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Firestein, S.K. (2002). Discussion of Dr. Fayek's Paper. J. Clin. Psychoanal., 11(4):619-625.

(2002). Journal of Clinical Psychoanalysis, 11(4):619-625

Discussion of Dr. Fayek's Paper

Stephen K. Firestein, M.D.

The clinical summary presented is filled with interesting and unusual features, quite sufficient for a lengthy discussion. Dr. Fayek has highlighted the issue of termination, and so I will restrict my comments to the concluding portion of his clinical narrative. His report ranges very widely, and at the risk of being considered redundant, I plan to enumerate a sequence in the patient's life of critical incidents of rejection and their pathological consequences. In so doing I prepare the basis for some of my later observations.

Termination of an analysis, in the ordinary, is expected to be a final and presumably permanent separation of patient and analyst. It sometimes turns out not to be permanent—and there are analysts who assert that it should not be permanent. It is generally expected, however, that when the purpose for the establishment of the analytic working relationship has been substantially accomplished, it is timely to consider terminating it.

At termination, the separation of two people who have become rather important to one another has now become a central issue, whether or not it has previously been a deliberate focus. The patient's earlier experiences with separation are therefore of special interest.

Dr. Fayek's patient, who was 41 years old at the beginning of treatment, came to him three months subsequent to a serious suicidal attempt. The summary indicates the development of great tension with her mother during adolescence, the patient being accused of seductive behavior in the manner in which she displayed her developed physical attractiveness.

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