What is a “Good Enough” Termination?

Glen O. Gabbard

In Freud's technique papers, he failed to develop a systematic approach to termination. Much of the existing literature is based on
psychoanalytic mythologies about the way patients are expected to end analysis. The models described in the literature are often starkly at
odds with what one sees in clinical practice. A wish for idealized versions of termination underlies much of what has been written, and we
need to shift to a conceptual model involving “good enough” termination. A number of different endings to psychoanalysis may, in the
long run, lead to productive outcomes; these models are examined, as are various approaches to the dilemmas presented at the time
of termination.

At a psychoanalytic meeting not long ago, I was listening to a presentation that offered a psychoanalytic perspective on
infertility (Kite 2007). The presenting analyst told the audience a story about a patient in her late thirties, single-minded in her pursuit of
pregnancy, who subjected herself to all the latest technological advances. The analyst knew that a psychoanalytic treatment would not cure
the patient's infertility, but she hoped the treatment might offer her some perspective on her intrapsychic conflicts and the complicated
grieving process attached to this unfortunate biological limitation. As she recounted her experience with this unhappy patient, I detected in
myself a rather embarrassing and certainly naive fantasy that the analysis would end with a long awaited pregnancy, followed by the birth
of a healthy baby. The analysis would then terminate with a grateful patient who would live happily ever after.
Near the end of the analyst's presentation, I learned that the patient terminated as she began—childless. I was dismayed. I felt
disappointed, even deprived. I wanted the ending that I wanted, even though I knew it
—————————————

The author thanks Nancy Chodorow, Thomas Ogden, and Cecilio Paniagua for helpful comments on the manuscript. Submitted for
publication December 5, 2008.
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was unlikely that talking to someone for a few years would change the function of that person's reproductive system.
As I reflected on this surprising state of unfulfilled expectation, I recognized that I was caught up in a form of
psychoanalytic mythology—I was in the thrall of a narrative derived more from literature and film than from clinical reality. Chodorow
(2003) made a similar observation in a paper about infertility: “We are drawn to case reports with fairy tale endings: When we terminated,
Mrs. A was enjoying her work, sexually responsive to her husband, and pregnant” (p. 1182). Our theory and our technique are laced with
mythic narratives. These story lines are variations on a central fantasy, usually unconscious or preconscious, about the outcome of
analysis. The patient comes to analysis with a set of problems. Analyst and patient struggle together to understand these problems, and the
patient ultimately falls in love with the analyst. The problems are resolved, the patient relinquishes the transference love for the analyst,
and an orderly termination is successfully negotiated. The patient embarks on a new life, grateful to the analyst, and leaves the old
problems behind. Variations of this fantasy are internalized during our training and persist in one form or another.
While Freud originated much of the psychoanalytic mythology that has haunted all of us, he also repeatedly undermined the myths he
had established. In fact, his practice bore little resemblance to his writing. Moreover, his followers promulgated a rigidity that was not at
all characteristic of Freud's practice (Lipton 1977; May 2008).
Burland (1997) analyzed a sample of 450 case reports that psychoanalytic candidates in the American
Psychoanalytic Association had written in order to obtain certification. The accounts were remarkable in their similarity, as though a
unified psychoanalytic treatment was being recounted from 450 vantage points. The analysand would re-create the past in the present with
the analyst, would have predictable struggles with a range of similar emotions, and emerge vastly improved. In his reflection on this not
unexpected finding, Spence (1998) noted, “We are led to wonder whether this concordance may stem from each candidate's need to
appear normative and unexceptional and to generate an account that would maximize his or her chances of being certified. This kind of
clinical summary would seem to be the likely outcome of conscious and preconscious narrative smoothing …” (p. 643). He further
cautions us to be leery of any practice that appears to conform closely to Freud's early technique papers.
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 In one way or another, analysts spend a good deal of their careers undoing what they learned in their training. One must learn to
improvise after being trained to play the scales. Our need to deconstruct myths emerges from the analyst's clinical experience, where the
necessity to think on one's own and respond to the patient's idiosyncratic needs and wishes flies in the face of what one has learned
about technique. Part of our task in becoming analysts is to find our own voice and our own particular amalgam of techniques that appear
to help patients, rather than simply adhering to received wisdom (Gabbard and Ogden 2009). The linear trajectory of an opening phase, a
middle phase, and a termination phase often doesn't square with the messiness of analytic practice. As Schlesinger (2005) notes,
psychological endings and beginnings tend to be delinked from any overarching chronological trajectory.
