When is psychoanalysis over

By these models they organize old and anticipate new experiences. Internal working models are interpreting and by that also selecting procedures.

Objective reality does no longer exist, psychic reality takes there place. These internal working models are implicit procedures, and the same brain structures involved with these implicit procedures are also involved with the implicit memory. These implicit procedures become manifest in the treatment. The purpose of the treatment is to come to a revision of these procedures.

It is not about the past, but about the way the patient perceives the other and interacts with him influenced by the past. So psychoanalysis is about the here and now in favour of the future.

In the treatment, implicit structures are reactivated in the here and now. These implicit structures, built up from the past, have come into being and were consolidated in an extremely complex manner, in which both nature and nurture played a part: things like how the patient was treated by his primary care givers, how he responded to that and the way in which the parent-objects responded to the reaction of their child, and the fantasies the child had in this context.

All this takes place within the context of a specific attachment relationship. It is the quality of this attachment relationship that regulates how and what of all these is internalised and consolidated in the implicit procedural memory. In short, it is not about an objective reality, but about a subjective psychic functioning.

It is this psychic functioning that has to be explored, and, if necessary, revisited in the treatment. This revision happens because the differences between the implicit model of the patient and the mental states of the therapist in the here and now are dealt with, within the context of a new attachment relationship.

New experiences in interpersonal relationships are acquired. The patient will experience that things are not necessarily what he perceives them to be, and then a new, alternative way of seeing comes into being, and within the patient there is room for experiencing alternative possibilities. He will start to realise that he has his thoughts about the other, just as the other has thoughts about him, without the other annexing him or he the other.

This is what we call reflective functioning. The process of mentalization is regained, in the sense of developing and recognizing mental states in oneself and in the other.

So psychoanalysis is deeply connected with the concept of change. That is why we now will elaborate the concept of change. Psychoanalysis aims for change, and not only that, but a specific form of change, not so much on the level of the reduction of symptoms but on the level of the underlying structure.

Traditionally, psychoanalysis wishes to distinguish itself from other forms of psychotherapeutic treatment by claiming that psychoanalysis leads to structural change, while other forms of psychotherapy lead to more superficial forms of change, e. The question is, however, whether this is the case, and what changes, and what is the cause of this change. Is there such a thing as structural change, not to be confused with the reduction of symptoms.

And what do we consider to be structural change, what is structural about it? Are all the changes we see during a psychoanalytic treatment structural? Are structural changes specific to psychoanalysis or do they also occur in treatments of other psychotherapeutic frames of reference?

Is structural change restricted to expressive forms of treatment or does it also occur within more supportive forms of treatment? All questions open for empirical research.

In the past, psychoanalysts were more focused upon the development of theories about the character, and about how symptomatology or pathology came into being. Nowadays, the focus has shifted to the how and what of the process of change. Much more than before, the purpose of psychoanalytic treatment has become: how to bring about or facilitate the transformation of a destructive internal working model into a more productive one. In present-day terms: psychoanalysis aims for a change in the way the mind is functioning; psychoanalysis aims for a change in the mode of mental functioning.

The return to consciousness of material that had been repressed earlier wishes and memories was seen as curative. The second change-theory was related to the structural model in which concepts as Id, Ego and Superego played an important part.

Those psychic structures are the mental functioning and the way the mind is functioning in a person is relatively permanent and stable even with a borderline personality disorder. What is meant by structural change depends on what the aim of a psychoanalytic treatment is.

When it is assumed that after a successful treatment, the patient is able to have more constructive solutions for his core-conflicts at his disposal there will be a problem. The idea that new solutions will take the place of old ones is incorrect.

She, too, was alive to the relative changeability of people. The thought at the time was that these new solutions were arrived at through the beneficial effect of the instrument of interpretation. These days, we assume that the latter is the case: they co-exist. In short: how structural is structural change, and what the treatment needs to focus on, in order for change to be structural. They see the psychoanalytic process as an intervention in the development, with the aim of creating new structures, and, especially, a new structural organisation.

During a successful psychoanalytic process, old structures or solutions are inhibited and new structures or solutions are reinforced. In other words: the new does not take the place of the old. Far away, also, from the thought that the patient projects his fantasies on or in the anonymous analyst who reflects these projections by means of interpretations, and thus renders them harmless, after which he returns them to the patient. Increasingly, it is about the relationship and about the psychoanalyst who, through counter-transference, knows himself to be involved in it.

The psychoanalyst not only needs to make contact with the mental states of the patient, but also with his own. Not only must he reflect about what the patient brings in and tries to actualise within the relationship with the analyst, but also about his own perceptions and behaviour.

It is up to the analyst to create a climate of safety, acceptance and tolerance, so the patient can increasingly identify with the accepting, safe and tolerating aspects of the person of the analyst.

By doing this, the patient has become familiar with a new form of object-relational involvement that is corrective towards the older object-relational dyad. Change within the psychoanalytic process, therefore, does not only occur on the basis of the interpretations of underlying experiences, but just as much as a result of being offering an adequate holding environment.

