Obsessive–Compulsive Disorders

The disorder-specific psychodrama therapy for obsessive-compulsive disorders begins by developing the patient’s self at the symptom level. The patient symbolizes his current obsessive thoughts (his sadistic superego), as a ‘tormenting spirit’ to which he is exposed, with a chair and a hand puppet on the object level. The compulsive actions are symbolized with another chair as self-protection against the threat of the ‘tormenting spirit’. As a doppelganger, the therapist empowers the patient to develop a relationship with his ‘tormenting spirit’ in a progressive way on the level of play, similar to child therapy, and thus to gain ego control over his masochistic self-censorship. At some point, the patient discovers on his own the inner conflicts that cause his obsessive-compulsive symptoms. The basis of the therapy is the resolution of the patient’s metacognitive confusion through separate external symbolization of the three involved metacognitive processes (ego-states) with chairs. These are his masochistic, self-injurious thinking, his self-protection through adaptation, and his healthy adult thinking. The presented action methods can qualitatively enrich the depth psychological, behavioral, and systemic therapy psychotherapy of obsessive-compulsive disorders.