Integrating Behavior Modification and Pharmacotherapy with the Psychoanalytic Treatment of Obsessive-Compulsive Disorder: A Case Study

This paper presents a multimodal method of treating OCD, arguing that no single modality of treatment is likely to be appropriate or maximally effective in the treatment of severe OCD. A patient with severe, disabling OCD that had led to a cessation of nearly all ordinary functioning began psychoanalysis at her request, unwilling to try other previously recommended treatments. After the establishment of a very firm, engaged analytic alliance and two years of analysis of issues such as the patient's rage, mistrust, need to control, and commitment to a life of illness, the patient agreed to add behavior modification and medication to her treatment plan. All three types of treatment were conducted by the author within analytic sessions. The paper details the ways in which these various modalities were integrated into the analysis, both practically and analytically. It shows how the different treatment approaches can be complementary and lead to enhanced therapeutic benefit.