title: Some alterations of the ego which make analyses interminable.
abstract: After summarizing the seven questions put by Freud in his 1937 paper 'Analysis terminable and interminable', the author reports on the case of a female patient in whose second analysis four difficulties arose: the condensation of several traumas; a preverbal main trauma; the need for a permanent auxiliary ego to perform certain psychical functions; and resistance to analysis of her sexual inhibitions. The concept of the 'skin-ego' is proposed as a guide to interpretation. Several factors in the negative therapeutic reaction are demonstrated: in neurotic patients, fulfillment of incestuous oedipal wishes with the analyst may be postponed until after the end of the analysis, thereby abolishing that end; while in borderline patients the need for an indestructible, immortal external object may make it impossible to bring the analysis to an end, the transference being both anaclitic and paradoxical. Three other cases are discussed more briefly and illustrate the alterations of the ego when confronted with destructive envy, boundless greed and the repetition compulsion. The concept of the 'all-embracing object', as distinct from the part-object and whole object, can explain some patients' need to change analysts.
mesh_terms: D000328:Adult; D004532:Ego; D005260:Female; D005619:Freudian Theory; D005783:Gender Identity; D006801:Humans; D008297:Male; D009289:Narcissism; D011369:Professional-Patient Relations; D011574:Psychoanalytic Theory; D011575:Psychoanalytic Therapy