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In leo rangell's paper, “Some Thoughts on Termination,” we find a master of his craft presenting his personal overview—glancing backwards from the vantage point of long experience. It is a stimulating article, and it has provoked some thoughts of my own on two issues: the centrality of anxiety in neurosogenesis and the criteria for termination.
Rangell states emphatically that the status of the patient's anxiety ought to have the highest priority—a priority which was once paramount in analysis but which has since been lessened. In his eyes, anxiety remains the fulcrum of neurosis, and he makes it clear that he disagrees with Brenner (1975), who “sees depression as playing a role parallel and equal to anxiety in neurosogenesis.” What I am struck by is the mixture of feelings this view stirs up in me. On the one hand, I feel a kinship with Rangell's insistent reminder that anxiety is the “fulcrum,” the “armature” around which the analysis turns. I agree that we have often lost sight of the crucial importance of this concept in doing our work in favor of new ideas, which, however attractive and à la mode, have done little