Thinking about Obsessional Thinking: An Integrative Model

This article outlines an integrative treatment model for individuals who present with a highly obsessional thinking pattern. These individuals may be understood to be suffering from severe anxiety that inhibits their ability to think about their social world, leaving them chronically unable to engage effectively in what Sullivan termed security operations. The world they inhabit is as experienced as unsafe. At the same time they may have very high demands on themselves to behave appropriately and achieve their goals. The high degree of anxiety experienced by these individuals leaves them poorly equipped to work in a traditionally psychoanalytic way. A treatment approach that combines the rich interpersonal relatedness of relational psychoanalysis, the empathic pragmatism of Mentalization-based Therapy, and a mindfulness based approach to the phenomenological aspects of anxiety itself allows the clinician to target both anxiety and the social-emotional lacunae that are typically found in these patients. A hypothetical illustrating this integrative approach is presented.