Enhancing Manualized Short-Term Psychodynamic Treatment for OCD by Considering Developmental and Modern Structural Theories

Abstract

This commentary considers a case study of the hybrid case of "Serena," seen by therapist (and case study author) Alma Campiani (2025), which demonstrated both quantitatively and qualitatively a positive outcome. The treatment involved the application of Leichsenring and Steinert’s (2017) manual-guided, short-term psychodynamic psychotherapy (STPP) approach designed for a primary diagnosis of OCD, which Serena had. The approach involves weaving together exposure principles with transference-focused interventions. Serena is an inhibited and anxious young woman of Cuban descent who grew up with parents traumatized by political and economic experiences in their home country and by the immigration process. Serena had reluctantly sought treatment after a panic attack, preceded by a marriage proposal; and she reported a pattern of longstanding intrusive violent thoughts. In the commentary we discuss areas of strength in the therapy as related to accomplishment of psychodynamic goals while utilizing an empirically supported manualized treatment. We also discuss how, from our psychoanalytic point of view that is not connected to manualized treatment, attention to the unconscious dynamics of the therapeutic pair could have enhanced treatment. Specifically, we propose that appreciation of a developmental perspective and Modern Structural Theory could have benefited the clinician and the treatment by helping the therapist better anticipate and address resistances and enactments. In addition, we comment on the importance of considering culture and immigration in identity formation of both the patient and therapist.