Fundamentals of Psychoanalytic Technique: A Lacanian Approach for Practitioners (Book Review)
Author: Fink, Bruce
Publisher: W.W. Norton & Company, 2007
Reviewed By: Macella Tarozzi Goldsmith, Vol. XXIX, No. 1, Winter 2009, pp. 38-40
It is appropriate for a book that discusses psychoanalytic technique to emphasize the major aspects of a therapeutic process that aims at long-lasting changes. What characterizes this book is the combination of already well-known techniques and the new approaches made possible by Jacques Lacan, a psychoanalyst who introduced controversial changes, like the variable duration of the psychoanalytic session.
Bruce Fink discusses topics that are often overlooked by other textbooks, and also particular techniques on how to approach specific difficulties encountered during a psychoanalytic session. Its chapters could be read separately according to the interests of the clinician. Still, the sequence of the chapters follows the order of the problems that come up in a non-orthodox therapy, such as a Lacanian therapy.
One of the threads of the book is that the Imaginary (one of Lacan’s categories) is an obstacle to understanding the analysand. Yet, understanding does not come in a single moment; if it did, that would be an indication that some prejudice is at work in the mind of the psychoanalyst. Alternating general considerations and specific, technical recommendations, Fink mingles together these two facets sometimes using a colloquial language that makes the narrative persuasive but also too casual. Considering that, for Lacan, in the psychoanalytic setting, language is basically metaphorical, and its function is to evoke, communication is problematic. This is probably why Lacan denied that the psychoanalytic practice is a science. What is it then?
Reading this book, the impression is that psychoanalysis is a trial-and-error activity, during which precision in language is valuable because it raises issues to the surface; the important thing is that the analyst must not take offense at the analysand’s words, which would make the therapeutic process fail immediately (pp. 26-27). Furthermore, Fink writes: “The more open-ended the question, the more unexpected, unpredictable, and often more productive the answer” (p. 33).
When Lacan wrote: “I do not discover the truth—I invent it,” he was making an important point indicating psychoanalysis’s empirical and tentative side, due to the difficulty of finding out what is repressed and why, what analysands avoid and deny because of their fears. But above all, the many desires of the analysand must be taken into account; indeed for Lacan desire is a vital part of us human beings.
Not all chapters of Fink’s book are of equal importance. The fourth chapter endorses the variable-length session. It is a debated topic that has many detractors. Fink’s overall approach is flexible, probably more than Lacan’s was, in that Fink keeps usually longer sessions at the beginning of a therapy, and with the passing of time, he keeps them shorter. They are punctuated to mark the important points to be worked out by the analysands themselves after the session, so that the following one will bring new, important material to be analyzed. There are different techniques for punctuating, and Fink provides concrete examples on this topic.
One danger, Fink warns, is that technique becomes an end in itself to the detriment of what is important, namely, the identification of the desire(s) of the analysand. But sometimes in the course of analysis, symptoms worsen because of the libidinal, dual relationship that is established during the sessions. Another danger is the resurgence of jouissance, considered by Fink a negative “enjoyment or satisfaction people derive from their symptoms” (p. 69n).
On the practical side, Lacanians charge by the session independently of their length, which, for Fink, makes the treatment more affordable. This may be true, but short sessions do not leave time for analyzing dreams, an additional inconvenience is that the analysands must wait because of the different length of the sessions of the previous analysands. This, in my view, can only add to the anxiety of the analysands. And indeed Lacan’s office was always crowded with people waiting for him to beckon them to enter the room where the actual session would take place.
As to interpreting, it should have an impact, whereas accuracy is less important given that it is only by approximation that we can understand another person. Besides, to explore and find new meanings is no panacea, they could be fantasies or even rationalizations—or simple clichés. Without giving a univocal definition of meaning, Fink insists that the analyst does not provide definite answers, the analysands must find them themselves and internalize them. Even less should psychoanalysts impose their values and views on the analysands: that would make them authoritarian. Another important technique consists in not interrupting the flow of language, keeping in mind that too much interpretation can jeopardize an analysis; interpretations should be polyvalent and, therefore, remain ambiguous. As long as interpretations elicit new material, they are productive, but they can also cause anxiety and disagreements between the analyst and the analysand (pp. 84-85).
