Neurosis and Fantasy: Lacanian Theory and Case Conceptualization Through Three Case Studies


Yael Goldman

Defense Date


Graduation Date

Spring 1-1-2004


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


case history, psychology


This dissertation examines clinical case conceptualization as approached from a Lacanian psychoanalytic perspective. By exploring the difference that utilizing a Lacanian model of psychotherapy makes to clinical formulations and clinical practice, the project joins in the greater conversation about demystifying therapeutic processes and articulating how theoretical models influence our case conceptualizations. When various therapeutic approaches are discussed in the United States, the work of the Parisian psychoanalyst, Jacques Lacan, is usually left out of the conversation. The available literature in English that does discuss Lacan tends to be highly theoretical and not clinical. This is unfortunate because Lacanian psychoanalysis can be a very useful approach to clinical practice. This dissertation illuminates Lacan's clinical relevance. Three Lacanian case studies, which are based upon the author's own clinical work, are presented. A discussion about case study methodology is followed by cases that highlight the role that a Lacanian orientation played in the formulations and therapeutic interactions. The case studies provide examples of Lacanian case conceptualization from diagnosis through termination. Each case illuminates components of Lacanian theory and is a weaving together of clinical material and theoretical exposition. The main themes that guide the three case studies are hysteria, obsessive neurosis, and the fundamental fantasy, respectively. The Lacanian diagnostic schema is discussed at length, particularly some of the defining characteristics of hysteric and obsessive structure, including how the hysteric's question, "Am I man or a woman?" and the obsessive's question, "Am I dead or alive?" play out in the clients' lives. Many Lacanian concepts such as the insistence of the signifying chain, the symbolic matrix, and the Other's desire, are grounded in concrete clinical material and are thus made more accessible, particularly for those not already well-versed in Lacanian theory. The case studies simultaneously clarify aspects of Lacanian theory and the clinical material, and provide needed examples of Lacanian case conceptualizations.





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