Jacques Lacan's theory has had a surprisingly limited affect on American psychoanalytic thought, and almost no noticeable affect on how analysis is conducted in the United States.  Lacan himself was openly contemptuous of American interpretations of Freud, and made pointed comments about the failings he saw in Ego Psychology, in particular.  Even now, 26 years after his death, the ascendance of Relational psychoanalysis in America is strictly incompatible with Lacan's articulated understanding of what occurs during analysis.  The result is that in America, Lacan is more often read in university literature courses than he is taught in therapeutic training programs, and American therapists have, for the most part, not had the benefit of engaging with his rich and varied contributions.

Bruce Fink's new book, Fundamentals of Psychoanalytic Technique:  A Lacanian Approach for Practitioners, goes a long way toward providing the kind of systematic introduction to Lacanian technique that is sorely needed in the United States. Fink's book also manages to ground an introduction of Lacan's theory in rich descriptions of the analytic encounter.  Along with Fink's earlier A Clinical Introduction to Lacanian Psychoanalysis, and his recent new translations of Lacan's seminal Ecrits, Fink's project redresses the unbalanced focus on a theoretical version of Lacan in America today.

The primary strength of Fink's book is in his systematic examination of the major technical areas important to Lacanian analysts.  He devotes chapters to listening, asking questions, interpreting and working with dreams, daydreams and fantasies, among other subjects.  He does not shy away from discussing what is perhaps the single most controversial (and misunderstood) aspect of Lacanian technique, scanding, or the variable-length session.  He presents a cogent and thorough explanation for why variable-length sessions (by no means necessarily shortened sessions) can be an important part of moving analytic work forward.  His clinical illustration of scanding, demonstrates using the practice to punctuate the most important (and avoided) material presented by a particular patient, and successfully removes the practice from a theoretical heresy about an analytic commandment (the fifty-minute hour) to a considered analytic technique.  Even for those not convinced by his argument, his chapter on scanding should go a long way toward promoting debate on the matter, while hopefully ameliorating the most outraged responses to its mere mention.

Fink's chapters on Listening and Hearing, Asking Questions, and Interpreting, should be required reading for all beginning therapists.  He manages to both be systematic, specific and practical in his recommendations, while maintaining room for the art that is good therapeutic technique.  Fink reminds us that analytic listening, indeed, all analytic activities, are removed from their more prosaic counterparts.  As Fink points out at the very start of his book, we all too often overlook what about a particular story or experience makes it unique, instead assimilating it to familiar stories which we already know.  This is dangerous and irresponsible when we practice therapy.  Fink uses his chapter on listening to reassert the importance of paying attention to slips of the tongue, and other mis-speaking, in order to observe the small eruptions of the unconscious that occur during every session.  He even provides very practical advice for how to do this for those who claim that people rarely make such slips:  listen to the news.  "One useful exercise is to listen to news announcers, whether on the radio or television, and practice listening for slips and stumblings as opposed to listening for content.  It is perhaps best to listen first to programs that one is not especially interested in, so that the content does not monopolize one's attention[…]Once one is able to regularly hear the slips and slurs in speech about matters that are of not much interest, one can then turn to programs that are closer to one's own heart…"(21)  His chapters on questions and interpretations are similarly pointed, and very good.  In particular, he takes care when discussing interpretations to highlight the importance of crafting interpretations that are pointed enough, and yet also polyvalent enough, that they elicit further analytic material from the analysand.  Starting from Freud's work in "Constructions in Analysis," Fink persuasively argues that empathic therapist reactions foreclose a whole range of reactions from analysand's, and, paradoxically, operate by denying the analysand's experience rather than acknowledging it.

The central chapter of Fink's book is on handling transference and countertransference.  Fink views transference globally, pointing out that while the analytic situation is designed to elicit transference, the nature of the repetition at play in transference suggests that patients experience similar patterns in other situations as well.  At the same time, he practically points out that not all reactions an analysand has to her therapist, or actions she takes that have an affect on her therapy, are likely to be motivated by transference, since any relationship as long-lasting and time-consuming as analysis is likely to result in concrete situations about which anyone is likely to have an opinion.  Fink artfully discusses the dangers of interpreting transference, especially by attempting to replace "faulty" transferential fantasies about the analyst with a more "realistic" understanding.  Fink argues that the notion that there is a rational, "observing ego" available in patients to understand such interpretations is suspect, illustrating that patients hear these interpretations precisely from the transferential position that they are supposed to affect.  Overall, his position is that transference is something to be handled and endured by the therapist, and that allowing the transference to proceed without undue interference or anxiety on the part of the analyst is the most therapeutically beneficial choice.

This is a rich and complex book, which cannot be adequately addressed in such a short review.  Fink's book is partly treatment manual, partly theoretical exegesis, and partly corrective polemic, focused on the different understandings of the purpose and best outcomes of psychoanalysis between American and Lacanian analysis.  Fink's chapter on "Non-normalizing Analysis" is essential reading for anyone interested in understanding how Lacanians view the relationship between psychoanalysis and mental health.  Fink highlights the points at which American analysis assumes and promotes a normality that is often in the service of flattening the vicissitudes of psychic life.  His short sections on "inappropriate affect" and "reality-testing," do a fabulous job of making manifest the questionable therapeutic utility of these concepts.

Bruce Fink has written a wonderful and necessary book about Lacanian analytic technique.  It is closely argued, rich in content, and it is clearly a book that either beginning therapists or more experienced clinicians will benefit from reading.

© 2008 Andrew Pollock

Andrew Pollock is a psychotherapist practicing in Baltimore, and a Director of the Baltimore Psychotherapy Institute.