Necessary and Unnecessary Losses: The Analyst's Mourning

We were in what seemed to me to be a particularly productive phase of the treatment. At long last (from my point of view) the patient was recognizing narcissistic aspects of her character that had hampered her in developing an enduring relationship. At thirty-five she was, I felt, really ready, for the first time, to engage in a deepening intimacy. Her whole life had been a momentous, courageous struggle with physical disabilities. Now she seemed ready to emerge more fully from the constraints of her psychological limitations. It was over the weekend that I got the message that she had suddenly died.

My experience of losing this patient was extremely painful, but I know I am hardly unique in having sustained such a loss. How do we bear these losses? What effects do they have over time, on our personal and professional lives?

Of course, the loss of a patient is usually less dramatic than this example. Patients terminate treatment, sometimes abruptly, sometimes with measured preparation. What is the accumulated impact on us, over the years, of living through so many endings? How can we best bear the sorrows that accompany a life in this rather peculiar profession?

Describing some peculiarities of the analytic relationship, especially in its termination phase, Nina Coltart (1996) writes,

The totality of the ending, which seems to go against the grain of all our work on love, loyalty, object-constancy, and intimacy, is reinforced by the austere prescription of no social contact thereafter. Thus we create an arbitrary situation that has much in common with a death. [p. 151]

This description is no less apt for the analyst than for the patient. We take it for granted that over the years we will suffer the loss of countless people who have been our partners in an intimate emotional exchange. However we lose contact with these people, the loss is usually total and final.