What sets off the termination of analysis and psychodynamic therapy from the variety of endings that enter into all human relationships? So asks Herbert J. Schlesinger in Endings and Beginnings: On Terminating Psychotherapy and Psychoanalysis, a work of remarkable clarity, conceptual rigor, and ingratiating readability. Schlesinger situates termination - which he understands, variously, as a phase of treatment, a treatment process, and a state of mind - within the family of beginnings and endings that permeate one another ...
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What sets off the termination of analysis and psychodynamic therapy from the variety of endings that enter into all human relationships? So asks Herbert J. Schlesinger in Endings and Beginnings: On Terminating Psychotherapy and Psychoanalysis, a work of remarkable clarity, conceptual rigor, and ingratiating readability. Schlesinger situates termination - which he understands, variously, as a phase of treatment, a treatment process, and a state of mind - within the family of beginnings and endings that permeate one another throughout the course of therapy. For Schlesinger, therapeutic endings cannot be aligned with the final phase of treatment. Far from it. Ending-phase phenomena are ongoing accompaniments of therapeutic work. They occur whenever patients achieve some portion of their treatment goals; they supervene when therapy stagnates; indeed, they color the beginning of treatment, for endings, as Schlesinger shows again and again, are often foreshadowed in beginnings. capacity to end therapy are key aspects of diagnostic evaluation, and that, for Schlesinger, The ending of psychotherapy is the most important part of the treatment.By linking beginning and ending phases not to the chronology of treatment but to the patient's experience of it, Schlesinger brings revivifying insight to a host of psychodynamic concepts - consider his view of the working through process as a minitermination and his use of attachment as an index of termination-related difficulties. Nor does he shy away from a trenchant critique of the instrumental medical model of psychiatric and psychotherapeutic training, which militates against the therapeutic exploration of treatment endings. His exemplification of how to begin treatment from the point of view of ending; his sensitive delineation of the mid-treatment ending crises characteristic of vulnerable patients; his richly woven case vignettes illustrating various ending contingencies and permutations - these topical inquiries are gems of pragmatic clinical wisdom. mourning as an anticipation of ending elicited by therapeutic gains over the course of treatment, and concluding with the nettlesome issue of therapist-patient contact after termination, Schlesinger speaks of matters that transcend theoretical allegiance and technical orientation. He speaks, that is, to any and all clinicians whose commitment to their work emboldens them to begin anew - and end anew - with each patient, each day. No less than The Texture of Treatment (TAP, 2003), Endings and Beginnings distills lessons learned over the course of a half century of practicing, teaching, and supervising psychotherapy and psychoanalysis, and is a gift to the profession.
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