Lacanian Psychotherapy: Theory and Practical Applications by Michael J. Miller (Book Review)

Author:  Miller, Michael J. 
Publisher:  New York, NY: Routledge
Reviewed By:  Ona Nierenberg

In 1912 Jung boasted, in a letter from America, that his modifications of psychoanalysis had overcome the resistances of many people who hitherto refused to have anything to do with it. I replied that this was nothing to boast of.
—Sigmund Freud, “On the History of the Analytic Movement”

I am not concerned with the truth that may be contained in the theories which I am rejecting, nor shall I attempt to refute them…I wish merely to show that these theories controvert the fundamental principles of analysis…and that for this reason they should not be known by the name of analaysis.
—Sigmund Freud, “On the History of the Analytic Movement”

In the fall of 1975, Lacan paid a rare visit to the United States. Convinced that he was a world-famous superstar, he announced upon his arrival in New York that he wanted to make a private visit to the Metropolitan Opera House. “Tell them I am Lacan,” he said. His academic hosts were a bit flustered, but knowing the consequences of crossing their imperious guest, they hit upon an ingenious solution: an urgent call was placed to the director of the Metropolitan, telling him that Jean-Paul Sartre wanted to visit, with the caveat that the visit would be absolutely incognito. Flattered and delighted by the prospect of entertaining such an eminent celebrity, the director agreed at once. Having been warned in advance not to address the French visitor by name, the gracious reception came off without a hitch, and a delightful and memorable day ensued. It was said that Lacan could not have been more delighted by his welcome. (Roudinesco, 1997, p.376–377)

This fabulous tale reveals a material truth: misrecognition and miscommunication mar/k Lacan’s reception in the United States. A devoted and active analyst for more than 50 years whose teaching ceaselessly questioned the formations of the unconscious and the practice of psychoanalysis, it is well-known that Lacan’s passage into the United States has not taken place primarily through institutions of clinical training and practice. In this country, with some exceptions, the teaching and study of Lacan’s writings are much more likely to occur in university humanities departments, including comparative literature, literary theory, media studies, feminist theory, intellectual history, and philosophy. While this peculiarly American divide does not imply an a priori problem1, taking it up as such is the motivation for Michael J. Miller’s recent text, Lacanian Psychotherapy: Theory and Practical Applications (2011). For Miller, American psychotherapists’ lack of exposure to Lacan creates an unnecessary impediment to what he believes could and should be Lacan’s wider embrace in what he broadly calls “the American clinic.” With this book, Miller embarks upon a project to reroute what he perceives to be the errant path of Lacan’s thought, aiming to retrieve it from its extraterritorial position vis-à-vis American psychodynamic psychotherapy. Miller hopes to show us “what might a Lacanian approach to psychotherapy actually look like” (p.xvi), thereby making the strangeness of Lacan’s work familiar to American clinicians for whom it may be unheard of, unintelligible, or unimportant.

Miller’s book focuses exclusively on Lacan’s writings of the 1950s and early 1960s.2 Although he does not explain why, one possible reason for this self-imposed constraint may be that Lacan’s works from that period are often explicitly addressed to psychoanalysts practicing in America and “American Freudianism”—in particular, the founders and representatives of ego psychology. Miller provides his own iteration of this well-documented inaugural period, when Lacan’s unique position in the Freudian field was established. As is widely known, the early Lacan was highly engaged in a critique as passionate as it was unique, a rallying cry for psychoanalysts to return to the radicalness of the unconscious and its laws as discovered by Freud. Thus, Lacan called his project a “return to Freud,” heralding the importance of sustaining psychoanalysis as a break from other notions of the subject and entreating psychoanalysts not to abandon their peculiar position in the clinic of the dispossessed for the mirage of the ego. Thanks to ego psychology, Lacan believed that the unassimilable kernel of truth, Freud’s “good news,” was in danger of having its future eclipsed by the seductive prepsychoanalytic illusion of the unified subject. Lacan called upon psychoanalysts to return to the unheimliche nature of the Freudian discovery, locus of fantastical evanescent surprises such as the dream, the lapsus, the parapraxis, and the joke (witz). This period of Lacan’s work highlighted the function and field of speech and language as cause of the human subject in all its estrangement from wholeness, and redirected psychoanalysts to the division of the parle-etre (the speaking/being) in relation to the Other.

