Dynamic Psychotherapy: The Therapeutic Process in the Treatment of Obsessive-Compulsive Disorder

Abstract

Dynamic Psychotherapy (DP) was developed to overcome the limitations of traditional psychoanalysis, responding to a broader demand of patients who seek help to cope with specific problems in the short term, such as Obsessive-Compulsive Disorder (OCD). OCD is a chronic disabling mental disorder that leads to substantial distress, functional disability and severe occupational and social impairments. Recognizing the literature gap in this field, and the improvements reported by dynamic therapists who have dealt with patients suffering from OCD, a study on the treatment of these patients was conducted in order to discuss the effects of this technique. The method involved a narrative literature review and the analysis of two clinical cases to discuss therapeutic processes, which include the specificities of OCD patients and the mechanisms adopted in the treatment through DP. The therapist’s active stance seemed to be essential to encourage the patient to face feared situations and identify the core conflict. Both patients who were treated through DP presented similarities, such as high anxiety, feelings of guilt and inhibition of aggressive and sexual impulses. Through emotional exploration, confrontation of defensive functioning and interpretative interventions of inner conflicts, patients had reached awareness of their hidden feelings and experiences, and their symptoms and feelings of guilt decreased. They also showed significant improvements in their interpersonal relationships. Although both treatments do not fit into short-term therapies, this technique has led to long-term results, providing evidence that DP may produce favorable outcomes in the treatment of OCD.

Dynamic Psychotherapy as a PTSD Treatment for Firefighters: A Case Study

“…Nevertheless, it is worth noting that “DP has traditionally placed emphasis on insight into relationship patterns and processing avoids emotions, including unconscious thoughts and feelings associated with traumatic events” [ 41 ] (p. 101). The aim of this technique is to enhance self-understanding, which may allow patients not only to reach their goals but also to continue to improve after the end of treatment [ 23 ].…”

“…This finding corroborates clinical studies that “have shown that patients benefit from DP, and that psychoanalysis-based psychotherapies have presented a continuous state of improvement in patients” [ 41 ] (p. 93). Patients had presented different treatment times and oscillations in the severity of psychopathological symptoms, which can be explained by the fact that DP is conducted considering the patients’ capacity to process and tolerate feelings, which reflects directly on the length of therapy [ 23 , 41 , 42 ]. Since the focus of DP is on raising awareness of unconscious thoughts and feelings related to traumatic events, the patients needed time to slow down the automatic processing of trauma stimuli and enhance emotion regulation in facing their experiences [ 25 ].…”

“…DP “emerged of overcoming the limitations of traditional psychoanalysis, responding to a broader demand of patients who seek help to cope with specific problems in a short-term. Especially when symptoms provoke social and occupational impairments, patients need a short-term solution, making it essential to focus on symptoms and sufferings that led them to seek the treatment” [ 23 ] (p. 1). In DP, the patient “must reconcile the occurrence of the traumatic event and its meaning with his or her concept of the self and the world” [ 24 ] (p. 416), understanding “the effect of the traumatic event on his or her personality, embedding in the context of his or her current experience” [ 19 ] (p. 2).…”

Controversies on Psychoanalytic Psychotherapies

“…Summarizing the PDT approach, this technique considers the unconscious conflicts, failures and distortions of the intrapsychic structures, mental representations, transference and countertransference and makes use of confrontation, clarification and interpretation (Coderch, 1990). Through emotional exploration, identification of patters in the patients' life, confrontation of defensive functioning and interpretative interventions about intrapsychic conflicts, the treatments obtained favourable outcomes, with the reduction of symptoms and an increase in patients' quality of life (Becker et al, 2019).…”

The efficacy and safety of acupuncture and moxibustion combined with western medicine for obsessive-compulsive disorder

“…[ 4 ] Epidemiological studies have shown that OCD can lead to severe damage to quality of life, mainly in terms of social functions. [ 5 ] Some researches indicated that OCD was linked to serious impairment in various areas of quality of life including mental quality of life, social relations, family, or work life. [ 6 – 12 ] Although the pathogenesis of OCD is unclear, it is likely to be the changes of corticostriato-thalamo-cortical circuitry including pivotal gray matter nodes.…”