Click Here to Buy: Myths of Termination by Judy Kantrowitz.
Myths of Termination: What Patients Can Teach Psychoanalysts About Endings, by Judy Kantrowitz (forward by Glenn Gabbard, MD) Routledge 2014.
Reviewed by N. Szajnberg, MD
Just before death (1956), Ernst Kris published his piece on personal myth and its transformation to personal history in psychoanalysis. Myths are archaic forms that live in the present, drive the present, as if they were still alive. Histories are life accounts that we feel are part of who we are, but do not drive our present. Resolving myths to histories permits us to build more autonomous futures.
Judy Kantrowitz’s book, Myths of Termination: What Patients Can Teach Psychoanalysts About Endings, does for our discipline, what Kris tried to do for clinical work: lay myths to rest in the past so we can work with truer knowledge in the present and help our analysands build solid futures.
Kantrowitz, who began her research interviewing analysands about analysis when she was a CORST candidate, divides this brief but concentrated work into seven chapters covering ideal versus real views of termination; insight loss and mourning as developments at termination; non-mutual endings (a poignant account); post-analytic contact; keeping analysis alive; what we learn; and reflections.
Here are the basics of her study. Kantrowitz interviewed eighty-two analysands, all volunteers, using a snowball recruitment (those interviewed recruited others). Seventy-seven percent were clinicians; 64 women and 18 men, the majority in their mid fifties to sixties. In fact, a frequent motivation to participate in Kantrowitz’s study was unresolved affect, particularly around termination. The time since termination ranged widely from one year (20 cases) through over 20 years (16) and over 50 years (2). Thirty-three percent found their analyses either unhelpful or hurtful, although 13% went on to a more successful later experience. Twenty-five reported non-mutual endings; thirteen had a later successful analysis.
Let’s look at the human experiences behind the numbers. Kantrowitz reminds us that Ticho distinguished between life and therapeutic goals (1972), echoed later by the Novicks (2006): treatment should facilitate resumption of progressive development. (And this reminds us of Winnicott’s thoughts on the maturational drive and how treatment can mesh with this normative drive to facilitate development.)
Kantrowitz then continues her myth-busting impressive track record. In multiple prior publications, she showed that what analysts thought predicted outcome — realty testing, object relationships, affect availability and tolerance, motivation — are myths. What drives analysis to success is the match between patient and analyst, which she found could not be predicted at the beginning, although this may reflect when Kantrowitz began her work a lack of certain tools, such as measuring attachment.
And she continues her myth-busting, as we would expect of any scientist with fortitude, an open, inquisitive mind and prepared to challenge received wisdom.
Following Bowlby, her second chapter looks at separation, loss and mourning. Loewald wrote that mourning at the end of analysis is necessary to internalize the analytic process and change in self-representation (although Schlesinger argues that mini-mournings happen throughout (2014)). But Kantrowitz challenges the assumption that there is always change in ending. Sixteen reported that ending was a continuous experience. Some reported positive changes: recovered memory (2); new insights (20); separation issues (5); reworking conflicts (2); displacement to analyst (20): new or recovered affects of anger, disappointment and joy (37) and grief and mourning (reported by most).
Post-analytic contact? No easy answer, at least no single answer. Some welcomed a more symmetrical relationship afterwards; some found that this interfered with positive internalization . Intriguingly, those who found post-contact most constructive and relatively unambivalent were non-clinicians, which makes sense. In any case, Kantrowitz found that transferences continue.
And what keeps the analysis alive after one leaves the building the last time? Well, 23 described a self-analytic function (although 59 found the work beneficial). Feelings of loss of the analyst revived earlier losses. Those who resumed analysis did so because of life’s vicissitudes or work with patients (a different kind of life vicissitude). If we were ballet dancers or musicians or athletes, we would expect ourselves to return to the barre, the instrument for practice or the gym. Why not for analysis?
I close with some touches of her wisdom from these interviews. Kantrowitz learned that “… those who relied only on dreams …were more self-sufficient, but they were not necessarily as comfortable with intimacy and self-exposure” (p 133). Yet, those who relied exclusively on talking to others may not have developed as great a confidence in their own capacities…” Kantrowitz clarifies that this is not a hierarchy with self-sufficiency higher than talking with others. Perhaps this is on a continuum or like Freud’s complemental series: self-healing has dual components ranging from talking with oneself (such as dreams) through talking (and listening) to others.
You will discover much more in this humane book that will be aid those who practice this humane discipline, psychoanalysis. We will practice more wisely because of it.
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