Introductory Lectures on Neuropsychoanalysis: Lecture Six, Part 2 " How to Treat the Mind" Middle Phase/Working Through

Working Through is also a well known technique in psychoanalytic treatment, so I am not going to dwell on the details here as to how to do it. But I am going to write about the neuropsychoanalysis theoretical assumptions behind working through. Working through basically means that you as the therapist make your transference and extratransference interpretations to the patient again and again. And you make them in every possible situation the patient faces, and in various interactions they have with their significant relationships, including their relationship with you. As you do this over time, the patient will begin to see in the present these repeated patterns. They will further see that these patterns have persisted throughout their lives. Finally they will see that these patterns result in failed attempts to meet a basic need, that their repressed, childhood, unworkable solution will never be able to meet. The patient will then understand why they are suffering from the resultant unpleasant feeling that brought them to therapy. They will further see that the only way to rid themselves of this feeling is to gradually change their unworkable solution to a workable one. Only as they develop and new prediction will the unmet need be met. Working through helps the patient create their new prediction and implement it in their relationships.

Now some unworkable predictions are not non declarative/unconscious. Some predictions are declarative/preconscious. It is not that the patient cannot bring these predictions back to mind, they simply resist doing so because they create unpleasant feelings. These preconscious predictions are more easily worked through than repressed unconscious ones. They are the primary focus in supportive therapies.

So your task as the therapist for the remainder of the Middle Phase is to assist your patient in creating a new prediction in their present lives, and to start to live out this new prediction in their present relationships, including their relationship with you. This takes a long time and many sessions ( Solms 2020.) That is why the Middle Phase of neuropsychoanalytic treatment is the longest phase. As you offer these interpretations and reconstructions over time your patient will, with your help, begin to implement their new prediction. As they experience the new prediction working, they start to get their basic need met. Then, over time, the new prediction triumphs over the old one. Now unfortunately, the old repeated, repressed, unconscious and unworkable prediction from childhood does not go away. It cannot go away. It is unconscious and non declarative and remains a permanent part of the patient's mind. But the new prediction develops alongside the old one, and over time the patient will come to live out the new one most of the time. Under stress, however, they may regress to the old prediction, but they will now recognize this on their own, and through self therapy will bring themselves back to the new healthier prediction.that ensures their basic need gets met.

When your patient has developed this ability to become their own therapist, you will have accomplished your therapeutic goal. It is then that the Middle Phase ends and you are to begin talking about ending the treatment. When this conversation begins (usually initiated by the patient) you have entered the third and final phase of the treatment, which is the termination phase or the Ending Phase.