Freiheit in der Zwickmühle

Obsessive-compulsive and psychotic symptoms often occur concurrently or in succession. Various psychoanalytic theories attribute this joint occurrence to functional interrelations between compulsion and psychosis. This hypothesis was investigated by means of a systematic single case study. We analyzed qualitative and quantitative data from the inpatient treatment of a young woman with obsessive-compulsive and paranoid hallucinatory symptoms according to the hermeneutic single-case efficacy design (HSCED). The results indicate an interrelationship between the two symptom groups in the sense of a joint or alternating psychological triangulation function: compulsive and psychotic symptoms on their own or in combination can apparently temporarily introduce a third position, which is urgently needed by the patient, even at the cost of massive compromises to the patient’s quality of life. Such functional relationships have implications for the assessment of treatment success. We discuss that in such complex dynamics in the therapy of psychosis there is a need to integrate psychodynamic concepts of therapeutic development into a model of personal recovery.