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Novick, J. (1976). Termination of Treatment in Adolescence. Psychoanal. St. Child, 31:389-414.
(1976). Psychoanalytic Study of the Child, 31:389-414
Termination of Treatment in Adolescence
Jack Novick, Ph.D.
This paper is an attempt to start a discussion on the hitherto neglected topic of termination of treatment in adolescence, using material from the 4-year analysis of a 17-year-old boy. Termination issues were discussed under five headings:
1. The Preconditions of a Terminal Phase. Many adolescents plan a unilateral termination of treatment at the very beginning or soon after treatment has started. It is often the condition under which the adolescent enters and thus avoids the analysis. I suggested that at some point in the treatment, the adolescent must be confronted with the seriousness of his disturbance and the necessity of giving himself up to the analytic process by relinquishing the plan for unilateral termination. Analysis cannot become terminable until it is experienced by the patient as interminable.
2. Some Criteria for Beginning the Terminal Phase. Most of the criteria put forward in the literature are in fact criteria of cure and not criteria for starting a terminal phase. The start of the terminal phase is not a decision but a mutual recognition and acceptance of an approaching end. In the case presented, the mutual recognition related to significant changes in the transference, the working alliance, and the countertransference. A central criterion for starting the terminal phase was the adolescent's ability to experience and increasingly maintain in the transference an oedipal level of psychic organization.
3. Technical questions regarding the Start of the Terminal Phase. Implicit to this paper is my view that termination is not only an important treatment issue but is in fact the central task of adolescence. Termination of treatment relates to the central task of terminating the infantile relationships with parents; thus the actual technique of starting the terminal phase is not a matter of indifference but is crucial to the outcome of treatment of adolescents. It is important that the topic be broached and the date set by the adolescent. The date of ending should occur at a time when the analyst is still working rather than coinciding with a holiday. Once the date is set, it should not be altered.
4. The Terminal Phase. I presented material from the terminal phase and concluded that the features of this phase did not differ significantly from those found in the terminal phase of adults. The features of the terminal phase are a function of the interaction of a transference neurosis with the reality of ending. In this case, the terminal phase was crucial to the analytic resolution of the transference neurosis. Material of the case presented argued against the view that the terminal phase deals primarily with the separation of the patient from the analyst as a real object. Rather it is the analyst as a transferenceobject who is mourned and transference wishes from all levels of development which have to be relinquished. The "real" aspects of the analyst, the functions of the analyst, are internalized as part of the ego ideal and provide the basis for self-analysis.
5. Termination and the Goals of Treatment. Most of the criteria for cure cited in the literature are irrelevant to clinical practice since they are often ideals of mental health rather than goals set in the context of the person's individual pathology. It is important, especially with adolescents, to distinguish between internal and external changes. In ideal cases, internal and external changes coincide. There are cases where external changes can occur without evident internal change (Eissler, 1963). The case presented was one in which external changes were minimal despite significant internal changes. This is not unusual in the treatment of adolescents. The translation of insight into action is the responsibility of the adolescent. A major goal of treatment is self-analysis and all that self-analysis implies. With the capacity for self-analysis external
changes can take place even after the end of treatment. In the case presented, important external changes occurred after termination of treatment.
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