Doubts about ending analysis and the internal parental couple.

Describing countertransference feelings and conflicts towards end of treatment is difficult for analysts and the literature on termination tends to focus on what should happen not what does. The inherent incompleteness and inevitable frustrations of patient's and analyst's wishes can throw both into confusion at the very point when the wish for certainty and completion is heightened. This paper describes a case where patient and analyst repeatedly felt thrown into doubt about whether and how analysis should end. The analyst came to think that, unconsciously, the doubts related to the patient's position with the internal parental couple. As the patient struggled with feelings of disintegration and exclusion the analyst experienced periods of theoretical confusion, which stood for her relationship with her analytic parents. The analyst came to see these periods of disintegration, situated within the transference-countertransference field, as crucial to the developmental process, pushing the analytic couple away from what could have become false "depressive" coherence towards more truthful encounters. She views the patient's capacity to bear this as a sign of readiness for termination. Retrospectively she finds helpful light can be thrown on this experience by Britton's concept of post-depressive paranoid- schizoid position, synthesizing Bion's extension of Kleinian theory and Steiner's concept of pathological organisations, but she places more emphasis than Britton does on describing the countertransference struggle. Ultimately, the author argues, the patient can be helped to achieve fuller integration if the analyst can tolerate some disintegration, repeatedly losing and regaining an internal parental couple.