OCD Therapy in NYC: A Depth-Oriented Approach

Obsessive-Compulsive Disorder (OCD) is often experienced as a relentless cycle of intrusive thoughts and ritualized behaviors. From a Self-Psychological perspective, these symptoms are understood as reflections of deep internal conflict or emotional disconnection. In my Manhattan practice, we view these obsessions and compulsions as defensive attempts to manage unresolved anxiety and vulnerability—driven by a profound need for emotional security in the face of a perceived loss of control.

Defending Against Fragmentation

Drawing on the work of Robert Stolorow, compulsive behaviors can be seen as "structural anchors" used to prevent feelings of emotional fragmentation. When early relational experiences lack empathic attunement, the sense of self can feel fragile or prone to shattering. The ritual becomes a way to "hold oneself together" against an onslaught of self-doubt or shame. True healing begins not just by stopping the ritual, but by cultivating an empathic understanding of the emotions that necessitate the defense.

The Cycle of Obsession and Compulsion

OCD functions as a feedback loop where the mind attempts to solve an emotional problem with a cognitive or physical ritual. We work to identify the specific triggers and the underlying vulnerabilities they activate:

• Intrusive Obsessions: Recurrent, unwanted thoughts that create intense distress and feel outside of one's control.
• Compulsive Rituals: Repetitive behaviors or mental acts performed to neutralize anxiety or prevent a feared event.
• Emotional Misattunement: The underlying feeling of being unseen or unsupported that fuels the need for hyper-vigilant self-control.
• Fragile Self-Cohesion: The sense that without these rituals, one's internal world might become unendurably chaotic.

A Reflection on Emotional Endurance

"Let everything happen to you: beauty and terror. Just keep going. No feeling is final."
— Rainer Maria Rilke

The Path to Integration: Our Therapeutic Approach

Our work focuses on repairing the internal sense of self to reduce the functional need for compulsive behaviors:

1. Cultivating Empathic Grounding

We provide a compassionate, validating space to explore the painful emotions—such as vulnerability or shame—that underlie the disorder. This "relational home" allows you to feel safe enough to examine the thoughts you usually try to suppress.

2. Strengthening Self-Cohesion

By building a more stable and resilient sense of self, the "terror" Rilke speaks of becomes more bearable. As your internal foundation strengthens, the need for rigid, external rituals naturally diminishes.

3. Deconstructing the Defensive Ritual

We look at the "logic" of the compulsion. What is it trying to protect? By understanding the ritual as a survival strategy rather than a "defect," we can develop healthier ways to achieve emotional security.

4. Restoring Agency and Flexibility

The goal is to move from a life dictated by fear to one guided by intention. Therapy helps you regain the mental flexibility to experience life’s "beauty and terror" without being paralyzed by either.