1、1Psychoanalytic Treatment of a Patient with Deep Depression and Obsessive-compulsive Disorder（Guangdong Ocean University，Zhanjiang ，Guangdong Province 524088，P.R.China） Abstract. Objective: To introduce the psychodynamic oriented treatment process of a patient with deep depression and obsessive-comp
2、ulsive disorder. Methods: A psychodynamic oriented treatment of fifty minutes once a week was used to a patient with deep depression and obsessive-compulsive disorder, total of 45 sessions. Results: His obsessive beliefs, depressive symptoms and his social function were all somewhat well up. He also
3、 understood some of the unconscious symbol of his symptoms. Conclusion: His early symbiotic and over-spoiled relationship between him and his mother, as well as the hostile relationship between him and his father, made him involving in the strong guilt of incest and parricide and the obliged repetit
4、ion to wash it out. Key words: Psychoanalytic Therapy; Depression; Obsessive-compulsive disorder Psychoanalysis was introduced into China from 1920s and 2even occurred the so-called “Flo wintex hot“ in 1987. As the social demand increasing and the psychological counseling and treatment developing, C
5、hina has emerged once again the “Flo wintex hot“ over the past decade. A case of psychoanalytic oriented treatment of a patient with deep depression and obsessive-compulsive disorder was reported in this essay. 1 History Information The patient, Tom, was born in 1989. He had been at home for two yea
6、rs since his suspension of schooling as a junior student in a senior middle school in September 2008. He went to see the psychiatrist in October 2008 and was diagnosed as obsessive-compulsive disorder, taking Seroxat, alprazolam and a small amount of risperidone as an outpatient. Tom was referred to
7、 me for psychological treatment in March 2009, with medication all through the therapy. In September 2007 being a junior, Tom became a group leader for the first time. He must manage a lot of people all of a sudden. He had especially conflicts with his classmates while collecting their assignments.
8、When someone did not send the assignment in time, Tom felt very angry and went to force them to present the assignment. But he was also very afraid of others retaliation due to his provocation. After that, Tom 3began worrying that someone might hit him in the back. These ideas emerged all day, and h
9、e worried that his classmates would be very cruel to kill him or to kill his parents, like Majiajue (a national - sensationed campus killer, cruelly killed his four roommates). Later, he sought counseling in his school, accepted one interview. After his suspension of schooling in September 2008, he
10、went to see the psychiatrist in October. 2 Background His father is a 49-year-old worker and his mother a 47-year-old middle school teacher. His sister, 2 years younger than him, studied in another senior high school. His father is taciturn, honest, and kind to his colleagues and family, but lack of
11、 dominance in the family. Tom had been close to his mother since childhood, but was isolated from his father and sister since childhood. Tom was introverted, lonely, much intelligent since childhood. He also liked painting, singing, but in general academic performance, and poor relationships with cl
12、assmates who said that Tom was a villain. So he had few friends, one or two. He started to play electronic games since grade one in junior middle school, gradually addicted, more estranged from the crowd. When entered into the senior high school, he thought 4about online games all day, mainly violen
13、t, and erotic content as well. 3 Treatment He came to see me accompanied by his mother. We conducted two evaluative interviews at first, including asking her mother some questions concerned. I thought that his condition was rather bad, there were some of the problems in himself, some confusions betw
14、een his imagination and reality, and a few of delusions as well. But his abnormal state had a limited scope, and it had limited impact on his behavior, not completely seen in the action as well. His behavior was not in clear violation of the norms of everyday life. He also met regularly with psychia
15、trist and medication, so I thought he could accept the psychodynamic psychotherapy, but the interview should be more structured in order to avoid serious regression. We decided to meet once a week for fifty minutes. The treatment lasted for one year and three months, 45 sessions in all. For quite a
16、long time during the first dozen sessions, he spoke much slowly, hesitant, often pause, repeatedly, much messy, often jumping between topics, and sometimes contradictory, confused, but always continuing, one by one in sections, much to say. What he said seemed related to the 5content of arrogant omn
17、ipotence and magical fantasy, some of which were abusive. Some contents involve delusions of persecution. Other contents related to guiltiness and self accusation. Whats more, the conversation was mingled with a large number of everyday tasks, and his emotion was very dull, monotonous and cold; his
18、posture was much passive and often down-headed, with very few eye-contacts, much like talking to himself; and he occasionally gave one or two sounds of laughter, especially when he mentioned his guilt. In this section, especially during the first ten times, I often felt helpless, weak, and lack of c
19、onfidence, worrying about whether I could help him or he was suitable for psychoanalytic treatment. But the treatment continued session by session, I thought Tom may deliver to me some positive, active power so that I had confidence and felt rest, which assured us to continue the treatment among his
20、 confused words, isolated emotions and free eyes. Why did the treatment continue smoothly? Firstly, I would like to say that he said a lot in each interview which indicated that he was willing to talk, though his feeling was very depressed and isolated and seldom presented, which was confirmed by hi
21、s mothers feedback, who said that Tom was very aspire and eager to our interview. Secondly, Tom accepted me 6and trusted me, but it was depressed and isolated either. Only once when he was criticizing his psychiatrist he spoke a few words to praise me and said that I was tolerant, helpful and trusta
