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Acting out has a variety of current usages; aspects of this concept were previously subsumed under acting out, acting in, actualization, and the more subtle collusion and treatment misalliances. All denote some form of repeating and putting into behavior, rather than remembering and verbalizing the original conflicts, and in that sense are considered resistances.
The various forms of acting out are examined. Actualization signifies a patient's (unilateral) motor or physiological activity that represents regressive reliving of transference fantasies within the analytic situation. The emphasis is on the patient rather than on the dyadic interaction. Two basic differences between actualization and enactment are identified: (1) in the actualization the analyst does not co-regress with the patient, and (2) the analyst is not destined to act in a spontaneous way that has meaning only after the fact. Enactment is a nonverbal communication that manifests itself symbolically through motor movements or autonomic nervous system discharge and brings about a behavioral response from the therapist. Enactment always involves symbolic behavioral interactions between patient and therapist which have unconscious meanings for both parties. It is therefore an interpersonal event, whether the analyst enters into the enactment as the frustrator or as the gratifier of the infantile demand. Enactment is also used loosely as a nonpejorative substitute for the older term acting out: it is defined as taking place whenever the analysand acts and stimulates the analyst to act rather than to report or put into words. An enactment may also be an attempt by the patient to gratify transference needs, combined with an unconscious reparenting activity by the therapist. Caution is always required, since attempts to make behavioral reparations do not replace verbal, but crucial, working through of transference and constructions from the past.