Chapter 2 Therapeutic Indications

When a patient meets an analyst, two cases can arise. In the first, it is an inaugural encounter; the individual requesting the consultation has never seen a practitioner of analysis before, nor has he had any prior experience of analysis. In the second, the patient wishes to have a new experience of analysis, feeling that there is still work to be done and so addresses himself, on the basis of various indications, to the person whom he hopes will be able to help him. Lacan has designated the analyst, in the patient’s imaginary world, as the subject who is supposed to know. No doubt it is necessary, from the outset, for the patient to imagine that the person he is seeing knows something about the mind and that he can enlighten him about his own. But this definition seems to give more of a phenomenological than a genuinely psychoanalytical account of the situation, even if the question is one of who is supposed to know in the patient’s unconscious. In any case, during the first encounters – indeed from the very first – the analyst is going to find himself, roughly speaking, faced with two different situations. In the first, he is going to be dealing with a person with whom the encounter will unfold on several levels at once which will all need to be linked up. Even if he does not speak about it, the patient will react to the analyst’s presence, to the presence of this particular analyst. In this reaction there will be a mingling of elements which already constitute a pre-transference, combined with others which are related to the analyst’s particular personality. As the consultation unfolds, the thread of the pre-transference which, in fact, is already a transference, will be apprehended more and more clearly, and will sometimes be perceived by the patient (‘I don’t know why, but you make me think of my uncle X …’). Within this transferential dimension, the patient, before or after talking about his symptoms and the reasons for his consultation, will tell a story, na