Ending Analysis: Theory and Technique

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This book, beyond dealing with the theoretical and technical questions concerning the termination of analysis, gives a picture of the particular nature of the psychoanalytic cure in relation to the therapies that have come forth from psychoanalytic roots. The theoretical work is supported by rich clinical details.

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CHAPTER ONE. The elusive criteria for ending analysis

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Any discussion on ending analysis is closely interwoven, or even virtually at one, with the aim of analysis. This is immediately clear from the vast literature on the subject where any one author, even while declaring his model of the termination of analysis, is in fact usually referring to his own theoretical and clinical model of psychoanalysis in general. We must clearly take into account the close links between the final phase of an analysis and the situation at its beginning: the level reached at the end cannot be viewed separately from that at the beginning, so it is not always possible to expect the same level of development for different cases. Naturally, the question of “analysability” arises here—which cases does a particular therapist accept or refuse? Just as each analyst’s criteria for analysability are fairly specific, so are the criteria for termination. For example, the interruption of an analysis whose course had been predictable from the start cannot be equated with one presenting all sorts of foreseeable difficulties and changes in technique.

 

CHAPTER TWO. Time in psychoanalysis and the concept of the psychoanalytic process

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If the conclusion of analysis is a feature to be borne in mind throughout the whole analytic process, not only near the actual end, we need to reflect on how the patient’s phantasy-related events unravel as he discovers—or re-discovers— and develops a sense of time.

The first part of this chapter follows the progress of the sense of time in analysis; in the second part we seek to understand what meaning we can give today to the concept of analytic process.

It is not possible here—and perhaps not useful either—to go back over all that has been said about the sense of time in psychoanalysis: Freud’s first famous assertion on the lack of time sense of the unconscious, the birth of a sense of time in relation to the oral and anal stages, the temporal perspective in relation to object frustration, hallucinatory anticipation, connections with the events of the depressive position and the oedipal constellation, cyclicity, linearity, continuity and discontinuity. I shall do no more here than hark back to or suggest some concepts that seem to me useful for this discussion.

 

CHAPTER THREE. The concluding phase of analysis

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Let us now imagine ourselves in the concluding period. We are about to part from our patient. We look back on our mental attitude towards him, how this analysis was similar to others, and in what respects it was unique. What change has there been from the beginning? How much was predictable, and how much unforeseen? What phantasies do we now have about the post-analysis stage, if any?

All this is summed up in the basic question: do we really need a particular technique to conclude an analysis? In this chapter we try to answer this question. Are changes in the setting necessary in the concluding phase? Who should fix the date for conclusion—the patient or the analyst? These technical questions have been widely debated, especially in the past. As I have already said, when speaking of the relational model that I have adopted, I am convinced that in the majority of cases the patient and the analyst can arrive at a decision together, so as a rule there seem to be no particular problems specific to this moment.

 

CHAPTER FOUR. Difficult conclusions

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In “Analysis Terminable and Interminable” Freud sought to understand what there is to hinder the good termination of an analysis, rather than what facilitates it. This is one of the reasons why this work gives such an impression of pessimism.

We too must now consider the factors that hinder an adequate conclusion, always keeping in mind the basic concept I keep stressing—namely, that these are not just specific problems related to ending analysis; they happen to be more directly noticeable when a project for conclusion is expected but resistance comes to light. Even interminability is a concept that does not just concern the end of analysis; it concerns all those situations that prevent us from progressing towards the conclusion.

That is why I agree with Etchegoyen (1986), who prefers to speak of factors that impede the psychoanalytic process. He singles out acting out, negative therapeutic reaction, and reversible perspective (meaning an attempt to overturn the analytic situation, moving it in the opposite direction). Acting out acts on analytic work, negative therapeutic reaction on the results of that work, and reversible perspective on the analytic “contract”. In other words, the first puts action in place of thought, the second annuls insight, and the third goes directly against the project for transformation by attacking the bond and the emergence of the psychotic part of the personality.

 

CHAPTER FIVE. What should we think of "Analysis Terminable and Interminable" today?

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Several times in the preceding chapters I have found myself citing Freud’s “Analysis Terminable and Interminable” (1937c). Given the nature of the theme we are working on, it could not have been otherwise. But now we must look at it in greater detail, standing beside Freud, as it were, and taking an overall view of the work.

After tackling the theoretical and technical questions, we come back to the initial question: is analysis terminable? How, and in what sense?

This is why I have not put this chapter at the beginning of the book, which might have seemed more logical. “Analysis Terminable and Interminable” is one of Freud’s most widely cited and fascinating works, besides being one of his last, and it can be looked upon as a sort of spiritual testament. However fascinating it is, none of us today would agree with all of it. We all feel, though—as Tagliacozzo said on this very subject of Freud’s last writings—that Freud’s heritage does not consist only of a body of doctrine that enables us to interpret so many mental happenings; above all, it has taught us a very special way of making our minds work (Tagliacozzo, 1990). That is why Freud’s writings—even if we cannot always accept all he says— continually open new ways to reflect on mental facts and events.

 

CHAPTER SIX. The post-analytic phase

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We have now reached the post-analytic phase, a topic that is still attracting much attention. In this chapter, we shall look closely at the post-analytic mental attitude, especially as regards self-analysis and re-analysis.

Reflection on the post-analytic phase brings us face to face with two basic questions, one theoretical and the other technical and clinical. From the theoretical point of view, we are expected to make a pronouncement on whether we extend to the period following the conclusion of analysis the specificity and dignity of a “phase of the process”. Is the ending of analysis the conclusion of a process or only of a relationship? Can we really speak of a post-analytic process? What becomes of the transference/ counter transference dynamics established during therapy?

Briefly, as far as the history of this concept is concerned, its official paternity can be attributed to Rangell (1966), who speaks of post-termination, meaning the period after the conclusion that is still part of the psychoanalytic process—his precursors include Pfeffer (1961). The concept was then fully developed by Guiard (1979), who considered the period following the conclusion as a true phase, which he calls the post-analytic process; it is a new part, with separate rights over the previous one. Guiard thus distinguishes an initial phase, a central phase of working through, and a final phase in which the patient truly becomes independent of the analyst.

 

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