Nearing the completion of my psychiatric residency, I ingenuously told my supervisor that I needed to know the steps of termination in therapy with patients. On the surface, this request reflected an awareness of the issues at hand and their importance. Beneath lay ambivalence and countertransference anxiety . For the graduating resident, time ordinarily invested in thought and study fills with practical considerations of job hunting and starting a practice. The resident' s own unresolved and unsettling separation issues can further push aside therapeutic considerations for his patients. Termination, the art of the veteran therapist, becomes an unwelcome task at this time of professional passage when anything codifying professional identity is sought. In the unfortunate sequence of most residencies, this can be the first experience with forced termination of therapy.
Forced termination is also a neglected topic within termination literature: a stepchild absent from standard psychotherapy texts from Colby to Tarachow. Weigert (1) and many others expound a necessary mutuality between patient and the rapist before termination can be set. Any prematurity on the therapist's part, by definition, sets up a forced situation with its concommitant transference reactions and may be initiated by unintentional countertransference reactions.
In reference to character analysis, Freud (2) doubted if even deep analysis could prevent a return of neurotic symptoms under the pressures of everyday life. The issue here becomes not whether treatment is terminable; but rather, one of understanding transference and countertransference.
Supervision and the resident's own therapy can make difficult terrain into a crucial learning experience. I share my experience with just one patient and my imperfect understanding of a complex interaction, in light of termination literature.
Becker, Jr, MD, Frederick L.
"Some reflections on Termination: Transference and Countertransference,"
Jefferson Journal of Psychiatry:
2, Article 5.
Available at: http://jdc.jefferson.edu/jeffjpsychiatry/vol3/iss2/5