In Theory: In psychodynamic therapy, insight alone is rarely sufficient for change. The same material, pattern, and relational dynamic must be revisited across time, and in different contexts. This process, described by Sigmund Freud as working through, is slow, recursive, and often frustrating. The patient understands something, loses that understanding, returns to it, and understands it again in a slightly different way. Change does not occur through comprehension alone, but through repeated encounters with the same truth until what is known becomes lived in the therapeutic relationship itself. This path of integration transforms an intellectual concept into an embodied reality, ensuring that the truth is no longer just a thought in the mind but a new way of being in the world.
In Experience: Someone understands in detail that their self-criticism originated outside themselves. Yet, in moments of isolation or fatigue, the same voice returns. The distance between knowing and living what is known is not closed by explanation. It must be met again where it still has force. Change appears as a gradual loosening in the moments where the pattern would otherwise take hold.
In Thought: The same questions, patterns, and conflicts tend to return across time. Understanding them does not always end their return.
In Print: Coughlin, P. Facilitating the Process of Working Through in Psychotherapy (2023)
In Attention: Notice when something believed to be gone shows itself again.
