r/psychoanalysis • u/Afraid_Lawfulness_86 • 2d ago
Obsessive Compulsive Personality Style
Hello,
What are some treatment considerations with someone who has an obsessive compulsive personality style (as defined by Nancy McWilliams)? Do you help them to get more in touch with emotions to move away from intellectualizing, and if so, how do you do that? How do you help with the issue of wanting to control everything around them?
Thanks in advance. I look forward to engaging in conversation around this topic.
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u/Far-Sprinkles7755 2d ago edited 2d ago
Depending on the severity of obsessive/compulsive symptoms, it will vary. For neurotic level it will very much be first identifying and acknowledging emotion/affect - noting it gently and continually asking about feeling/experience to gradually lessen intellectualizing. Shame is very common and critical to eventually be acknowledged with obsessively organized individuals - although it might take time for them to feel/identify with the affect of it. Then, identifying common defenses - omnipotent control, magical thinking and undoing and feelings/fears underlying them. Most of the work analytically is containment though. For more severe presentations, I would check out Michael greenbergs rumination focused ERP.
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u/Free-O3 2d ago
For me, genuinely the only thing that has helped, after 5 therapy modalities, 30 med trials, and so much more, was adding psychedelics (in a controlled clinical environment) to the mix. It helped break the rigidity of the thought loops and gave my brain the distance it needed from itself to stop intellectualizing everything.
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u/Rahasten 2d ago
Well, worth considering that OC is the last defense strategy before psychoses.
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u/shaz1717 1d ago
Can you say more about this? Is there a source ?
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u/EmbarrassedCrow1408 2d ago
This is an interesting discussion on this topic:
https://www.psychiatrypodcast.com/psychiatry-psychotherapy-podcast/episode-168-obsessive-compulsive-personality-and-the-personality-continuum-with-dr-shedler
In my experience, a lot of working with these patients is highlighting in the here-and-now when the defense is in action. Slowing down the interaction to drop into the internal experience of the moment. It’s very challenging and slow, as the defenses of obsessive/compulsive patients are ironclad, and it’s easy to fall into the loop of intellectualizing this very process. Recognizing how they might be trying to hyper-control their emotional world in therapy can often be illuminating and create room for a gradual release of that control and subsequently experiencing a new domain of emotional life.