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Roose, S.P. Yang, S. Caligor, E. Cabaniss, D.L. Luber, B. Donovan, J. Rosen, P. Forand, N.R. (2004). Posttermination Contact: A Survey Of Prevalence, Characteristics, And Analyst Attitudes. J. Amer. Psychoanal. Assn., 52(2):455-457.
Psychoanalytic Electronic Publishing: Posttermination Contact: A Survey Of Prevalence, Characteristics, And Analyst Attitudes
(2004). Journal of the American Psychoanalytic Association, 52(2):455-457
Psychoanalysts believe that psychological work by the patient after termination of analysis consolidates and extends gains made during treatment. However, there is controversy over whether further contact bet-ween patient and analyst is appropriate. Some argue that if a patient returns to see the analyst it signifies an incomplete treatment, whereas others maintain that after termination a therapeutic relationship endures
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and that patients can therefore benefit from recontacting their analysts. Systematic data on posttermination contact are limited.
Questionnaires were distributed to active graduates of the Columbia University Center for Psychoanalytic Training and Research inquiring about the analyst's three most recently terminated cases that met the following criteria: the patient was in analysis; the analysis ended, for any reason, at least one year prior to the survey; and the case was not a training analysis (though control cases from the analyst's training could be included).
Sixty percent (109/181) of analysts returned the survey, with 87 providing data on 241 cases. The median age of the patients was 31-40 years, and 42% percent were male. Eighty-three percent of cases were conducted at a frequency of four times a week, and 97% used the couch. Thirty-one percent of patients took psychotropic medication at some point during the analysis, and analysts prescribed the medication in 67% of these cases. Of the 241 cases, 22% continued for less than three years, 54% for three to six years, and 25% for more than six years; the median duration of an analysis was between four and five years.
In 87% of cases, regular contact ended at the termination of the analysis; in these cases, the possibility of posttermination contact was raised by 78% of the analysands. Eighty-seven percent of analysts let their patients know they could be available in the future.
Of the 210 cases in which regular contact ended with termination, 35% of patients had no subsequent contact, 25% percent had contact by phone, letter, or e-mail only, and 40% returned to see the analyst in person. Among analysands who returned to see their analyst, 35% came for a single office visit, 55% had extended consultations or began psychotherapy, and 5% resumed analysis.
Most analysands raised the issue of posttermination contact. The overwhelming majority of analysts responded by communicating both their availability and their interest. Posttermination contact in the form of phone calls, letters, and/or e-mail was common for this sample of analysts. Within four years, 40% of patients had returned to see their former analyst in person. Neither duration of treatment, nor the analyst's
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assessment of outcome, nor the nature of termination (planned or unplanned) predicted which patients would return to see the analyst. An unanticipated finding was that after termination 23% of analysts changed their role from psychoanalyst to psychopharmacologist. This is another example of the profound impact that medication use has, not only on the analysand, but on the analyst as well.
In this sample of patients and psychoanalysts, neither believed that termination of the analysis signified the end of the relationship. Patients frequently came back to see the analyst for further therapeutic work, and a number of patients came back on more than one occasion. The frequency of posttermination contact suggests the need to revise the concept of termination. Termination signifies not the end of the therapeutic relationship but only the end of the analysis proper.