Experts Describe When Analysis Ready to End

The public often has the impression that once a relationship between a psychoanalyst and a patient gets under way, it will go on indefinitely. After all, it’s common knowledge that filmmaker Woody Allen spent years in analysis.

In truth, though, most analyses do end, several psychoanalysts said at the meeting of the American Psychoanalytic Association in New York City in January.

The purpose of analysis, as of other psychotherapies, is to relieve suffering and symptoms, Kerry Sulkowicz, M.D., a New York City psychoanalyst, explained at a session for the press. But with analysis, he explained, a therapist works hard to get at the root causes of a disorder or disorders, and analysis should bring about changes in some fundamental aspects of the patient’s personality. As a result, a patient may need to stay in analysis for at least five years for such goals to be achieved. Nonetheless, Sulkowicz pointed out, analysts do want analysis to end, and termination usually comes through mutual agreement between the analyst and patient, although most often it is the patient who initiates termination.

Patients want to end analysis or may be spurred in that direction when they become aware that analysis has brought them greater psychological health—for instance, a reduction in inner conflicts and more freedom with their emotions and relatedness to others, suggested Joseph Caston, M.D., a San Francisco analyst, in a paper presented at the meeting. Another reason why patients want to bring analysis to a close, Caston proposed, is “the human pull to construct narrative structures—such as beginnings and especially endings. . . . Children become able to recognize beginnings, middles, and endings by at least age 5, and after that it is a part of us forever.”

In fact, undertaking analysis is not unlike writing a poem, Caston ventured—“both must begin, both have one point or many, and both end with a sense of significance.”

But bidding adieu to one’s analyst can also mean auf wiedersehen (“see you again” in German), Sandra Walker, M.D., a Seattle psychoanalyst, pointed out at the press briefing. In other words: Sometimes patients return to their analysts for additional treatment or a “tune-up”. ▪