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Emanuel Windholz, in introducing the panel, gave a brief historical review of some of the origins of the concepts of working through. He referred to Freud's concepts of the adhesiveness of the libido and the resistance of the id, to Phyllis Greenacre's concept of organizing trauma, and to the work of Novey and Stewart.
Ralph R. Greenson then reported two case histories which laid the groundwork for the discussion of working through.1 The first case, Greenson felt, presented no problems in working through, while the second case had special features which illustrated the concepts of working through and of the working alliance.
Greenson describes working through as centering around insight and change. He regards working through as occurring only after the patient has insight; it is the goal of working through to make insight effective, i.e., to achieve significant and lasting changes in the patient. By making insight the pivotal issue we can distinguish between those resistances which prevent insight and those resistances which prevent insight leading to change. The analytic work on the first set of resistances is the analytic work proper; it has no special designation. The analysis of those resistances which keep insight from leading to change is the work of working through, to which both the analyst and the patient must contribute. This consists essentially of the same procedures as performed in ordinary analytic work; it may be a repetition and elaboration of such work. However, in certain cases special problems may develop following the acquisition of the insight, which prevents it from becoming effective and which requires special interventions.