Over the last thirty years of analytic practice, my views on termination have shifted. My growing awareness that the ending of an
analysis is a highly idiosyncratic clinical phenomenon has led me to do a good deal of rethinking about how we might define a “good
enough” termination. In my own development as an analyst, I was particularly struck by how my clinical experience with terminations
was dramatically at odds with what I had been taught to expect. Here I will examine the myths surrounding termination, knowing they are
part of a larger mythic structure of psychoanalytic thought that may constrain us in the consulting room. I will also offer some thoughts
about the varieties of termination that may ultimately be “good enough.”
The Concept of Termination
I was trained in an era in which the interpretive resolution of the transference neurosis was emphasized, perhaps even valorized.
Eissler's vision of interpretation (1953) haunted my choice of interventions as I sat behind the couch. When I departed from an interpretive
approach, I knew that I must somehow interpretively resolve the “parameter” I had used. Then I noted that some patients, at some points
in the analysis, do much better with noninterpretive interventions than with systematic interpretation of the transference neurosis. I was
sufficiently stubborn and rebellious to pursue what I thought was helpful to the patient rather than what my supervisors dictated I should
do.
I was also influenced by Freud's comment at the end of his classic 1912 technique paper that no one can be destroyed in absentia or in
effigy.
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Whatever Freud had in mind when he wrote that passage, I took it to mean that the transference must disappear by the end of the
analysis. In addition, without knowing it, I had fallen victim to what Silverman (1985) has termed the myth of the perfectly analyzed
analyst.
In this regard, I was influenced to a great extent by my teachers and supervisors. I once attended a seminar by one of the leading
psychoanalytic educators of our time. In the midst of his commentary on my case presentation, he wagged a finger at me and admonished,
“If you're thinking of terminating a patient, and he still has symptoms of any kind, you need to question whether he is ready to terminate.”
I was nonplussed by this comment—apparently I was falling far short of this analytic ideal of eradicating all of my patient's symptoms. I
found myself adrift in a sea of imperfections—both my own and my patient's.
As I approached the termination of one of my control cases, an esteemed supervisor of mine explained to me that
the termination phase should involve approximately one month for each year of the analysis. Hence a six-year analysis should have
a termination phase of six months. I seized this formula with gratitude. He was providing me a thread of certainty in the context of
massive ambiguity. However, this formula rapidly began to fail me when I discovered that many patients have very different ideas about
the duration of a termination phase and are thus at odds with the formula. Some patients even wish to bypass the termination process
entirely.
Another supervisor was dismissive when my patient voiced a wish to terminate. He reassured me that when the issue
of termination first comes up, it is always a “resistance” and should be dealt with accordingly. He seemed confident of this formulation,
but neither my patient nor I shared that confidence.
There can be little doubt that termination has been idealized in psychoanalytic discourse. Bergmann (1997) has observed that analysts
have traditionally been more preoccupied with what psychoanalysis should achieve than with what it realistically can achieve.
“Termination,” as opposed to the ending of an analysis, generally implies that the analysis has come to an end through mutual agreement
and negotiation by patient and analyst rather than by a financial setback or an unplanned relocation of the patient. There is also the
implication that patient and analyst must allow sufficient time to work through the patient's feelings regarding the loss of the analyst and
the changes that have been made in the course of the analytic work (Schlesinger 2005). In my years as director of a
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psychoanalytic institute, and in my subsequent work as a consultant and supervisor of other analysts, I have come to recognize that few
analyses end according to this idealized view of termination, an observation made by others as well (Novick 1982; Novick and Novick
2006; Orgel 2000; Schlesinger 2005).
In the early decades of the development of psychoanalysis as a profession, the authority of the analyst was critically important in
determining the patient's readiness for termination. The analyst was considered to have the capacity to make a clear and objective
judgment on termination, as in the well-known quotation from Ernst Ticho (1972): “The analyst should know what he considers a mature
human being to be” (p. 318).
In reality, the analyst often harbors a good deal of uncertainty regarding how much improvement the patient really has made, how
much additional change could be accomplished with an extension of the analysis, whether the analyst's own value system is clouding
things, and whether or not the current gains are a function of the transference and will disappear in the absence of the analytic
relationship. Bergmann (1997) states frankly that psychoanalysis lacks a paradigm for termination. Freud himself did not include
the technique of termination in his technique papers.