The fifth chapter on interpreting concludes with some reflections on the role of wit in therapy, which is a way of unblocking a stalemate. Dreams, like wit, are creative and “potentially inexhaustible” (p. 106), that is why analysts seldom explore wishes in dreams; it would be “like finding a needle in a haystack” (p. 110).
Whereas the sixth chapter, on dreams and fantasies, is the least innovative of this book, the seventh chapter on transference and countertransference explores the most intricate psychoanalytic notions. It is the most dense of the entire book. Since the aim is to “cure” the analysands who resist symbolization, psychoanalysis is not simply a matter of making them able to function in society. However, the analyst is a distorted mirror for the analysand, so that the danger is to initiate a comedy of errors whereby transference can become a resistance to the work of analysis. The analysts then, should keep their countertransference to a minimum and rely instead on the symbolic triadic structure that must be reconstructed in order to transcend the dual, imaginary mirror-like relation.
The Imaginary, though, remains indestructible in the human psyche of almost anyone. Fink suggests that when the negative transference of the analysand is unmanageable, the analyst could refer the analysand to another psychoanalyst, while the analyst will consult a supervisor who could unravel the imaginary impasse. Other important points are raised by Fink: the sex of the psychoanalyst and also his or her sexual orientation are mentioned as being relevant, but how relevant his or her age is is not mentioned.
In this book several case histories are touched upon; and they are useful within the limits of a second-hand narrative. Besides, Fink does not claim to give a complete guide for each case, since each one is different and should be treated differently. The author also discusses alternative theories, those of Wilfried Bion, D. W. Winnicott, and Melanie Klein, to name just a few. He insists also that there is no objectivity in the psychoanalytic practice, at the most there is the objectivity of the symbolic, linguistic order.
As to emotions, Fink distrusts them, although the analyst is not neutral and plays an important role in the repetition that happens in analysis. For Lacan, transference reactions are indicative of a failure in symbolization; Fink agrees, adding that analysands should put themselves in the position of the symbolic Other.
The protagonists of an analysis are of course two, but there is also a third element: the symbolic Other that ideally keeps at bay the possible distortions due to the prejudices of the analysts themselves. Fink writes that the more thoroughly the analyst’s training has been, the better able s/he is to analyze other people. For Lacan, though, there is no distinction between a personal analysis and a training analysis.
In the eighth chapter, Fink deals with the sessions by phone, a useful complement to the in-person sessions when the analysand is incapacitated. These sessions eliminate some imaginary aspects of the normal session. Furthermore, visual contact is not indispensable ,considering that a blind person can be analyzed. This type of analysis, though, is not for everyone, including both the analyst and the analysand (p. 202). It is no more than a possible alternative to the standard sessions.
The ninth chapter, on analysis that normalizes, criticizes such an aim; for Fink it would be tyrannical, the work of a pedagogue (p. 207). Also Lacan discouraged mediocrity. Bion, for instance (who is not mentioned in the book on this point), tried to normalize Samuel Beckett, but to no avail. If there were a universal theory of human nature, the term “normalization” would be acceptable; instead, women and men differ, they have different desires, and even different logics (p. 213). This is a controversial point that would deserve further study. Even fantasies, which in analysis are re-configured, are different in different people.
There is no universal view on how humans are or should be. In this sense the author consistently adopts a postmodern attitude. Fink prefers to use the terms “appropriate and inappropriate” rather than “normal,” but aren’t these terms quite similar? To perform better in society is the goal of many analysts, Freud included. Reality testing, whether it is social or economic, is another attempt at normalization; yet, human reality is mediated by language and it is nonobjective, since it depends on perception. For Lacan what is real is the unconscious, its reality is sexual and also traumatic (p. 227).
The last and final chapter, on treating psychosis, begins with the accurate claim that Lacan sharply differentiates it from neurosis. In neurosis the three categories of the Imaginary, the Real, and the Symbolic are linked together, although in a lose way, whereas in psychosis the three categories (or, using Freudian language, the Oedipus complex) have never been linked together. Because of this, in the case of psychosis, Fink uses alternative techniques and aims, thinking that some form of therapy is advisable even in severe cases. In a note Fink quotes Lacan’s puzzling comment: “The unconscious is there but it does not function.” (p. 232n), which was his way of saying that it has no role to play in the therapy of psychotics, who have not gone through the primal repression typical of neurotics.
