Introductory Lectures on Neuropsychoanalysis: Lecture Five Part 5 " How to Treat the Mind" Middle Phase/Working Through

MIDDLE PHASE AND 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 every interaction that have with their significant relationships in all their various contexts. 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, and that they are not doing so. The pattern is not working now and has never worked for them. 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 change their pattern from an unworkable solution to a workable one........ 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 begin to see these repeated patterns themselves, and with your help begin to establish new ones. And as the patient sees that these new patterns work, and therefore they start to get their basic unmet need met, they gradually adopt the new pattern until eventually it triumphs over the old one. Now unfortunately, the old repeated, repressed, unconscious and unworkable pattern 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 pattern 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 pattern, but they will now recognize this on their own, and through self therapy will bring themselves back to the new and healthier pattern.