Good Goodbyes Knowing How to End in Psychotherapy and Psychoanalysis

by Novick, Jack; Novick, Kerry Kelly

• ISBN13: 9780765704122
• ISBN10: 0765704129
• Format: Hardcover
• Copyright: 2006-03-07
• Publisher: Jason Aronson, Inc.
• More Book Details
• Purchase Benefits

Summary

Life is full of comings and goings, helloes and goodbyes, meetings and partings.

Author Biography

Jack Novick is a child, adolescent, and adult psychoanalysts who trained with Anna Freud. He is on the faculties of the Michigan Psychoanalytic Institute, the Michigan Psychoanalytic Council, the New York University Psychoanalytic Institute, the New York Freudian Society, the Chicago Center for Psychoanalysis, and the University of Michigan Medical School. Kerry Kelly Novick is a child, adolescent, and adult psychoanalysts who trained with Anna Freud. She is on the faculties of the Michigan Psychoanalytic Institute, the Michigan Psychoanalytic Council, the New York University Psychoanalytic Institute, the New York Freudian Society, the Chicago Center for Psychoanalysis, and the University of Michigan Medical School.

Table of Contents

Acknowledgments	xi
1 Overview	1	(16)
How does Freud relate to the modern practice of psychotherapy?	1	(1)
How does therapy with children and adolescents apply to adults?	2	(1)
Why is termination important?	2	(1)
How has termination been understood in the past?	3	(1)
Is there a current model or paradigm of termination?	3	(1)
Why has there been little study or understanding of termination?	4	(2)
What new model of termination could be proposed?	6	(1)
What are the two systems of self-regulation?	7	(2)
What relevance does termination have in earlier phases of treatment?	9	(1)
What are the types of termination?	10	(3)
What are the different phases of treatment?	13	(1)
Are there other aspects of treatment phases that are relevant to termination?	13	(1)
What are the therapeutic alliance tasks for each treatment phase?	13	(4)
2 Evaluation	17	(8)
What can you see at evaluation that is relevant to termination?	17	(1)
How can you identify and address such issues?	17	(2)
What other fantasies or ideas about treatment can patients bring?	19	(1)
Why is sadomasochism important in relation to termination?	19	(1)
What alternative is the therapist looking for? How does this help set treatment goals?	20	(1)
When will treatment end?	20	(2)
What is gained from talking about termination at the beginning?	22	(1)
Are there other reasons to complete evaluation before beginning therapy?	22	(1)
What impact do administrative aspects of therapy have?	22	(1)
What are the working arrangements?	23	(1)
Are some working arrangements more important than others?	23	(1)
What are the positive and negative possibilities for termination at the evaluation phase?	24	(1)
3 Beginning Phase	25	(10)
What can you see at the beginning phase of treatment that is relevant to termination?	25	(1)
What are the different patterns of separation you can see at the beginning phase?	25	(1)
How can you address denial?	26	(1)
How can you address denial of the significance of the break?	26	(1)
How can you deal with clinging, dependency, and rage about separation?	27	(1)
Are there other termination dangers in this phase?	28	(5)
How is the transition from the beginning phase of treatment to the middle phase marked?	33	(1)
How does the transition relate to termination?	33	(2)
4 Middle Phase	35	(20)
What characterizes the middle phase of treatment in relation to termination?	35	(1)
How does internal conflict between the two systems manifest itself?	35	(1)
What is the conflict in the area of relationships?	35	(1)
How can the therapist help?	36	(1)
What is the conflict in the area of work?	37	(1)
How can the therapist help?	37	(2)
What is the conflict in the area of feelings?	39	(3)
How great is the danger of premature termination in the middle phase of treatment?	42	(1)
What is going on in the patient who denies change?	42	(1)
What is happening when the patient makes staying in treatment the therapist's issue?	43	(1)
Is this related to dependency issues? How does it connect to termination?	44	(1)
What are other issues in the middle phase that might lead to premature termination?	45	(2)
What if there are external reasons for ending?	47	(1)
What is the therapist's role in middle phase difficulties?	48	(1)
How does the therapist support progression between the middle and pretermination phases?	49	(1)
How can therapists make positive use of their own feelings?	49	(2)
How does the concept of a pretermination phase help during the middle phase?	51	(1)
How does the therapist support open-system functioning?	52	(1)
What are the signs of the transition between the middle phase and the pretermination phase of treatment?	53	(2)
5 Pretermination	55	(48)
What is the pretermination phase?	55	(1)
Why do we need a pretermination phase?	55	(1)
What are the characteristics of the pretermination phase?	56	(1)
What is the emotional tone of this phase of treatment?	57	(1)
What is the therapist's role in pretermination?	58	(1)
