Working Through As Metaphor And As A Modality Of Treatment

Although Freud encoded the idea of “working through” as a mere metaphor, it served the essential role of designating the necessary activities of analyst and analysand that go beyond the elucidation of mental contents through interpretation. From a neurobiological viewpoint, these processes involve the establishment of new neural networks through gradual habituation. From the vantage point of cognition, this necessarily slow process amounts to learning new skills in communication, the mastery of mounting unpleasure, and the expansion of “referential activity.” These considerations imply that the crux of analytic work is changing those biological functions we call thought processes, thereby improving the person's ability to regulate behavior adaptively. Thus, the interpretation of mental content is a byproduct of the analytic work—a result of clearer thinking, facilitated by identifying areas of primitive mentation and assisting analysands to expand their repertory of psychological skills. Only these intrapsychic changes in functional capacity will enable patients to reach the insight necessary for continuous adaptation through self-inquiry.