Given this structural lack, the approach taken by the author consists in saying what analysts should not do: “Primum non nocere.” (p. 236). The therapist must avoid a recurrence of the initial breakdown by being calming and nonpersecutory. Punctuating is unnecessary because “The majority of the work with a psychotic analysand takes place during the session itself, not in between sessions as it is often the case with neurotics.” (p. 236). Since the Other, as understood by Lacan, stands for an ultimately unexplainable ontological void, it is counterproductive to “remind” the psychotic of this lack by insisting on the importance of the symbolic, polysemic linguistic system. To make the differential diagnosis, the psychoanalyst must consider the “transferential relationship.” With the psychotic, the Imaginary and the Real registers (or categories) predominate in the transference; in Fink’s words: “Transference in psychosis tends to involve passion, not knowledge (except insofar as it is related to passion), whereas in neurosis it tends to involve both” (p. 247).
Fink stresses the practical aspects of a cure for psychotics, but does not mention in detail Lacan’s theory of psychosis; that would have meant starting from his dissertation of 1932 on paranoia. Following Lacan’s well-known dictum that the unconscious is structured as a language, the author quickly identifies the unconscious with the symbolic dimension (p. 248). The symbolic Other finds no place in the mind of the psychotic, and it would be foolish for the therapists to act rigidly, because, then, they would be perceived as persecutory and cruel, like the Other the patient was accustomed to. Such an approach, plus the stress factor, could trigger a second break.
The relationship between analyst and patient should be based on the Imaginary; analysts should avoid speaking about themselves and the sessions should be face to face to stabilize the morbid state of jouissance in which psychotics finds themselves: “[The analyst] must do his best to dispel any of the psychotic’s projections that seem to situate him as this dangerous Other who enjoys at the psychotic’s expense” (p. 253). Given the fragility of the psychotic’s ego, the analyst will alleviate or, ideally, demolish the delusional systems of these ill people by finding for them a project, some meaningful way to occupy their lives, and a belief system replacing the explanatory principle which is the Symbolic order. But this is why the analysis of psychotics can last a very long time, almost indefinitely.
There are different types of psychosis, but there are also borderline cases. If the outbreak of psychosis happens to an adult, the breaking point can be the loss of a dear person or a particularly stressful situation; in these cases Fink encourages the patient to engage in traveling or in an artistic activity, which somehow reactivate the link between the Imaginary and the Symbolic. The solution advocated by the author is that the therapist should help “the analysand find a way back to the former stability or find a new situation that will lead to stability of the same or of a slightly different kind” (p. 265).
Stabilization is the aim or, minimally, amelioration. In the end, to find and fix meaning, limiting jouissance will improve the patient’s life. Ultimately, the patient must accept the fact that, if the past cannot be changed, it can be given a different interpretation; he or she must accept human finitude without disregarding the important role of desire. Fink’s final comments are that “the work with psychotics is unpredictable” (p. 271). Being so different from neurosis, Lacan did not believe it possible to make neurotics out of psychotics; instead Fink believes that sometimes it is not easy to distinguish between neurosis and psychosis.
Considering the book as a whole, one does not find a detailed discussion of Lacan’s theories, but most exergues at the beginning of its sections are by Lacan. Their purpose is to function as points of departure for what follows.
Being an introductory book, Fundamentals of Psychoanalytic Technique is a useful and detailed work for the professionals who want to familiarize themselves with Lacan’s psychoanalytic theories. In my view, the length of the many footnotes sometimes blocks fluent reading of the text. Some of them are informative, some go beyond what is necessary to grasp a given concept or technique. More concision would have been desirable, although the notes, per se, are an indication of good scholarship.
Finally, since for Lacan the Symbolic structure is linguistic and psychoanalysis is based on language, it is perhaps appropriate to ask whether the psychoanalyst or the analysand has the last word.
Macella Tarozzi Goldsmith, New York City
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