymentalaggression.
Theyvalueself-controlovermostothervirtues,andemphasizeattributeslikediscipline,order,reliability,loyalty,integrity,andperseverance.
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Obsessiveandcompulsivepeoplearenotedforavoidanceofaffect-ladenwholesinfavorofseparatelyconsideredminutia.Theyarepeoplewhohearallthewordsandnoneofthemusic.
TRANSFERENCE&COUNTER-TRANSFERENCEWITHOBSESSIVE&COMPULSIVECLIENTSThesecharacterstendtobe‘goodclients’.Theyareserious,conscientious,honest,motivated,andhard-working.Nonetheless,theycanhaveareputationforbeingdifficult.
• Despitealltheirdutifulcooperation,theyconveyanundertoneofirritabilityandcriticism.
• Theytendtowaitimpatientlyforthetherapisttospeakandtheninterrupt
beforeasentenceisfinished.
• Onaconsciouslevel,theyseemutterlyunawareoftheirnegativity.Counter-transferencewithobsessionalclientsoftenincludesanannoyedimpatience.Thereisawishtoshakethemup,togetthemtobeopenaboutordinaryfeelings,togivethemaverbalenema,orinsistthatthey“shitorgetoffthepot”.
• Theircombinationofexcessiveconscioussubmissionandpowerfulunconsciousdefiancecanbemaddening.
Therapistscanoftenfeelmystifiedbytheobsessionalperson’sshameaboutmostemotionsandresistancetoadmittingtothem.Therapistscanevenfeeltheirrectalsphinctermuscletightening,inidentificationwiththeconstrictedemotionalworldoftheclient,andinarealefforttocontainaretaliatorywishto“dump”onsuchanexasperatingperson.
• Theatmosphereofveiledcriticismthatthesecharactersemitcanbediscouragingandundermining.
• Clinicianscaneasilyfeelboredordistancedbytheclient’sunremitting
intellectualizations,anddistancinguseoflanguage.
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Feelingsofinsignificance,boredom,andobliterationarerelativelyrarewhenworkingwithintrojectiveobsessionalclients,buttheymayvexthetherapistwhohasamoreanaclyticobsessiveasaclient.
• Doubtsaboutwhetheranythingisbeingaccomplishedintherapyaretypicalforthetherapistaswellasfortheobsessiveandcompulsiveclient.
Thisisespeciallytruebeforethepersonisbraveenoughtoexpresssuchconcernsdirectly.
THERAPEUTICIMPLICATIONSFORTHEOBSESSIVE&COMPULSIVE
• Thefirstruleofpracticewithobsessiveandcompulsivepeopleisordinarykindness.
Theyareusedtobeingexasperatingtoothers,andtheyaregratefulfornon-retaliatoryresponsestotheirirritatingqualities.
• Appreciationfor,andinterpretationof,theirvulnerabilitytoshameisessential.Refusaltoadvisethem,hurrythem,andcriticizethemfortheeffectsoftheirisolation,undoing,andreactionformationwillfostermovementintherapy.Counter-transferencedrivenpowerstrugglesarecommonbetweentherapistsandobsessiveclients;theycanproducetemporaryaffectivemovement,butinthelongrun,theyonlyreplicateearlyobjectrelations.Onemustbemindfultoavoidbecomingthetherapeuticequivalentofthedemanding,controllingparent,especiallyastheylooktounconsciouslyevokethisstancefromthetherapist.
• Onemustremembertokeeprelatingwarmlytothischaracter.Refusingtocontroltheclientmustbedistinguishedfromattitudesthatwillbefeltasemotionallydisengagingfromtheclient.Forexample,remainingsilentwithaclientwhofeelspressureorabandonmentinsilencewillbeself-defeating.Anexceptiontothegeneralruleofrefusingtoadviseorcontrolconcernspeoplewhosecompulsionsareoutrightdangerous.Withself-destructivecompulsivity,thetherapisthastwochoices:
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1. Tolerateanxietyaboutwhattheclientisdoinguntiltheslowintegrationofthetherapyworkreducestheactingout.(Sexualactingout.)
2. Attheoutset,makethetherapycontingentontheclient’sstoppingthe
compulsivebehavior.(Drugaddiction,etc.)Notethatbyacceptingcompulsivelyself-harmingpeopleintotherapyunconditionally,thetherapistmayunwittinglycontributetotheirfantasiesthattherapywilloperatemagically,withouttheirhavingatsomepointtoexertself-control.Thesecondpositionisparticularlyadvisablewhentheclient’scompulsioninvolvessubstanceabuse;doingtherapywithsomeonewhosementalprocessesarechemicallyalteredisanexerciseinfutility.
