The Last Act
Separation and Termination of Analysis
(Paper presented during the Symposium on ”Separation”, December, 10-11, 2016, Bogazici University Cultural Center.)
In her famous paper on the criteria for the termination of a psychoanalysis in 1950, Melanie Klein writes that the termination of analysis reactivates the patient’s earlier experience of weaning and the trauma of parting, loss and mourning (Klein, 1950). This phase of termination is therefore an important one as it presents an opportunity to analyze the conflicts and anxieties of the first year of life. These anxieties are divided between persecutory anxieties in a paranoid schizoid position and depressive anxieties that we encounter in the depressive position. We know that the infant in his first year of life will experience the trauma of birth and various other threats to his organism. All that according to Melanie Klein stirs up feelings of annihilation and fear of death. It is during this time that the infant will go through the various phases of separating from the maternal body namely the breast and accept that mother is a separate entity from him.
This weaning time is an important one as this is when the infant fantasizes that he has lost his first love object because of his aggression and greed and wants to repair. During weaning times, depressive feelings are normally increased and mourning is required. This is the best time for integration of the external world and the time to establish the protective aspect of the superego. This is what we expect to see in the termination phase of an analysis too. In the phase of termination of analysis, reality testing should be well established, together with satisfactory object relations. This is also the time when the oedipal complex is processed with what it requires in terms of mourning in a depressive position even if at times persecutory anxieties and depressive anxieties are all mixed but still reduced. At the end of analysis says Melanie Klein, a good internal object should replace an idealized one as the split between persecutory and idealized figures is diminished. It’s also when the patient can process the ambivalence of love and hate.
Integration is a precondition for the introjection of the mother as a complete person not idealized or devalued but a “good enough” mother. This is precisely what the analyst should look for when offering to terminate an analysis with a patient.
I will use parts of a clinical case to illustrate the theory and describe the transference and counter transference during this period of termination with a patient, Mrs. A, which lasted a few months. I will also speak of the very last session.
When Mrs. A came to me nine years ago, she had moved away from her hometown to live in Istanbul. Mrs. A was suffering of melancholic depression, with brooding, inhibition and rumination. She was somatizing, and was constantly exhausted and angry. She told me that she had a creative block and could not draw which was a problem because she was an aspiring artist. She also wanted to separate from her boyfriend as she felt ugly and overweight and could not bear the thought of becoming a mother. Mrs. A often toyed with suicidal thoughts. For Mrs. A, the world was an arid and deserted space and she would often bring recurrent dreams of bombed out and devastated landscapes or of a barren garden with a single dried out dead tree in the middle. Mrs. A’s mother had committed suicide when Mrs. A was a child and away at a summer camp with her school friends. Mrs. A was suffering from a pathological complicated mourning and from a complicated relationship with her internal and external objects. Her excess weight could be linked to the need to incorporate and engulf the lost object to which her Self had identified.
In On Negation, Freud writes about the compensating introjection of a loss (Freud, 1925h). Mrs. A had indeed introjected a dead mother in the meaning of André Green but also a suicidal, depressive and abandoning mother which made it impossible for her to create, and procreate, to become the artist that she longed to be or start a family of her own. Mrs. A was a prisoner of the crypt: her mother’s tomb when she started analysis. How could she separate from mother in order to live?
Mrs. A moved during a long analysis (9 years) through various stages of separation and establishment of object relations: In the beginning, I felt either unseen or totally submerged and certainly stuck and until later when she discovered that I was a person different from her. In each stage of differentiation we needed to work through separation anxiety.
Our separations before weekends and especially before the summer vacations were complicated as her mother killed herself in August when Mrs. A had left for camp. We were then faced with the danger of desperation and the destruction of meaning. Would she find me alive when we both returned from our vacations? Or would I also disappear like her mother did? I felt guilty of leaving, and very anxious during my vacations. In my counter transference, I had to deal with omnipotent fantasies that she wouldn’t survive without me and that she would attempt suicide during the summer break.
During the analysis, Mrs. A started to slowly become aware of her adhesive identification to her dead mother. During the breaks, she would put me in her place by making me live what she must have endured as a child, by making me feel guilty, and anxious wondering if I will find her again when we both returned from vacation or after every week end. All that in projective identification.
After every summer holiday her acting out would threaten the analysis, in an unconscious wish to kill the analyst and the analysis. She would for example, come to the sessions with lice in her hair, perhaps in order to infect my couch, or she would fight with her husband and colleagues also in order to avoid killing me with her anger... in a fatal repetition of her past traumas. I had to survive.
