What sets off the termination of analysis and psychodynamic therapy from the variety of endings that enter into all human relationships? So asks Herbert J. Schlesinger in Endings and Beginnings: On Terminating Psychotherapy and Psychoanalysis a work of remarkable clarity, conceptual rigor, and ingratiating readability. Schlesinger situates termination - which he understands, variously, as a phase of treatment, a treatment process, and a state of mind - within the family of "beginnings" and endings" that permeate one another throughout the course of therapy. For Schlesinger, therapeutic endings cannot be aligned only with the final phase of treatment. Far from it. Ending-phase phenomena appear throughout the therapeutic work. They occur whenever patients achieve some portion of their treatment goals; they supervene when therapy stagnates; indeed, they color the beginning of treatment, for endings, as Schlesinger shows again and again, are often foreshadowed in beginnings. Small wonder that an assessment of the patient's relationship to time and capacity to end therapy are key aspects of diagnostic evaluation, and that, for Schlesinger, "The ending of psychotherapy is the most important part of the treatment."
By linking beginning and ending phases not to the chronology of treatment but to the patient's experience of it, Schlesinger brings revivifying insight to a host of psychodynamic concepts - consider his view of the "working through" process as a "minitermination" and his use of "attachment" as an index of termination-related difficulties. Nor does he shy away from a trenchant critique of the instrumental "medical model" of psychiatric and psychotherapeutic training, which militates against the therapeutic exploration of treatment endings. His exemplification of how to begin treatment from the point of view of ending; his sensitive delineation of the mid-treatment "ending" crises characteristic of "vulnerable patients"; his richly woven case vignettes illustrating various "ending" contingencies and permutations - these topical inquiries are gems of pragmatic clinical wisdom.
Surveying endings and terminations over the analyst's life course, examining mourning as an anticipation of ending elicited by therapeutic gains over the course of treatment, and concluding with the nettlesome issue of therapist-patient contact after termination, Schlesinger speaks of matters that transcend theoretical allegiance and technical orientation. He speaks, that is, to any and all clinicians whose commitment to their work emboldens them to begin anew - and end anew - with each patient, each day. No less than The Texture of Treatment (TAP, 2003), Endings and Beginnings distills lessons learned over the course of a half century of practicing, teaching, and supervising psychotherapy and psychoanalysis and is a gift to the profession.
--- from the publisher
Preface Chapter 1 A Little History and Some Definitions
Chapter 2 Patterns of Ending Psychotherapy
Chapter 3 How to Tell When Treatment May End
Chapter 4 Beginning from the Vantage Point of Ending
Chapter 5 Ending for “Beginners”
Chapter 6 Ending and Termination in the Treatment of Vulnerable Patients
Chapter 7 Impasse or Stalemate: The Problems of Ending and Termination
Chapter 8 Interminable Analysis
Chapter 9 Ending, Termination, and the Life Course of the Analyst
Chapter 10 Mourning in the Analytic Situation: An Aspect of Termination
Chapter 11 Is There Life after Termination?
"This book is a small miracle; there is nothing quite like it. Schlesinger's genius is to see that focusing on 'endings' in psychodynamic treatment is the way to parse, track and manage all of treatment from first to last, as well as the way to individualize therapy, the way to keep the mission in focus, the way to define psychoanalysis and psychotherapy in operational terms, and, of course, the way to know when to stop. But this is no airy theorizing. It is a hands-on book where practitioners at all levels of experience will find virtual vignettes of every patient they have encountered, in all the stop and go situations, sketched with extraordinary sympathy for the hard realities of the therapist's situation on the one hand, and startlingly realistic disclosures of the patient's sometimes inconvenient reality on the other hand. Schlesinger gives us what we all want these days: a way to think realistically, helpfully, and planfully about the full range of patients without getting lost in traditional shibboleths or formal rituals, and without replacing our clinical mission with sheer improvisation and helpless submission to circumstance. He wastes so little space on theorizing that the reader will be immediately helped in his work by any single page chosen at random, and as a whole I can think of no one book that will save more therapists and more patients from wandering in the wilderness." --Lawrence Friedman, M.D., Clinical Professor of Psychiatry at the Weill-Cornell Medical College Faculty, New York University Psychoanalytic Institute
"Endings and Beginnings is a truly worthy companion to Herbert Schlesinger's earlier, scintillating The Texture of Treatment. Here again he masterfully encompasses the daunting complexity of the psychoanalytic treatment experience, itself a stylized mirror of the complexity of life experience. This time Schlesinger refracts this experience through the lens of endings and beginnings, two sides of a single coin that is the currency of the therapeutic process, and, writ larger, of the life process. Schlesinger shows how psychodynamic treatment can be endlessly considered from the viewpoints of endings and beginnings, separations and bondings, attachments and avoidances, all infused with the fully ambivalent panoply of emotions that makes us complexly human. And he does all this with lucidly chosen vignettes, a lifetime of distilled clinical experience, uncommon wisdom, and an unbounded joy in unraveling life's experiences."--Robert S. Wallerstein, M.D., Emeritus Professor and former Chair,Department of Psychiatry, UCSF School of Medicine
About the Author
Herbert J. Schlesinger, Ph.D. is Clinical Professor of Psychology in Psychiatry, College of Physicians and Surgeons, Columbia University, and Supervising Analyst, Columbia University Center for Psychoanalytic Training and Research. He is the author of The Texture of Treatment: On the Matter of Psychoanalytic Technique (TAP, 2003).