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Horowitz, M.J. Becker, T.C. (1993). The Difference Between Termination in Psychotherapy and Psychoanalysis. J. Amer. Psychoanal. Assn., 41:765-773.

(1993). Journal of the American Psychoanalytic Association, 41:765-773

The Difference Between Termination in Psychotherapy and Psychoanalysis

Mardi J. Horowitz, M.D. and Terrence C. Becker, M.D.

HOROWITZ INTRODUCED THE FOLLOWING questions: Do the processes by which one decides to terminate a psychoanalysis and a time-unlimited psychotherapy differ? What does the analyst expect to have happen and what does he expect to do during the termination period in psychoanalysis as contrasted to psychotherapy? What is the role, in the two types of treatment, of mourning and identification? How do recapitulation of symptoms and regressive transference reactions differ in the two types of treatment, once a termination date has been established? What is the expectation of symptomatic recurrences after completion at the last hour? What does the analyst discuss with the patient about what to expect after the last hour?

Addressing himself mainly to the first question, Dr. Shane presented his paper entitled: "The Decision to Terminate in Psychoanalysis." The chief indication for the termination of a psychoanalysis is the resolution of the transference neurosis. The termination of a psychoanalytically oriented psychotherapy does not rest upon this thoroughgoing resolution of the transference. Another major contrast is the role of symptomatic improvement versus structural change; whereas psychotherapy is often terminated when symptoms resolve, the determinants of termination in psychoanalysis are often uncoupled from symptomatic change. Deep psychic structural transformations are paramount in assessing progress, and may or may not entail abatement of symptoms at any given time, depending on their meaning in the context of the transference. Finally, though it is generally agreed that life goals and therapeutic goals should be kept separate in either modality, life goals may more often influence the decision to terminate in psychotherapy, at least from the patient's point of view.

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