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David, an unemployed young lawyer, shuffled dejectedly into my office one day toward the end of his third year of analysis. He lay down on the couch, clenched his fists and in an embarrassed whisper related the following nightmare:
I cut off my pinky with a letter opener, put it in my pocket and carried it around. My wife and I were going to go to the movies together, but she was late. So I decided to put it in the freezer, which was empty except for two ice cubes which had melted together. Suddenly I saw the blood gushing out of me and I went into a panic. I wanted to call you or an emergency room to get it sewn back on. I picked up the phone, but I couldn't speak—only a scream came out. When I woke up I had the feeling that something was worse with me than I really knew.
The explication of this terrifying, evocative dream proved to be the turning point in David's treatment. Indeed, a longstanding therapeutic impasse became capable of resolution only after a translation of this dream finally permitted him access to those words signifying his long hidden desire. It is my intention here to suggest a few of the possible applications of the work of Lacan in the immediate clinical situation by focusing upon this dream and the treatment context in which it arose. The material reported here occurred during the course of analytic practice prior to my first being introduced to the writings of Lacan. I have selected this clinical example to indicate how the integration of a Lacanian perspective may enhance and modify more traditional analytic modes of listening to and interpreting a patient's communication.
David was in his late 20s when he first sought consultation with me. During our first meetings, this tall, muscular young man kept his head bowed, gazed at the floor and seemed to shrivel in his seat as he