Hyman Spotnitz, M.D. – The Talking “Cure”: When Is Therapy Over?

A guy walks into a therapist’s office – sadly, this is no joke – and says, “I just read a piece in The New York Times, and I’ve got some questions: What do you know about my condition? What’s your success rate with people like me? When will I get well?”

(Mark O’Connell, LCSW, The Huffington Post)

"Tell Me The Truth" by Radka Salcmannova
“Tell Me The Truth” by Radka Salcmannova

With rare exceptions, the ultimate aim of all good psychotherapists is, well, to make themselves obsolete. After all, whatever drove you to therapy in the first place – depression, anxiety, relationship problems, you name it – the common goal of treatment is to feel and function better independent of your therapist.

To put it bluntly, good therapy is supposed to come to an end.

But when? And how is the patient to know? Is the criterion for termination “cure” or is it just feeling well enough to be able to call it a day and live with the inevitable limitations and problems we all have?

The term “cure,” I think, is illusory — even undesirable — because there will always be problems to repair. Having no problems is an unrealistic goal. It’s more important for patients to be able to deal with their problems and to handle adversity when it inevitably arises.

(Richard A. Friedman, M.D., The New York Times)

"Brooklyn" by Radka Salcmannova
“Brooklyn” by Radka Salcmannova

When the most powerful resistances to communication are resolved. he develops many nuances and refinements in feeling. Eventually he is able to experience the full range of human emotions. As he expresses them in the analytics relationship, one observes, in a sense, the emotional evolution of a human being. Eventually he acquires the rich “orchestration” of the mature personality.

The successfully treated individual commands an abundance of behavior patterns. Since he can express his feelings in socially appropriate ways, he does not have to go out of contact, however great the provocation, to prevent himself from behaving destructively. He is also able to accept and tolerate the emotions of other people. Emotional perceptiveness and easy responsiveness change his whole orientation to life. He can relate comfortably to people and face up to painful realities without resorting to the old narcissistic defense. No longer does the patient present evidence of his old pathological patterns except through careful diagnostic testing or skillful interviewing, which may reveal traces of his past limitation.

"Memories" by Radka Salcmannova
“Memories” by Radka Salcmannova

The recovered patient conveys the attitude that he has completed a voyage of self-discovery. “I’m just beginning to know what I’m really like,” one woman said. Many patients feel that they have found a loyal and constant companion in the genuine self that can communicate in the language of feelings. They experience this new awareness of feelings as an important asset in dealing with the contingencies of life.

Recovery does not mean that all difficulties have melted away or that new problems will not be encountered in the future. But the patient can now grapple with problems as a total personality and is thus in a position to resolve the primary fixations through re-educational methods. There is a notable increase in the patient’s capacity for self-fulfillment and happiness, and he can sustain the impact of traumatic events with considerable resiliency. He has developed the tolerance and undestanding to entertain and resolve psychological conflicts of ordinary magnitude.

The fully recovered patient is able to recognize and describe the analyst’s shortcomings, to criticize the treatment process constructively, and to suggest improvements in the analyst’s approach. The patient, if called on to do so, can describe the factors that led to his illness and identify those that were essential for his progress.

The patient can understand other people; he know what makes them tick. He can accept diferences in perspectives and attitudes. He impresses his relatives and associates with his effective functioning at home, at work, and in social situations. He is a more sociocentric human being than when he entered treatment. He demonstrates that he can live among people with a sense of emotional integrity and self-respect, and that he prefers it…

"Are you ready? Yes, I am" by Radka Salcmannova
“Are you ready? Yes, I am” by Radka Salcmannova

Obviously, modern psychoanalysis is dedicated to achieving far more than transforming a miserable human being into one suffering from common unhappiness – the therapeutic expectation stated by Freud and repeated by Blum after nearly a century of clinical expereicne and expansision of psychoanalytic theory. Warming against over-optimism and high expectioants in the treatment of the severe emmotional disorders, Blum remarked that “classical analysis does not terminate with an ode to joy” (Harold P. Blum, M.D).

Hyman Spotnitz, M.D., “The Essence of Recovery”

First published in “Modern Psychoanalysis of the Schizophrenic Patient” in 1954 , re-released in 2004. 

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