Termination presents both parties with an extraordinary challenge. In his 1915 paper on transference love, Freud noted that “the
analyst pursues a course for which there is no model in real life” (p. 163). This statement is nowhere more applicable than in a discussion
of termination. In real life, of course, an intense relationship involving love and profound attachment is brought to an end only by death,
by extraordinary rage, or by severe narcissistic injury (Bergmann 1997).
Freud (1937) included in one of his final contributions the observation that “the business of the analysis is to secure the best possible
psychological conditions for the functions of the ego …” (pp. 249-250). This comment is difficult to operationalize, and Firestein (1982),
after surveying a group of senior training analysts about their views of termination, observed that there is a tendency among analysts to
“enshrine certain clinical aphorisms” (p. 495). The reliance on aphorisms is understandable in light of the impossibility of prescribing a
standard analytic approach for something that is highly variable. Yet Abend (1988) warns that relying on typical fantasies and issues
during termination may inhibit the open-minded receptivity to the uniqueness of each analytic unfolding.
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“A Practical Matter”
The problem in theorizing about optimal technical strategies for termination reflects a more general problem in psychoanalytic
education and practice. Psychoanalysis as a discipline is about the idiosyncratic, the unique, and the overdetermined (Gabbard 2007). It
does not lend itself to reductionistic etiological formulations or generic technical approaches. Idealized models of termination are
constructed as a way of attempting to manage the array of different endings to analytic work, all of which call for imperfect choices.
Hence the interpretive resolution of the transference neurosis, the eradication of symptoms, the achievement of “full genitality,” the
modification of the superego, and the ability to love and work are often clustered together as indications for a termination process that will
take several months and be mutually agreed on. Theories do not help us much when faced with termination. As Ferro (2002) stresses,
borrowing from Bion, terminations are based not on predictive theories, but on permissive models that are reinvented each day.
Freud (1937) viewed termination as “a practical matter” (p. 249). The original German could just as easily be translated “a matter of
practice,” stressing that various developments in the course of the analysis involving the patient or the analyst would arise that would be
key determinants of when the analysis ends. Hence the practical was contrasted with the ideal. In a scholarly examination of thirty-six of
Freud's cases between 1910 and 1920, May (2008) found that two-thirds lasted fewer than 250 hours. Some lasted only a few months.
Above all, Freud was pragmatic. Many ended at the beginning of his nearly three-month summer holiday. He started some analyses
knowing that the person would be in the city for only a short time. May notes that only one or two of Freud's patients were in truly open-
ended analyses.
Equally common is that a patient wishes to terminate because he or she feels the goals of the analysis have been accomplished.
Frequently there are significant disparities between the analyst's goals and those of the patient (Gabbard 2001). It is possible, of course,
that the patient may be enacting a flight into health. However, it is equally plausible that the analysand is presenting an entirely legitimate
view stemming from a set of goals more limited than the analyst's. In this situation, if the analyst offers the view that the patient is not
ready to terminate and needs further analysis, the patient may simply defy the analyst by terminating anyway. However, the patient is then
left with a complex set of residual feelings:
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anger, resentment, guilt about disappointing the analyst, and a gnawing uncertainty that the termination may be a mistake. Other patients
may dutifully comply with the analyst's recommendation to stay, while secretly resenting it and merely going through the motions of
treatment to satisfy the analyst. The latter situation, of course, is common in training analyses, where the analysand feels that a particular
trajectory of the analysis with an idealized termination phase is required to earn the mantle of “psychoanalyst.” Subtle forms of coercion to
continue the analysis often lead to an “as if” analysis—a situation of “false self” compliance to please the analyst.
Psychoanalysis, though, is a noncoercive collaboration involving a process of two people thinking what either alone cannot think. The
risk of transforming the analysis into a power struggle is considerable at the time termination is negotiated. Analysts must be wary of this
risk and be prepared to accept less than optimal outcomes (according to their idealized criteria) if the patient feels satisfied and wishes to
move on in life.