22、ble. I thought that all of those positive transferences not only displayed his desire to develop relations with others but also his ability to love others. That is to say, hidden behind his abnormal state of victim, guilt, and arrogant omnipotence, there was tremendous positive force which had so st
23、rong enough power to help him that he did not collapse completely and did not take them into action. Of course, his arrogant omnipotence remained at the fantasy level, no actions, which indicated that his ability to test the reality was basically integrity. So the treatment continued naturally, not
24、terminated by his abnormal state. Tom showed a manner of passive, rigid behavior in the treatment room. His mood was flat, apathy, isolated, almost without eye contact with me. His mother was required to accompany on the way to the therapy room. Once a time he encouraged himself to come alone, but h
25、e finally dared not to see the therapist instead of staying in a bookstore nearby the therapy room. His mother then told me that he was afraid of coming to see me alone. He showed me two contradictory 7attitudes simultaneously: on the one hand he was eager to see me, he seemed to have a lot of words
26、 to say each interview as if there were so much compelled to tell me; on the other hand his body language was full of fear, avoidance and denial. After about 12 sessions, Tom made more eye contact with me, and came to see me alone, which indicated that his depression eased up and his projection on m
27、e declined. After about 18 sessions, he became more natural, and even laugh at me. After that, he began to arrive late, went to internet caf after leaving home, often played over the time, and missed the timing of therapy. Then I felt my passion to treat him became lower, or even thought that he dec
28、eived to come to therapy but go to Internet cafes in fact. About the 25th session or so, Tom became depressed, fewer interests. He felt his brain was slow. It was difficult for him to think. He always worried that his brain was hurt because of excessive fear and extra brain activities when the disea
29、se came as a junior in senior middle school. During this section he highlighted his guiltiness, showing more and more self-blames, saying that he was “cunning, selfish, ignoble, like a wolf in sheeps clothing, brutal, cruel, coward.“ He recalled a large number of past bitter experiences, especially
30、the painful experiences when the disease came as a junior in senior middle 8school. He worried very much about his slow brain, complaining again and again about his ability of memory. He said that his brain was drying. He doubted that his diagnosis was wrong and medication was mistaken. Meanwhile, w
31、hat he said was more and more structured and logical, not as messy as in the past; contents of magical experiences declined; When he talked about his guilty he had no longer the kind of laughter as before, instead of sad look, low and deep, much pain. He trust me wholeheartedly, started to present h
32、is inward world to me. Such a situation almost lasted 2 or 3 months, until the 36th session or so there were some changes: few contents of self-blame, but filled with more and more daily tasks in the conversation. His words became simple and sentences became short, as if I asked and then he answered
33、, if I did not and then he did not speak. However, his ability of memory became better, his mood also changed for the better. He felt that his brain was getting better to think, and gradually he began to read some books and restored some activities like playing basketball with others. I were much en
34、joyed for him to seek back some sense of fun in daily tasks, and thought that he was well up, that he found the life of meaning, and that perhaps its time to end the treatment. At the 43rd session we 9discussed preliminarily to end the treatment, and decided to finish another two sessions, one week
35、intervals. The 45th session in June 2010 was the last treatment, Tom said that he would go out to work for a month before returning schooling to prepare for next years college entrance examination with his families agree. 4 Discussion In the first section of treatment, Tom showed many oral and anal
36、masochism hostile aggressions, characterized to be omnipotent and magical. He believed that I would hurt him in the same way, which made him very fearful and worried. It was not so successful for him to repress his fear and hostile aggression, resulted in contradiction to his appreciation and trust
37、to me. So, in a long period of treatment he behaved incongruently: on the one hand, Tom showed a manner of passive, rigid behavior, and his emotion was flat, apathy, isolated, free eyes, almost no eyes contact with me; on the other hand, Tom was very aspire and eager to see me, much to share with me
38、. As the treatment progressing, our eyes contacts became more and more natural, and his mood changed better and better, which meant that his fear to the therapists retaliation reduced, that the threat and fear of his cruel, magical masochism 10aggression declined. He even started to attack the thera
39、pist, said that the therapist was ugly, though in a laugh and humor style, which indicated that his ego defense became more mature. We know that in the second phase of treatment, Tom became deep depressed, with a lot of self-accusations and self-crimes. Then he became more open and deep to tell me h
40、is stories, much related to the disease course as a junior in senior middle school. Someone did not send the assignment in time and Tom compelled them to hand in. After that, he started to fear, worrying about others retaliation. Later, these compelled and retaliation ideas emerged again and again.
41、They became so cruel and terrible that Tom imagined that he himself became cruel like them. Finally, he thought again and again that why they killed others cruelly. Tom said himself that he was afraid that the brain would run and run after his cure, never stopped as in the illness course. Reviewing
42、of these experiences, with sadness and melancholy, he was mourning his loss and mental illness. Recent telephone visit informed that Tom has been well since ending the treatment, he has had a lot of progress, and returned schooling to prepare for next years college entrance examination. He stopped medication two months ago without
