Good Enough Endings

Breaks, Interruptions, and Terminations from Contemporary Relational Perspectives

Jill Salberg

• Publisher: Routledge
• Year: 2011
• eBook ISBN: 9781135847296
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

In the relational literature, the subject of termination - the ending of an analysis - has received scant attention, and traditional Freudian or ego-psychological criteria are not always enough to assess the readiness to terminate therapy in the coconstructed, intersubjective analytic relationship. Good Enough Endings seeks to remedy this gap, bringing together contributions from contemporary relational thinkers, while at the same time engaging with ideas from other psychoanalytic perspectives. Topics given consideration include:

• Can there be a relational criteria or paradigm for termination, and what would it include?
• How do treatment goals of the analyst and/or that of the patient affect the decision to terminate?
• How do recent developments in attachment theory and research influence the preparation to end analysis?
• What occurs for the patient after termination, and how do we assess the need for follow-up?

Integrating elements of existing psychoanalytic theory with the fruits of the relational turn, Good Enough Endings expands and expounds upon the relational considerations in ending analysis, providing a resource for reflection and insight into the final - and perhaps most difficult - aspect of psychoanalytic treatment.

Part I
Termination: Theories and positions

Chapter 1
Historical overview *

Jill Salberg

Although Freud (1912) had written some early papers on technique, the question of termination was first raised in a monograph, The Development of Psychoanalysis, by Ferenczi and Rank (1924). They proposed that when a full transference neurosis had developed in the patient, the analyst then, “sets a definite period of time completing the last part of the treatment” (p. 13). Rank’s (1924) book, The Trauma of Birth, instigated a heated debate about the shortening of treatment. Rank and Ferenczi had experimented with setting a time limit and had found that this stirred up separation anxiety and maternal transference. For Rank, separation carried the meaning of disconnection from mother as well as the final separation of death, and so the time limit of therapy evoked maternal separation anxiety and existential death anxieties, both aspects of Rank’s new theories. These ideas stirred up a huge controversy that lasted for a few years and partially ended with the departure of Rank, both from Freud’s inner circle and eventually to America.

I want to draw attention to the fact that Rank and Ferenczi had noted certain problems within analytic treatment, which they were trying to creatively think about. The idea that treatment needed some push, some added pressure for the patient to work through the transference neurosis led to their formulating the setting of an end date. This idea has persisted throughout the history of psychoanalysis and has continued to gain and lose favor. Dupont (1994), in discussing the letters between Freud and Ferenczi during the time of the Rank controversy, noted: “The crisis centered around the same problems that periodically arose between the two men: technical attempts to shorten analysis (fixation of a termination date, active technique, and so forth); pathogenic effect of phantasy vs. trauma; verbal remembering vs. re-experiencing through repetition” (p. 312). These are the same issues we continue to struggle with today, some of which will be taken up in this book.

Despite Freud having also used the setting of a time limit with the Wolf Man, he was not in favor of this device, fearing that instead of speeding up the work, the reverse would occur with an increase in resistance by the patient to the psychoanalytic work. No doubt, setting the termination date, especially an early one, would catalyze a great many reactions from patients including creating a kind of crisis in the treatment. Perhaps Rank believed that this was a recreation of the original crisis, the birth trauma, so it easily fit in with the theories he was developing—theories that Freud would come to feel were too far a departure from his own formulations of psychoanalysis. Unfortunately, the controversy around Rank’s ideas became a problem for Ferenczi who wished to remain theoretically loyal to Freud and thereafter began to distance himself from Rank.

