Lacanian Psychotherapy

Theory and Practical Applications

Michael J. Miller

• Publisher: Routledge
• Year: 2011
• ISBN:
  9781136726743
• Edition: 1
• Topic: Psychology
• Subtopic: Psychoanalysis
• Index: Psychology

The work of Jacques Lacan is associated more with literature and philosophy than mainstream American psychology, due in large part to the dense language he employs in articulating his theory– including often at the expense of clinical illustration. As a result, his contributions are frequently fascinating, yet their utility in the therapeutic setting can be difficult to pinpoint. Lacanian Psychotherapy fills in this clinical gap by presenting theoretical discussions in clear, accessible language and applying them to several chapter-length case studies, thereby demonstrating their clinical relevance. The central concern of the book is the usefulness of Lacan's notion that the unconscious is structured like and by language. This concept implies a peculiar manner of listening ("to the letter") and intervention, which Miller applies to a number of common clinical concerns– including including case formulation, dreams, transference, and diagnosis– including all in the context of real-world psychotherapy.

1

Shattering Discourse to Bring Forth Speech

Whether it wishes to be an agent of healing, training, or sounding the depths, psychoanalysis has but one medium: the patient’s speech.

—Lacan (1953/2002, p. 40)

Jacques Lacan, a rising star on the psychoanalytic scene, although already a controversial figure for his variable-length session, found himself in January of 1953 the newly elected president of the Société Psychanalytique de Paris (SPP) (Nobus, 2000, p. 193). He was, via that institution and its affiliation with the International Psychoanalytic Association, invited to address the upcoming Annual Congress of Romance Language–Speaking Psychoanalysts in Rome on the subject of speech and language. “In the meantime,” he tells us, “serious disagreements,” largely over Lacan’s use of the variable length session, “led to a secession within the French group” (1953/2002, p. 31).¹ Lacan in turn resigned his position at the SPP 6 months after attaining it to join those who had seceded in the newly formed Société Française de Psychanalyse (SFP).

Despite the mounting political tension surrounding Lacan, he was allowed to make the address he had been invited for, and the members of the SFP were allowed to attend. During that address, nicknamed the “Rome Discourse,” Lacan circulated a paper entitled “The Function and Field of Speech and Language in Psychoanalysis,” a work that might be seen (or heard) as the “newborn’s cry” (1953/2002, p. 32) of a Lacanian psychoanalysis. At the least, it provides the reader with one possible starting point from which to understand Lacan’s agenda, which was at the core of the “serious disagreements” to which he alludes. That agenda was “to revamp the foundations our discipline derives from language” (p. 32).

With this paper, Lacan made plain what was at stake in his “return to Freud.” His aim was to bring psychoanalysis back to what he saw as Freud’s greatest discovery: simply put, that the “talking cure” was about talking.

Lacan also commented extensively on what, in his view, psychoanalysis was not about, and the tone of his critique leaves little doubt as to one aggravating factor in the rift between Lacan and his contemporaries. Unfortunately, this tone set the stage for a lasting schism between Lacan’s vision of psychoanalysis and that of Kris, Loewenstein, Hartmann, Balint, and Winnicott, whose views (though hardly all one) have largely been constitutive of the impact made by psychoanalysis on current American psychodynamic therapy (see, for example, Jacobs, 1991; Maroda, 1999, 2001; McWilliams, 1994). Here we see a perennial problem with Lacan: In his attempts to move psychoanalytic praxis into the “symbolic” realm of productive dialogue, his politics and his rhetoric often leave us stuck in what Lacan (1988b) called “the imaginary,” a narcissistic world of “us and them”; rivals who will not concede even to speak each other’s names (Fink, 2004; Schneiderman, 1983).

The “Newborn’s Cry” of a Lacanian Psychoanalysis

While any number of Lacan’s texts will provide the reader with examples of what he found wrong with analysis as taken up by his contemporaries, it seems fitting to turn to the first cries of the newborn enfant terrible to orient ourselves. In “The Function and Field of Speech and Language in Psychoanalysis” (1953/2002), Lacan wastes little time in voicing what he sees as the problem:

One can trace over the years a growing aversion regarding the functions of speech and the field of language. It is responsible for the “changes in aim and technique” that are acknowledged within the psychoanalytic movement, and whose relation to the general decline in therapeutic effectiveness is nevertheless ambiguous. (p. 34)

This “aversion regarding the functions of speech and the field of language” is to be found in an emphasis, in “the literature that we call our ‘scientific activity,’” that is, a psychoanalysis as interpreted by ego psychologists and object-relations theorists, on “[t]he function of the imaginary … the concept of libidinal object relations … [and] the importance of countertransference” (pp. 242–243).

