Termination of Treatment
TERMINATION OF TREATMENT
Very early on Sigmund Freud determined what for him was the sign of the end of a psychoanalytic treatment, that is to say that it is complete with the "practical recovery of the patient, the restoration of his ability to lead an active life and of his capacity for enjoyment" (1904a, p. 253), criteria that he repeated in the Lecture 28 of the Introduction to Psychoanalysis (1916-17a). But almost as soon, noticing the unpredictability of the resolution of the transference, he remarked: "In the early years of my psycho-analytic practice I used to have the greatest difficulty in prevailing on my patients to continue their analysis. This difficulty has long since been shifted, and I now have to take the greatest pains to induce them to give it up (1913c, p. 130).
In "Analysis Terminable and Interminable" (1937c) he specified the ideal conditions for termination of treatment: "An analysis is ended when the analyst and the patient cease to meet each other for the analytic session. This happens when two conditions have been approximately fulfilled: first, that the patient shall no longer be suffering from his symptoms and shall have overcome his anxieties and his inhibitions; and secondly, that the analyst shall judge that so much repressed material has been made conscious, so much that was unintelligible has been explained, and so much internal resistance conquered, that there is no need to fear a repetition of the pathological processes concerned" (1937c, p. 219).
Eight years earlier Sàndor Ferenczi suggested: "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, so to speak, though even when this occurs the physician must be the more suspicious of the two and must think of the possibility that behind the patient's wish to take his departure some neurotic factor may still be concealed. 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" ("Termination of Analysis," p. 85). He also indicated the "ideal goal" to aim for: "The far sharper severance between the world of fantasy and that of reality which is the result of analysis gives them an almost unlimited inner freedom and simultaneously a much surer grip in acting and making decisions; in other words it gives them more economic and more effective control" (p. 81).
Extending the duration of treatment and the perennial problem of the "interminable analysis" have always been issues of concern to the psychoanalytical community and have been ceaselessly discussed in many articles, congresses, and seminars Multiple and disparate criteria to judge when a treatment may be considered ended have consequently been proposed, in accordance with changing theory and practice.
On the analysand's side the following has been recommended: behavior adapted to reality, an ability to handle suffering and depression, overcoming of penis envy and castration anxiety, access to genitality in psychosexual behavior, reinforcement of sublimations, diminution of guilt, and the like. Sacha Nacht (1965) recommended taking account of the "lessening of the fear of suffering, the acceptance of the patient of himself, his ability to satisfy his desires, compatible at once with his ideals and his milieu, and the possibility of his engaging in action, while avoiding submission to the automatism of repetition" (Lebovici, 1980). Attachment to a new external libidinal object was regarded with suspicion by Wilhelm Reich (1949) and especially by Annie Reich, who saw therein a defensive acting-out, like the divorces that occur at the end of an analysis.
On the analyst's side there is an "intuition" by unconscious perceptions that termination is necessary, that the transference neurosis is on the way to being "liquidated." Melitta Schmideberg (1938) has even recommended that the analysis be systematically interrupted after six years so that the bond with the analyst won't make separation impossible.
With the "Wolf Man" case (1918b), Freud used the technique of fixing a date of termination to the analysis, but the results led him to rarely ever repeat this, nor to recommend it. Sàndor Ferenczi, with the "active technique," like Otto Rank, with the application to treatment of the principles of The Birth Trauma (1924), both aimed at shortening the duration of the treatment, but their attempts were criticized by most of their contemporaries and by Freud himself. Franz Alexander suggested experimental interruptions (1963), while, in France, Sacha Nacht (1965) recommended breaking "the closed world" of the transference by making the analyst more "present," to "demythify" him, so as to favor "integration, by successive, nuanced phases into external, objective reality"—suggestions that have since been severely criticized. A process based on progressive severance, consisting in diminishing gradually the frequency of sessions is doubtless the easiest and the most often employed.
Whatever the criteria utilized to recognize that an analysis is in process of termination, they can only be based on the evolving conception that the protagonists of the situation have been maintaining of the goals of the treatment, as their special relation proceeds, and as they analyze the conscious and unconscious motivations inciting them to conclude it. Freud's realist positions on the two "rocks," which any psychoanalytic pretension to omnipotence will come up against, should not be forgotten either: the male "refusal of femininity" and the "penis envy" of the female. The end of the analysis is also a recognition of the unanalyzable, even if every treatment should involve an attempt to gain on a little bit of its territory.
Generally there has been agreement that the traditional framework of the treatment should be maintained until the very last session, while a few face-to-face sessions have been recommended in some cases where working through the separation was particularly difficult.
Alain de Mijolla
See also: Psychoanalytic treatment.
Ferenczi, Sàndor. (1955). The problem of the termination of the analysis. In The selected papers of Sàndor Ferenczi. Vol. III (Final contributions to the problems and methods of psychoanalysis. (Michael Balint, Ed.; Eric Mosbacher, et al, Trans.). New York: Basic Books. (Original work published 1927)
Firestein, Stephen K. (1974). Terminasion de l'analyse. Revue française de psychanalyse, 44,2.
Freud, Sigmund. (1937c). Analysis terminable and interminable. SE, 23: 209-253.
Lebovici, Serge. (1980). L'expérience du psychanalyste chez l'enfant et chez l'adulte devant le modèle de la névrose infantile et de la névrose de transfert (The experience of the psychoanalyst of children and adults with the models of infantile neurosis and transference neurosis). Revue française de psychanalyse, 44, 5-6.
Nacht, Sacha. (1965). Le transfert (Transference). In Guérir avec Freud. Paris: Payot, 1971.