Following the Letter: Case Studies in the Application of Lacanian Theory to Psychotherapy

Defense Date


Graduation Date

Spring 1-1-2007


Campus Only

Submission Type


Degree Name



Clinical Psychology


McAnulty College and Graduate School of Liberal Arts

Committee Chair

Bruce Fink

Committee Member

Paul Richer

Committee Member

Russell A. Walsh


desire, dreams, Lacan, phallus, psychoanalysis, psychotherapeutic technique, psychotherapy, speech to the letter, transference


The writings of psychoanalyst Jacques Lacan, while they have received considerable attention in the fields of literary criticism and philosophy in the United States, have been largely neglected by the discourse of American clinical psychoanalysis and psychotherapy. Where Lacan has been taken up in the context of clinical psychoanalysis, discussions have almost exclusively been theoretical in nature, and have not provided in-depth discussions of clinical case material. This dissertation seeks to bring specific aspects of Lacanian theory--primarily Lacan's notion of the importance of the "letter" of the patient's speech--into dialogue with clinical concerns that are commonly encountered by psychotherapists working outside the frame of psychoanalysis (see below). Using the method of the qualitative clinical case study, as conducted by a practitioner-researcher, the Lacanian notion of the letter is explored via four in-depth studies of three American patients in time-limited psychotherapy. Lacan is engaged and interpreted theoretically throughout the dissertation, and the case studies represent syntheses of the practitioner-researcher's interpretation of Lacanian theory and aspects of psychotherapy to which those interpretations were applied. Special attention is given to clinical phenomena widely recognized as salient to psychodynamic and psychoanalytic therapy in the United States, for example: the nature of the unconscious in therapy, aggressiveness, transference, countertransference, and the nature of the therapeutic relationship. The notion of following the patient's speech "to the letter" is applied in each of these areas, and the results which this type of attention and intervention had upon the therapeutic process itself are discussed. It is found that these therapies move toward a Lacanian-influenced set of practices in the service of widely agreed upon (non-Lacanian) psychotherapeutic goals, such as the production of mutative discourse, the development of psychological insight, and heightened ability to articulate desire.





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