In Shakespeare, Othello in his madness has to murder Desdemona as this is his way to prevent her loss. Fear of separation can also become fear of annihilation so any defense is justified. In destruction, still lies the hope to possess and control the love object.
Kristeva writes in 1989 that if the grip of the object is in danger, violence might follow and feelings of omnipotence, envy and dominating the partner play a great role in the defense against the fate of being separated (Kristeva, 1989).
The wish of separation is not recognized anymore as one’s own inner need of change but it is felt to be an external persecuting danger.
During the termination phase, the guilt of Mrs. A and her omnipotent and murderous fantasies against the mother will replay in the transference. I will have to survive all along.
The analytic process allowed my patient to recover past memories of a good alive mother and a mother that was at times funny and creative, that loved art and encouraged her to draw. Together, they would go to an art shop where they would engage in various artistic activities.
In the analysis, she was also able to identify to a creative analyst who could contain her and survive her unconscious attacks. The analytic process provided her with a creative transitional space in which she and I could play safely. This allowed Mrs. A to slowly separate from the encrypted dead mother and finally become able to start mourning.
Six years after the beginning of the analysis, Mrs. A got married and had a child. She was able to find the job of her dreams working in an artistic association. She also started losing weight and discovered a more feminine self.
Mrs. A was no more mobilized in her melancholic depression but could now speak it and paint it. It’s the symbolic that should take the place of the lost object and art and literature are, according to Kristeva, a symbolic sublimation (Kristeva, 1989). The encounter between her melancholia and her drawing had become dynamic. Mother will be retrieved through the outside world of concrete signs and language.
I would like to concentrate here on the last months of termination.
The last months of termination should be long enough in order to create a new transitional space/time which will allow the introduction of what Freud calls the “verdict of reality” (Freud, 1917 e [1915]) and prepare for the last session.
Mrs. A brought to the session a recurrent dream which led to our decision to think of termination. Mrs. A dreamt that she was back in her old neighborhood and strolling through the streets with a sense of appropriation. She will describe in detail all the buildings, the trees, the smells, the colors. She expressed a new wish to return to her hometown and live there in order to teach art to the children victims of war and conflict. A need for spatial integration and readiness for transmission that comes at the end of her analysis.
After years of analysis, Mrs. A was finally showing Ego capacity to deal with separation anxiety and capacity to be alone, to love and be loved. “Buoyancy” which is a term used by Jean Michel Quinodoz (Quinodoz, 1993). Quinodoz writes that “buoyancy is the synthesis and culmination of complex processes of integration, which we have worked together to create a temporo-spatial psychical space of relationship, a space whose nature is fundamentally different from that in which separation anxiety rules”. In other words, Buoyancy is a feeling of existing and flying with one’s own wings. Towards the end of analysis this happens when the patient feels that he has introjected a self-supporting capacity. However, this feeling always comes with some sadness as the analysands is going to feel that his relationship with the analyst is coming to an end. However, we are far from separation anxiety.
Despite all that, once we had decided on a termination date, Mrs. A started arriving very late to her sessions, cancelling last minute, leaving the sessions before the end. Her acting out and anger fits started again. I started feeling hopeless, very sleepy and glued to my chair, paralyzed, unable to interpret or react. Where we back in the crypt?
During that difficult phase, she started sleeping again in the sessions, as acting out had started replacing the dreaming and so did somatization, lack of mentalization and concretization.
Acting out is in a way an attempt to find an object in which to deposit projections and discharge anxiety, an object to carry and contain the patient’s projective identification. Often patients will re-introject this anxiety in themselves. Acting out is also a defensive or protective attempt against the psychotic parts of the self in order to avoid psychosis and disintegration due to the dread of separation. In the final phase of the analysis we will see a repetition of the phantasy that she killed her mother with her murderous and envious attacks. She fantasized that I too would not survive and that I would get depressed and die when she would leave analysis making our separations before the weekend again very painful and difficult.
In addition, she will start bringing recurrent dreams of falling into a well, of getting pregnant and then miscarrying. Mrs. A and I could elaborate together how she was trying unconsciously to miscarry the separation time and the termination part of her analysis in identification to a suicidal mother and to an abandoning mother who could not contain and hold her. But this was also a way to control separation with the love object and kill the object in order not to say goodbye. For Mrs. A, separation meant death and destruction.
