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Russell Banks is arguably one of the most important writers of contemporary American fiction. In the course of his career, he has written many novels and short stories that are at times highly psychological in nature and lend themselves to psychoanalytic modes of understanding. In his most recent novel, Foregone, Banks focuses his attention on the inner life of an old man, a documentary film-maker, who is dying of cancer. The man is consumed with guilt and feels compelled to reveal to his wife for the first time information about his past transgressions, which center upon his lies as well as his betrayal and abandonment of other people. He believes she should know about these experiences before he dies in order to allow her to assess her love for him. In speaking of these matters, he is particularly concerned with the way that he has shaped his inner life and his behavior in order to fulfill others’ expectations of him, which is a major issue that is confronted by those engaged in clinical work. He tries to explore these problems by engaging in a form of free association in the presence of his wife and a film-maker who is making a documentary about him. In this book review essay, I examine Banks’s novel by providing an overview as well as a discussion of its psychoanalytic dimensions. Quite often, the form of the novel and the language that Banks utilizes reflect psychoanalytic perspectives.