What is Working Through?

Introduction

In psychodynamic psychotherapy, working through is seen as the process of repeating, elaborating, and amplifying interpretations. It is believed that such working through is critical towards the success of therapy.

The concept was introduced by Sigmund Freud in 1914, and assumed ever greater importance in psychoanalysis, in contrast to the immediacy of abreaction.

Interpretation and Resistance

Interpretations are made when the client comes up with some material, be it written, a piece of art, music, or verbal, and are intended to bring the material offered into connection with the unconscious mind. Because of the resistance to accepting the unconscious, interpretations, whether correct or partially incorrect, consciously accepted or rejected, will inevitably require amplifying and extending to other aspects of the client’s life.

In a process Sandor Rado compared to the labour of mourning, the unconscious content must be demonstrated repeatedly in all its various forms and linkages – the process of working through.

Because of the power of resistance, the client’s rational thought and conscious awareness may not be sufficient on their own to overcome the maladjustment, entailing further interpretation and further working through.

Rat Man

Before formulating the concept of working through, in his case study of the Rat Man, Freud wrote of his interpretations:

“It is never the aim of discussions like these to create convictions. They are only intended to bring the repressed complexes into consciousness…and to facilitate the emergence of fresh material from the unconscious. A sense of conviction is only attained after the patient has himself worked over the reclaimed material”.

Transference

The necessity of working through the transference is stressed in almost all forms of psychodynamic therapy, from object relations theory, through the openings offered for working through by transference disruption in self psychology, to the repetitive exploration of the transference in group therapy.

What is Abreaction?

Introduction

Abreaction (German: Abreagieren) is a psychoanalytical term for reliving an experience to purge it of its emotional excesses – a type of catharsis.

Sometimes it is a method of becoming conscious of repressed traumatic events.

Psychoanalytic Origins

The concept of abreaction may have actually been initially formulated by Freud’s mentor, Josef Breuer; but it was in their joint work of 1895, Studies on Hysteria, that it was first made public to denote the fact that pent-up emotions associated with a trauma can be discharged by talking about it. The release of strangulated affect by bringing a particular moment or problem into conscious focus, and thereby abreacting the stifled emotion attached to it, formed the cornerstone of Freud’s early cathartic method of treating hysterical conversion symptoms. For instance, they believed that pent-up emotions associated with trauma can be discharged by talking about it. Freud and Breur, however, did not treat the spontaneous emotional reliving of traumatic event as curative. They instead described abreaction as the full emotional and motoric response to a traumatic event necessary in adequately relieving a person of being repetitively and unpredictably assailed by the trauma’s original and unmitigated emotional intensity. Although the element of surprise is not compatible with Freud’s approach to therapy, other theorists consider that, in abreaction, it is an important part of analytic technique.

Early in his career, psychoanalyst Carl Jung expressed interest in abreaction, or what he referred to as trauma theory, but later decided it had limitations in treatment of neurosis. Jung said:

Though traumata of clearly aetiological significance were occasionally present, the majority of them appeared very improbable. Many traumata were so unimportant, even so normal, that they could be regarded at most as a pretext for the neurosis. But what especially aroused my criticism was the fact that not a few traumata were simply inventions of fantasy and had never happened at all.

Later Developments

Mainstream psychoanalysis tended over time (with Freud) to downplay the role of abreaction, in favour of the working through of the emotions revealed through such acting-out of the past. However, Otto Rank explored abreaction of birth trauma as a central part of his revision of Freudian theory; while Edward Bibring revived the notion of abreaction as emotional reliving, a theme subsequently taken up by Vamik Volkan in his re-grief therapy.

Abreaction Therapies

In Scientology, Dianetics is a form of abreaction that science fiction writer L. Ron Hubbard borrowed from the United States Navy when he spent three months in a San Diego hospital in 1943 with the complaints of an ulcer and malaria. Hubbard later wrote, in his autobiography My Philosophy, that he had observed abreactive therapy in the hospital, though in later life he claimed to have made the discovery on his own after being wounded in battle and given up as untreatable.