Working Through in the Therapy of Schizophrenia

Working through in the analytic situation involves overcoming resistances to structural change within the id, ego, and superego. The

working alliance is an essential precondition to successful working through since it involves the continuing operation of identificatory processes without which the potential threat to object constancy might lead either to increased resistances or to psychosis. The deepest anxiety of the patient lies in the fear of loss of object representation without corresponding replacement, of which the continuing working alliance stands as guarantor. Such processes as the development of insight, the abreaction of affects, the testing of the reality of insights through their conjunction with emotional responses, and the mastery of anxiety within the analytic situation are all affective elements in the working through process, but only in the situation where new identifications are available to replace old object ties and investments which must ultimately be abandoned or radically altered if analysis is to be successful. And under ordinary circumstances the analytic situation in itself, without educative, restrictive, or overtly supportive atmospheres, provides adequate opportunity for safeguarding structural integrity in the patient.