In contrast, some patients who unconsciously wish to initiate a sadomasochistic enactment bring up termination as though it were a
gauntlet thrown at the analyst's feet. They hope to continue rather than stop. The extent to which the desire to terminate
represents enactment and flight rather than a realistic move toward autonomy and agency is a complex assessment. Both elements may be
present. However the analyst responds will create disappointment in the analysand at some level, as in the following vignette.
Ms. T. was a thirty-seven-year-old woman who came to analysis after numerous failed relationships. She inevitably re-created a
sadomasochistic relationship that was reflective of years of intense struggle with her father to free herself from his efforts to control her.
After five years of analysis that had allowed her to make substantial improvement and maintain a stable relationship with a man who was
sensitive and considerate, she ended a session by telling me that she wished to terminate. There was no time to discuss it, so I suggested
we could talk about it at the next session.
When she arrived, she launched into an emotional tirade: “I am ready to terminate, but I'm furious at you for reacting so casually when
I brought it up yesterday. I'm hurt that you would let me go! You had time at the end of the session to say something. But you just acted
like it was a regular session and ended it as usual. I imagine that you've just been waiting for me to leave and you're relieved. If that's true,
then by God I'm not going to quit. I'll just stay!”
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I responded that it was hard for her to imagine that I could care unless I fought with her about her decision.
Ms. T. replied, “Well, would you let me terminate if I wasn't really ready?”
“Would I let you terminate?” I echoed back. “I think the idea that you have the freedom to choose terrifies you.”
“I have made terrible decisions all my life. What if I screw up this decision as well? Aren't you going to stop me?”
I again suggested to her that my refusal to forbid her to leave was construed as a sign that I was fed up with her. I asked her if there
was any other way that she could understand our interaction.
Ms. T. replied, “You know what my parents were like. I never experienced anyone who expressed love by letting me do what I wanted
to do. I had to follow a script that they had written for me. I have put considerable energy into getting you to fight with me and control me,
but you won't. I have caught you by surprise a couple of times, and I felt so powerful when you fell out of your analyst role and tried to
persuade me to do one thing or another. But I can tell that you always see that as a problem and right yourself. I know I'm going to walk
out of here feeling you don't care because you won't get into it with me. There are so few things that I have any control over—only if I
come or not, whether I pay the bill or not, and whether I talk. That's it!”
A silence ensued. Then she said, “How have you tolerated this? I don't want to leave analysis with you thinking I was a pain in the ass.
I feel I have to make everything right.”
I told her that she wasn't able to make everything right with her parents and probably wouldn't be able to do that with me, either.
The analysis did not end—by her choice. It continued in a rather extended termination phase. I wondered at the time, “Am I colluding
with her defiant enactment of not terminating?” Frankly, it was not clear. To proceed with termination would have been perceived by her
as a cold, sadistic act of indifference. To insist on her continuing would be perceived as sadistic coercion.
Nearly two years later, she arrived and told me a dream: “I was in my house holding a quilt, and my father came and told me that the
junk man had just left. He had hauled off the trash in the backyard. My father seemed pleased. I looked outside and the yard was clean, but
I felt sad and frightened. I cried. I felt like a child. I told my father I wanted the junk man to return the junk to the yard.”
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 In her associations to the dream, Ms. T. talked of her ambivalence about ending: “As long as I'm unhappy with men, I can punish
my father. I can make him feel bad about how he treated me as a child. It's revenge. (She paused.) The quilt I was holding was my security
blanket, my wish not to grow up. Quilt rhymes with guilt, doesn't it?”
“Yes, it does,” I acknowledged.
Ms. T. thought for a moment: “There's a part of me that wants to hang on to all the junk inside me so Dad will feel the guilt that he
deserves to feel.”
I noted that she seemed to be the one clutching the quilt in the dream, and I wondered if she was hanging on to guilt more than
her father. I went on to say that I wondered if I was the junk man hauling off her own guilt, and she wanted me to stop.
She replied, “Dad always wanted to brag about how well his daughter is doing. In the dream he admires the clean yard.”
I said that she wanted to reclaim that junk, and the guilt that the junk man wanted to take away. I pointed out to her that she was now
feeling guilty about how she had treated me.
Ms. T. reflected a moment, and said, “I have treated you like a junk man instead of an analyst. I guess I'm the junkyard dog. I'm
so ambivalent: I want a clean yard or a clean psyche—whatever. But I don't want you to stop worrying about me, and I don't want you to
take credit like my dad for my success. Do you think I have been obnoxious to you?”
