A few heroic analysts have described their work in the face of life-threatening illness. However, there are only limited descriptions of these illnesses and deaths from the patient's point of view. Experiences of less heroic colleagues are almost unavailable. Clinical experience with ten patients whose previous analyst died while they were in treatment, two whose analyst died shortly after termination, and two terminally ill colleagues who sought consultation suggests that the analysts' understandable denial of the severity of their illness and the patients' collusion in this denial often affects patients negatively. Extensive difficulties commonly arose during the illness and after the analyst's death. These often involved significant boundary crossings and violations. The analytic community does not seem to handle these situations well. Recommendations are offered that might spare patients unnecessary pain and harm.
References
1.
Abend, S.M. (1982). Serious illness in the analyst: Countertransference considerations. Journal of the American Psychoanalytic Association30:365—379.
2.
Becker, E. (1973). The Denial of Death. New York : Free Press.
3.
Bowlby, J. (1980). Loss, Sadness and Depression: Attachment and Loss Vol. III. New York: Basic Books.
4.
Burton, A., (1962). Death as a countertransference. Psychoanalytic Review49:3—20.
5.
Clark, R. (1995). The pope's confessor: A metaphor relating to illness in the analyst. Journal of the American Psychoanalytic Association43:137—149.
6.
Craige, H. (2002). Mourning analysis: The post-termination phase . Journal of the American Psychoanalytic Association50:507—550.
7.
Dewald, P.A. (1982). Serious illness in the analyst: Transference, countertransference, and reality responses. Journal of the American Psychoanalytic Association30:347—63.
8.
Eissler, K. (1993). On possible effects of aging on the practice of psychoanalysis: An essay. Psychoanalytic Inquiry13:316—332.
9.
Fajardo, B. (2001). Life-threatening illness in the analyst. Journal of the American Psychoanalytic Association49:569—586.
10.
Feinsilver, D. (1998). The therapist as a person facing death: The hardest of external realities and therapeutic action. International Journal of Psychoanalysis79:1131—1150.
11.
Firestein, S. (1992). Death of the analyst: Termination, interruption, what? In Illness in the Analyst: Implications for the Treatment Relationship, ed. H. Schwartz & A.-L. SilverMadison, CT: International Universities Press, pp. 333—340.
12.
Freedman, A. (1992). Death of the psychoanalyst as a form of termination of psychoanalysis. In Illness in the Analyst: Implications for the Treatment Relationship, ed. H.Schwartz & A.-L. SilverMadison, CT: International Universities Press, pp. 299—332.
13.
Freud, S. (1912—1913). Totem and taboo. Standard Edition13:1—164.
14.
Gabbard, G., & Lester, E. (1996). Boundaries and Boundary Violations in Psychoanalysis . New York: Basic Books.
15.
——— Peltz, M., & The Cope Study Group On Boundary Violations. (2001). Speaking the unspeakable: Institutional reactions to boundary violations by training analysts. Journal of the American Psychoanalytic Association49:659—673.
16.
Galatzer-Levy, R. (1991). Panel report: Presentation of clinical experience . Journal of the American Psychoanalytic Association39:725—738
17.
Hoffman, I. (2000). At death's door: Therapists and patients as agents . Psychoanalytic Dialogues10:823—846.
18.
Kasper, A. (1959). The doctor and death. In The Meaning of Death, ed. H. Feifel.New York: McGraw-Hill, pp. 259—270.
19.
Klumpner, G., & Frank, A. (1991). On methods of reporting clinical material. Journal of the American Psychoanalytic Association39:537—551.
20.
Lord, R., Ritvo, S., & Solnit, A. (1978). Patients' reactions to the death of the psychoanalyst . International Journal of Psychoanalysis59:189—197.
21.
Morrison, A. (1990). Doing psychotherapy while living with a life-threatening illness. In Illness in the Analyst: Implications for the Treatment Relationship, ed. H. Schwartz & A.-L. SilverMadison, CT: International Universities Press, pp. 302—332.
22.
——— (1997). Ten years of doing psychotherapy while living with a life-threatening illness: Self-disclosure and other ramifications. Psychoanalytic Dialogues7:225—241.
23.
Pizer, B. (1997). When the analyst is ill: A dimension of self-disclosure . Psychoanalytic Quarterly66:450—469.
24.
Schlessinger, N., & Robbins, F. (1983). A Developmental View of the Psychoanalytic Process: Follow-up Studies and Their Consequences. New York: International Universities Press.
25.
Schur, M. (1972). Freud: Living and Dying. New York: International Universities Press.
26.
Schwaber, E.A. (1998). “Traveling affectively alone”: A personal derailment in analytic listening. Journal of the American Psychoanalytic Association46:1004—1065.
27.
Schwartz, H.J. (1987). Illness in the doctor: Implications for the psychoanalytic process. Journal of the American Psychoanalytic Association35:657—692.
28.
——— & Silver, A.-L., EDS. (1990 ). Illness in the Analyst: Implications for the Treatment Relationship . Madison, CT: International Universities Press.
29.
Segal, H. (1997). Psychoanalysis, Literature and War: Papers 1972—1995 . New York: Routledge.
30.
Silver, A.-L. (1990). Resuming the work with a life-threatening illness—and further reflections. Contemporary Psychoanalysis18:314—326.
31.
Van Gennep, A. (1909). The Rites of Passage, transl. M. Vizedom. London: Routledge & Kegan Paul.
32.
Winer, J. (2002). BOPS Studies the functionally impaired faculty analyst. The American Psychoanalyst33(2): 9,15.
