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Dave came to therapy feeling stuck and unsuccessful in all life areas. He married and quickly divorced and succeeded financially but lost everything. He even became religious and then secular again, after “religion turned from love to awe”. He followed the rules of Judaism “obsessively”, and also today, he fears he will be punished for various thoughts and acts. For over a year, he felt compelled to give charity in the first kiosk he saw that day, or else he would die.Freud might see this compulsive behavior as an expression of ‘moral anxiety’. There is an intra-psychic struggle between Dave’s id’s drives (that made him sleep around and get involved in delinquency), and his super-ego, according to which he should not be doing and thinking such things, making him feel guilt. In his maladaptive efforts to settle the conflict, he tries to undo his acts and please the super-ego by giving charity that will save him from punishment. Treatment will aim to free the repressed conflict and allow it to enter consciousness and become integrated. Another aim might be strengthening his ego, allowing the development of healthier defense mechanisms in order to rid of anxiety.


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