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Wallerstein (1989) identified “therapeutic lifers” as “patients continuing in an open-ended, ongoing therapy with no intent or plan for termination … [characterized by] the continuing necessity for ongoing treatment support and management” (p. 932). These patients frustrate the public theory (Sandler, 1983) of the contours of psychoanalytic time and space. The description of a patient as a lifer, perhaps in reaction to that frustration, carries a pejorative message intimating the patient's unwillingness to face up to the responsibilities of adult life and the therapist's capacity to bring that about.
Howard B. Levine, David Kitron, Phil Mollon, and Michael D. Clifford are all scholars fluent in theory and experienced in the widening scope of psychoanalytic practice. Each works within a different conceptual framework. But each offers a narrative of one or more patients for whom ethical treatment required “open-ended, ongoing therapy with no intent or plan for termination” (Kitron, this issue, p. 21).
In doing so, these contributors integrate recognition of developmental deficit with a concern for the consequences of trauma. In each case, the source of later incapacity, despite implicit allowances for constitutional endowment, resides in lived experience. And each implicitly asserts that in the absence of trauma by commission or by omission (cumulative trauma), the patient, from some innate developmental thrust, would have achieved a higher level of functioning.
Christina Emanuel and Clifford explore the time and space in which therapy takes place. (Ethics demand that I disclose that both Christina and Michael are my colleagues and my friends.) Emanuel explicates formally a perspective compatible with Clifford's framework. This is that entanglement, in both its everyday and its quantum usage, extends beyond both the traditional analytic frame and formal termination. Neither Emanuel's nor Clifford's patients manifest the attributes of dysfunction that lead Levine and Moll