Termination In Psychoanalysis and Psychotherapy (Revised Edition) (Book Review)

Author:  Firestein, Stephen K.
Publisher: Madison, CT: International Universities Press, 2001
Reviewed By: Jeff Golland, Fall 2002, pp. 36-37

Beginnings and endings have fascinated people well before the advent of psychoanalysis. Anthropologists have studied creation myths for a century, while dramatists have focused on life’s endings for millennia. Psychoanalysis began with questions about origins, causality; outcome, goals, aims, teleology, were thought better left to philosophy. Freud (1914) offered recommendations on the technique for beginning a treatment and promised a discussion on its ending. When he came at last to write on termination (1937), his ideas were more in the domain of philosophy than of technique.

My scholarly interest in beginnings and endings (1972) predates completion of my analytic training. Twenty-five years later, from a psychoanalytic perspective and experience, I again wrote on the subject (1997). Early in this time span Firestein’s first edition (1978) appeared; it was the first book-length treatise on the topic. American psychoanalysis had passed its hegemonic period. Analyses were becoming longer, alternate and briefer treatments were competing, and the mainstream ego-psychological perspective of American psychoanalysis was experiencing its first challenge from within (Kohut, 1971). Firestein’s text was a research report based on his study of eight analyses conducted by candidates at the treatment center of the New York Psychoanalytic Institute. The research was stimulated in part by the completion of his “own didactic analysis a year or so before” (p 1).

My analysis, while meeting training requirements, continued beyond graduation and was never considered by me “didactic.” Its difficult termination phase stimulated quick purchase and reading of Firestein’s book. I was left disappointed and angry. Not one of the eight cases presented seemed to have had a termination resembling my own, nor did any match my own clinical or theoretical understanding of the phase. Each was, in my view, a too-short treatment in which termination was usually analyst-led, and for reasons that seemed arbitrary at best. Decisions to terminate often seemed confounded by issues associated with the eight student analysts’ completion of their own training. I dismissed the book as uninformative and I awaited further developments in the literature and in my own clinical practice.

Over time, Firestein (1978) became a routine citation in the burgeoning literature on termination, with my reaction apparently not shared by others, at least explicitly. Such routine citation seemed, in fact, to have given the book near-classic status. In my own teaching, I felt obliged to include it in the bibliography but passed it over with brief negative comment on its database.

When, 28 years later, the current revision appeared, I was again eager to read Firestein’s work. No longer a new analyst, his contributions to the profession and to the literature, including additional work on this topic, were most respectable. Since he and I seemed, from my reading of his other work, to share a common contemporary Freudian frame of reference, I expected the revision would deal well both with psychotherapy terminations (promised by the new title) and with a review of the many good papers published on the subject in the intervening years.

As is my habit, I read the table of contents in advance of beginning the text. I was shocked. Pages 1-215, including the original introduction, each of the eight clinical examples, and the “substantive conclusions” chapter are identical to those pages in the original, and they even appear to be from the same galleys! What is new is a brief introduction to the new edition, an expanded reference list, and a 25-page concluding chapter (replacing the last two chapters of the original). Again I found myself disappointed and angry at what now seemed like a publisher’s scam.

The book turned out to be better than I expected or recalled. The clinical descriptions that form the essential content of the book are extensive and rich. They make it clear that, even with training cases selected by narrower criteria of analyzability common to the early ‘70s, psychoanalytic treatment is always unpredictable and complex. A range of reactions to termination of treatment and ensuing difficulties are presented. The clinical chapters are not scholarly, nor meant to be. Citations are all but reserved for the concluding chapters. I found this a plus, allowing for engagement in the clinical matters and the theoretical matters separately. Diverse perspectives on both clinical and theoretical issues are, nonetheless, presented. Such diversity is not an innovation of the current era of theoretical pluralism. It has long been a feature of sound psychoanalytic training, and it results in highlighting the individuality of each treatment. For me this is a hallmark of the anti-normative psychoanalytic technical approach. A focus on the subjectivity of the analyst, with an emphasis on counter-transference as potential interference, is another unrecalled strength of the presentation. Some of the substantive conclusions, identical in the two editions, an admittedly modest attempt, seem consistent with current thinking, at least my own. Among these are: that there is a termination phase focusing on ending and extending beyond the cessation of formal sessions; that this phase is marked by affective intensification and, not uncommonly, acting-out; that the treatment alliance is tested and strengthened; that shorter treatment breaks are not predictive; and that there is an emotional impact on the analyst. These multiple assets combined to dissipate the disappointment and anger with which I had begun my reading.