As a graduate of the Duquesne University program, Miller had the rare experience as a clinical psychology graduate student of being taught by a practicing Lacanian analyst and author (also one of the foremost translators of Lacan), Dr. Bruce Fink. He cites his work with Fink, his professor and supervisor, as inspiration for showing American clinicians “[w]hat happens when we use Lacan?”; for offering an “evaluat[ion]” of Lacan’s theoretical work by “chronicling its attempted application” (p.xvii); and for “tak[ing] a closer look at how Lacan can be useful” (p.xviii). Miller posits that the dearth of “clinical illustrations of Lacan’s theories,” is a crucial as well as surmountable obstacle to Lacan’s popularity among American psychotherapists: “[T]here are few concrete illustrations of Lacan’s theories, written such that they may be taken up constructively by the reader and considered as an option for practice” (p.xvi). Thus, Miller pairs four of his own clinical examples with a particular Lacanian essay or concept that he believes the case best illustrates (or vice versa). This allows him to demonstrate the technique he calls “listening to the letter,” by which he means paying careful attention to the material of a patient’s speech. It is Miller’s premise that Lacan’s famously baroque style, made even more arduous in English translation, has led American clinicians to too quickly dismiss the work and thus miss out on the clinical “utility” Lacan might offer. He takes as his mission to prove that “Lacan’s conception of lanaguage [can] be practical for psychotherapists practicing in the real world” (p.189) by creating a method out of Lacan’s supposed madness.

The frequently intimidating and always challenging terrain of the Freudian/ Lacanian field provides fertile ground for a sympathetic, even encouraging, response to Miller’s stated project, which is to be distinguished for its uncompromising emphasis on the clinical encounter as a domain of speech and language. Nevertheless, I believe that this book cannot simply be counted as an addition to the cannon of secondary literature that is indespensable to all of us who have the desire to read Lacan. I am not referring here to its many confusions of theory and concepts; after all, this would not be the first or last exegesis to stumble in its efforts to fix the meanings of such elusive concepts as “the phallus,” “desire,” and “the letter.” In my opinion, this book presents the reader with a difficulty that supercedes any potential criticism about its content, provoking us to question its very foundation. Its contradictions, paradoxes, and misuses of languge require us to interrogate at what point application (practical as it may be) becomes an act of obliteration of its source. This is a question that both Freud and Lacan devoted considerable effort to with respect to the term “psychoanalysis.” Miller unwittingly calls upon us to do the same through his act of nomination. By authorizing himself to name a practice “Lacanian psychotherapy,” he opens himself up to a direction of inquiry other than evaluating the “utility” of his intended project. It is Miller’s act of naming, his assumption that invoking the name of Lacan is sufficient to establish something called “Lacanian psychotherapy,” that I have taken as my point of departure.

Let us begin by taking Miller at his word in his enthusiasm for Lacan on “The Purloined Letter,” which cautioned analysts that the search for hidden meaning obscures the truth of what is “readily observable, the ‘obvious,’ in plain sight” (p.40). We begin, then, with the curious case of the book’s title. While I would wager that this is the first time the word “practical” has been uttered in the same breath as Lacan’s name, it is certain that Lacan referred to “psychotherapy” only insofar as he assiduously distinguished that practice from psychoanalysis. But not only is “Lacanian psychotherapy” an oxymoron, it is also a misnomer given Miller’s rationale to report the results of “what happened when I applied some Lacanian principles to relatively short-term psychotherapies” (p.xviii). If he had confined his ambitions to telling us “what might attunement to language mean for psychotherapy as directed by a nonanalyst” (p.26) and come up with a title more appropriate to such an aim, his book might have become an interesting contribution to the timely and important conversation about the place of psychoanalysis in the mental health professions. However, Miller has a significantly different goal, which is to associate the name of a psychoanalyst whose life’s work was devoted to exploring and upholding the specificity of the practice of psychoanalysis with a practice, psychotherapy, in which he never engaged.3 As a result, we are led to wonder if “Lacanian psychotherapy” is but another name to add to the series of resistances to psychoanalysis as a unique endeavor (medicalization, ego psychology, repression of the death drive) that have been so abundantly generated by its enemies and friends alike.

