Late Middle Phase to Termination

Adult Psychoanalytic Training (APT)
2021-22, 3rd Trimester — Fridays, 3:30-5:00pm
Christopher J. Keats, MD


[Note: This class will be held at 3:30-5:00pm for the first 6 weeks, then from 1:45-3:15pm for the last 4 weeks.]

Predicting what will happen in an analysis is very like predicting the weather:  it’s much easier to predict with confidence the next few days, or even the next week (though surprises do occur); the further out from the present that you project, the more difficult is it to predict and prepare for.

Our aim is to introduce you to a variety of theoretical and clinical issues around termination.  Our intention is less to prescribe a particular approach to termination than to facilitate your own thinking about it, as you approach termination (or not) with each individual analysand.

As we travel through the course material, we will be holding the tension between the ideas of how termination should be achieved according to different schools of analytic thought, and also the tension between how analyses are “supposed” to terminate and how termination often actually occurs.

Since you are completing (“terminating”) the didactic portion of your analytic training, we will be emphasizing the development of your own reflections and ideas about analysis and termination.  As a preface to your own continued learning in the field and your transition to teaching, we will be asking each of you to generate three questions for class discussion based on the topic and readings for a pre-assigned class date, which you will provide to your cohort during class on that day.  We will have sign-ups during the first meeting, so please have a look at your calendar and the syllabus overall in advance so you have dates in mind.

We will be holding your own termination of didactics in mind throughout the course.  We anticipate that the last two weeks of class meetings in particular will provide an opportunity to reflect on and discuss your current and future processes of completing didactics, control cases, training analyses and your experience as a cohort.

The skills associates learn in this course will enable them to co-create termination experiences that consolidate and protect the prior work of the analyses and deepen the analytic experience, producing more durable changes in their analysands.

Learning Objectives

At the completion of this course, associates will be able to:

  1. Recognize analytic material that suggests a readiness for termination,
  2. Identify a variety of criteria and procedures for termination from different schools of analytic thought,
  3. Better anticipate potential resistances to and avoidances of termination, fostering their ability to analyze and weather the affects that are often stimulated and the conflicts which emerge during termination, and
  4. Begin reflecting on and developing their own philosophy of, criteria for, and approach to termination.

March 25, 2022 — Considerations related to Pre-termination

[40 pages]

Please read the introduction to the course and learning objectives before the first class.  We encourage you to read the summaries of each week’s reading as we progress through the course.

Dewald, P. (1990) Conceptualizations of PSA Process. Psychoanalytic Quarterly, 59:693-711.

This article provides a good overview from a classical perspective.

Atlas, G. & Aron, L. (2018) Ch2, “The Prospective Function” in Dramatic Dialogue: Contemporary Clinical Practice, pp21-41.

This article introduces the shift from fate to destiny, from being acted upon to becoming an agentic subject, and includes a case example in which a termination enactment is conceived of as a “rehearsal for the future.” It offers a somewhat different perspective from the re-enactment/regression focus of Dewald. The intention of the article is to introduce the prospective function—the presence of the analysand’s future in the work, not just their past and present. It also expresses an attitude toward termination that tolerates more indeterminacy than Dewald’s writing seems to suggest, and thus presages the relational material and approach that we will get into in more detail later in the course.

April 1, 2022 — Historical Criteria for Termination: What can we expect of analysis?

[38 pages]

Freud, S. (1937). Analysis Terminable and Interminable. Int. J. Psycho-Anal., 18:373-405.

This is Freud’s classic paper on termination, which somewhat surprisingly focuses less on criteria or procedures for termination, and more on what it is reasonable to expect from psychoanalytic treatment.

Reich, A. (1950). On the Termination of Analysis. Int. J. Psycho-Anal., 31:179-183.

Offers a mid-century critique of Freud from that point in history and refers to the Ferenczi article to which Freud’s article above may have been a response.

April 8, 2022 — Classical and Ego Psychological formulations of Termination

[45 pages]

Rangell, L. (1982). Some Thoughts on Termination. Psychoanal. Inq., 2(3):367-392.

