Client and Therapist Constructions of the Experience of Ending Psychoanalytic Psychotherapy: Tracing the Power Lines

This study adopted a social constructionist framework to explore how clients and therapists construct their experiences of termination from long-term psychoanalytic psychotherapy. To this end, six psychoanalytic therapists and three clients were interviewed and their accounts were analysed qualitatively using a discourse analysis approach. Prominent therapist discourses elaborated termination as a loss experience. Clients also constructed termination in terms of available discourses of loss, however, additional client narratives were generated which storied termination in a variety of other ways, such as conveying hopes for a new beginning. Analysis revealed certain contradictions between the discourses deployed by therapists and those of clients, for example, whilst therapists constructed termination as a typically mutual process, clients storied termination as a time during which they had felt powerless. Discourses of termination were thus examined with reference to the institutions and ideologies they support and the power relations they reproduce. Analysis revealed that the within-therapy focus that still persists in more traditional approaches to analytic psychotherapy reproduces specific power relations and reinforces a view of clients as in need of expert help. Therefore, the ways in which power is enacted within the therapeutic relationship tends either not to be seen or is not explicitly addressed within certain approaches to psychoanalytic therapy, specifically, within a local NHS psychotherapy service. As such, this study argues for the adoption by therapists of a critical, reflexive approach to the ways in which therapy is enacted within specific settings. Further, it calls for the issue of power to be explicitly addressed within the practice of therapy in order to make clients more powerful. In practice, as with recent feminist and post-structuralist developments within psychoanalytic theory and practice, this would mean acknowledging the lived realities of clients and connecting with the structural inequalities that position them within society.