Perhaps no other scientific field can boast of such a contentious relationship with one of its founders as psychology does with Sigmund Freud.
While he educated and inspired multiple generations of aspiring psychoanalysts, his theories have been primarily relegated to the confines of historical background, literary analysis, and popular culture since the 1960s.
And yet the subfield of psychoanalysis persists, with new patients, or analysands, reclining on new couches to explore the deepest recesses of their unconscious. But this begs the question: are there still clinical applications for Freudian theories and structures?
Bruce Fink attempts to answer with a unequivocal yes in A Clinical Introduction to Freud: Techniques for Everyday Practice.
Quotes aware of the prevailing assumptions about Freud, his theories and the ubiquity in Woody Allen movies, Fink’s introduction seems to beg for patience and tolerance at times.
“Give Freud a chance,” Fink more or less insists, particularly addressing new clinicians or students assigned this text for a course, and reminds us that many in the field continue to endorse Freud’s theories and provide evidence supporting them.
Despite his best attempts, however, Fink’s arguments fail to bring Freudian theory into the 21st century in any compelling way, and although his discussions of Freud’s cases contain interesting analysis, the applications for the modern clinician are disappointingly few.
The book is divided into seven chapters which are then subdivided into sections, and followed with five appendices, offering additional insights regarding the examples mentioned in the text. Space is given to address Freud’s critics and make comparisons between psychoanalytic and DSM-V diagnoses.
From chapter to chapter, Fink attempts to build a burgeoning understanding of Freud’s psychoanalytic structures, theories and vocabulary, beginning with more theoretical considerations in “Tracing a Symptom Back to Its Origins,” “The Unconscious is the Exact Opposite of the Conscious” and “Dreams: The Royal Road to the Unconscious.”
Fink addresses the particulars of two of Freud’s most notable and studied cases: the Rat Man (Ernst Langer) and Dora (Ida Bauer). He painstakingly recounts the particulars of these cases, Freud’s approach and assessment of them and how they illustrate the corresponding theories from the earlier chapters. It seems noteworthy that Fink spends relatively little time exploring his own cases, but liberally peppers A Clinical Introduction to Freud with anecdotal references to his analysands and often includes quotes from them as section subheaders.
This represents, at best, a missed opportunity to meticulously lead the reader—ostensibly a student of psychology and aspiring therapist—through the process of applying Freudian theory to a contemporary case and elucidate the challenges of using Freud’s methods in a clinical setting. Instead, Fink uses the far less accessible examples of Langer and Bauer to illustrate the ongoing vocabulary of consciousness vs. unconsciousness, the imagery of dreams and the various expressions of obsession and hysteria.
“Hysteria and the Case of Dora” perhaps best clearly illustrates what is most and least successful in A Clinical Introduction to Freud. Fink thoughtfully delves into Freud’s mishandling of the case, the problems of his own assertions and occasional lack of insight and delivers a pithy lesson to the clinician-in-training: don’t hog the ball. Or else to say, let the analysand talk instead of insisting on one’s own theories, as Freud did in this case.
However, Fink’s own interpretation of Dora/Ida’s symptoms reads as woefully out-of-date to this modern reader; he makes repeated, dichotomous assertions about gender expression and sexuality that most would gladly consign to the early 20th century where they arguably belong. In addition, Fink’s interpretations of Dora’s experience and that of Freud’s other analysands consistently fail to take into account cultural and systemic pressures in any meaningful way. As a result, despite its 2017 publication date, A Clinical Introduction Freud at times reads as hopelessly dated to the point where it seems mired not only in Freud’s theories but his era as well.
Again, students of psychology will find points of interest in this text. Indeed, there is much to consider in Fink’s discussions of the roles and impact of language and narrative, in both our dreams and their deconstruction. The casual reader, unless exceptionally intrigued by theory, would likely be better off reading Freud’s work directly with some commentary, or else reading a biography or historical analysis.
Unfortunately, despite Fink’s insistence of Freud’s continuing relevance and application, he fails to make a convincing case and instead devotes much of his considerable resources to sniping at cognitive behavioral therapy, the DSM-V and theories critical of Freud’s work. And while there are critiques to be made of any theoretical framework or institution, his suggestion that we abandon the physiological study of mental illness is at minimum a dangerous and potentially damaging suggestion. An argument for more integrated study could easily be made, but Fink emphatically does not make such an argument here.
A Clinical Introduction to Freud
Norton, March 2017
384 pages, hardcover