Process: Late Middle Phase and Termination

Adult Psychoanalytic Training (APT)
2019-20, 3rd Trimester — Fridays, 1:45-3:15pm
Ronald Furedy, MD

Learning Objectives

By studying the termination process the clinical associates will gain:

  1. a deeper understanding of the importance of the termination phase in analysis. This increased understanding will help the clinical associate co-create a terminations experience that consolidates the work of analysis and deepens the analytic experience producing more durable and lasting intrapsychic changes for the analysand.
  2. an understanding of the analytic material that suggests a readiness for termination, combined with an understanding of the potential resistance to and avoidance of experiencing termination will result in the clinical associates and their analysands being better able to recognize and analyze the affects stimulated and the conflicts that emerge during terminations.

March 20, 2020 — Freud’s classic paper on termination

[33 pages]

A clinician’s end of life retrospective of his practice, in which he relates what he has achieved, what he could not achieve, and what obstacles he feels he has encountered.

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

March 27, 2020 — Historical perspective

[5 pages]

In 1950, the International Journal of Psychoanalysis published nine articles on the topic of termination. We look at one of these articles as a representative of the thinking reflective of this era. Twenty-six years later this second paper addresses using dreams as a possible termination signal, and the importance of understanding the changing structure of recurrent dreams during termination.

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

April 3, 2020 — Examination of goals

[45 pages]

Ernst Ticho raises an important distinction between treatment goals of the analyst and life goals of the patient. Ten years later an entire edition of Psychoanalytic Inquiry was devoted to termination. In one of the articles, Leo Rangell also examines the goals of analysis.

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

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

April 10, 2020 — Termination Dreams

[52 pages]

Jerome Oremland provides case examples in which dreams were termination events. While Gillman mentions termination dreams, his article provides results of a survey of 48 successfully completed analyses from 15 institutes around the country. He felt this survey supported the conclusion that a definite termination period was useful, mobilizing new material in the analysis. Caston refers to both papers in his rather philosophic approach to termination.

Oremland, J.D. (1973). A Specific Dream During the Termination Phase of Successful Psychoanalyses. J. Amer. Psychoanal. Assn., 21:285-302.

Gillman, R.D. (1982). The Termination Phase in Psychoanalytic Practice: A Survey of 48 Completed Cases. Psychoanal. Inq., 2(3):463-472.

Caston, J. (2007). Poetic Closure, Psychoanalytic Termination, and Death. J. Amer. Psychoanal. Assn., 55(1):7-30.

April 17, 2020 — Barriers to termination

[34 pages]

Owen Renick explores problems that can lead an analysis to stall and not reach termination. Martin Bergmann’s paper looks at how wishes to terminate can be a reaction formation against dependency, and how prolonged analyses can result in new intrapsychic equilibriums being established that are difficult to resolve.

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

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

April 24, 2020 — Post-analytic contact

[30 pages]

If termination were termination, why would there be any further contact with the analysand? The Roose et al. survey showed that whatever psychoanalytic theory might be cited, it is common practice to have some form of contact with analytic patients after termination. Schachter illustrates aspects of post-termination contact with case examples.

Roose, S.P. Yang, S. Caligor, E. Cabaniss, D.L. Luber, B. Donovan, J. Rosen, P. Forand, N.R. (2004). Posttermination Contact: A Survey Of Prevalence, Characteristics, And Analyst Attitudes. J. Amer. Psychoanal. Assn., 52(2):455-457.

Schachter, J. (1990). Post-Termination Patient-Analyst Contact: I. Analysts’ Attitudes and Experience; II. Impact on Patients. Int. J. Psycho-Anal., 71:475-485.

Hartlaub, G.H. Martin, G.C. Rhine, M.W. (1986). Recontact with the Analyst Following Termination: A Survey of Seventy-One Cases. J. Amer. Psychoanal. Assn., 34:895-910.

May 1, 2020 — Change of theoretical position

[30 pages]

Jack Novick changed his view that termination should be distinct from the rest of analysis, to questioning whether a termination phase was unique or necessary for all analysands.

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

Novick, J. (1997). Termination Conceivable and Inconceivable. Psychoanal. Psychol., 14(2):145-162.

May 8, 2020 — Termination changes in the analysand

[27 pages]

Ira Milner gives case examples of the return of symptoms at the end of an analysis. Hans Loewald’s article ranges widely but also touches on the fact that Oedipal or earlier separation individuation issues can present in different forms and are available for interpretive work in the termination phase.

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

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

May 15, 2020 — Countertransference informs and alerts the analyst to unspoken unconscious material

[36 pages]

Edith Weigert notes Annie Reich’s and Edith Buxbaum’s views that resolution of the transference can be misjudged or delayed by countertransference. She adds, however, that countertransference, if recognized and understood, does have a significant contribution to make. Judith Viorst, skillfully writes about the experience of loss for the analysand and the analyst.

Weigert, E. (1952). Contribution to the Problem of Terminating Psychoanalyses. Psychoanal Q., 21:465-480.

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

May 22, 2020 — Resistance to intense affect and superego conflicts during termination

[39 pages]

Levenson speaks to how affects may increase in intensity during termination, including anger with aggression. The intensity may lead the analyst to retreat to authority to manage these intense affects. Salberg addresses many topics including the necessary integrative work that may only occur during termination. The mutual process of detaching creates powerful feelings in both the analyst and analysand.

Levenson, L.N. (1998). Superego Defense Analysis in the Termination Phase. J. Amer. Psychoanal. Assn., 46(3):847-866.

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

May 29, 2020 — When does it end? Does it ever end?

[50 pages]

Levine and Yanof speak to the complexities of post analytic contact at the institute, which can be over-stimulating and requires secure analytic capacity in both. Kantrowitz discusses that termination leads to an awareness of the limitation of time, life, and analysis. Hidden difficulties may surface. Hidden grandiose fantasies may emerge. She also addresses the amazingly topic of maintaining and nurturing our capacity for self-analysis.

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

Kantrowitz, J.L. (2012). Afterward: Keeping Analysis Alive over Time. Psychoanal Q., 81(4):905-929.

Optional Reading

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

(This article was assigned in a previous class.)