The earliest paper solely on termination was written by Ferenczi (1927) and was partly his attempt to differentiate himself from his earlier work with Rank. Interestingly, the paper reflects Ferenczi’s now arguing against the shortening of treatments and his emphasizing working for as long as the patient wanted to continue. It is a paper filled with idealism along with high standards for the analyst. He believed that the analyst “must know and be in control of even the most recondite weaknesses of his own character and this is impossible without a fully completed analysis” (p. 84). What standard of a “fully completed analysis” could Ferenczi have been thinking of? Clearly it was not his analysis with Freud, an analysis that had been three brief, interrupted sets of meetings that totaled 7 to 8 weeks. Further, Ferenczi felt that Freud, by not continuing the analysis, abandoned the process too soon, before a negative transference could be elaborated and worked through (see Aron & Harris, 1993). In fact, later in his paper he says, “The proper ending of an analysis is when neither the physician nor the patient puts an end to it, but when it dies of exhaustion…A truly cured patient frees himself from analysis slowly but surely; so long as he wishes to come to analysis, he should continue to do so” (p. 85). (Bass, in Chapter 14, reflects further on Ferenczi’s contribution.) For Ferenczi, termination involved a gradual and spontaneous mourning of childhood longings, something he had not been able to fully do with Freud. One can only imagine that Ferenczi might have been chiding Freud.

Freud (1937) articulated his own views on ending analysis quite late in his life in “Analysis Terminable and Interminable.” We cannot know why Freud did not include a paper on termination earlier when he wrote his original papers on technique, although I imagine he did not yet think that termination might prove to be troublesome. The technique papers had been written while Freud still ascribed to the topographic model of mind. Making the unconscious conscious was still the goal, along with symptom relief, so it is very likely that once the symptoms were gone, ending was considered to be a fait accompli, something easily done. With the shift to the structural model, Freud was moving from a strict emphasis on the unconscious nature of the drives to the relationship between the agencies of the mind: id, ego, and superego. This would come to include a shift from id analysis to an emphasis on the ego, its mechanisms of defense, and analyzing fully the transference neurosis. The goal for Freud, remember, was where id was, now ego should be.

It is important to have this historical context in mind when reading Freud on termination because of what may have been on his agenda. Leupold-Löwenthal (1987), in discussing Freud’s paper, believes that, “After Anna Freud’s The Ego and the Mechanisms of Defense (1936) and Heinz Hartmann’s Vienna lectures on ego theory (1939), ego psychology had increasingly become a central aspect of the theory of psychoanalytic technique” (p. 52). Further, he believes that the 1936 International Psychoanalytical Association (IPA) Congress in Marienbad, Czech Republic, on “The Theory of Therapeutic Results” was upsetting to Freud, and his paper on termination may very well be a critical and perhaps “last word” on that meeting. By the time of his termination paper, Freud is elderly, worn out by his long fight against a cancer that had returned once again, along with his ongoing battles to keep psychoanalysis thriving as he envisioned it, while watching “the gathering storms” of his world inexorably moving toward war. Freud wrote,

The discussion of the technical problem of how to accelerate the slow progress of an analysis leads us to another, more deeply interesting question: Is there such a thing as a natural end to an analysis—is there any possibility at all of bringing an analysis to such an end? (p. 219)

It is not surprising then that his tone is somewhat skeptical and at times pessimistic about the results of psychoanalysis, concerned whether it can safeguard against a return of symptoms or even from new symptoms cropping up. Analyses had been increasing in length, something he now had to accept and reckon with. He notes and distinguishes between the miseries of Europe with the prosperity of America. Freud suggests that short-term therapy is a wrong-minded adaptation to the fast pace of American life. Additionally, Rank had settled in America and was practicing what Freud feared was a diluted and not true form of psychoanalysis. Later in his paper, Freud cites Ferenczi’s paper on termination and remarked, “The paper as a whole, however, seems to me to be in the nature of a warning not to aim at shortening analysis but at deepening it” (p. 247). Freud is agreeing with and warmly recalling Ferenczi, who, although 17 years younger than Freud, had predeceased him 4 years prior to this paper’s publication.