I replied, “I think at times you have treated me with contempt and that you feel guilty about that. And now you feel I'm removing the
junk from you so that I'm also taking away your role as the junkyard dog. This worries you because you've clung to that role as a way of
refusing to relinquish a particular dance that went on with your father and now with me.”
In this vignette Ms. T. was deeply ambivalent about ending the analysis. The conflict continued beyond the last session. She wished to
advance developmentally but did not want to give up the sadomasochistic bond with her father or with me. Her initial wish to terminate—
two years before her actual termination—was both an invitation to join her in a sadomasochistic enactment and a genuine desire to
become autonomous from a controlling and persecuting internal object. When she “defied” me by staying, her decision was similarly
double-edged—an enactment of defiance against a rejecting internal object and a recognition that she needed further analysis.
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Because of the anxieties about ending the treatment, we analysts are always in danger of selectively focusing on only one aspect of the
patient, rather than holding the complexity (Gabbard 2007). Rosenfeld (1987) cautioned that under the sway of intense anxiety, analysts
frequently stop thinking. They are prone to collude with only one part of the patient's personality to keep the other, unwelcome dimension
out of mind. This form of splitting is especially common when we wish to see the ending unfold according to our
preferred unconscious narrative. With Ms. T., I had to struggle with my own wish for a happy ending that obscured her need to continue to
torment me even as she left the analysis.
In a letter to Fliess, Freud commented on the termination of one of his patients (Strachey 1964): “I am beginning to understanding
that the apparently interminable nature of the treatment is something determined by law and is dependent on the transference. I hope that
this residue will not prejudice practical success…. the asymptotic termination of treatment is substantially a matter of indifference to me;
it is for outsiders rather that it is a disappointment” (p. 215). In this quotation, Freud clearly states that he is willing to accept less than
idealized circumstances for termination and outcomes that fall far short of perfection.
There is no reason to believe that the best possible psychological conditions for the ego can always be achieved after a designated
number of years in analysis in one particular developmental phase of the patient's life. It is now commonplace for some patients to engage
in a kind of “intermittent analysis,” where they return periodically for periods of analytic work based on particular conflicts that are
triggered by life events. Indeed, at least ten of Freud's thirty-six patients in May's study (2008) were seen intermittently over the years as
needed. Hence when patients are perhaps in too much of a hurry to end the treatment, it is critically important for the analyst to pave the
way for the patient's return. We must, of course, try to understand the rush to leave, but zealous attempts to persuade the patient to stay
longer may be fatal to the alliance needed for analyzing.
Outcome and Termination
Considerations of termination cannot be divorced from an evaluation of the goals and outcomes of psychoanalytic treatment. We all
want alleviation of suffering and substantial improvement in the areas that brought the patient to analysis. We want the lost soul to find the
long-desired
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romantic partner, and we want the patient inhibited in work to gain a promotion and become assertive. Freud clearly did not envision
happy endings. He knew that suffering would continue and that “common unhappiness” was inherent in the outcome. In New Introductory
Lectures, Freud (1933) commented that he had never been a “therapeutic enthusiast” (p. 151). En route to Clark University in 1909, Freud
shared his contempt for America with Jung and is alleged to have said that the Americans were not aware that he was bringing them “the
plague” (Roudinesco 1999). Possibly he knew that the American psyche—infected with variations of “manifest destiny,” the “New
World,” and the “Promised Land”—would need to alter the narrative of psychoanalysis to conform to the vision of the
American dream embedded in the culture. Indeed, psychoanalysis ultimately appeared to follow a Hollywood narrative of happy endings
that led to the overpromising of what analysis could do—it was the panacea for all social ills.
We analysts, however seasoned, jaded, and callused we may be, secretly hope for uplifting endings. Our teachers and mentors are
influential, but we must own the responsibility for perpetuating the mythology. In an era of diminishing practices and shrinking institute
classes, some colleagues want to “sell” analysis by painting a rosy picture designed to please the consumer. Others cling to the view that
analysis brings about an idealized version of structural change and dramatic symptom relief. Thinking about analysis as a remover
of symptoms places an undue burden on the treatment. Some symptoms (e.g., certain forms of anxiety) are essential signals of inner
turmoil. We can't do without them.
