Emotional turbulence during the ending of psychotherapy with an anorexic adolescent

In this paper I reflect on the phase of the analytic process which precedes the termination of a psychoanalysis and describe my work with an adolescent girl. Adolescents with serious eating disorders relive in a particularly violent way, in the final phase of their analysis, the catastrophic anxiety of separation and the fear of annihilation connected with this. The perception of the final date, felt to be irrevocable, reactivates in these patients the psychotic part of their personality, which tries through a phantasy of omnipotent possession (expressed through pathological projective identification) to obscure the reality of separateness and loss. It is useful with these patients to set a date for ending at least a year in advance to enable the working through of these psychotic anxieties. Clinical material illustrates how in the final year of treatment all phases of the analytic process are relived in a violent way, and how this emotional turbulence manifests id as a battle between omnipotent phantasy and an increasing insight into psychic reality.