Words and working through

The paper discusses communication--its modes and its changes--between analyst and patient, and, more particularly, within the patient himself in the course of a psychoanalysis. Clinical material from two cases illustrates how patients may need to communicate to the analyst both in words and also--in order to bring their less developed self--by more primitive modes, which can be understood and conceptualized by Melanie Klein's notion of projective identification. As the patient feels understood by the analyst's words (the mutative interpretations) he may slowly become more aware of his primitive modes of relating, until, ultimately, his method of communication changes and he is himself able to express his understanding of himself in his own words. This brings structural change and a resumption of ego development, and is a mutative moment. In brief: mutative interpretations are not by themselves the agency of change. They put the patient in a position to change. He himself must do the active, mutative working through in his own words.