This is a good ego-psychologically oriented article which includes formulations of the goals of analysis, criteria for termination, the “arc” of treatment, and the central issue of the patient’s anxiety and autonomy in considerations of termination and its timing. It also includes countertransference cautions.

Ticho, E.A. (1972). Termination of Psychoanalysis: Treatment Goals, Life Goals. Psychoanal Q., 41:315-333.

This is a valuable article about criteria for termination (including the analysand’s ability to continue to grow and develop on their own); it also includes the technique of termination from a more traditional perspective.

April 15, 2022 — Termination Phase

[27 pages]

Loewald, H.W. (1988). Termination Analyzable and Unanalyzable. Psychoanal. St. Child, 43:155-166.

This article is focused a bit more on the relationship with the analyst. Loewald argues that the termination phase is crucial because it presents work that can only be done in termination, especially mourning. It also includes some recommendations on technical questions around setting termination dates, and the issue of resistance to termination.

Miller, I. (1965). On the Return of Symptoms in the Terminal Phase of Psycho-Analysis. Int. J. Psycho-Anal., 46:487-501.

Return of symptoms is a crucial concept treated here with a classical approach. Miller argues the return of symptoms is not only oedipal but includes all stages of psychosexual development. The negative therapeutic reaction and guilt are also considered.

April 22, 2022 — Termination Dreams

[32 pages]

Novick, J. (1988). The Timing of Termination. Int. R. Psycho-Anal., 15:307-318.

This article summarizes material Novick wrote in the past, includes dream material and case examples, and introduces the issue of potential defensive functions of termination ideation.

Cavenar, J. & Nash, J. (1976), The Dream as a Signal for Termination. JAPA, 24:425-436.

This article offers a different take on the issue of recurrence of symptoms in termination. The clinical examples are strong.

Gabbard, G.O. (2021) The “dragons of primeval days”: Termination and the persistence of the infantile, IJP, 102:3, 595-602

April 29, 2022 — Barriers to Termination

[34 pages]

Renik, O. (1992). Use of the Analyst as a Fetish. Psychoanal Q., 61:542-563.

This is one of the best examples of non-mutual endings in the literature.

Bergmann, M.S. (1997). Termination: The Achilles Heel of Psychoanalytic Technique. Psychoanal. Psychol., 14(2):163-174.

This article reviews much of the prior theory about termination and underscores that there has never been a firm paradigm for analytic termination. With this article, we begin to move into a newer, more indeterminate ideas about termination—or non-termination, as Bergmann argues that the demands of terminating an analysis are unlike any other relationship. He makes space for the appropriateness of interminable analyses.

Klein, M. (1950). On the criteria for the termination of a psycho-analysis. The International Journal of Psychoanalysis, 31, 78–80.

May 6, 2022 — Relational Approaches Part 1: Not all Termination Work is Re-work

[43 pages]

The following three weeks are largely new material and largely relational.

Davies, J.D. (2005). Transformations of Desire and Despair: Reflections on the Termination Process from a Relational Perspective. Psychoanalytic Dialogues, 15(6):779-805.

Here Davies is writing from the perspective of dissociated self-states. Unlike some other relational writers, she does hold to the ideas that termination (relinquishment) of the analytic relationship must occur, that there is a return to earlier work that occurs during termination, and that there is work specific to a termination phase that must be done. She also makes room for countertransference messiness.

Cooper, S. (2009). Familiar and Unfamiliar Forms of Interaction in the Ending Phases of Analysis, Psychoanalytic Dialogues, 19(5):588-603.

Cooper also writes about work that occurs during termination, from the perspective not of a return of symptoms or a regression, but of relational configurations that haven’t been worked through or have not had the occasion to emerge outside the context of termination. The article includes a transcript of an analytic session, which we rarely get to see. He attends to the analysand’s future, which is often only implicit. He also references the challenges of countertransference.

