Termination

Adult Psychoanalytic Psychotherapy (APP)
2019-20, 4th Block — Mondays, 8:00-9:15pm

Introduction

Hello APPP seminar members, 

Our theme of study for the fourth block series is “termination.” Termination can be interpreted a thousand ways within psychoanalytic contexts: the end of times, the end of a way of life, loss of capacity, my mind, reason, health, my life, my patient’s life, an animal’s death, my analyst’s death, a planet’s death, a fear of death, divorce, separation, a loved one’s death, genocide, mass killing, aging, suicide, the closure of a group, ending a relationship, ending an analysis or therapy… to name a few free associations. The loss of a way of life is really on my mind right now as we collectively share the effects of the pandemic requiring each day that we cooperate as a people across the globe by making sacrifices of all kinds to live and let live. What comes to your mind when you hear the word “termination?” 

Our seminar falls on what will be your last class segment and the last hour and a half of your two-year study group… 5/18/20. One of our tasks will be to attend to the closure of your seminar series with your cohort. Having led analytically-oriented groups for decades, I can tell you that the practice of ending is acquired, meaning that it requires practice, critical thought and a capacity to self-reflect in the face of a micro-death. I strongly recommend that you attend our full sessions even if that flies in the face of a desire to cut out early, for whatever reason.

Death of the body, even micro-deaths, are little discussed realities in our psychoanalytic theories and practices and even when addressed are usually done so in reductive or superficial manner (Razinksy, 2013). We will have the unique opportunity, therefore, to study termination processes as you are terminating your two-year learning experience with your cohort and the APPP institution. I maintained an inter-disciplinary approach having designed our curriculum keeping a keen eye towards clinical applications of materials that we will address in our discussions.

Please come to each session with a question that arises for you as you read the material. The questions you provide will become our study guide. I will provide study questions beginning with the second seminar as well.

April 6, 2020 — Termination: The end of times as we knew it as you prepare to end your cohort time.

This seminar will provide the space for each of us to build a sense of cohesion in the last leg of your two years together and for me to join you in it. This is especially important given the extraordinary massive upheaval we are all experiencing as persons, therapists, students and world citizens. Together, we are in the midst of losing a way of life without knowing what kind of future we may hope to live towards. Our way of life is dying, in some ways forever yet we do not know the kind of world we will be released to. Can we ever return to a time of not knowing a plague’s possibility such as its devastating effects that breaks down differences and destroys everything that stands in its way. Will we have a job? Will we live or will our loved ones or patients live? How will our governments change or not? Do our theories hold in treating the kind of unprecidented trauma we are facing clinically? Further, our first meetings occur at the very time that UW’s IHME model is forecasting that hospitalizations will generally peak (in mid-April in King County) towards a flattening curve but only if we maintain our social distancing measures through May, early June (Seattle Times, March 26, 2020).
Your assignment is to read the overview of the entire block. Open the papers and peruse them briefly. We will take the time we need to re-orient in our setting within a world health crises. Then, I would like to know what sections you most gravitate towards. That will help me adjust the curriculum to your needs.

Beriato, S. (2020, March) That Discomfort You’re Feeling is Grief, Harvard Business Review

April 13, 2020 — Loss of a Way of Life; Pandemic Outcomes, Clinical Applications

APPP Quest (draft)

Our second seminar focuses on a paper I wrote for a chapter in a book that is forthcoming. This is an early draft and please do not share it. Our focus is pandemic experience and the loss of a way of life and a community came together and created a clinic on its own behalf. I use a case vignette taken from a therapy retreat of a moment in group life that I claim galvanized the group towards a collective action through the expression of a shared truth. I format my article from my reading of an article Lacan wrote in 1945 on “collective logic.” If you don’t yet know who Jacques Lacan is, please google him online. He is one of the most forward thinking and influential psychoanalysts (from France) of our times, especially in Europe and amongst academics (critical studies, political studies, queer theory, feminisms, anthropology, literature, post-colonial studies and so on). We will consider how we might consider catastrophic events as an impetus for creative outcomes within our own disciplines (thinking into new theory where the old theories do not hold) or just as people rising to a higher level of creativity in all kinds of ways such as in the production of the “Pandemic Story” workbook for children. 

Optional Reading

My Pandemic Story: A guided Activity Workbook for the World’s Children, Families, Teachers and Caregivers. (2020)

April 20, 2020 — “Life in Death” Freud in context 

[26 pages]

The first seminar will give us an opportunity to meet each other virtually and access what, as a group, you are most interested in focusing on in seminar time, given the materials I am sending to you for this session.