For Lacan, these new emphases in psychoanalysis constituted a shift away from the “symbolic” register—the proper domain of psychoanalysis, which involves a discourse between the “Subject” and the “Other”—and toward the “imaginary” register, by way of which two egos relate either in friendly identification (“me and somebody like me”) or via adversarial posturing.

Psychoanalysis, as part of its acculturation to an American paradigm,² has become focused on “communication” between egos as the curative factor in psychoanalytic treatment. The analyst’s ego communicates with, becomes a model for, and props up the ego of his analysand; that is, the psychoanalyst has been relegated simply to influencing the patient to be more like him.

“[P]sychoanalysis in the United States has been inflected toward the adaptation of the individual to the social environment, the search for behavior patterns, and all the objectification implied in the notion of ‘human relations’” (p. 39). Rather than remain true to itself as an exploration of the symbolic and linguistic systems that structure the unconscious subject, as per his reading of Freud, psychoanalysis according to Lacan has become little more than a glorified exercise in behavior modification; a mirage of “communication,” which leaves the subject without her own history (p. 39), has come to replace the proper analytic experience.

Further, Lacan argues that the analyst is mistaken in his notion that language and speech are fundamentally inadequate to the psychoanalytic project. As a result of this supposed mistake, the practice of analysis has become focused on an illusory something situated beyond speech, which makes itself known in an interpersonal, affective way.

Already, characterizing this focus of clinical practice as a mistake is bound to strike us as counterintuitive. To speak from my own experience as a student of psychodynamic therapy (which I imagine is not entirely unique), I have been trained to “follow the affect” of my patients and to pay constant attention to my countertransference feelings, and even to regard them as typical of the position that the client must tend to put others in. So interpersonal, relational experience as well as the importance of affect have been central to my own training, perhaps as a result of the influences Lacan was protesting. Yet some have gone further than the emphasis I have described and recommend that we actually engage these feelings in the session: to let the client know, for example, that I might be feeling angry “for”—or even with—him (see, for example, Jacobs, 1991; Maroda, 1999, 2001).

Intervention based at least partially on these interpersonal, intuitive aspects of our experience with the patient has sometimes been presented in psychodynamic training as preferable to acting on the basis of a prefabricated, intellectualized construction we may have reached. Indeed, some would maintain that to intervene based on the latter is often nothing short of colluding with the client, for we often see her as already too intellectually defended, and to make such a mistake would be to encourage her destructive interpersonal patterns via the defense with which I have allowed myself to become complicit, while what is really needed is for the client to be brought back to an authentic, interpersonal expression of an affective state that lies beyond words.³

Karen Maroda (2001) brings this idea to its logical (and perhaps chilling) conclusion when, discussing her disclosure of her anger with a client, she writes: “I realized how important the expression of my affect was to breaking through to Sally and patients like her. Sadism was preferable to my neutrality” (p. 34, emphasis added).

Not so, says Lacan (1953/2002), with some contempt of his own:

[N]othing could be more misleading for the analyst than to seek to guide himself by some supposed “contact” he experiences with the subject’s reality. This vacuous buzzword of intuitionist and even phenomenological psychology has become extended in contemporary usage in a way that is thoroughly symptomatic of the ever scarcer effects of speech in the present social context. But its obsessive value becomes flagrant when it is recommended in a relationship which, according to its very rules, excludes all real contact. (p. 39)

For Lacan, to entirely base an approach to treatment upon such interpersonal “contact,” using as our guide our own countertransference fantasies, feelings, and intuitions, boils down to little more than an exercise in narcissism. To intervene based upon hunches about the patient’s affect, and to privilege an affectively based “contact” beyond that of language, is to miss the point of Freud’s “Promethean” discovery as illustrated in The Psychopathology of Everyday Life (1904), Jokes and Their Relation to the Unconscious (1905b), The Interpretation of Dreams (1900), “Notes Upon a Case of Obsessional Neurosis” (1909), and “Fragments of an Analysis of a Case of Hysteria” (1905a), to name a few—that the subject exists and is always to be found in language itself.

But what is at stake for Lacan is more than simply an appreciation of one of the philosophical underpinnings of Freud’s work. Rather, “[b]ringing psychoanalytic experience back to speech and language as its foundations is of direct concern to its technique” (Lacan, 1953/2002, p. 76).

To better understand what it might mean for Lacan to be accusing his contemporaries of propagating a narcissistic psychoanalysis, we must return briefly to his conception of the ego, noting that he maintained that this concept of Freud’s, too, was misappropriated by the ego psychologists. Lacan accuses ego psychology of misconstruing the ego as a “reality function” (although this is in fact reflective of Freud’s later conceptions of it) and insinuates that his acculturated peers have been mistakenly seduced by the belief that “the subject’s ego is identical to the presence that is speaking …” (p. 88).