Given its raison d’être to function as a literal teaching of “listening to the letter,” it is all the more notable that confusions of terminology and slippages of language are so pervasive throughout this book with respect to the terms psychoanalysis and psychotherapy. Nowhere does Miller examine the fact that there are differences between the practice and theory he would like to “apply” (psychoanalysis) and the domain of his desired “application” (psychotherapy). Significantly, this lack lends itself to the creation of an illusion of synonymy, as if there could be a perfect rapport between the two. Miller presumes continuity, whereas psychoanalysis (according to both Freud and Lacan) is the product of a rupture and exclusion, its exile from bordering disciplines such as psychology, psychiatry, and philosophy the cause for its very existence. “American analyst or analytic therapist” (p.xv) is a typical Millerian phrase, presupposing via their coupling that the one is substantively equivalent to the other. We also find the surprising pairing of “Lacanians and the rest of psychodynamic clinicians” along with a reference to “a dialogue between Lacanian theory and more mainstream psychodynamic therapists,” (italics mine, p.xvi), which presume “psychodynamic clinicians” or “psychotherapists” as the general category to which “Lacanians” are subsumed. This supposition of the synonymy between “Lacanians” and “psychodynamic psychotherapists” is furthered by Miller’s prevalent use of the trope “the clinician” as a catchall category. What is most revealing, however, is that there where Miller does mark the distinction between psychoanalyst and psychotherapist, he does so in the form of an authorial disclaimer:

I am not an psychoanalyst…although I do consider my work with these patients to have been analytic in nature…This admittedly curtails my rights to speak as an authority, and puts my project in danger of relying on too little knowledge…While this is a viable objection, I must clarify that my aim is not to speak as a psychoanalyst, nor do I wish to portray myself as an authority on all matters Lacanian…This may be problematic to those who are invested in a purist approach to Lacanian praxis (whatever that may be), but I contend that my position—as a non-analyst—helps the honesty and rigor of this project. I can afford to be excited and fascinated by Lacan’s work, hopefully without becoming its zealous missionary. (italics mine, p.xvii–xviii)

Of course, not every treatment is a psychoanalysis, nor it is necessary for every clinician to be a psychoanalyst, but it is essential to know the difference. This pained paragraph exposes the underside of Miller’s insistence that there is no real consequential distinction between a psychotherapist and a psychoanalyst. His authorization to speak on “matters Lacanian” can only be achieved at the cost of insulting and undermining his potential critics in advance (ouch!). While this may function as the support for his claim that psychoanalytic listening can be learned from a book, there is absolutely no support for attributing such a notion to Lacan.

Miller is right to point out that “[j]ust as there are qualitative differences between the way a trained musician and the casual listener will hear music, we find a difference between proper psychoanalytic listening and everyday listening” (p.12). Where he goes awry, however, is to imagine that psychoanalytic listening can be found in a book, via acquistion of knowledge and its application (“technique”). On one of the many occasions Lacan sought to capture what is peculiar to psychoanalysis, he said, “analysis is what one expects from an analyst” (Lacan, 1991/2007, p.53). While this statement may appear at first glance to be a perfect example of the inscrutable style that Miller disparages, if we do not turn away too soon, we may notice that its peculiar structure is not a tautology. Lacan, who insisted that psychoanalysis could not be defined in terms of standards and norms (this many times per week, that many minutes per session), refers us to the psychoanalyst as the measure of psychoanalysis. Why? Because there is an absolutely inextricable knot between the formation of a psychoanalyst and the practice of psychoanalysis, that is to say, psychoanalytic listening. No matter how divisive their orientations, all schools of psychoanalysis would agree that there is one defining aspect of psychoanalytic training: the analyst’s own analysis. This lived experience is not necessary for the practice of psychotherapy, which requires only a course of study with a period of supervised practice, just like medicine, dentistry, or law. Advisable as it may be, there is no necessity for a psychotherapist to go through psychotherapy, because the “training” as such presumes that the practice is completely teachable and learnable as a universal discourse and graduated knowledge on the model of the university. This is far from the “impossible profession” as Freud defined it, which undermines the ideal of the transparency of knowledge and creates something that can only be transmitted the way it is practiced, one by one. Lacan never ceased to emphasize this imperative that had been announced by Freud—the need for each analyst to experience the surprise, horror, and awe generated by the encounter with one’s own unconscious; to discover the signifiers that mark one’s own desire, history, and body; and to permit the fall of the idols and identifications that have functioned as sustenance, support, and guarantee of one’s unconscious enjoyment. This is the sine qua non of analytic formation, but even at that, there is no guarantee. Nevertheless, according to Lacan, without it there is no possibility of being able to hear the absolute alterity of the subject of the unconscious, no way to conduct the cure.

