Criteria For The Termination Of An Analysis

The paper was originally read before the British Psycho-Analytical Society, as one of Four Short Communications on the Criteria for the Termination of an Analysis, on April 6, 1949. It was subsequently published as Bridger, H.. Criteria for the termination of analysis. Int. J. Psycho-Anal.(1950), 31:202-203. We republish it here with kind permission of the International Journal of Psychoanalysis.

The analytical situation can be considered as a transitional community of two people created for the purpose of changing and reintegrating the patient's internal object relationships, and thus progressively enabling him to bridge the gap between one way of life and another. On the time scale of the patient's external world, this transitional community exists for fifty minutes on a certain number of days each week. Between one session and the next there may be periods of one or more days, as well as an occasional break of some weeks or months.

These periods are either arbitrarily decided upon by the analyst or patient, or are mutually arranged. In any case they are all occasions when the patient has an opportunity to experience for himself the implications of terminating analysis.

It should be remembered, however, that terminating the existence of the transitional community in the patient's social life is dynamically different from terminating the psycho-analytic process. The former is an event in the external world; the latter is the end-result of a developmental internal process.

The criteria being sought are therefore those which will enable the analyst to determine, and before that even to predict, relative to the various external forces operating on analyst and patient, the optimal moment in time when the event of termination should occur in the psycho-analytical process.

Defining the nature of a transference interpretation, James Strachey (1) wrote: 'I have suggested that it is a procedure which enables the patient, under controlled conditions and in limited doses, to employ his sense of reality for the purpose of making a comparison between his archaic and imaginary objects and his actual and real ones; and I have argued that the small-scale correction which he can thus make in his attitude towards the external world is the first step towards the internal readjustment which is our ultimate aim.'

On this basis, at any particular moment in time during the analysis, the integrate of small-scale corrections made in the patient's attitude to the external world should have a correspondence with the integrate of steps made in the internal readjustment. The forces operating on the patient in the external world can be assessed only in the light of the material brought by the patient in all its varied forms. Actual evidence from other sources concerning the changes which the patient is able to make in his external relationships with the various social groups to which he belongs are not normally available to the analyst.

It was possible, however, for criteria to be established within this wider social frame of reference by those working in other kinds of transitional communities where the therapeutic techniques were different not only from psycho-analysis but from each other. I refer to the follow-up study of patients from an E.M.S.2 Hospital by Guttman and Thomas (2), and to the follow-up study by Curle and Trist (3) of those repatriated prisoners of war who had voluntarily attended Civil Resettlement Units before returning to civilian life. The latter case in particular is of special interest, since these social scientists were able to establish criteria for the rehabilitation and reintegration of people into social communities. These criteria formed the basis for an assessment of the success of treatment experienced in a carefully designed resettlement process. In addition, the criteria provided a framework not only for the reconsideration of the structure and culture of the units in relation to their purpose, but also for evaluating the degree to which a repatriate was ready to terminate his stay at the transitional community.

In the psycho-analytic process the infantile patterns of behaviour and unresolved emotional conflicts, which are determining the patient's course of action, are brought to light and worked through in the transference. Nevertheless, the integrate of the internal and external reconnections thus made requires the consideration of various frames of reference if criteria for the final termination event are to be found. One way of looking at the problem would be to consider the criteria for ending an analytic session, since the fact that fifty minutes has elapsed cannot be considered to be the sole criterion. I shall, however, confine myself to two sets of situations which might provide the analyst, in the analytical situation, with similar opportunities to those which the social scientists mentioned above have found in their transitional communities. The first set is comprised of the short-term experiments in termination which the patient experiences throughout analysis by being set the task of getting along on his own between one session and the next. In contrast, the second set comprises those experiences in the patient's external world which involve the termination of relationships, for example, change of job, place of residence, divorce, death and so on. In both sets, consideration has to be given to the forces at work, and the circumstances prevailing, at the time of the separation events.

In the former case the analyst is continually receiving communications, in one way or another, from the patient, indicative of the degree to which his internal world is coping with the anticipated break periods, or has coped with the actual experience of them. For the patient's internal world the time scales of these breaks are by no means the same as the time scale of the external world. In the 'here and now' of the analytical situation the coming, or past, break of a day, week or month may well mean, or have meant, 'for ever' on the patient's internal time scale. One aspect therefore of this set of situations might be the assessment of the patient's ability to tolerate the operation of a reality time scale in his internal world. Another aspect concerns the main ways in which separation events occur, namely, whether the breaks are determined by the analyst, by the patient, or are mutually agreed upon. There would be qualitative and quantitative differences in the assessment of them when compared one with another. Considering these and other aspects the analyst could, on the specific knowledge gained in the context of the analytical situation, construct what one might call periodic 'progress reports' on the patient's preparedness for the termination event.

As and when, in the second set of situations, the patient brings into the analysis material concerning those separation events occurring in his external world, whether in advance, at the time, or in retrospect, it is worked through in the transference. In this frame of reference another series of 'progress reports' could be made.

Although part of the therapeutic task of the analyst in this transitional community of two people is always the examination and assessment of the patient's ability to cope with many other problems relating to the final termination event, particular emphasis has been given here to separation experiences and short-term experiments in termination, which occur throughout analysis, and are dealt with in the analytical situation. In constructing, on this evidence, specific periodic 'progress reports' for each patient, and comparing them one with another throughout analysis, certain general criteria for the final termination event may well emerge.