For Lacan, nothing could be further from the truth. As we see first in “The Mirror Stage as Formative of the I Function” (1949/2002), Lacan sets up the ego as the symptom upon which he begins to construct the imaginary register. Briefly put, the ego for Lacan is the locus of mistaken identity: a misrecognition by the subject of itself as a two-dimensional image. Maintaining that he is in line with Freud on this question, he refers to the ego (1953/2002) as “the system of the subject’s objectifications” (p. 88). The ego for Lacan is itself an objectification; the fundamental objectification, a primary symptom that sets the stage for ensuing symptoms over the course of a lifetime, which finally lead the patient to psychoanalysis. If this is the nature of the ego, then it must be counterproductive for the analyst to simply align herself with the patient’s ego: This would be nothing other than strengthening the disease in hope of a cure.

This is precisely the direction in which Lacan sees psychoanalysis heading as it strays from its engagement in speech and language in favor of attending to affect, countertransference, intuition, and the like as they culminate in a curative relationship between analyst and patient. Michael Balint’s (1968) notion of a “two-body psychology” is used as an example:

Analysis is becoming the relation of two bodies between which a fantasmatic communication is established in which the analyst teaches the subject to apprehend himself as an object. Subjectivity is admitted into analysis only as long as it is bracketed as an illusion, and speech is excluded from a search for lived experience that becomes its supreme aim. (Lacan, 1953/2002, p. 304)

In the search for an intersubjective, two-body, perhaps emotionally corrective relationship, analysis succeeds only in objectifying the patient, giving her an even stronger (read: more restrictive) ego than the one that led her to the analyst in the first place, and imprisoning her subjectivity even more radically than it had been before. Worse yet, the analyst can only give the patient one kind of new ego: one that is modeled on the analyst’s own. As Lacan puts it, we risk the subject’s “being captured in an objectification—no less imaginary than before—of his stationary state, indeed, of his statue, in a renewed status of his alienation” (p. 43). For Lacan, then, when that statue is to be sculpted by the hands of the analyst for whom the patient has become a mirror of sorts, analysis has become a narcissistic project. Gallop (1985) puts it succinctly: “The enterprise of ego psychology reshapes the analysand’s imagoes into ones that better correspond to ‘reality’—that is, to the analyst’s reality. … The analysand … has simply substituted the analyst’s imaginary for his own” (p. 61).

Following the Letter: The Analysis of Language

Lacan proposes that this impasse, brought about along the imaginary axis between two egos, is to be avoided by attending to the symbolic axis: the register of speech and language. This is not to be taken as a purely intellectual exercise, and not therefore as collusive with a patient’s intellectual defenses. Indeed, why equate language with intellectual defenses at all? Rather, we find in the end that speech and language are the best indicators we have of a patient’s subjectivity, and that if we are to meet the subject at all, it must be by the road of his speech rather than that of our imaginary identifications: “The analyst’s art must … involve suspending the subject’s certainties until their final mirages have been consumed. And it is in the subject’s discourse that their dissolution must be punctuated” (p. 251).

But this requires the analyst to listen, to take up the patient’s speech, in a way that is different from what we are used to, or intuitively comfortable with. The analyst is not to listen for what the patient means: “I know what you mean” is the alignment of speech with the imaginary register, and thereby with the ego, which is the problem in the first place. It tells the subject that his speech is unimportant and that what matters is that the analyst’s ego is identified with the patient’s: “I understand you. I am like you. You are like me.”

Instead, we might say that the analyst is not to take the patient at her word. Better put, he is not to invest in her word, the word spoken in service of the ego’s intentions. Rather, he is to take the patient at her word. Hence an exchange between analyst and patient like the following:

P: And when I get home, I’d like to relax, sit down in front of the TV and turn er on—turn it on.

A: Turn er on?

P: I meant to say “turn it on.” You know what I mean.

A: Hm. You said “turn er on.”

This attention to the letter, rather than the “spirit” or intention of the patient’s speech, lies at the heart of Lacan’s “return to Freud.” Lacan maintains what he sees as fidelity to Freud by regarding symptoms, fantasies, and dreams (and of course, the speech of the patient) as conform...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright
• Dedication
• Contents
• Acknowledgements
• About the Patients
• Introduction: AnOther Psychoanalysis
• Chapter 1. Shattering Discourse to Bring Forth Speech
• Chapter 2. Evidence and Psychotherapy: A History of Case Histories
• Chapter 3. Strength in Letters
• Chapter 4. Aggressiveness in Psychotherapy
• Chapter 5. Organa Non Grata
• Chapter 6. Che Vuoi? The Letter and the Desire of the Other
• Chapter 7. Conclusions
• References
• Index