The course covers basic concepts of the psychoanalytic therapies. Emphasis will be placed on helping students develop a psychoanalytic sensibility and familiarity with analytic techniques. The course will illustrate the implication of the various analytic ideas for technique and focus on the use of formulation as a guide for intervention. Appreciation of individual differences is a part of analytic sensibility and the course will therefore, focus on developing the facility of adapting treatment to the unique patient, in consideration of differences in diagnosis, personal history, age, gender, sexual orientation, culture, religion and other aspects of individuality. Finally, it is hoped that the training will facilitate the development of a professional identity of the student as a psychodynamically oriented clinician and professional in the field. Requirements Each student will carry two individual adult clients under supervision, in open-ended, psychoanalytically oriented treatment. Students are expected to have psychodynamic/psychoanalytic supervisors for their cases. Video recordings and case material of both cases will be presented in class for discussion. One of the cases will be written up following the model required for oral presentations of cases at GSAPP as well as other professional settings but with certain elaborations. It is expected that the write up will integrate case material with relevant concepts from the course readings and lectures. Cases may be individuals already in treatment with the student. The second writing assignment will be a clinical exploration of a topic discussed in class. In other words, students are expected to select a topic of interest, read the related research and theory and apply it to a clinical vignette. Details of these assignments will be discussed further in class.
In this chapter we discuss the final phase of the therapy. First we raise the question, "When should the therapy come to an end?" By this we mean, "How does one decide that the therapy should stop?" This in turn raises the question, "Who should decide when the therapy comes to an end?" If we remain faithful to the principles we have espoused in previous chapters, we must advocate a commitment to the client's autonomy: It is the client who must decide, ultimately, when the therapy stops. Furthermore, if we are faithful to the principles previously set forth, the client and the therapist work together in helping the client to arrive at the right decision about when the therapy should come to an end.After an extended period of psychoanalytic therapy, the client told his therapist that he believed the therapy had been most successful. Hearing this, the therapist thought to himself that the client was giving the message, "I'm ready to consider bringing the therapy to a close." The therapist then commented to the client, "You seem to be saying you are ready to consider termination." The client protested that he wasn't aware of any such desire, that he did not want to terminate. If he did terminate, he said, it would be only on the condition that the therapist and the client would dine together once a week after the termination.The therapy continued. Therapist and client agreed on a date for termination, some months off. Midway through this period, the client began a session with the comment, "I've been thinking it over, and I've decided that we need to dine together once a month after termination." The therapist understood this statement to indicate that the client still agreed to the plan to terminate-and still accepted all that this plan implied psychodynamically. As we would expect, on the day of termination, while therapist and client were saying their goodbyes, the client said, "You know, I don't think we will have to meet for dinner later on."Even though a collaborative decision-making process is our ideal, there are times, we believe, when it is appropriate, helpful, and necessary for the therapist alone to decide that the therapy should terminate. In these circumstances the therapist usually decides that the therapy should stop at some future time, then announces this decision to the client. Firestein (1978) offers two examples of a constructive decision by the therapist only, that the therapy should come to an end. In one of these cases the client was getting a great deal of pleasure from the regular sessions with the therapist. Firestein viewed the placing of a limit on the length of the therapy (by the therapist's saying, "We will stop some months 207
Termination in psychoanalysis, or mutual ending (as one of our panelists prefers to term it), is not a simple technical issue for which criteria, rules, and procedures exist and which have simply to be applied. Rather, as our panelists will demonstrate, it is a concept which, in its complexity, relates to all aspects of the analytic process. Further, each termination has to be understood as an idiosyncratic phenomenon from which can be derived insights that perhaps can be applied to other terminations. Notwithstanding, each termination of an analysis must be considered a unique process, deserving of understanding in its own right.Such is also the case with the length of an analysis. Each analyst and analysand, individually and mutually, has to balance and come to terms with the myriad factors that relate to ending or continuing the analytic work.From the papers presented today and the discussion of them, we can observe skilled and experienced psychoanalysts address and evaluate many of the considerations that are a part of the mutual ending (and/or the continuing) of the analytic work. We will also have the opportunity to observe the manner in which analysands participate in the continuing and ending process.Our first speaker is Dr.
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