Three years ago, my family and I relocated overseas. I resigned from my public consultant position and also closed down my private practice. Whilst the former was a straightforward process, the latter included ending psychotherapy with a handful of elderly patients, one of whom had a disrupted attachment history and whom I needed to refer on to another psychotherapist. This experience taught me much about termination in psychotherapy, especially when initiated by the therapist. With this background, I found Anne Power's book about imposed endings in psychotherapy an illuminating and enriching read.
Power's focus is on retirement. How do elderly therapists approach retirement and what impact does its announcement have on their patients, on themselves, and on their colleagues? Drawing on John Bowlby's attachment theory, Power interviews thirteen retiring or retired therapists, with ages ranging from 61 to 88 (all female bar one), and four therapists who closed their practices temporarily for other reasons.
What emerges is a wealth of clinical vignettes interwoven with a review of the relevant literature and Power's own observations. As expected, patients with disturbed attachment styles were the most affected by the announcement of retirement. Therapists themselves responded in a variety of ways: some with a sense of great sadness and loss, especially those for whom work itself was a strong attachment; the younger ones with ambivalence; and others who seemed to retire with ease.
The relative weight of push and pull factors seemed to determine the nature of the transition. When pull factors, such as pursuing creative interests, were dominant, therapists closed down their practices faster. In contrast, retiring because of duty of care or counter transference struggles seemed to stretch the termination process. Somewhere between 6–18 months, depending on various patient and therapist factors, seemed to be the norm for time between announcement of retirement to patient and date of retirement.
Power also discusses the thorny issue of mandatory retirement. As the case of ‘Beatrice’ highlights, there is no standard solution for what is a complex issue. At 88, Beatrice impressed Power with her talent and energy for the work. Beatrice, however, acknowledged that her analytic capacity had reduced and admitted to being more easily carried along by her counter transference. At her age, she also wanted to avoid traumatising patients who were vulnerable to sudden abandonment through death of their therapist. She retired voluntarily. Not all therapists, however, are as insightful as Beatrice and some may defend against the narcissistic insults of aging by working past their expiry date. Power therefore calls upon therapist supervisors and professional bodies to assume greater responsibility for triggering retirement. Power argues that, for various reasons, retirement is a taboo subject for discussion amongst therapists. Whether because of financial reasons, or the “reparative meaning” that therapists find in their work, or even an organizational defence based on the Oedipus complex (when competence is challenged by younger colleagues, it is written off as a wish to replace the parent!), collective denial of aging and retirement seems to be entrenched in the profession. This is not helped by the not quite good enough example set by Freud, who continued to see patients until close to his death.
Power's book is intelligent, engaging, and useful for anyone interested in aging, retirement, and psychotherapy. There is a very pertinent appendix, which poses questions all of us should consider when thinking of our own retirements. How many of us, for example, have a therapeutic will and executor in the event of our sudden death?
At 225 pages, it is not a long read. I must admit, however, that I did start to countdown the pages towards the end. This would suggest that either I was too mindful of the book editor's deadline for submission of this review, or that the book was at times repetitive and needing some editing.
