When the Analyst Dies and the Patient Goes Missing: An Ethical Crisis in Psychoanalysis

ABSTRACT

This essay argues with urgency the need for psychoanalysts to redress a dangerous lacuna in psychoanalytic praxis. There is, Lentz argues, a disturbing inattention to the quiet but devastating reality that many treatments end because the analyst has died or has become too ill to practice. Lentz focuses on patients’ traumatic experiences of this kind of loss, which can ultimately render the treatment harmful rather than healing. Through clinical examples, literature review, and autobiographical narrative, she demonstrates the many ways that the “patient goes missing,” both on a psychical level and as a result of a collective disavowal by the field. Lentz discusses commonly-held patient affects, including the patient’s “felt insignificance” to the analyst, and resonances of boundary violation which can permeate the patient’s sense of loss. At root, this is meant to be an activist essay, calling on reform in the field, and offering some suggestions for change.

Acknowledgments

I owe thanks to Lauren Levine, Robert Bartlett, Rachel Kozlowski, and Ezra Tawil, who have discussed this work, read drafts, and generally supported me in the writing of this essay. But most especially, I owe thanks to Adrienne Harris, whose guidance, wisdom, and empathy powerfully shaped my thoughts on this difficult topic.

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No potential conflict of interest was reported by the author(s).

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Notes on contributors

Kirsten Lentz

Kirsten Lentz, Ph.D., L.C.S.W., is a graduate of the New York University Postdoctoral Program in Psychotherapy and Psychoanalysis. Prior to her psychoanalytic and social work training, she earned a PhD at Brown University where she studied social theory and studies in gender and sexuality. She writes and lectures on issues of gender, sexuality, and cultural marginalization. She has a private practice in New York City.