Razinsky, L. (2013). Freud, Psychoanalysis and Death, pp253-278

I am sending you chapter 14 (“Death in Life”) of Liran Razinsky’s 2013 text. The entire text is provocative and carefully researched but I chose this particular chapter because she summarizes aspects of her entire text critiquing Freud and the psychoanalytic school’s failure to adequately incorporate the topic of death into its theory and therefore practice. 

April 27, 2020 — Loss of the Analyst or Patient; Closure in treatment

[20 pages]

Another termination topic we will cover is the closure of a therapeutic (analytic) relationship with your patient. There are general guidelines, but the closure process is always singularly driven and cannot be reduced into categorical models or seamless procedural outlines. By singularity, I mean the singularity of the analyst/therapist and that of the patient. Each patient will close, leave, or just not show up in their own unique manner in relationship to you, the transference and always a measure of the unexpected.

Holmes, J. “Termination in Psychoanalytic Psychotherapy: An Attachment Perspective”. European Journal of Psychoanalysis 

I’ve given you “Termination in Psychoanalytic Psychotherapy: an Attachment Perspective” by Jeremy Holmes as a general guideline to a way of articulating some of the central concerns. It is a solid paper, general in its approach and accessible as compared to much of the psychoanalytic literature. Please read this paper as a background that we may or not directly refer to. 

Laplanche, J. (1999) Essays on Otherness, pp214-233

I am also sending you a short chapter titled “Transference: its Provocations by the Analyst” from Jean Laplanche’s important 1999 text Essays on Otherness. Laplanche is one of the great post-Lacanian thinkers of our time. Laplanche builds his thinking throughout the chapter culminating in a few pithy pages at the end that focus on the patient’s termination from the analysis, entrance into culture and the transitional effects on the transference over time. We will spend much of this session digesting this chapter. Don’t be concerned if you don’t grasp what he is saying right away as we will study important parts of the text together. Perhaps your reflections on your own transferential processes over time in the program, with each other, particular instructors etc. and your patients will come to mind as you read Laplanche’s perspective.

May 4, 2020 — Mourning Death Clinically; A Psychoanalytic Case Study

Brooks, R.M., (2012). “The ethical dimensions of life and analytic work through a Levinasian lens,” International Journal of Jungian Studies.

Our fifth session focuses on a clinical case study of a woman’s grief process inaugurated from the sudden and tragic loss of her 19 year old son. You may read the whole article if you wish (which may set up contexts for my interpretations – I am the author) but our class time will focus on the actual case which can be found towards the end of the paper. I hope this discussion will encourage you to talk about your own clinical situations, questions or comments that are sparked as we read the case illustration together.

May 11, 2020 — Clinical Terminations: “Beginnings and Endings: Time and Termination in Psychoanalysis”

[7 pages]

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

This article addresses the complex process of termination in psychoanalysis. Implicit in selfconsciousness is the knowledge of death; similarly, one begins treatment knowing that it must end. It is argued that the end is always present in the beginning of treatment and, conversely, termination leads back to the onset of analysis. It is also proposed that termination issues, rather than represent a phase in the treatment, are present throughout the analysis. Terminations are different from endings in that terminations are inevitably incomplete. A case is offered to illustrate these points and to show some of the challenges encountered even when termination is mutually planned and agreed upon. Although the word termination implies finality, artful termination involves transcending the need for the analytic relationship while continuing the work of insight and relational transformation.

May 18, 2020 — Commemorative Ritual and beginning to create your own collective ritual for ending with your APPP cohort

[15 pages]

Slochower, J. (2011) “Out of the Analytic Shadow: On the Dynamics of Commemorative Ritual”, Psychoanalytic Dialogues, 21:6, pp676-690 

In our second to the last session, I am asking you to read an article from Psychoanalytic Dialogues by Joyce Slochower titled “Out of the Analytic Shadow: On the Dynamics of Commemorative Ritual”. We will discuss this article and then proceed to talking how you may thoughtfully create your own process of closure that we will follow on May 18th, your last facilitated session. The process of closure in a group (of any kind) is facilitated to review a shared history through singular experience, identify regrets (retroactive insights), tie up loose ends, acknowledge the end of a shared experience and say a genuine goodbye to each other. This is not a therapy group and I am not authorized to be your therapist however closings amongst colleagues can be sincere, meaningful and real even in a professional setting. We will discuss the closure of a group further and design your final session together. Our last group session will be designed for and by you.

May 26, 2020 — Closure with each other.

This is your last session of the program. Please be on time. We will follow the design your group created the session before to commemorate the closure of this seminar, the APPP program and your two-year shared cohort experience.