The Crisis of Ending Treatment

Endings are never easy. We ask of our patients and from ourselves a kind of attachment and trust that will allow for the unfolding of the deep work of treatment. We encourage the opening up to vulnerability, the unearthing of deep wounds, quiet hopes, and desperate longings, understanding from the beginning that it will lead to ending and parting.

The crisis of ending can be explosive or deadly silent. Either way, it demands extra attention for it can unfold and play out in less than satisfactory resolutions. Endings are the ultimate rupture and therefore can create for many patients, and for us, a kind of crisis. This leaves the dyad susceptible to particular enactments involving complex unconscious processes having to do with early attachment issues, losses, betrayals, and traumas. All of this heightens what is at stake in ending.

While during much of the treatment enactments have space and time to be worked with, the ones surrounding ending can happen quickly and catch us unawares.

In sometimes remaining unseen, these enactments can lead to abrupt endings or angry battles that can spoil an otherwise good treatment. Even worse, there can be an acting out of buried unformulated narcissistic injuries and needs across both members of the dyad. Patients may fear ever replacing this closeness with others in their lives and so the loss feels too great, their own need too demanding. As analysts we too may resist losing the closeness, the feeling of being needed, and our seemingly great capability to fulfill longings for our patients. It can become cloudy what is to be worked through and what is to be acted upon. Sometimes we've hit an impasse and we need to stay the course. Harder to discern is when an interruption is the better course of action, allowing for consolidation and integration of work done. Sometimes further growth must take place in life after or outside analysis.

The impending rupture may cause an uptick in our own anxieties and ruminations. We may worry, have