‘Hiccups of the mind’: psychotherapy with a young boy with obsessive-compulsive disorder

ABSTRACT

This paper presents a case study of a six-year-old boy who, unusually, had intensive psychoanalytic psychotherapy as a form of treatment for OCD. Obsessive-compulsive disorder (OCD) can be clinically diagnosed as a psychiatric condition from the age of four or five. The standard treatment for OCD in the NHS tends to be a combination of cognitive and behavioural therapies. This little boy suffered classic symptoms of OCD, which included repetitive intrusive thoughts, compulsions, and ritualistic behaviour. After just over two years of psychoanalytic treatment, his distressing symptoms were alleviated, and in the follow-up sixteen months later, the symptoms had not re-emerged. This paper highlights the psychoanalytic approach used in this case, focusing on the meanings and possible aetiology of paediatric OCD. Using the qualitative research approach of thematic analysis, three main themes that emerged in this work are discussed, by referring to clinical examples from the child’s therapy. Based on the findings, I suggest that the contribution and maintenance of early onset OCD in this boy, to some extent camouflaged infantile relationship struggles, particularly in relation to oedipal difficulties. I will describe a ‘turning point’ in the therapy, to further illustrate my formulation, as well the demonstrating the complexity of the process of change in child psychotherapy, as evidenced in this case.

KEYWORDS:

• Obsessive-compulsive disorder
• early onset of paediatric OCD
• oedipus complex
• OCD

Acknowledgments

I am so grateful to Michael Rustin’s generous support and guidance in writing this article - without Michael’s help, this paper would not have been possible. I would like to thank Emily Ryan who read a draft of my paper and helped me to formulate the structure. I would also like to express my sincere gratitude to: Henry whom I learnt so much from, and all my many supervisors especially my very supportive clinical supervisor Paul Barrows who sadly passed away before this paper was published.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1. All names and other possible identifying details have been changed.

Additional information

Notes on contributors

Sayi Thomas

Sayi Thomas is a child and adolescent psychoanalytic psychotherapist trained at The Tavistock & Portman NHS Foundation Trust.  She has worked in a number of different organisations including CAMHS and the voluntary sector.  Sayi has also been a visiting lecturer on the D24 & M34G courses organised by the Tavistock & Portman.