Kristeva writes that melancholia stems from the denial of separation from the mother. An impossibility to mourn the loss of the symbiotic relationship and mourn the maternal object. A denial of the “matricide” which says Kristeva is a vital necessity (Kristeva, 1989, p. 28).
According to Kristeva, the separation from and loss of the mother is a biological and psychic necessity, the condition of our individuation but it has to be eroticized. How would that unfold at the end of analysis?
Instead of killing the mother, the melancholic introjects the maternal object and kills the self. It’s a matter of “to kill or be killed”. This is the danger of what could be replayed once we decided to end analysis and set up a date for the ending.
So the end of analysis is a long period in which the components of primary depression will get reactivated but also the depression that stems from the oedipal disappointment and the exclusion from the primal scene. With the internalization of “buoyancy” the psychical object relations space becomes established with the oedipal complex and its resolution. Indeed, towards the end of analysis the patient will have to accept the impossibility to have her infantile wishes fulfilled and gratified. During the last month of her analytic process Mrs. A dreamt that she was standing on a sea shore and that the adults who were with her would say no to all her demands. She felt rejected and kept at a distance from the group. Mrs. A will speak of her sadness of having to renounce to have a social relationship with me and will find a yoga workshop in my neighborhood in order to (she says that laughingly) pass in front of my window. She fantasizes that I would watch her pass by.
Bianca Lechevalier writes that what should unfold at the end of analysis “is no more the symbiotic transference on a frame, which represents the maternal body but the alliance in a work that is conducted in triangulation“ (Lechevalier, 2015).
Mrs. A refers a friend to me. Is she sending me a replacement to control and watch over me? Is she making me a gift before termination or making sure that she will not abandon me to emptiness and depression? An unconscious wish to verify through her friend that I am still alive. In the last sessions Mrs. A will speak obsessively about the dangers facing Turkey and the dangers of terrorist attacks. We were able to elaborate that what was dangerous for her also, was to leave analysis but also the danger of her unconscious wishes to attack the analyst who is letting her go. Mourning the end of analysis is always also about ambivalence and death wishes.
In the last week of her analysis Mrs. A tells me that she wants to find an art workshop for herself and her child. In a repetition of what her mother did with her. Here we are into transmission of something very libidinal and alive. Mrs. A will also speak of a singer from her village, describes the smells and colors and the dialect. She expresses wishes to move back to her village eventually and build an art school there for under-privileged children. She wants to return home she says and I am thinking: and reunite with the mother of the beginning of life.
She says: “My child is fascinated with the fire in the chimney in Cinderella’s story” (she often referred to Cinderella during her analysis). The good fairy is here now. Mrs. A’s internal objects are warm and alive. We are far from the cold icy eyes of the shark that loomed so often in her earlier recurrent dreams. She is ready to keep the fire burning… the fire of life.
She says: “I don’t want to be Cinderella anymore”, Cinderella who sweeps the ashes of her dead mother… and you will continue living without watching me pass by your office from the window”.
About the last session:
Do we need to differentiate it from all the others?
Bianca Lechevalier describes the last session as an abutment or roc that will reactivate the oedipal issue. She writes:
“Fixing a limit can be lived by the patient as weaning or castration and with time that comes to a stop the patient might live it as something of a death.” (Lechevalier, 2015, p. 198)
The last session constitutes in a way the superposition of the real limited time (the frame) and the unreal unlimited time (the analytic thinking and its insights and après coup). Real time as Freud writes in 1915 in his verdict of reality (Freud, (1917 e [1915]).
Some analysands will feel that the superego function of the frame will disappear in the last session and they will act in their primary fantasy in a manic way. Some will bring a present, sweets, flowers… We must maintain the frame till the last second and it is the dreams of the patient that can then enact the fantasies of the moment.
Mrs A wants to bring me her artwork and she wants me to give her a book, all concrete expectations. I tell her that we can imagine together our last exchanges… So on the last day she comes in with a dream, her last gift.
“My colleague is having an affair with the director of my art association. I am shocked because he is married. Then, there are sentences and comments published on a secret twitter account. Those could provoke a scandal and could be censured by the government”. We are in the primal scene and in an oedipal situation. The analyst will replace her with another patient, maybe her friend that she just referred to me.
The paternal function is not here just to separate the patient from the body of the archaic mother but is actually playing a part in the oedipal situation. Mrs. A has to renounce her omnipotence and has to renounce the father/analyst who will not gratify her infantile wishes.
