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The dreams of a patient with chronic PTSD suggested that she was engaged in an unconscious search for a ritual to address one of her traumas. As dream analysis proceeded, the ritual was imagined, thought through, and planned jointly by therapist and patient, and eventually it was performed by the patient outside of the treatment setting. The positive effect of the ritual on working through of the trauma became evident in subsequent dreams and in a significant reduction of overt symptoms. Anthropological and psychological views of ritual, particularly concepts related to the numinous aspect of these activities, provide a context for the therapeutic intervention. [ABSTRACT FROM AUTHOR]

This paper reviews the concept of repetition compulsion (RC) from Freud's original formulation to recent contributions from psychoanalysis and the neurosciences. Literature on RC presented four major controversies: (1) Does RC describe a broad range of dysfunctional repetitive behaviors, or only the repetition of severe traumatic experiences? (2) Is RC an attempt to achieve mastery and control of a traumatic experience, or to reach a particular psychic state as analgesia or excitement, which reduces the perception of emotional pain? (3) Is the death instinct an acceptable explanation for RC? (4) Is RC a useful, meaningful, and specific concept? The author describes his personal perspective on RC which integrates psychodynamic and biological contributions. Clinical material is provided.