Psychoanalytic treatment acquaints patients with a way of thinking about themselves that facilitates the appreciation of meanings,
attachments, symptoms, and unconscious fantasies and fears. We must accept that no analysis is complete—rather, a process is set in
motion. Orgel (2000), in a thoughtful contribution on the reality of termination, asks poignantly if any analysand ever ends analysis with
an emotional conviction that it is complete. Kogan (2007) notes that “there is no such thing as an ideal termination; the symptoms never
disappear completely; the patient does not achieve all of the structural changes one would like; nor does he manage to acquire a totally
integrated personality” (p. 43). Schlesinger (2005) cites Leupold-Löwenthal's suggestion (1988) that “infinite” might be a better
translation of Freud's “interminable.” The terminated patient is not “fully analyzed”—he or she is simply embarking on a life of self-
analytic reflection that offers depth and richness to one's
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existence. Suffering, intrapsychic conflict, and problems in work and love will continue. A tragic vision is central to the psychoanalytic
journey (Schafer 1970).
Perhaps an idealization of mourning haunts us as part of our exaggerated expectations of termination. Grief and mourning cannot be
programmed. Grief manages us—we don't manage it. It comes when we least expect it and recedes as quickly as it arrived. We cannot
prescribe how our patients will take leave of us. Working through the depressive position is a lifelong task. We must be wary of valorizing
its achievement. As Ferro, Ogden, Bion, and others note, we oscillate between the depressive and the paranoid-schizoid throughout our
lives.
In a similar vein, transference is not destroyed or “resolved.” In every follow-up study of terminated patients, the findings demonstrate
that transference persists (Gabbard and Lester 2003; Norman et al. 1976; Pfeffer 1993). It can be instantly reestablished during a
meeting with one's old analyst or even with a new analyst.
Neuroscience research suggests that representations of self and others are embedded in neural networks (Westen and
Gabbard 2002a, b). Structural change in psychoanalytic treatment does not involve the total destruction of old object relationships that
fuel the transference. Neural networks cannot be destroyed. They can only be superseded by the strengthening of new models of
relatedness that emerge in analysis such that the old object relations are relatively weakened (Gabbard and Westen 2003). The
characteristic enactments of unconscious internal object relations continue to occur, but the patient who is in analysis begins to observe
these relational patterns as they develop. Hence patients who have benefited from analysis catch themselves repeating the old patterns.
They gain a sense of mastery over the tendency to see people not as they are, but as past figures who haunt their present.
Psychoanalysis as Both a Two-Person and A One-Person Psychology
There is now a broad consensus that the analytic enterprise is both a one-person and a two-person psychology. We accept the analyst's
participation in the patient's transference and recognize that countertransference enactments are inevitable and frequently useful in
advancing the process. Analysts today are skeptical that the “real relationship” can be definitively separated
from transference and countertransference. The classical
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view of the “blank screen” analyst has largely disappeared from our discourse. We acknowledge that the analyst is a real person for the
analysand, and the analysand is a significant figure in the analyst's life.
In the current zeitgeist of two-person psychology and intersubjectiv-ity, we know that both analyst and analysand must disentangle
themselves from a significant connection with another human being that has shaped their lives. To some extent analyst and analysand lose
themselves as separate individuals in the analytic experience, and it is only through termination that each “retrieves” a sense of being a
discrete mind (Ogden 1997). Both parties are different from what they were when they set out on the analytic journey, however, and the
mind retrieved is not quite the same as the mind that began the analysis.
The other implication of this revised model is that the influence of countertransference is ubiquitous (Gabbard 1995), particularly at
the time that one begins to consider the possibility of termination. Some inordinately long analyses undoubtedly stem from
the countertransference reluctance to let go of the patient (Renik 2003). For example, an experienced analyst in another city consulted me
some years ago at a conference. He pulled me aside and asked to take a walk. In the course of this walk, the analyst told me that he had
been treating an intelligent, attractive female analyst who began her analysis as a candidate and had now graduated from analytic training.
She was successful in her work and seemed to have mastered the neurotic inhibitions that had led her to be reticent about success. She was
in a reasonably happy relationship and things had been going well for her in her life. Yet my colleague told me that he just could not bear
to see her go. He said they had a therapeutic relationship that was characterized by considerable humor and caring, in addition to the good
analytic work that had been done. He told me he felt like the Henry Higgins character in My Fair Lady, in that he had “trained” her to the
point where she was successful, but now could not let her go. He commented wryly, “I've grown accustomed to her face.”
