I am a psychoanalyst in private practice in NYC, and today I would like to share how I adapt Lacan’s teachings to the way I learn to work with my American patients from the moment they contact me for the first time, before the therapeutic work is established.

First let me give you a bit of background about my work.  Most of my patients find me through various digital marketplaces like Psychology Today or like Zocdoc (popular in the US), where patients can access psychologists, psychiatrists, and other mental health professionals. They may or may not know anything about psychoanalysis.

Patients contact me because they like my profile, because my office is in a convenient location, because of the languages I speak, because of the way I look —since I have a picture attached to my profile— or because I accept their insurance.  It could really be anything in my profile that speaks to them.

With that in mind, I want to take you to that first phone call to discuss a first consultation.  I want to share with you something that I hear frequently and that feels uniquely American.  Most patients start the conversation with: “Can we meet to see if we are a good fit?”

This consultation feels like an interview of the therapist by the potential patient, especially considering that I was found on a marketplace.

And so I have taken up the challenge to see if Lacan’s teaching can offer any guidance on how to listen to this expectation and how to address it.

Can this phone call and the expectation of a good fit lead us in the direction of the notion of transference and, more specifically, in the direction of the subject supposed to know?

 I think yes.

The seminar of the Psychoanalytical Act places the transference at the heart of the psychoanalytical act. In other words, we can also say that transference is at the heart of this subjective adventure taken by the psychoanalysand in an analysis.

Lacan restores Transference in a completely new fashion by relating it to the subject supposed to know. The whole scaffolding of an analysis is supported over the shoulders of the subject supposed to know. So much so that the psychoanalysand can learn nothing in the analytical experience unless transference operates within it.

So much so is at the heart of an analysis, that the fall of the subject supposed to know, marks the end of analysis—the end and a beginning, in the emergence of a new analyst capable of putting back in its place the subject supposed to know.

The challenge for a new analyst is to take up the challenge of this act. It is a game, Lacan will say—a game between a psychoanalysand and the psychoanalyst, in which the later plays the part of “the-subject-supposed-to-know”. It’s a game, because he knows what his own analyst has become in the accomplishment of this act: namely, this residue, this rubbish, this rejected thing. He knows only too well that he doesn’t possess that supposed knowledge. And by playing this game, “By restoring the subject supposed to know, by himself picking up the torch of the analyst, he installs the object a at the level of the “subject supposed to know”.

This is the frame that we must set in place at the beginning of any therapeutic work. As a new analyst how do I play this game? There is a certain performance required as you can tell—a performance, a putting up of an act, that requires the most severe discipline.

It’s a game about lending a body to a false subject suppose to know! What a task. Incarnating, embodying a subject that doesn’t exist, and building the supposition that this subject knows something.

How do I seat on my chair in New York and play this game?

The phone calls that I receive sound a bit like this:

“I see that you your office is next to mine, can I come to see if we are good fit?”

“I want to work with a woman older than me because I’m about to make important decision and I need the help of an experienced woman.”

What people imagine in me is endless!

As an analyst, I know that this is a sensitive moment and that the references given by the caller can position me in the place of the subject supposed to know for that individual. Again, different at every time.

Let me know tell you of a recent phone call:

 “I’m calling you because I see that you are not American, and that you speak French”. I have to say that I was surprised by the level of detail given. I then asked why was that important, to which she replied with details about her story as a woman of color.

This woman has picked me and decided to make that first phone call because of what she supposes, because of she imagines of me and the signifiers that help relate her suffering to me. She thinks I’m a good fit for her.

So, this idea of a patient looking for a fit might sound trivial, but again, thanks to Lacan’s teachings we know that it is not, quite the opposite. We know that what is at stake needs to be taken seriously and professionally, because what is at stake it’s the establishment of transference and, more specifically, the establishment of the subject supposed to know in the person of the analyst.

And so while there is this initial fit, a very important one, let me also tell you the subject supposed to know is a misfit because he is not the subject who knows and he knows it.

The subject supposed to know while playing the game of the fit, works his way to restore the object a to this place, and by doing so, slowly “the subject realizes as a lack”, and this lack, as Lacan doesn’t stop hammering, is the very essence of all speaking beings.

Assumption of a fit that is not, a supposed fit that is just that: a supposed fit.

A patient searching for a fit, for that one who knows and who “will realize the subject as a sexed partner in what is imagined as unification in the sexual act”. That’s what is at stake in the fit.

And so while the analyst should uphold this notion of this fit, the analyst must never lose sight that he is not that perfect match, that he is not the perfect fit, and that the analyst is nothing but the support of this little object a, and must never lose sight of the ignorance of the subject who is alienated from this realization of lack.

Let us go back to the woman of the phone call:

It is in this first phone call that my patient accepts that there is something to her suffering that she ignores and that could be causing her problems; and in an effort to seek an answer, she makes that phone call to someone whom she imagines might know something about “being a woman of color in America” and will consequently have answers and will bring reassurance.

Lacan reminds us that Transference is implied in the act through which the analyst gives to the doing of the analysand support and authorization. And so, I as the analyst give the proper weight to what this woman says and confirm the fact of transference:  As analyst we do not need to answer to this believe of our patient. I don’t have to say, “No, you are wrong, that is not my story.” Or “Yes, you are right about me.” The trust that she has deposited in me believing that I’m the one who is supposed to know, allows me to invite my patient to continue to speak freely. Which she does because she thinks we are a good fit.

However, again, the fit is a fallacy! And I know that the outfit that will allow me to dress for the occasion is that of the “the woman of color living in America”. I’m sure the truth of my patient lies in there somewhere. And that I as her analyst will have to sustain the semblance of a fit because that’s the only way that I, as her analyst, will be able to disturb the ignorance of the analysand and help her learn something about her own suffering.

And so, the analyst must be able to hold and exist in this precise place of tension between fit and misfit, in this gap which Lacan teaches us is the place of the object a. And while there is the expectation that the analyst will answer from this place of fit, of perfect match, the psychoanalyst must just be the holder of this place for the duration of treatment until the end.

Our patients will always aspire to a fit as an aspiration of completeness, but we know what is at stake in our work: to bring down the notion of a possible completeness. And so we don’t answer; we remain silent and seated in the chair of the subject supposed to know. Until the end, when we can finally remove this outfit.

I’m going to end there, not because there isn’t more to say, there always is, but because I want to fit in our limited time of today.

Thank you.