Abstract
In this paper, the authors are focusing on several goals: a) reflection on psychotherapy by the novice psychoanalytic therapist and his reliance on supervision and theory, b) work with patients with obsessional neurosis, and c) reflection on some historical concepts of obsessional neurosis and their use in the present practice. The authors demonstrate some of the difficulties in the concurrent practice of clinical work in different contexts (in an inpatient psychiatric unit for patients with severe mental disorders and neurotic patients in outpatient private practice).
The text uses several case fragments of patients with obsessionals neurosis to demonstrate the various manifestations of anal phases, anal sadistic phases and oedipal struggles. The case study examples illustrate the concept of "anal character" and its use in routine clinical work, including psychoanalytic psychotherapy.
The reference case is Freud' s case study of the Rat Man. The paper also rehabilitates diagnostic thinking about patients and demonstrates the inspirational nature of diagnostic concepts and theory, outlining their limits and the defensive function of diagnosis.