LA PSYCHOTHERAPIE CHEZ L'OBSESSIONEL

The present paper is a study of the role of psychotherapy in the treatment of obsessive-compulsive disorders (OCD). It also includes an attempts to integrate several paradigms in order to obtain the best possible approach in helping each patient on an individual basis. The aim of this psychotherapy may limit itself to simple verifications in the pharmacotherapeutic follow-up, or it may be as ambitious as an attempt to modify the character structure of the individual. In the process of the latter case, one expects the defensive aim of symptoms to be no longer relevant, insofar as the patient successfully solves the conflicts that caused the symptoms. We can only use tags or labels to bear witness of the efficiency of such ambitious use of psychotherapy, and even these tags or labels seem to be concerned with compulsive personality rather than with OCD proper. At each end of the range of aims (encouraging the followup of pharmacotherapeutic or behavioral treatments character modification), the therapist is inevitably confronted with a multitude of features frequently present in the obsessive patient. Because it is a disorder which invades and influences the patient's feelings, thoughts, behavior and relationships with other people, the obsessive patient's mind is a constant pray to special problems at every meeting with his therapist, whether they be related to the administration of drugs or to a behavioral therapy regime. Obviously, such problems will multiply if one initiates systematic psychotherapy in such patients. The present paper focuses on some of the problems which frequently arise in the therapist's relationship with such patients and makes suggestions as to the way of dealing with those problems. Successful treatment of the obsessive patient depends on individual approach which meets his specific needs and in which a treatment based on flexibility and sympathy should substitute for any form of dogmatic attitude. Such an approach may include the above-mentioned methods and others too, if need be (e.g. family group therapy, selfgroups, etc.). As yet, no such treatment alone has ever proved capable of permanently curing the disorder. Even the best results obtained with pharmacotherapy and behavioral therapy show that symptoms are only reduced and the rate of relapse remains very high. By combining psychotherapy and the armamentorium, the therapist will be better equipped for relieving his patient's sufferings, not only by reducing the severity of symptoms but also by directing extreme energy and obstinacy towards more productive activities. Thus, by encouraging the building of a more consistent ego, he will give his patient the opportunity of improving the quality of his life.