Obsessional thinking as "paradoxical action"

Obsessive-compulsive neurosis has long intrigued psychoanalysts. Although they may disagree about the underlying etiological mechanisms, analysts generally agree that obsessive individuals are often difficult to engage in the psychoanalytic process and are therefore difficult to treat psychoanalytically. The author offers a selective integration of theoretical approaches to this disorder and elaborates on Schafer's theory of obsessional thinking as paradoxical or conflictual action as a way to understand the resistance frequently encountered in these patients. A case report illustrates this psychoanalytic approach to obsessional neurosis.