Dr. Gabbard, presented this paper to the plenary panels at the International Congress of Psychoanalysis in Vancouver and published it in the International Journal of Psychoanalysis. My aim is to summarize aspects of the paper and offer some of my reflections.
The author introduced the main theme of his work saying“ In passing Freud offered the following thought: “One feels inclined to doubt sometimes whether the dragons of primeval days are really extinct” (1937, 229).
Freud was openly acknowledging that the infantile dread of being ignored, rejected, scorned, hated, unwanted, despised or abandoned is a force that lives on despite positive experiences later in life that theoretically might mitigate against it. p. 595. Freud’s paper is complex and pessimistic in nature accentuating the strength of the drives and the infantile longings that cannot be tamed.
Gabbard, forty years ago, when he was in training at the Menninger Clinic, attended many conferences on interminable cases. He was perplexed and intrigued by some comments made by the senior analysts. One of his puzzlements was that one supervisor advised him that the termination phase had to be equivalent to the years of analysis. He was skeptical about prevailing views about termination and outcome of analysis. He felt that some discussions had mythical aspects transmitted from one generation to the other.
In (2009) he published a seminal paper to demystify the many aspects of termination. This research contradicted the many myths proposed in the literature. Briefly, many patients, when ending their analysis, felt abandoned during the termination. This differed from others where their major dissatisfaction was feeling forced by the analyst to stay in treatment. For some their level of dissatisfaction led them to begin a second analysis. Most of the time the analysis did not finish in a collaborative manner. Gabbard also found a group of patients who did not want to finish the analysis. These patients were “therapeutic lifers”, a term coined by Wallerstein in his book Forty-Two Lives in Treatment”.
Many reasons emerged why patients did not want to terminate. One aspect was the function of transferences, the patient was attached to the analyst who was the best relationship he/she ever had. Another aspect was linked to a particular form of object relatedness that started early on in the patient’s life. These patients maintained a link to the object, a stubborn wish to not be separated in order to maintain an infantile attachment. Gabbard, in a skillful manner, introduced a theoretical – clinical idea that emerged from the British Middle School. He stated “Winnicott’s description suggests that, in some cases, the intensity and pervasiveness of the infantile in our work may best be glimpsed by studying the defences against the infantile. The prospect of painful losses, troubling experiences in the maturing process, the obligatory recognition (and terror) of ageing and the inevitability of death may reactivate the darkest nether-regions of our unconscious. Moreover, the prospect of termination may awaken long-buried traumas, bringing patients face to face with unmetabolized experiences of complicated efforts to separate from their parents that were fraught with conflict and tears. Many analysands harbour (harbor?) a fantasy that the analytic dyad will create a form of reparenting that will replace the disappointments with their own parents. We analysts may unwittingly encourage this view.” p.598. The author, integrating the work of Ogden, Winnicott, and Loewald, articulates an intersubjective model that also takes into consideration the defences against the infantile.
In synthesis, Gabbard’s idea is that the infantile is very present in our life. An important point is that the analyst, like the patient, also has to tame his own dragons. Gabbard recalled that in his second analysis during termination his own dragons came to light with many painful memories that helped him to understand the pain of loss.
The paper concludes with some suggestions. The author does not believe in strict rules or techniques on how to terminate an analysis. The analyst must have tact to finish an analysis, an idea which is not clear. One is left to conjecture: Is it kindness, respect, humility, harm mitigation? All come to mind. Given its ambiguity, Gabbard calls on the analyst to extend a form of elasticity that respects a patient’s limitations and resists imposing any form of “idealized” myths.
This paper is a must read. It is written in a clear and engaging manner and could open a new vision in teaching the termination phase in analysis.
My comments will be brief. The vast literature suggests a change from a dogmatic stand on termination to a more flexible way, emphasizing the unpredictable and surprising.
Michel Gribinski (2002)” in Les Separations Imparfaites” (Imperfect Separations) thinks that every separation and ending is imperfect. The patient must leave his past dragons; the analyst must alter his theoretical thinking creating new words that will bring a certain kind of aliveness in analysis.
From another angle Paul Ricoeur (2020), the eminent Freud scholar, focuses on mourning and loss. For Ricoeur, the loss of the object recaptures the history of the subject and thus the loss and history are elaborated again. At the end of an analysis there is still suffering but is more tolerable with greater self-awareness.
In the age of the pandemic, I think terminations will be more powerful. The loss of our own mortality as well as the loss of people around us has accentuated the magnitude of this catastrophic event. We live in an unpredictable state of mind with much uncertainty. It is important for us to remain internally vigilant over our own primeval dragons, minimizing their potential to intermingle and influence the work of termination in unexpected ways.
References:
Gabbard, G. O. (2021) “The dragons of the primeval days: Termination and the persistence of the infantile”, International Journal of Psychoanalysis. V.102, Issue 3, p.595 -602.
Gabbard, G. O. (2009). “What is A “Good Enough” Termination?” Journal of the American Psychoanalytic Association 57: 575–594.
Gribinski, M. (2002) “Les Separations Imparfaites” (Imperfect Separations). Éditions Gallimard, Paris.
Ricouer, P. (2020). Attorno alla Psychoanalyse.(Around Psychoanalysis) Edited by Francesco Barale. Jaka Book. Milano
I would like to thank Dr. Sharon Neuwald for her editing and suggestions.
