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If I may use the term neuromental as a synthetic construct of brain and mind, our neuromental function appears so highly construed toward action that we might fairly suspect that anything that does not work toward action is evidence of malfunction. Because psychoanalysis is a reflective and contemplative exercise, we perhaps make excuses too readily for obsessive paralysis in our analysands. We do have pathologies of impulsiveness akin to the hyperkinetic motor pathologies, but our theory tends to portray the acting sociopath, perhaps enviously, as lacking the lead jacket of neurotic restraint imposed on the rest of us by civilization. Some analysts might think that any focus on movements and motoric aspects per se cannot be analytic.
But many of us, in evaluating analyzability, by which we mean the good possibility of a satisfactory outcome, have long ago down-weighted the criterion of whether the patient could think or speak with insight about mental processes and have relied much more heavily on criteria of action: active interpersonal relatedness, and especially, the ability to work in a sustained and productive way. Our patients who worry too much are now helped to select worries that can eventually be resolved by action, over those that cannot, and we demand that they use what is learned in their current lives as “working through.” In a review of the useful aspects of acting out, subtitled “enactment, reliving and actualization,” Roughton (1993) remarks that “Anna Freud was correct twenty years ago in her observation of a trend in analysis towards ‘a decreasing interest in free association and dream-interpretation … with an increasing insistence on reliving emotional experience and repeating it (acting out) in the transference’” (1968, p. 167).