Terminating Without Fatality

Abstract

The psychoanalytic relationship is unique among intimate relationships, in that its ultimate goal is separation. After termination, the analysand mourns the loss of the analyst and while feeling vulnerable and bereft, faces demanding emotional tasks alone. The post-termination phase is a precarious time during which the hard-won gains of an analysis may be threatened or even lost. Given the analysand's vulnerability, it is disturbing that many of our common termination practices may undermine the patient's leave-taking and harm the positive internal images of the analyst and the analytic relationship that have been forged during the analysis. Findings from recent research about the patient's experience after analysis are presented and implications are drawn for practice regarding the termination and post-termination phases. The author recommends that our theory and technique of termination should be reexamined and revised in light of new research and within the context of contemporary two-person theories of psychoanalysis.

In real life, only death and hostility bring a libidinal relationship to an end. The kind of termination psychoanalysis demands is without precedent.

—Martin Bergmann (1997, p. 163)

Notes

¹All further reference to my research will be to this article.

²Because the majority of the analysands in my 2002 research were female and the majority of training analysts male, the feminine pronoun will, for the sake of convenience and continuity, be used in this article to refer to the patients, and the masculine pronoun will be used to refer to the analysts, except where a particular male patient is quoted.

³In my research study, 121 psychoanalytic candidates who had completed their training analysis responded to a survey about their post-termination experience. Twenty candidates were interviewed to obtain a deeper understanding of the mourning process that follows analysis. Ninety-four percent of the respondents reported an average score of 4 on a scale of 1 (not at all) to 5 (very much so) in answer to the question, “How strongly did you feel the loss of the unique analytic relationship after termination?” On a different question, 76% of respondents experienced a sense of painful loss after termination that lasted, on average, between six months and a year, while 24% experienced no discernible sense of painful loss.

⁴The analyst also has a set of emotional tasks that I will address later in the article.

⁵Stephen Firestein, author of a large body of work on termination of psychoanalysis (1969, 1978, 1982) writes (personal communication) “it is for me incomprehensible for an analyst to refuse to respond to a patient's post-termination communication, whatever its form.”

⁶Should the analyst feel uncomfortable with the informality of certain forms of communication, such as e-mail, a more formal manner of reply such as sending a note by postal mail might be considered (Ellen Pinsky, personal communication).

⁷ Novick (1997) has argued that analysts do not have first-hand experience with termination mourning, because they never really lose their own analysts. Rather, they become colleagues with their former analysts, often working closely together in the same professional community. However, my findings indicate that analysts-in-training do have a strong experience of the loss of the unique analytic relationship after the termination of their training analyses. The unique features of the analytic relationship, including the analyst's nondemanding empathic preoccupation with the analysand's inner life, is lost with termination and can never be replaced by a collegial relationship or friendship with the former analyst. It is on the basis of this finding that I have generalized the results of my study of analytic candidates who had completed their analyses to all analysands.

⁸It is my understanding that some training institutes will not consider a case to be successfully terminated for purposes of graduation unless the analyst conducts the analysis at 4 or 5 times per week until the last day.

⁹ Stone (1961) writes, “the terminal diminution in frequency in analytic hours, which some patients require … not only plays an obvious and important cognitive function, but constitutes a certain subtle (not always appreciated) “psychosomatic” process of attenuation.”