In support of the Psychodynamic approach, the Cognitive -Behavioural view does not seem to give any convincing argument to the selection of obsession in the first place. In the case of the mother obsessed with germs, it can be claimed that the fear of contamination may have been socially conditioned to some extent, and so was merely an obvious choice. If we also take the case of the woman with the ‘hot colour’ obsession, the form taken here is much less compliant with the Cognitive-Behavioural view.As mentioned earlier, however, it is not necessary to therefore try and chose which one of these contrasting viewpoints is best, as they can be amalgamated to create one, much more comprehensive approach to understanding the disorder. For example, it could be said that the obsessions do indeed stem from unresolved internal conflicts.
However, these conflicts are present to some extent in everyone and so it takes a combination of this and a period of emotional vulnerability such as depression to cause the issue to produce enough anxiety to be displaced onto a related but less threatening thought or item.Then the compulsions are created to deal with the anxiety in some symbolically related way, but their superficial nature will see the disorder perpetuated rather than cured. In this respect the strongest elements from both approaches can be seen to support each other. What has not been suggested by either approach, but seems congruent, is the possibility that the Obsessive-Compulsive disorder sufferer may not be able to distract themselves from the original conflict, and so displaces it onto a linked subject that can be more easily dismissed. Thus the creation of the compulsive routines (that often seem diametrically opposed to the obsession) may be an attempt to distract from the obsession by focussing on a different act.
Although it seems that there is some compromise to be reached between the two approaches regarding the understanding of Obsessive-Compulsive disorder, with both having their own relative merits, the treatments they prescribe are quite disparate. Both have been developed as ‘humane’ alternatives to the traditional (and largely unsuccessful) treatments, which included electro-convulsive therapy and psychosurgery.The treatment of Obsessive-Compulsive disorder that is employed in the Psychoanalytic approach is a very simple derivative of basic cathartic therapy. It involves the therapist identifying the underlying conflicts that were displaced, and getting the patient to recognise it as the origin of their anxiety. Then it can be confronted and the Obsessive-Compulsive disorder should naturally disappear (as it is a defence mechanism that is no longer needed).There are a number of problems with this treatment, with the first being that it involves a thorough analysis of the defences, and an undoing of the repression, all of which can take years. The second problem is that, as the therapy is still in its relative infancy, there is no real statistics as yet that can be seen to confirm or refute its efficacy. In this respect it can be suggested that to some extent it questions the validity of the whole theory.
The Cognitive-Behavioural treatment of Obsessive-Compulsive disorder has, on the other hand, received the validation of a significantly high success rate, both immediately after treatment (with approximately 66% of patients loosing their symptoms) and in follow-ups of up to six years later (with over 90% of those patients who had improved maintaining their improvements)(Sue, Sue and Sue, 2000).The therapy involves a three stage system of modelling (showing them that their obsessive situation is actually safe), flooding (encouraging them to place themselves in that situation), and response prevention (not allowing them to carry out their compulsions). The success of these techniques is a strong indicator that the disorder is driven by or at least strongly connected to anxiety, as in particular flooding and response prevention have long been used as effective methods of dealing with anxiety disorders.
This apparent success should not, however be taken to show that the Cognitive-Behavioural approach is thus superior to the Psychoanalytic approach. The success of this therapy stems from a combination of ‘Pavlovian extinction’ (that the feared result is not directly linked to the obsessive subject that the patient is trying to avoid) in the flooding, and ‘Instrumental extinction’ (no negative effect results from not completing the compulsion) in the response prevention (Hollander and Stein, 1997). Therefore it is merely dealing with the symptoms through conditioning, rather than dealing with any underlying cause that may exist.If the concept of combining the two approaches (as in the discussion on understanding Obsessive-Compulsive disorder earlier) is to hold any merit, it would mean that this treatment alone is not enough, as it makes no attempt to deal with the unresolved unconscious issues that are responsible for the obsessions. This is supported by the fact that the effects of the Cognitive-Behavioural treatment are very specific; obsessive thoughts, compulsive rituals and anxiety are all largely removed, but the depression, social activity family harmony of the patient remain unaffected. This may be seen as suggestive that there is indeed an underlying problem which needs resolved for the sufferer to be totally cured.
Perhaps then the most effective treatment would be the simultaneous use of both the Psychoanalytic and Cognitive-Behavioural methods, each of which is geared to deal with a specific aspect of the disorder.While both the Cognitive-Behavioural and Psychodynamic/Psychoanalytic approaches to Obsessive-Compulsive disorder are in many ways quite disparate, the differing focuses that they hold means that they both contain a number of very salient points. Thus rather than having a preference for one over the other, it has been shown here that personal preference goes to a hybrid of the two. It seems that only in forming this amalgamation is it possible to fully understand and treat all the aspects of this disorder as it is understood at the moment.
That is assuming, of course, that the problems prevalent in Obsessive-Compulsive disorder are not caused purely by some neurochemical dysfunction or other biomedical explanation.References:Dubovsky, S.L. & Butler, L.D. (1995) Abnormal Psychology: Casebook and Study Guide: London. W.W.
Norton & Company.Freud, S. (1909) Notes upon a case of obsessional Neurosis. In J. Strachey (Ed & Trans.) The Complete Psychological Works Vol. 10: New York. Norton (1976) cited in Rosenhan & Seligman (1995).
Hollander, E. & Stein, D.J. (1997) Obsessive-Compulsive Disorders: Diagnosis, Etiology and Treatment: New York.
Marcel Dekker, Inc.Horowitz, M. (1975) Intrusive and repetitive thoughts after experimental stress. Archives of General Psychiatry, 32, 1457-1463 cited in Rosenhan & Seligman (1995).