He went on to say that he knew he had to embark upon a termination process, and already felt guilty for postponing it as long as he
had. He was convinced that she too was having difficulty saying good-bye. He noted that she seemed to be fabricating issues for the
analysis in the service of prolonging it and convincing both of them that she was not ready to terminate. He was concerned that he was
taking advantage of the patient's good will and not acting ethically. I offered him a series of phone consultations, and over the ensuing
months he was able to start the process
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of termination while dealing with his intense reactions to the loss in our consultative sessions.
As Hirsch (2008) has stressed, we are always vulnerable to misusing theory as a way of remaining attached to our patients. In this
case, my analytic colleague had convinced himself that this patient needed a little more time to feel sufficiently autonomous that the
analysis would be internalized and she could function independently. He finally recognized that he was deceiving himself in this regard to
gratify his own wish to hold on to her. As he and I talked, he noted both an erotic longing for the patient and a view of her as a narcissistic
extension of himself that he could not sever.
Hirsch also calls attention to the fact that the analyst's economic situation is a major factor in how one thinks about termination. While
it is easy to justify one's decisions based on considerations about the accomplishment of goals, the patient's capacity for love and work,
and the patient's ability to continue a self-analytic process, these altruistic clinical assessments are easily infiltrated by the analyst's need
for survival and the creature comforts to which we all aspire. Perhaps one of the greatest psychoanalytic myths of termination is that the
assessment of readiness is based on a set of criteria that do not take the analyst's self-interest into account.
Bergmann (1997) notes that the love experienced in the transference may be the best love relationship that life has offered the patient.
Hence the patient can be reluctant to give up the attachment and may search for new conflicts or stagnate in an impasse situation to
maintain the status quo. The same phenomena can apply to analysts, whose countertransference may feel more real and more fulfilling
than love relationships in their personal lives. The impending loss through termination not uncommonly mobilizes manic defenses in both
parties to deny loss by embarking on a nonanalytic relationship either in fantasy or in action (Gabbard and Lester 2003). Many
egregious boundary violations emerge from the unbearable grief of the termination process. As Orgel (2000) notes, regressive pulls are at
their greatest strength during termination. Bergmann stresses that life experience teaches one that it is artificial and even harmful to bring
about a separation under conditions of gratitude and love. As he puts it, “Psychoanalysis makes demands on internalization that are not
asked for in any other human relationship” (p. 169). Some analysts may counterphobically or even prematurely suggest that the analysis
should end to evade superego pressure that they are exploiting the patient for their own purposes.
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The two-person nature of psychoanalytic work includes a consideration of how the analyst's theory affects what is perceived in the
patient. Moreover, the goals of analysis will be regarded quite differently according to that theory.
 The Imperfect Termination
In a field where there are no perfectly analyzed analysts and no perfectly analyzed analysands, we need to embrace the notion of the
imperfect analysis or the imperfect termination. Those instances in which we feel that we have accomplished all that we can are few and
far between. In most cases, “a matter of practice” will be the determinant of the ending. Hence terminations need to be tailored to the
individual analysand, the dyadic nature of the process, and the practical circumstances. Analysts must embrace a wide variety of
possibilities so that the treatment is tailored to the patient's needs and not the analyst's theoretical preferences.
The patient's concerns about readiness to terminate, financial setbacks, and practical matters of time in one's schedule must be
recognized and taken seriously, and not discounted as mere manifestations of resistance. The analyst approaches them as reasons for
disruption, accepting that it cannot be known in advance whether the patient will need to return for more analysis in the future.
As I have argued elsewhere (Gabbard 2000), each patient must do analysis in the way that he or she must do it. Patients cannot avoid
enacting an internal object relations scenario that is revealing of who they are. We cannot legislate in advance how the termination should
unfold. We must respect our patients' need to do it their way. As Poland (2006) notes, “The analyst is a translator, and the translator has
no right to determine how the patient-author unfolds the story, not even what ending the author chooses. The analyst's responsibility to
question never diminishes the patient's full right to unique, personal answers” (p. 224).
