Portal: Clinical Practice

🏥 Clinical Practice Portal

Resources for clinicians, analysts, and practitioners working with Lacanian psychoanalysis in clinical settings.

Clinical Structures

Understanding the three fundamental structures is essential for diagnosis and treatment direction:

Neurosis The most common structure, characterized by repression and symptom formation. Subtypes: Hysteria — Question: "Am I a man or a woman?" Obsessive neurosis — Question: "To be or not to be?" Phobia — Anxiety management through avoidance Key mechanisms: Repression, Return of the repressed, Symptom, Fantasy Treatment approach: Analysis of the fundamental fantasy, transference work, bringing the unconscious to speech

Psychosis Characterized by foreclosure of the Name of the Father and a problematic relationship to the Symbolic. Subtypes: Schizophrenia — Symbolic dissolution Paranoia — Certainty and persecution Melancholia — Identification with the object Key mechanisms: Foreclosure, Holophrase, Elementary phenomena, Return in the Real Treatment approach: Supporting sinthome formation, working with délire, avoiding destabilizing interpretations

Perversion Structured around disavowal of castration and instrumentalization of the Other. Forms: Fetishism — Substitute for castration Sadism — Making the Other exist Masochism — Contract with the Other Key mechanisms: Disavowal, Avowal, Jouissance of the Other Treatment approach: Questioning the certainty of the perverse position, dialecticizing the scenario

Fundamental Concepts for Practice

The Analytic Frame

• Analytic setting — The frame and its functions
• Free association — The fundamental rule
• Evenly suspended attention — The analyst's listening position
• Abstinence — Why the analyst doesn't gratify demand
• Neutrality — Benevolent indifference
• Variable-length session — The scansion of speech

Transference & Resistance

• Transference — The motor of analysis
• Transference love — When love emerges in treatment
• Subject supposed to know — The analyst's position in transference
• Resistance — Not an obstacle but material
• Countertransference — The analyst's own responses

The Analyst's Interventions

• Interpretation — Targeting the signifier, not meaning
• Scansion — Punctuation and cuts
• Equivocation — Playing on multiple meanings
• Construction — Building knowledge about history
• Analytic act — Beyond technique
• Cut — Interrupting, separating, deciding

Desire & Jouissance

• Desire — The fundamental lack that drives the subject
• Demand — What is articulated vs. what is meant
• Desire of the analyst — What enables analytic work
• Jouissance — Beyond the pleasure principle
• Plus-de-jouir — Surplus enjoyment
• Objet petit a — Object-cause of desire

Clinical Challenges

Working with Anxiety

• Anxiety — The affect that doesn't deceive
• Inhibition — Restriction of ego functions
• Symptom — Compromise formation
• Acting out — Message addressed to the Other
• Passage à l'acte — Exit from the symbolic

Impasses & Stagnation

• Negative therapeutic reaction — Getting worse with treatment
• Transference impasse — When analysis stalls
• Resistance to interpretation — What's not heard
• Working through — Overcoming repetition

Endings & Terminations

• End of analysis — The goal and its criteria
• Traversing the fantasy — Fundamental transformation
• Destitution subjective — Fall of the subject supposed to know
• Pass — Testifying to one's analysis

Case Consultation Resources

• Seminar II — The Ego in Freud's Theory (clinical technique)
• Seminar VIII — Transference (detailed case studies)
• Seminar X — Anxiety (clinical theory of affect)
• Seminar XVII — The Other Side of Psychoanalysis (social bond)

Supervision & Training

Becoming an Analyst

• Training analysis — The requirement of personal analysis
• Control analysis — Supervision of clinical work
• Seminar — Theoretical formation
• Cartel — Working in small groups

Ethical Considerations

• Ethics of psychoanalysis — Not the ethics of the good
• Desire of the analyst — What sustains the position
• Responsibility — The subject's response-ability
• Confidentiality — Absolute discretion

Diagnostic Tools

Structural Diagnosis

• Preliminary interviews — Assessment phase
• Elementary phenomena — Signs of psychosis
• Transference neurosis — Emergence in treatment
• Perverse scenario — Fixed staging of jouissance

Differential Diagnosis

• Neurosis vs. Psychosis — Key differentiating features
• Perversion vs. Perverse traits — Structure vs. behavior
• Melancholia vs. Depression — Mourning and identification
• Phobia vs. Anxiety disorder — Symbolic function

Contemporary Issues

• Autism — Lacanian approaches to autism spectrum
• Addiction — Substance use and repetition
• Eating disorders — Anorexia and bulimia
• Trauma — Working with PTSD
• Gender dysphoria — Sexuation and identification

Clinical Literature

Essential Reading

• Écrits — "The Direction of the Treatment" (clinical orientation)
• Seminar XI — Four Fundamental Concepts (core theory)
• Seminar XX — Encore (sexuation and jouissance)
• Miller, J.-A. — "Clinical Variations on the Themes from the Freudian Unconscious"

Case Studies

• Dora — Freud's case, Lacan's reading
• Little Hans — Phobia as supplement
• Schreber — Paranoia and foreclosure
• Rat Man — Obsessive neurosis

Professional Development

• Workshops & Conferences — Upcoming clinical trainings
• Study Groups — Join or form a clinical group
• Journals — Current research
• Organizations — Training institutes

Discussion & Community

• Case Discussions — Share and discuss clinical material (anonymized)
• Theoretical Debates — Contemporary controversies
• Q&A — Ask experienced analysts

---

Quick Reference

Structure	Key Mechanism	Fundamental Question	Treatment Approach
Neurosis	Repression	"What am I for the Other?"	Interpretation, fantasy analysis
Psychosis	Foreclosure	Certainty, not question	Support, sinthome, avoid interpretation
Perversion	Disavowal	"I know, but still..."	Question the scenario, dialecticize

---