Endings and Beginnings: On Terminating Psychotherapy and Psychoanalysis

What sets off the termination of analysis and psychodynamic therapy from the variety of endings that enter into all human relationships? So asks Herbert J. Schlesinger in Endings and Beginnings: On Terminating Psychotherapy and Psychoanalysis, a work of remarkable clarity, conceptual rigor, and ingratiating readability. Schlesinger situates termination - which he understands, variously, as a phase of treatment, a treatment process, and a state of mind - within the family of "beginnings and endings" that permeate one another throughout the course of therapy.

For Schlesinger, therapeutic endings cannot be aligned with the final phase of treatment; ending-phase phenomena are ongoing accompaniments of therapeutic work. They occur whenever patients achieve some portion of their treatment goals and supervene when therapy stagnates. Small wonder that an assessment of the patient's relationship to time and capacity to end therapy are key aspects of diagnostic evaluation. By linking beginning and ending phases not to the chronology of treatment but to the patient’s experience of it, Schlesinger brings revivifying insight to a host of psychodynamic concepts. Nor does he shy away from a trenchant critique of the instrumental “medical model” of psychiatric and psychotherapeutic training, which militates against the therapeutic exploration of treatment endings.

Schlesinger's exemplification of how to begin treatment from the point of view of ending; his sensitive delineation of the mid-treatment "ending" crises characteristic of "vulnerable patients"; his richly woven case vignettes illustrating various "ending" contingencies and permutations - these inquiries are gems of pragmatic clinical wisdom. Endings and Beginnings distills lessons learned over the course of a half century of practicing, teaching, and supervising psychotherapy and psychoanalysis and is a gift to the profession.

"This book is a small miracle; there is nothing quite like it.  Schlesinger's genius is to see that focusing on endings" in psychotherapy is the way to parse, track and manage all of treatment from first to last, as well as the way to individualize therapy, to keep the mission in focus, and, of course, to know when to stop.  He is clear, terse, detailed and clinical and, best of all, he is right there at the therapist's side telling him what he means in practice - suggesting the how, when, and where of technique.  He wastes so little space on theorizing that the reader will be immediately helped in his work by any single page chosen at random, and as a whole I can think of no one book that will save more therapists and more patients from wandering in the wilderness." 

- Lawrence Friedman, M.D., Clinical Professor of Psychiatry, Weill Medical College of Cornell University

"Endings and Beginnings is a truly worthy companion to Herbert Schlesinger's earlier, masterful The Texture of Treatment.  This time he shows how psychodynamic treatment can be endlessly considered from the viewpoints of endings and beginnings, separations and bondings, attachments and avoidances, all infused with the fully ambivalent panoply of emotions that makes us complexly human.  And he does all this with lucidly chosen vignettes, a lifetime of distilled clinical experience, uncommon wisdom, and an unbounded joy in unraveling life's experiences."

- Robert S. Wallerstein, M.D., Emeritus Professor and Former Chair, Department of Psychiatry, UCSF School of Medicine

"Schlesinger brings 50 years of experience as a practitioner, teacher, supervisor, and author to this task.  He is interested in the clinical theory of both psychodynamic psychotherapy and psychoanalysis, and he is able to switch back and forth effortlessly between the technical problems of beginning and ending in each of these two modalities of treatment.  This work fulfills the promise of the previous book, The Texture of Treatment.  Both are clearly written, theoretically consistent, jargon free, and brimming with clinical insights.  Schlesinger has produced two volumes appropriate for both advanced and beginning therapists - no easy task."

- Edwin Fancher, M.A., FIPA, in Division 39 Newsletter, Fall 2006

"This book is about more than ending.  It includes topics about impasse or stalemate in therapy, the ailing analyst, interminable analysis, and mourning processes in analysis.  It is highly recommended to practicing clinicians and trainees doing psychotherapy and psychoanalysis."

- Clarence G. Shulz, M.D., in The Journal of Nervous and Mental Disease, 195.1, 2007

"I found the distinctive style of this book to be among its assets and enjoyed it as one might enjoy a wll-organized lecture.  The work is easy to read and to comprehend.  The language is free of jargon and the very 'ordinariness' of Dr. Schlesinger's language demonstrates a virtuosity of its own.  The simplicity of language converys, without self-aggrandizement, the wealth of the author's experience as analyst, teacher, supervisor, consultant, and writer.  In addition, it allows readers of various theoretical persuasions to work with the ideas and observations presented, and to apply them within the conceptual framework they prefer.  To put the matter somewhat differently: the ideas and observations offerred by this book are not theory bound and, to my mind, this is a good thing."

- Peter Blos, Jr., in International Journal of Psychoanalysis, 87.6, 2006

"This is a book for clinicians, whether psychoanalysts or analytically oriented psychotherapists. It deals with the clinical situation head on, without benefit or encumbrance of elaborate theory. Dr. Schlesinger writes with lucidity and plain-spoken eloquence about the trials and travails of psychotherapy....These and a host of other ideas are discussed in realistic and commonsense terms, with a liberal salting of therapeutic wisdom and prudent perspective. Clinicians at all levels of experience will find much useful and pragmatic advice in these pages."

- W.W. Meissner, S.J., M.D., University Professor of Psychoanalysis, Boston College, in Bulletin of the Menninger Clinic, Vol. 71, No. 3 (Summer 2007)

"Endings and Beginnings is a compendium of common and uncommon sense. As if one were sitting at a master's feet, this sense begins with Schlesinger's oft-stated idea that ending is what therapy and analysis are all about. It is a bonus that the life and mind of the therapist/analyst figure prominently but without intrusiveness throughout the book."

- Richard L. Munich, JAPA 56, 2008