The seriously ill or dying analyst and the limits of neutrality.

Abstract

This article discusses a major dilemma that confronts the analyst who suffers from a prolonged or terminal illness. How much factual information should be revealed to patients concerning the illness and the prognosis? Discussion focuses on accounts by four analysts who suffered serious illnesses and wrote about their experiences. Transference and countertransference issues are considered, followed by relevant references to neutrality-its uses and abuses -in analysis when serious illness strikes. Guidelines offered by others are reviewed, and leads for future thought about this topic are suggested. This article is concerned with the impact on psychoanalytic work of the analyst's becoming seriously ill. Although I have never been seriously disabled, a review of the sparse literature on this topic has stimulated thoughts about a phenomenon that must be considered by all of us in the course of psychoanalytic work. The surrounding ground for this article is psychoanalysis: its framework, its parameters, and the conditions essential for psychoanalysis to take place. The figures in the ground are the accounts provided by four analysts who have become seriously ill and have written about their experiences. The differences in the ways in which the illness was viewed and dealt with intrapsychically and in relation to patients is revealing and is the topic of discussion.Psychoanalysis and psychoanalytic psychotherapy are conducted according to certain prescribed procedures in order to establish a setting of freedom from judgment, trust, regularity, constancy, and self-examination. This frame becomes as important to the patient as it is for the analyst. Of course, some disruptions may occur in the course of the analysis. Patients may take Requests for reprints should be sent to Stanley Rosner, Ph.D.,

Preventing problems of professional competence in the face of life-threatening illness.

“…Like others facing life-threatening diagnoses, psychologists may find that while medical events are moving quickly all around them, their own process of psychological adjustment moves more slowly (DeMarce, 2007; Rolland, 1984). Further, Rosner (1986) reminded us that psychologists enjoy no immunity from decrements in professional functioning; emotional distress about a terminal diagnosis may even interfere with the psychologist's normally keen awareness of his or her level of competence. Psychologists whose lives are at risk “are as capable of denial, anxiety reactions, and withdrawal as are any other human beings.…”

“…They are concerned about loss of life, economic well-being, and competency. Interest in patients becomes secondary under conditions of threat to life” (Rosner, 1986, p. 359). It stands to reason that any human being struggling for safety and survival will have less motivation for pursuing higher-order needs linked to professionalism and self-actualization (Maslow, 1987).…”

“…Counselman and Alonso (1993) astutely observed that, “patients like to see their therapists as invincible… it is very tempting for therapists to agree with this flattering view, and to deny their own vulnerability to illness, aging, and inevitable death” (p. 593). Diagnosis of a life-threatening condition may trigger all manner of defensive countertransference reactions in psychologists who might strike a pose as hero, suffering martyr, or stoic parent, ostensibly in the service of protecting clients, but ultimately for no purpose other than denying their own mortality, thereby delaying the business of assessing their competence for current and subsequent practice (Rosner, 1986). Acknowledging such vulnerabilities and difficulties “might be seen as inimical to the image of the competent psychologist, and this may then, unfortunately, lead to the exactly opposite effect” (Barnett, 2008, p. 11).…”

Externalizing lupus: A therapist/patient's challenge.

“…Self-disclosure was a significant issue in my own work, both at school and in my independent practice. Some writers have viewed self-disclosure through the lenses of transference, countertransference, and neutrality (Abend, 1982; Dewald, 1994; Rosner, 1986). They recommend that the therapist give as little information as possible to their clients regarding the reasons for an interruption or discontinuation of therapy when it is related to the therapist's health.…”

“…They recommend that the therapist give as little information as possible to their clients regarding the reasons for an interruption or discontinuation of therapy when it is related to the therapist's health. Concerns raised about giving too much information include the possibility that the therapist is attempting to reduce the client's anger at the interruption, enlist sympathy and concern for the therapist, or obtain “masochistic gratification in announcing the illness” (Rosner, 1986, p. 366). Positive reasons for sharing information include not abandoning the client without giving some reasons, clarifying the interruption, and strengthening the trust between the therapist and client (Rosner, 1986).…”