• Manycompulsionsarenotresponsivetotherapeuticworkuntilthedrivenpersonencounterssharpnegativeconsequences.
Aslongasoneis‘gettingawaywith’compulsivity,thereislittleincentivetochange.Whywouldsomeonewanttocontinuepsychotherapyonceacompulsivebehaviorisundercontrol?Peoplefeelthedifferencebetweenbeingabletodisciplineacompulsion(throughwillorsubmissiontoauthorityorstructure)andnothavingacompulsioninthefirstplace.Onceacompulsionhasstopped,theclientcanaddressandworkthroughtheissuesthatdrovethecompulsion.Theclientcanfindadeeperinternalsecurity,ratherthanatenuousachievementofself-control.
• Thesecondimportantfeatureofgoodwork,especiallywithmoreobsessivepeople,istheavoidanceofintellectualization.
Anyinterpretationsthatonlyaddressacognitivelevelofunderstanding,beforeaffectiveresponseshavebeendis-inhibited,willbecounter-productive.Becauseitcanfeellikeapowerstruggleforthetherapisttokeepasking,“Howdoyoufeel?–amoreeffectivewaytobringinaffectivedimensionsisthroughimagery,symbolism,andartisticcommunication.Keepinmindtheobsessionalpeopleusewordstofendofffeelingsratherthantoexpressthem;thereforeamorepoeticstyleofspeechandrepresentationcanberichanduseful.
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• Thethirdimportantcomponentofgoodworkisthepractitioner’swillingnesstohelpclientsexpresstheirangerandcriticismabouttherapyandthetherapist.
Obsessiveandcompulsiveclientsneedground-layingcommentsfromthetherapistthatnormalizehavingresentfulthoughtsabouttherapy.Theseclientswilloftenprotestagainsttheseground-layingstatementsatfirst,astheycan’timaginebeingactivelydissatisfiedandcritical.
• Thetherapist’spositionofcuriositytowardsnegativefeelingsmaybegintheprocessofmakingego-alientheautomaticprocessofisolatingthesefeelings.
Tobeusefultoobsessiveandcompulsiveclients,oneneedsnotonlytohelpthemfindandnametheiraffects,butonemustalsoencouragethemtoenjoythem.Psychotherapyinvolvesmorethanjustmakingtheunconsciousconscious;itrequireschangingtheclient’sconvictionthatwhathasbeenmadeconsciousisshameful.Thetherapistmustalsopointouttheharmbeingdonebynotfeeling.Emotionsmakeonefeelalive,energized,andfullyhuman,eveniftheyexpressattitudestheclienthascometoseeas‘bad’.
• Especiallywithcompulsiveclients,itisusefultocommentontheirdifficultytoleratingjustbeing,ratherthandoing.
• Ultimately,thetherapist’squietdedicationtoemotionalhonesty,andthe
client’sgrowingexperiencethatheorshewillnotbejudgedorcontrolled,willmovetheworkforward.
Medicationsandcognitive-behavioraltherapies,suchasexposuretherapy,havebecomemoresuccessfulwithmoresevereobsessive-compulsivedisorders.Obsessiveandcompulsivepeoplewithintrojectivedynamicshaveastrongercenterofgravitypsychologically;theyarejudgmentalandself-critical.
• Therefore,atherapistwhocommunicatesempathicacceptanceoftheirsubjectiveexperience,withoutevokingthedeeperaffectsandbeliefsthatshapetheirexperience,isdeprivingsuchclientsofanyempathyworthitsname.
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DIFFERENTIALDIAGNOSISOrdinarily,obsessiveandcompulsivedynamicsareeasytodifferentiatefromotherkindsofcharacters.Isolationandundoingareusuallyprettyvisible,alongwithcompulsiveorganization,sincethedriven-nesstoactcannotbeeasilymasked.ObsessivevsSchizoidPersonalityAlthoughaschizoidpersonwithdrawsfromtheouterworld,heorshetendstobeconsciousofintenseinnerfeelingsandvividfantasies.Incontrast,awithdrawnobsessionalpersonusesisolationsocompletelythatheorshemaybesubjectively“blank”orwoodeninappearance.
