Meeting of the New York Psychoanalytic Society

November 27, 1956. RE-EVALUATION OF THE PROCESS OF WORKING THROUGH. Phyllis Greenacre, M.D.

In certain cases, a sound and thorough working through is essential for a sustained therapeutic result. In the early days of psychoanalytic treatment working through subserved first, a progressive and repetitive overcoming of resistances which uncovered the repressed instinctual demands; second, a working to the supposed traumatic memories which were considered the nuclei of the neuroses. With the realization that many of the events described were partly wishful fantasies connected with developmental conflicts, the theory of traumatic etiology became underemphasized. It was not the event but the fantasy that was assumed to be of primary etiological significance.

Different combinations of subjective and objective experiences may however occur so that the 'typical' fantasies of the infantile years do not appear in generic form, but are, rather, given a special repetitive strength, form, and pressure through having been confirmed by external events, either instigated by the child or, more rarely, by occurring more or less coincidentally. When the infantile fantasy is re-enforced by external verification, it becomes powerfully real. The organizing effect of such an event is incalculably great and the fantasy behind it gains much force and predisposes to later repetitive acting out.

The cases presented are those in which the acting out is focused on fantasies based upon real experiences. Certain patients, despite repeated analyses by competent analysts and consistent improvement, were subsequently drawn into former neurotic tensions and symptoms. Of these the author states that further analysis revealed that the adhesiveness of the neurosis seemed to be due to the persistent effect of severe, organizing experiences of childhood and adolescence. The author was impressed with the fact that the realities occurred most often in the latency period, and that despite the relative