A Psychotherapy Dominated by Separation, Termination, and Death

Abstract

Mr. B is a 69-year-old gay white man with a history of unsatisfying interpersonal relationships, alcohol abuse, and a slowly progressive lung cancer, who was seen for psychotherapy in a resident clinic for seven years. His pattern of ambivalent attachments to others was evident in therapy by his repeatedly planning to terminate treatment and then subsequently readily agreeing to return. This pattern changed at his most recent, final termination-after a 1 1 / 2 -year period of weekly treatment with me (MCT). This termination has greater resonance when viewed in the context of Mr. B's untreated cancer and the likelihood that his death is nearing.Mr. B saw three residents (the first female, the second male, and the third female) for psychotherapy over seven years, and was followed concurrently by a separate psychopharmacologist and, during our treatment, a substance abuse counselor. His initial therapy centered largely around exploration of interpersonal relationships and isolation, and the end of his relationship with his longtime partner. Early in that treatment, he wrote his therapist of his intent to terminate: "I have decided that there is no point in continuing Herr Dr. Freud's talking cure . . . Analysis and religion require faith which is not one of my strong points." When asked, he returned to therapy and continued with this therapist for nearly three years. Mr. B had no appointments during the last month of the therapist's residency, and he was not reachable by phone when the residency ended.Mr. B was then transferred to a PGY-2 resident. Shortly thereafter, he was diagnosed with lung cancer. In session Mr. B explored his thoughts about dying and spoke of missed opportunities in his life. His alcohol use escalated, and he observed a tendency to binge drink when feeling sad. He described the cancer as a guillotine hanging over his head. A particularly intense period in the therapy ensued-one in which the patient revealed aspects of his sexual history for the first time. Coincidentally, due to changes in the therapist's own schedule, individual sessions were spaced out to every two weeks. The therapist also notified Mr. B of anticipated upcoming schedule changes, and explained that the details of their appointment time would be worked out closer to the transition. Mr. B subsequently wrote a letter stating that he did not want to continue in therapy. At his therapist's request, he came in for another appointment and explained that he was leaving town to care for his ill sister. He said he would call to resume treatment when he returned to town. The therapist has not heard from Mr. B since that time.Mr. B and I began working together several months later, after he was referred by his psychopharmacologist for a new therapist. Mr. B explained that his previous therapist had told him that because of schedule changes, he would not be seeing patients any more-an explanation that differed dramatically from the one provided by the therapist. Months later Mr. B described himself as feeling hurt to see his previous the...

Psycho-Oncology

“…While there are only few clinical trials evaluating the effectiveness of psychodynamic therapies in the physically ill (Ando et al 2007, Ludwig et al 2013, several single cases studies have been published over the past few years (Lacy and Higgings 2005;Redding 2005;Tepper et al 2006). …”