The clinical notion of working within

Clinical material is used to illustrate the Modern Kleinian approach to and within a patient’s defensive system and their particular transference profile. Rather than embrace the traditional concept of the working-through (WT) process, the author focuses on the analytic here-and-now of working within a patient’s unconscious phantasy world, the transference, and any pathological organizations that are relied upon. This is a more holistic and comprehensive method of working analytically, based on working within a patient’s internal object relational experience, which hopefully leads to growth and transformation. A summary of the first two analytic sessions with one patient, material from a psychotic patient in treatment for 6 months, and a higher functioning patient seen for more than a year are presented to show the utility of working in this manner with all patients regardless of their level of psychic organization.