Once both agree that termination is a realistic possibility, what is left to work on?	59	(1)
What happens at the beginning of the pretermination phase?	60	(1)
What are the tasks of the pretermination phase?	60	(1)
What is meant by "maintaining progressive momentum" and "taking increasing responsibility for joint work" and what difficulties can arise?	61	(1)
What is meant by "putting insights into action" and what difficulties can arise?	62	(1)
How do we see conflict between open-system and closed-system functioning in the pretermination phase and how do we deal with it?	63	(7)
How are the goals of treatment restated or redefined in the pretermination phase?	70	(2)
How does the pretermination phase contribute to evaluating readiness for termination?	72	(1)
What specific dimensions are we assessing in terms of readiness to do work of termination?	72	(1)
How do pleasure in competence and autonomous ego functioning appear in clinical work?	73	(2)
How does the patient begin to use new ego skills to resolve conflicts within and negotiate with other people? How does this relate to the development of the self-analytic function that is considered a goal of treatment?	75	(2)
What contributes to neutralization, the distancing of play and work from omnipotent needs?	77	(2)
How do you establish that change is really internal?	79	(1)
How do we see change in relationships from externalization to attunement?	80	(1)
How does the pretermination phase allow for increasing autonomy in the relationship between child and parents, or adult patient and internal representations of parents?	81	(1)
How does transformation of the relationship to parents relate to termination readiness?	82	(1)
How does the therapist assess the level of the transference and how is this relevant to termination?	83	(1)
How can the therapist distinguish between the patient's internal and external sources of self-esteem and pleasure?	83	(5)
How do the factors of transference and relationship affect readiness for termination?	88	(1)
What is the relevance of the quality of love between patient and therapist?	89	(1)
Where does the therapist's love for the patient belong during the pretermination phase?	90	(1)
What do we look for in the patient's life outside treatment?	91	(1)
What if therapist and patient do not agree on readiness for termination?	92	(1)
Why is it necessary to set aside omnipotent beliefs before starting a termination phase?	92	(1)
Do dreams indicate readiness for termination?	93	(1)
Are "tapering" and "weaning" good models for termination?	94	(2)
How do you start a termination phase?	96	(1)
How does termination differ from pretermination?	97	(1)
How do you pick a date?	97	(1)
What happens if there are external reasons for a particular date? Do the above considerations still apply?	98	(1)
What are some possible confusions?	98	(5)
6 Termination	103	(22)
What are the tasks for A patient during the termination phase?	103	(1)
What are the therapist's tusks during the termination phase?	104	(1)
Are there tasks for parents or significant others in the patient's life during the termination phase?	104	(1)
Is there a standard way of dealing with termination?	105	(1)
What are the reasons for such a variety of styles in termination?	105	(1)
Why does termination arouse such intense countertransference?	106	(1)
What is the relevance of the two systems of self-regulation to termination?	107	(1)
What is the role of pleasure in the termination phase?	108	(1)
What is the role of anger, hostility, and revenge in the termination phase?	108	(1)
Does closed-system functioning appear at all in the termination phase?	109	(2)
Are there particular resistances in the termination phase?	111	(1)
Should the therapist ever change the date for ending?	112	(1)
If the patient doesn't force the analyst to change the date, what next?	112	(1)
Are idealizations normal and necessary for dealing with painful situations like termination?	113	(1)
What about disappointment?	114	(1)
Is there a sequence to the tasks of the termination phase?	115	(2)
What is the role of mourning and sadness?	117	(1)
What about the therapist's mourning?	118	(1)
Is it possible to go through termination without mourning?	119	(1)
Does the analyst speak to the patient about life after treatment?	119	(2)
What happens on the last day?	121	(4)
7 Post-termination	125	(12)
What is the post-termination phase?	125	(1)
What are the tasks of the patient in this phase?	125	(1)
What are the tasks of the therapist after the treatment?	125	(1)
Is there change after the end of therapy?	125	(3)
How do therapists react after treatment?	128	(1)
What are some other kinds of post-termination contact after child and adolescent treatments?	129	(1)
What are other ways adults make contact after therapy?	130	(1)
Do patients ever resume treatment with the same therapist?	131	(2)
What is the impact of post-termination contact on the therapist?	133	(1)
Do patients contact the therapist after treatment with positive news?	134	(3)
8 Final Thoughts	137	(2)
References	139	(4)
Index	143	(6)
About the Authors	149