May 13, 2022 — Relational Appoaches Part 2: Foreshadowings,  and Good Enough Endings

[46 pages]

Knafo, D. (2018). Beginnings and endings: Time and termination in psychoanalysis. Psychoanalytic Psychology, 35(1), pp1-7

Knafo is also pointing to the new work that emerges in termination, but in addition offers the intriguing reflection that the ending of the analysis is often present in its beginning. She addresses the idea that we can end an analysis but never really terminate it. This article also includes a partial transcript of a session. The clinical example is a vehicle for presentation of her thoughts about the entirety of an analysis, and the article includes dream material relating to termination.

Salberg, J. (2009). Leaning Into Termination. Psychoanal. Dial., 19(6):704-722.

Salberg also includes the idea of the end being present in the beginning. This article offers an overview of the development of theory regarding termination, offers reflections on termination from training analyses, and brings up the issues of unresolved countertransference and post-analytic contact. Salberg’s argument is that termination is an aspect of analysis that is particularly primed for enactments of all kinds. She also supports the idea that termination must occur, but in a good-enough way.

Gabbard, G. (2009). What is a “Good Enough” Termination? JAPA, 57:575-594.

This article is fast becoming a classic in the literature. It’s an opportunity for the class to reflect on what each clinical associate believes analysis is supposed to accomplish. The article also lays the groundwork for the return of patients for additional work.

May 20, 2022 — Eternal Dilemmas and Relational Evolutions

[55 pages]

Grand, S. (2009). Termination as Necessary Madness, Psychoanalytic Dialogues, 19(6): 723-733.

This article includes an argument that resistance to termination has been feminized, and willingness to terminate has been masculinized, as part of an inquiry into one of the fundaments of psychoanalysis: intimacy entwined with the severing of intimacy.

Kantrowitz, J.L. (2002). Termination and the Meaning of Time: Limitations and Possibilities. J. Clin. Psychoanal., 11(4):561-585.

Reading this article leaves us with the feeling that some of the 21st century writings (as opposed to 20th century writings) seem more useful to the type of patients we see now. This article takes up the wish for timelessness and omnipotence: termination brings up both individual and universal dilemmas. It addresses some of the differences between younger and older patients and might be especially helpful for work with middle-aged and older patients. It also points out that the analyst’s stage of life affects the loss and countertransference associated with termination.

Mendenhall, S. (2009). From Termination to the Evolution of a Relationship: A New Understanding, Psychoanalytic Inquiry, 29(2):117-135.

This article replaces the concept of termination with the idea of evolutions of the analytic relationship including the return for more work at a later date. It includes the evolution of thinking about re-contact and provides statistics about the prevalence of re-contact. It also brings up the idea of NON-termination—that termination is not necessary. There are references to neuroscientific and self-psychological perspectives. The clinical example pertains to the shift to remote telephone therapy and provides an opportunity to discuss the issue of remote terminations.

May 27, 2022 — Post-termination for Patients, Candidates, and Analysts

[59 pages]

Reis, B. (2010), “Afterwardness and termination” in Good Enough Endings: Breaks, Interruptions, and Terminations from Contemporary Relational Perspectives, Jill Salberg, ed., pp213-222.

Here we have Freud’s idea of nachtraglichkeit and Winnicott’s idea of the transitional object, in the context of the post-termination reworking of both the analysis and the relationship to the analytic object.

Viorst, J. (1982). Experiences of Loss at the End of Analysis: The Analyst’s Response to Termination. Psychoanal. Inq., 2(3):399-418.

This article references the Ticho article above and takes up the issue of countertransference around terminations.

Levine, H.B. Yanof, J.A. (2004). Boundaries and Postanalytic Contacts in Institutes. J. Amer. Psychoanal. Assn., 52(3):873-901.

This article addresses the experience of non -professional contact between analysts and former analysands, and also the specific experience of termination and post-analytic contact between you and your training analysts.

These articles provide a bridge for you as CAs to begin thinking of termination with your TAs and with your cohort. We provide some preparation around post-analytic contact and Institute life after graduation/termination.