Freud, S. (1937). Analysis Terminable and Interminable. Int. J. Psycho-Anal., 18:373- 405
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Freud, S. (1937). Analysis Terminable and Interminable. Int. J. Psycho-Anal., 18:373- 405. (1937). International Journal of Psycho-Analysis, 18:373-405 Analysis Terminable and Interminable Sigmund Freud Experience has taught us that psycho-analytic therapy—the liberation of a human being from his neurotic symptoms, inhibitions and abnormalities of character—is a lengthy business. Hence, from the very beginning, attempts have been made to shorten the course of analysis. Such endeavours required no justification: they could claim to be prompted by the strongest considerations alike of reason and expediency. But it may be that there lurked in them some trace of the impatient contempt with which the medical profession of an earlier day regarded the neuroses, seeing in them the unnecessary results of invisible lesions. If you were obliged to deal with them, you simply aimed at getting rid of them with the utmost despatch. Basing his procedure on the theory formulated in Das Trauma der Geburt (1924) Otto Rank made a particularly determined attempt to shorten analysis. He assumed that the cardinal source of neurosis was the experience of birth, on the ground of the possibility that the infant's 'primal fixation' to the mother might not be surmounted but persist in the form of 'primal repression'. His hope was that, if this primal trauma were overcome by analysis, the whole neurosis would clear up, so that this one small piece of analytic work, for which a few months should suffice, would do away with the necessity for all the rest. Rank's argument was certainly bold and ingenious but it did not stand the test of critical examination. Moreover, it was a premature attempt, conceived under the stress of the contrast between the post-War misery of Europe and the 'prosperity' of America, and designed to accelerate the tempo of analytic therapy to suit the rush of American life. We have heard little of the clinical results of Rank's plan. Probably - 373 - it has not accomplished more than would be done if the men of a fire-brigade, summoned to deal with a fire from an upset oil-lamp, merely removed the lamp from the room in which the conflagration had broken out. Much less time would certainly be spent in so doing than in extinguishing the whole fire. The theory and practice of Rank's experiment are now things of the past—as is American 'prosperity'. Before the War, I myself had already tried another way of speeding up analysis. I had undertaken to treat a young Russian, a rich man spoilt by riches, who had come to Vienna in a state of complete helplessness, accompanied by physician and attendant.1 It was possible in the course of several years to restore to him a considerable measure of independence, and to awaken his interest in life, while his relations to the principal people in his life were adjusted. But then we came to a full stop. We made no progress in clearing up his childhood's neurosis, which was the basis of his later illness, and it was obvious that the patient found his present situation quite comfortable and did not intend to take any step which would bring him nearer to the end of his treatment. It was a case of the patient himself obstructing the cure: the analysis was in danger of failing as a result of its—partial—success. In this predicament I resorted to the heroic remedy of fixing a date for the conclusion of the analysis. At the beginning of a period of treatment I told the patient that the coming year was to be the last of his analysis, no matter what progress he made or failed to make in the time still left to him. At first he did not believe me, but, once he was convinced that I was in dead earnest, the change which I had hoped for began to take place. His resistances crumbled away, and in the last months of treatment he was able to produce all the memories and to discover the connecting links which were necessary for the understanding of his early neurosis and his recovery from the illness from which he was then suffering. When he took leave of me at midsummer, 1914, unsuspecting, as we all were, of what was so shortly to happen, I believed that his cure was complete and permanent. In a postscript to this patient's case-history (1923) I have already reported that I was mistaken. When, towards the end of the War, he returned to Vienna, a refugee and destitute, I had to help him to ————————————— 1 Cf. the paper, published with the patient's consent, 'The History of an Infantile Neurosis' (1918). It contains no detailed account of the young man's subsequent illness, which is touched on only when its connection with his infantile neurosis requires it. - 374 - master a part of the transference which had remained unresolved. Within a few months this was successfully accomplished and I was able to conclude my postscript with the statement that 'since then the patient has felt normal and has behaved unexceptionably, in spite of the War having robbed him of his home, his possessions and all his family relationships'. Fifteen years have passed since then, but this verdict has not proved erroneous, though certain reservations have had to be made. The patient has remained in Vienna and has made good, although in a humble social position. Several times, however, during this period, his satisfactory state of health has broken down, and the attacks of neurotic illness from which he has suffered could be construed only as offshoots of his original neurosis. Thanks to the skill of one of my pupils, Dr. Ruth Mack Brunswick, a short course of treatment has sufficed on each occasion to clear up these attacks. I hope Dr. Mack Brunswick herself will report on this case before long. Some of these relapses were caused by still unresolved residues of the transference; short-lived though the attacks were, they were distinctly paranoid in character. In other instances, however, the pathogenic material consisted of fragments from the history of the patient's childhood, which had not come to light while I was analysing him and which now came away (the comparison is obvious) like sutures after an operation or small pieces of necrotic bone. I have found the history of this man's recovery almost as interesting as that of his illness. Since then I have employed the method of fixing a date for the termination of analysis in other cases and I have also inquired about the experience of other analysts in this respect. There can be only one verdict about the value of this device for putting pressure on the patient. The measure is effective, provided that one hits the right time at which to employ it. But it cannot be held to guarantee perfect accomplishment of the task of psycho- analysis. On the contrary, we may be quite sure that, while the impending termination of the treatment will have the effect of bringing part of the material to light, another part will be walled up, as if buried, behind it and will elude our therapeutic efforts. Once the date for discontinuing the treatment has been fixed we must not extend the time; otherwise the patient will lose all his faith in the analyst. The most obvious expedient is to let him continue his treatment with another analyst, although we know that a change of this sort involves a fresh loss of time and the sacrifice of some of the results of the work already done. No - 375 - general rule can be laid down as to the right time for resorting to this forcible technical method: the analyst must use his own tact in the matter. A mistake, once made, cannot be rectified. The saying that the lion springs once and once only must hold good here. II The discussion of the technical problem of how to accelerate the slow progress of analysis suggests another deeply interesting question: is there such a thing as a natural end to an analysis or is it really possible to conduct it to such an end? To judge by the ordinary talk of analysts we should presume that it is, for we often hear them say, when deploring or excusing the admitted imperfection of some fellow-mortal: 'His analysis was not finished' or 'He was not thoroughly analysed'. Now we must first decide what is meant by the ambiguous term, 'the end of an analysis'. From the practical standpoint it is easily defined. An analysis is ended when analyst and patient cease to meet for the analytic session. This happens when two conditions have been approximately fulfilled. First, the patient must no longer be suffering from his former symptoms and must have overcome his various anxieties and inhibitions and, secondly, the analyst must have formed the opinion that so much repressed material has been brought into consciousness, so much that was inexplicable elucidated, and so much inner resistance overcome that no repetition of the patient's specific pathological processes is to be feared. If for external reasons one is prevented from reaching this goal, it is more correct to say that an analysis is incomplete than to say that it has not come to an end. The second definition of the 'end' of an analysis is much more ambitious. According to it we have to answer the question whether the effect upon the patient is so profound that we can be certain that no further change would take place in him if his analysis were continued.