Meetings of the New York Psychoanalytic Society

DISCUSSION: Dr. Heinz Hartmann commented on the fact that there have been no clinical studies of the problem of working through. He suggested that the analyst plays an important role in the process by aiding in the facilitation of the transference and by making the unconscious conscious. The effect on the patient has been described as furthering the synthetic function and integration of the ego; not only is there a broadening but there is also a solidification of ego functions and an increase in ego autonomy. The conservative tendency of the ego and the term fixation have had different meanings at different times. A new impulse may follow old unconscious models even though the danger situation has changed. This is based on fixation but is not the result of the repetition compulsion. Uniformity due to structure formation is not a consequence of the repetition compulsion, and Dr. Schur's concept of the domestication of the repetition compulsion is relevant here. When considering working through in relation to normal development, it is useful to keep in mind the point made by Freud in Inhibitions, Symptoms, and Anxiety, that the repressed does not remain unchanged in the unconscious but modifications may occur from its representation in the ego. Dr. Hartmann questioned whether working through always produces new structures, or whether more often its consequence is a strengthening of existing structures.

Dr. Edward D. Joseph welcomed Dr. Stewart's emphasis on the prime role of the patient in working through. In addition to advantages of working through mentioned by the author, Dr. Joseph added a true sense of conviction—a genuine feeling representing a condition of structural harmony in which id drives enter the ego with the sanction of the superego. Confirmation that adequate maternal care facilitates working through is found in the strong sense of conviction in intensely oral characters as opposed to the doubts that typically accompany anality. Dr. Joseph a