The Importance of a Clinical Perspective-Reply

In Reply.— Dr Gottlieb reminded us that psychoanalysis and psychodynamic psychotherapy may provide a "complete cure" for patients with OCD. In our own series of 21 patients, who collectively were the recipients of more than one century of psychodynamic treatments, we had no reason to be so optimistic. This is not to say that we believe that the conditions of patients with OCD do not improve in psychotherapy, but simply to suggest that a research center like ours generally receives only patients whose conditions have failed to improve with traditional treatments. Perhaps Dr Gottlieb was correct in asserting that we too readily passed over these traditional treatments; however, neither in his letter nor elsewhere in the literature on the psychodynamic treatment of obsessional states are there clear and consistent data documenting the frequency of positive responses to psychodynamic approaches. Much has been written about the criteria for analyzability; but after 70 years