Commentary on Cecilio Paniagua's ‘A Terminating Case’

The title selected by the analyst, ‘A terminating case’, suggests a particular mental set with which the analyst approached his patient. The patient is 47 years old and has had about nineteen years of treatment with three analysts. He has had many symptoms and life problems, has visited emergency rooms, sat up for extended periods of the analysis, required medication and psychiatric hospitalisation, and, in general, has been a difficult and challenging analysand. However, the analyst believes that the end may be in sight. In fact, a date has been set fourteen months prior to a planned termination (fourteen months or less prior to termination would probably include a third of all analytic sessions that have ever been conducted, but not all would necessarily be titled ‘A terminating case’ by analysts writing descriptions of them). The clue offered by the title is born out by the session. The analyst hopes that the analysis is coming to an end, but also has misgivings, i.e. ‘However, I did not feel thoroughly satisfied … he had not become as psychologically minded and self-regulated as I would have wished him to’ (p. 166). The theme of conflict about termination runs through the session, preoccupying both analyst and patient. The analyst believes that the patient is better than the patient fears, or at least better than he is willing to admit, and that the patient's misgivings about his progress serve to support his longing for a caretaker analyst-father. However, the analyst has his own doubts. The patient is still hypochondriacal and frightened; he complains that his wife provides him with neither children nor sexual pleasure, and that his analyst reminds him of his critical, grumpy father. Who will be there when he needs support in the future? Like the analyst, the patient also has his doubts. Maybe he really is better.

The analyst thinks that ‘prolonging his treatment would mean fostering his childish dependence in an unwholesome way’ (p. 170). Perhaps, but is this