Part I, Chapter 1: Desire in Analysis (pp. 3-10)

Lacan's approach to therapy is radically different from those of psychotherapy. The onus is not placed on the patient. Lacan do believe that patient does not really want to change. If symptoms have developed, it is because a great deal of energy has become tied up in those symptoms, for (s)he obtains what Freud refered to as a "substitute satisfaction" from symptoms, and cannot be easily induced to give it up.

Just as patients do not come to therapy with a "genuine desire to change," they do not come with a "genuine desire for self-knowledge." Although many patients express a desire to know what went wrong, there is a more deeply wooted wish not to know any of those things. Freud occasionally talked about a drive to know(Wissentrieb), but Lacan restricts such a drive to children's curiosity about sex. In therapy, according to Lacan, the analysand's basic position is one of a refusal of knowledge, a will not to know(a ne rien vouloir savoir). It is only the analysis's desire that allows the analysand to overcome this "wanting to know nothing," sustaining the analysand through the painful process of formulating some kind of new knowledge. Lacan goes on to say that the only resistance in analysis is the analyst's resistance, for the patient's resistance is taken as a given, and their resistance to knowing can be surmonted if the analyst is willing to intervene.

Patients often go into therapy because their desire is dying. In the majority of cases, people go into therapy at moments of crisis, at times when their usual modus operandi is breaking down.

...tbc