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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.