Both relationship and interpretation are important. Treurniet concur with this when they show that the distinction between supportive and expressive is misleading.

Interpretation can be very supportive, and the offering of support is an important part of an adequate expressive therapy. It will be obvious that it is not about support in itself, but about functional support. In psychoanalytic therapy, it is about more than just interpretation. Interpretation is necessary but, in itself, not enough. In other words, no support without insight, and no insight without support.

The analyst functions, in the treatment, as a new object which can give the patient a new, hopefully corrective, experience through which his development can be resumed where earlier it had come to a standstill. Rangell made the statement that a successful psychoanalytic treatment makes the patient become his own analyst. Object-relationships and dynamic structure. International Journal of Psychoanalysis, 27, Feldman, R.

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He is more autonomous. He can see his feelings for what they are — real but not necessarily appropriate to the context he finds himself in. This example of rupture repaired gave him a sense of validatory empowerment and enabled him to decide to leave therapy at a moment which, on balance, felt right to him.

Brief Dynamic Therapy: Foregrounding Termination. The rationale informing Brief Dynamic Therapies e. A time limit is implicit from the first moment of therapy. Different varieties of brief dynamic therapy handle the ending in different ways. Balint , who realised that for psychoanalytic psychotherapy to reach out from the ivory couches of Hampstead to the masses, it must perforce abbreviate itself, and who had himself suffered major discontinuities in his life leaving Budapest for the UK to escape the Nazis, the premature death of his first wife , suggested that at the end of therapy the patient should feel both very much better and very much worse, and that what mattered was that this could be acknowledged i.

If the pain of loss can be experienced it can be transcended; follow-ups and interminable therapies are simply attempts to evade the reality of irreversible separation. Its emphasis is on trauma resolution through direct emotional confrontation of avoided feelings — fear, rage, pain and yearning. Yallom makes a convincing case that death anxiety, a fundamental existential issue, tends to be avoided by patients and therapists alike.

Addressing the full implications of termination brings one face-to-face with the transience of life, the distorting impact of trauma on development, the limitations of therapy and the inevitability of suffering. Schopenhauer , the supreme yet unbowed pessimist, introduced to Western philosophy the Buddhist precept that suffering is where we start from, and that embracing suffering is the first step towards transcending it.

The Will, like the unconscious, is infinite and timeless, driven by intrinsic energetic forces that predate human existence and will continue once human life has passed from the universe. These include in the up-swing: conception, birth, weaning, walking, talking, school-entry, friendship, adolescence, sexual experimentation, leaving home, finding a sexual partner, occupation, procreation, parenthood.

Each of these, especially if interrupted or perverted by trauma, will play themselves out in their positive and negative aspects, in the metaphor of the therapeutic relationship Waddell To conclude, illustrate this, and as an antidote to Schopenhaurian gloom, consider the stage and screen hit Mamma Mia!

The success of the piece depends largely on its sing-along use of music from the ABBA, a palindromic Swedish s two-couple pop-group, now disbanded, each man-woman partner now separated. The setting is a Greek Island. Sophie, a teenage girl, brought up by a single parent, Donna, who runs a hotel that has seen better times, is about to get married.

Sophie assumes that she will be able instantly to select the right one when she meets them, but to her dismay she discovers the pre-DNA truism that no one can be absolutely sure who their father is, and that they are all possibilities.

Who is to give her away? In her confusion she asks each one of them. The wedding ceremony begins. The naively presiding Greek-orthodox priest invites the father to give the bride away.

All three rise to assume the honour. Sophie graciously accepts their blessing, is happy to waive the DNA test and accept all three as her fathers, but suddenly announces that she is not ready for marriage and that the wedding is off.

She accepts. Sophie and Sky are delighted and relieved and announce that they will embark on a round-the-world trip, and the movie ends happily with Greek feasting and dancing. The attachment implication is that one can only leave home if there is a secure base to return to. Now her mother has a man, Sophie can now look after herself rather than play the role of the parentified child looking after her mother a common pattern in children with disorganised attachment styles.

With a secure base now in place and available when needed, she is free to explore the world. Renunciation of Oedipal longings to possess the parent, attendant feelings of sadness and envy overcome, is a necessary developmental step towards psychosexual maturity. Successful termination of therapy implies the establishment of a more-or-less secure attachment dynamic, with internal feelings of security matched by external relationships, including if needs be a continuing relationship with a therapist.

In both perspectives coming to terms with loss is a central theme. Sophie can leave home and move onto new attachments from Donna to Sky secure in the knowledge that Donna, herself at last firmly attached to Sam, will be available to her when needed.

Her inner world is intact, threatened neither by her own aggression, nor needing a rigid external scaffold to support it. Similar principles apply, all being well, to the therapeutic powers of psychotherapy — including its termination. Allen, J. Fonagy, P. Bachrach , H. Balint, M. Benjamin, J. Beutler, L. Lambert, ed. Bollas, C. Bowlby, J. Britton, R. Cassidy, J. Cavell, M. Dozier, M. Shaver, eds, Handbook of Attachment , 2 nd Ed.

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