Serge Viderman writes that the last session deconstructs the analytic space (Viderman, 1974). Mrs. A will mention for the first time the objects and furniture in my office as if there was suddenly a modification of space. The analytical space becomes a real space with real objects instead of being an imaginary space symbolizing the maternal body. Here too the patient will be confronted with mourning the rituals and the real objects together with mourning the transference, the imaginary and fantasized objects.
Often, when the patients come back to see the analyst years later, they will be surprised to discover a smaller or bigger couch or that the analyst is smaller or bigger than what they had perceived during their analysis.
The end of analysis is also about separating with the frame and its containing function, the psychic aspect of the frame and its maternal and paternal functions but also the sensorial, sensual, sexual aspects of the frame that represents the maternal body (placenta, umbilical cord, first exchanges between mother and baby). We know from José Bleger’s article that the frame is the expression of the most archaic fusion or symbiosis with the maternal body but also it is the protection against this symbiosis (Bleger, 1979).
How can one speak of termination of the transference without addressing the counter transference of the analyst: Separation was after all something that we both shared. We were then to live together the pains of separation and mourning each other in an act of reciprocal gratefulness.
During this period of termination and also while writing this text I found myself dreaming on many occasion of my analyst and thinking about my own analysis and my last session. It is the notion of “après coup” that makes the analysis interminable.
The counter transference is still at work in the après coup after the last session.
And we analysts, often never see our patients again. Our dreams will permit the continuation of elaboration of this counter transference. Bianca Lechevalier describes the last session calling it a “suspended bridge” as to indicate that there will be many “après coups” to this last session (Lechevalier, 2015). That even if the last session is in a way a suspension of meaning it could be looked at as a “suspended bridge”. Sometimes, says Lechevalier, the development of our patients in the years after termination is tragic or painful. We sometimes learn about it. What happens then to our counter transference? How do we deal with it? All those issues are for us to reflect upon, to think about.
Mrs. A looks at her watch and says:
“It is almost the end… It will be hard not to see you or hear your voice anymore. My little daughter doesn’t like goodbyes. We were reading together Cinderella and she said that she wanted to find me a prince charming so that she can keep her daddy for herself but my husband told her that one day she will find her own prince”. I make a note to myself that we are ending Mrs. A’s analysis with an oedipal fairy tale. The patient and the analyst will have to renounce seeing each other in another context.
Mrs. A laughs and says … “It’s funny, but I just had a thought… I could maybe write a book in the future and illustrate it… Also, I’d like to buy an apartment.
Mrs. A’s libidinal investments are being transferred here in the last minutes of analysis from the analyst and the analysis towards other interests, like art, and humanitarian work, in order to repair, but maybe also in gratitude.
Mrs. A: Nine years in analysis with you… like 9 months… a time of creation… It reminds me of the quote from Shakespeare’s the Tempest:
“What is past is prologue…”
Mrs. A gets up quietly and moves towards the door, as always since 9 nine years, the same gesture, the same handshake, the same goodbye.
Termination of analysis always ends with a movement, a door is open and a door is closed, on another primal scene.
References
Bleger J. (1979), Psychanalyse du cadre psychanalytique, Kaës R., Missenard A., Kaspi R. et al., Crise, rupture et dépassement, Dunod, 257-275.
Freud S. (1917 e [1915]), Deuil et mélancolie, Métapsychologie, trad. fr. J. Laplanche, J.-B. Pontalis, J.-P Briand, J.-P. Grossein, M. Tort, Paris, Gallimard, 1968 ; OCF.P, XIII, 1988 ; GW, X.
Freud S. (1925 h), La négation, Résultats, idées, problèmes, II, Paris, PUF, 1985 ; OCF.P, XVII, 1992 ; GW, XIII. P. 235-239
Klein M. (1950), On the criteria for the termination of a psychoanalysis, Int. J. Psychoanal., 31:78-80.
Kristeva J. (1989), Black Sun, Columbia University Press.
Lechevalier B. (2015), Irruption du temps dans la butée de la dernière séance ou pont suspendu dans son après-coup ? Temporalites Psychiques en Psychanalyse, sous la direction de Myriam Boubli et André Barbier. In Press Ed. 193-208.
Quinodoz J.-M. (1993), The Taming of Solitude: Separation Anxiety in Psychoanalysis. Routledge. p. 181.
Viderman S. (1974), La bouteille à la mer, Revue française de Psychanalyse, 2-3, 323-384, p. 383.