This paper then becomes a last word in the long conversation Freud had engaged in with numerous colleagues. (For a fuller elucidation of views on Freud’s paper, see the collection of papers in the International Psychoanalytic Association Educational Monograph no. 1, On Freud’s Analysis Terminable and Interminable, edited by Joseph Sandler.) He refuted Rank’s time-limited approach, and one of the cases Freud discusses is of a discontented analysand, already an analyst in the field (see Freud, 1937, p. 221n, where Strachey states that Jones believes he is discussing Ferenczi). After ending his analysis, this man became a teacher in the field who ends up berating his analyst for not having “finished the analysis,” something Ferenczi rebuked Freud for. Sounding disheartened, Freud comes to the conclusion that even a successful analysis is not a prophylactic against future illness, perhaps suggesting some awareness of the limitations of his technique.

Reich (1950) was the first analyst to notice and comment on the paucity of psychoanalytic thinking and writing on this topic. What I hope to show is how the topic is both picked up and then dropped at different times throughout the literature. Returning to Ferenczi’s and Freud’s papers that, although written late in their lives and careers, feel very much in dialogue with each other (see Bergmann, 1997; Reich, 1950). Freud’s tone was much more pessimistic than Ferenczi, but he raised three possible points of view regarding termination: the skeptical, the optimistic, and the ambitious. Freud (1927), who reminded us that our ideals were often illusions and that the road to reality was lined with disappointments, held the skeptical and, I might add, somewhat ambivalent view. The optimistic stance, held by Ferenczi, reveals his belief in the possibility of a fully curative analysis, exposing his longing for a deeper, more fully elaborated analysis with Freud. This very well may have been Ferenczi’s ambition toward which his experiments with “active” technique and mutual analysis were directed (see The Clinical Diary of Sándor Ferenczi, edited by J. DuPont). His experimental work provoked condemnation from Freud who felt that Ferenczi was departing from the techniques of psychoanalysis as Freud had conceived of them.* What has become known as the “relational turn” hinged in many ways on the rediscovery and consideration of these alterations in technique.

While attempting to hold these two disparate points of view, Reich (1950) raised another concern: “In nearly all cases which I have analyzed there remained a wish to be loved by the analyst, to keep in contact with him, to build up a friendship” (p. 181). This is interesting given that up until the time of her writing, the early analysts were often each other’s patients, colleagues, and confidantes. Although she goes on to suggest that this is a derivative of early longings from the original objects, the parents, I understand this also to be a hint of what is often going on between patient and analyst in the room. To my mind, there is a unique, special, and deep bond that develops between the analytic dyad, particular to that pair that in many ways feels the way deep friendship can feel and interpretation cannot quite dissipate, nor perhaps should it (see Salberg, Glennon, and Layton, Chapters 7, 15, and 11, this volume).

Freud (1937) acknowledged that many of the cases he was treating (as opposed to the early days of psychoanalysis) were “training analyses,” a relatively new concept for the first generation of analysts and not a requirement as it is today. Returning to another part of his paper, Freud, no longer skeptical or ambivalent, wrote, “There was no question of shortening the treatment; the purpose was radically to exhaust the possibilities of illness in them and to bring about a deep-going alteration of their personality” (p. 224). Here is ambition laid bare—we as analyst/patient need a radical transformation of ourselves in order to effectively cure our patients. Is there any way to hear this but as a kind of grandiosity entwined with idealization? What would such an alteration of oneself look like, and does this then become an impossible standard for an already impossible profession?

I believe the ambitious point of view, one that was held simultaneously by both Freud and Ferenczi, reveals the ongoing problematic relationship that the field has inherited regarding termination. There is an unspoken but nonetheless prevalent idealization of what a fully complete analysis might look like. Certainly the bar is set high for analysts with Freud suggesting that analysts should routinely return every 5 years to undergo a further analysis.* How are we to hear and understand this? As Freud approaches his death, he wants to wrap up his life’s passion and work and in so doing had to wrestle with his own loss of idealism and omnipotence. Unfortunately, there were no easy endings in sight. A more accurate translation of the title of Freud’s paper wo...

Table of contents

• RELATIONAL PERSPECTIVES BOOK SERIES
• Contents
• Acknowledgments
• Contributors
• Introduction
• Part I Termination: Theories and positions
• Part II On the clinical frontier
• Part III Musings on the multiple meanings of ending
• Index