Some patients feel they must engage in a gradual reduction of the frequency of sessions as a way of testing the waters before making a
final separation. Sabbadini (2007) argues that this practice is ill advised: “If the patients are ready, they should end, and if they are not,
they should continue” (p. 711). His concern is that ending through this process of “weaning” (an unfortunate term) means bypassing the
experience of losing analysis. Instead, one ultimately loses a diluted version of treatment that has ended. I have a different view. As Bion
(2005) suggested in
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his Italian seminars, we must acknowledge that sometimes only the patient knows what is best for him, and that may fly in the face of our
theories, biases, and subjective preferences. It may be of greater therapeutic significance for the patient to chart his own course
of termination than to comply with what the analyst feels is a necessary ending to an analytic process.
Britton (2002) reminds us that there are borderline patients who cannot terminate—those who have suffered severe early trauma or
neglect, serious attachment difficulties, and other deficit conditions may not be capable of classical termination scenarios. Freud
(1933) observed that there are “severely handicapped patients who are kept under analytic supervision all through their lives” (p. 156), and
May's study (2008) revealed patients in Freud's practice who were in a kind of continuous analysis. As Freud noted, “These people would
otherwise have been altogether incapable of existence and we must feel glad that they can be kept on their feet by this piecemeal and
recurrent treatment” (p. 156).
In his follow-up report to the Menninger Foundation Psychotherapy Research Project, Wallerstein (1986) noted that some patients,
those he termed “therapeutic lifers,” had good outcomes as long as they never had the threat of termination over their heads. They might
need only occasional appointments every six months or so, but they knew their analyst would be there for them. Most senior analysts have
patients like this in their practice, though they may be loath to acknowledge it in public. We need to reach a point in
professional discourse at which these patients are not stigmatized as “failures.” For certain patients, true internalization of the analytic
process in the way that we classically regard it may be next to impossible. Thomä and Kächele (1994) have suggested that for some
patients a model based on the family doctor one consults when necessary may be far better than a radical separation.
In the same vein, some patients may need to terminate rather abruptly, even when there is clearly more work to do. Practical
limitations of time and money may enter into this, and intrapsychic barriers may also be sufficiently powerful to disrupt the analytic
process. There are other patients who must be analyzed with “one foot out the door,” which assures them that they will not be swallowed
up or annihilated by the intimacy of the analytic process. We try to understand the sources of anxiety, but we always fall short of a
complete analysis.
Finally, some patients can change only after they are out the door and out of sight of the analyst. They may wish to deprive the analyst
of
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gratification related to their improvement (Gabbard 2000). We don't always know who they are in advance of the termination.
Concluding Comments
 What is a good enough termination?
As I suggested at the beginning, this question cannot be answered generically. Psychoanalysis is about the particular rather than the
general. As noted above, Bergmann (1997) observes that in our field we lack a paradigm for termination. This is as it should be. There are
multiple scenarios that are “good enough.” We must maintain a humility about what we know and what we can achieve while respecting
the idea that the patient may know better.
What we can do is attempt to analyze the meaning of the patient's wish to stop, the meaning of our
own countertransference contributions to the termination process, and the influence of our own internal narratives about how we would
like analysis to be. We can also facilitate a return to treatment by avoiding coercion and respecting the idea that the patient may know
what's best. For some patients, true termination may be ill-advised; for them, a periodic consultation may be the best course.
Faced with a host of idiosyncratic circumstances in the termination discussions we encounter over the course of an analytic practice,
analysts still must rely on some form of theoretical edifice as a way of thinking about the potential ending of an analysis. What matters to
the analyst in the face of a possible termination? What goals are at the heart of the process?
In my work (Gabbard 1996), I have emphasized the importance of living in one's own skin. Certainly this goal is in keeping with
Grinberg's conceptualization of analysis as a search for truth about oneself (1980). We may operationalize this view in terms of the extent
to which patients have acquainted themselves, even immersed themselves, in their unconscious processes. Hence a central consideration
when thinking about termination is whether a process has been set in motion sufficiently to allow for the possibility of ongoing self-
analysis.
Whatever termination is, it is certainly not the end. Analysands continue trying to work through the loss of the analyst in fantasy,
in dreams, and in other relationships. I leave you with some thoughts of Winston Churchill (1943) that are relevant in this context: “Now
this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.”
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Article Citation [Who Cited This?]

Gabbard, G.O. (2009). What is a “Good Enough” Termination?. J. Amer. Psychoanal. Assn., 57(3):575-594