Patricia Stewart – Psychoanalysis – Who Needs It

THE LETTER 12 (Spring 1998) pages 41-47

Bruce Fink opens his latest book with the old joke:

How many psychologists does it take to change a lightbulb?

Only one, but the lightbulb has to really want to change!

He goes on to tell us that many psychologists do believe that the patient must genuinely want to change for therapy to be effective. Lacan’s approach, however, is different. Fink reminds us of Freud’s insight that symptoms provide satisfaction, however obscure; at some level the individual enjoys his or her symptoms. There is consequently no such thing as a genuine desire to change. In the absence of this desire to change, it is often up to the analyst to express his desire that the analysis continue, otherwise the patient is likely to break off therapy. Fink says that the patient’s desire to continue therapy must, at certain times, wane or disappear. This is a problem that we have all experienced. But there is an even greater difficulty, which is encountered in varying degrees, although I believe it is a challenge for psychoanalysis in general: how do we get people into analysis in the first place? If what they want is a patch repair kit which will at least temporarily restore satisfaction to previous levels, and there are plenty of those kits on offer, who needs psychoanalysis? What are the actual considerations here?

A preliminary question is, should people be going into analysis at all? This is an ethical question. The dictionary tells us that ethics involves acting morally, is the science of morals, that branch of philosophy which is concerned with human character and conduct. It comes from the Greek, ethos, custom, character. Morals comes from the Latin, mos, manner or custom. So we have to consider the manner and custom, and the character and conduct of…

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