The book, though, is hardly definitive as to the “state of the art” on its titular topic, and wound up leaving me disappointed. First impressions of long ago were not completely off the mark. The eight cases presented were training cases of candidate analysts. The topic of termination was raised after from 3 ½ to 7 years, often by the analyst, and the analyst seemed to lead the process most of the time. The length of the “phase” was as often measured in weeks as in months. One of the eight terminations was forced by the analyst’s relocation; two seemed clear treatment failures. All were close in time to the analyst’s own termination, noted (in the first edition) as a high risk factor for countertransference interference. (While this latter situation is unavoidable at one time for every analyst, a researcher should not consider it exemplary.) In other words, the database for termination research was seriously compromised.

Despite the limitations of the data, the non-clinical chapters in both the first and the current editions are surprisingly valuable. In fact, the two excised chapters, one on methodology and one a literature review, might well have been profitably included, with some extension. As to methodology, psychologist-psychoanalysts would likely raise different questions than did Firestein. Given the pioneering nature of this project, his questions and answers are, nonetheless, useful. The literature review (itself adapted from a 1974 article) dealt with criteria, technique, special occurrences and post-termination developments in a way not as well covered in Firestein’s new concluding chapter.

External factors impacting termination, while acknowledged, are given short shrift. Unpredictable factors influence the course of every analysis and its termination. Providing for optimal termination in their face seems to me a critical dilemma to be addressed.

Firestein’s actual revision, the new concluding chapter bearing the book’s new title, aims to extend his early study from psychoanalytic to psychotherapeutic terminations, psychotherapy as defined by Wolberg (1954) and by Fromm-Reichmann (1950). Firestein finds many considerations in common and he highlights some differences. Matters of technique and risks from countertransference reactions are emphasized. This chapter, for me, was sketchy and something of a teaser; much more could have been said about each of the important topics raised.

This book is closer to a re-issue than a revision. Its strength lies less in the treatment of its stated topic than in the presentation of rich clinical psychoanalytic material, and in the broaching of multiple considerations related to the topic. I had hoped, perhaps as naively as I did when I bought the original, for a definitive text. There may never be a definitive text on any psychoanalytic topic. Perhaps the best we can do is to continue to discuss the several facets of important issues, gaining incremental insight as we go. This formulation may parallel one for psychoanalytic treatment, itself. I was especially disappointed, though, that Firestein chose to make his concluding statements on the arbitrariness of termination. While I would not disagree with them in substance, such an ending leaves a false impression. Termination work in any individual treatment can be much better than arbitrary. Study of the now fulsome literature when combined with a sensitive accounting for each individual’s unique circumstances can result in successful terminations in both psychoanalysis and psychotherapy.

In the end, what does this book contribute? A useful increment, a set of considerations, a wish to know more. I prefer the original with its now excised chapters to the revision, while hoping for more papers on the subject from the author.

References

Firestein, S. K. (1978). Termination in psychoanalysis. New York: International Universities Press.
Freud, S. (1913). On beginning the treatment. S.E., 12, 123-144.
Freud, S. (1937). Analysis terminable and interminable. S.E., 23, 216-253.
Fromm-Reichman, F. (1950). Principles of intensive psychotherapy. Chicago:University of Chicago Press.
Golland, J. (1972). A “hello” and “goodbye” group. International Journal of Group Psychotherapy, 22, 258-261.
Golland, J. (1997). Not an endgame: Terminations in psychoanalysis. Psychoanalytic Psychology, 14, 259-270.
Kohut, H. (1971). The analysis of the self. New York: International Universities Press.
Wolberg, L. (1954). The technique of psychotherapy. New York: Grune & Stratton.

Reviewer Note

Jeff Golland is training and supervising analyst and faculty member at the Psychoanalytic Training Institute of the New York Freudian Society. He currently serves the Society as Vice-president and as one of its two representatives to the IPS Board.

Copyright

© APA Div. 39 (Psychoanalysis). All rights reserved. Readers therefore must apply the same principles of fair use to the works in this electronic archive that they would to a published, printed archive. These works may be read online, downloaded for personal or educational use, or the URL of a document (from this server) included in another electronic document. No other distribution or mirroring of the texts is allowed. The texts themselves may not be published commercially (in print or electronic form), edited, or otherwise altered without the permission of the Division of Psychoanalysis. All other interest and rights in the works, including but not limited to the right to grant or deny permission for further reproduction of the works, the right to use material from the works in subsequent works, and the right to redistribute the works by electronic means, are retained by the Division of Psychoanalysis. Direct inquiries to the chair of the Publications Committee.