In fact, Miller reveals that he cannot but falter on this very subject by repeatededly questioning his own interventions and wondering how to orient himself to the speech of his patients. For all his certainty regarding “listening to the letter,” he nevertheless keeps bumping up against his uncertainty regarding what to listen for. He is troubled by his acknowledgement that “my punctuations [of the patient’s language] were chosen according to my own subjectivity” (p.61, emphasis in the original) and feels unable to satisfactorily answer an imagined interlocutor’s query: “How can I claim to be respecting the patient’s subjectivity when I am arguably subtly manipulating him into associating to ideas which I, and not he, have deemed to be important?” (p.62). He worries “how does a therapist remain a therapist and not become a persecutory English teacher?” by repeating the patient’s “mistakes” back to him and, furthermore, expresses concern regarding “the clinician’s authority over the language of the patient” (pp.90–91). He also feels it necessary to caution the therapist who may take up his method not to “set himself up as an authority upon ‘proper’ language and put the patient in an inferior position based on class, ethnicity, educatinal type, or home region” (p.194). Miller’s persistent doubts highlight that the practice of listening as defined by psychoanalysis is not simply a “technique” to be acquired, but is an effect of a relation to the unconscious that cannot be learned solely through study and supervision.

Miller’s case narratives highlight the problem of what he calls “applied psychoanalysis.” If one were to follow Miller’s prescription for “listening to the letter,” one would come away with the belief that the signifier, according to Lacan, is nothing but “words, words, words!” and that they are important only insofar as they lead to the uncovering of hidden meanings. Most telling are his case examples, which invariably lead from a repeated word Miller takes note of and highlights to the ultimate revelation of a pivotal preconscious memory that functions as a kind of catharsis. For example, one patient complains of his lack of productivity in various aspects of his life. Through Miller’s repeated attention to this word and other words he supposes to be related by meaning (i.e., “void,” “stuck”), the therapy leads to a discovery of the patient’s traumatic experiences with toilet training, which Miller reports subsequently allows the patient to “move.” While this may build a case for the importance of listening to the patient’s speech, it is nevertheless to be distinguished from analytic listening. Lacan, whose warning to analysts was that “two ears are too many,” opposed understanding to the listening that opens to the surprise of the signifier as the split between meaning and what is said.

One reason that Miller misses this point is because his reading of Lacan excises one of the three registers that is fundamental to Lacan’s teaching—the Real, which is knotted to the Symbolic and the Imaginary. For Lacan, these registers only exist with respect to one another, and he shows this by the figure of the Borromean knot. Excluding the Real (there is not one mention of it in Miller’s text) allows for the mistaken notion that language is all in Lacanian psychoanalysis. In fact, Miller’s goal of “applying” psychoanalysis is founded on this exclusion. While it is true that the early Lacan focuses primarily on the relation between the Symbolic and the Imaginary, the Real is always present (and becomes a pivotal part of his later work). Even in the early Lacan that Miller focuses on, we could say that his famous revision of the Saussurean diagram indicates the presence of the Real by the bar that severs the signifier from the signified. The human subject, the subject of psychoanalysis, exists only as an effect of the language, but that does not imply that the subject is only and all language: according to Lacan, the human subject comes into being precisely because the relation of the human animal to language is one of lack. The mythical entry into language severs us irrevocably from wholeness and totality, permitting the subject as such to exist, and producing a remainder, the theorizing of which Lacan called his one and only innovation: objet a. It is that little letter, “a,” object cause of desire, that specifies the position of the analyst, and it is that little letter that Miller has no place for. Lacan places the object a at the center of the three intertwined rings of RSI, because this algebraic sign (as Lacan called it) indicates an impossibility in relation to the desire of the Other that will come to be figured by the subject as a loss through analysis. The particular form given to the fantasy of how to recuperate this loss will establish the coordinates of jouissance, as well as the signifiers of desire. This is the logic of the phantasm, where symbolic (signifier), imaginary (narcissism), and real (jouissance) are knotted together, and without appreciating this structure there is no way to “listen to the letter.” For the sake of readability, sense, and meaning, Miller has gotten rid of the real dimension of jouissance that Lacan found increasingly important for the last 25 years or so of his teachings and his life. There is no question that Lacan’s seminars of the 1970s and 1980s are challenging, even impossible, to read in a way that would make them more accessible to a wider number of readers. It is always possible to decide that such a labor is not in line with one’s desire. But Miller’s strategy is to mock the difficulty of this late work as a mere artifact of Lacan’s personality, while choosing to call his own work “Lacanian.” This is an uncanny repetition of the repudiation of the late Freud by the ego psychologists, a history Miller obviously knows well, but fails to see as pertinent to his own relation to Lacan.

Perhaps the most important contribution of Miller’s book is that it forces us to reckon with the question of “application.” This is of particular concern when it comes to psychoanalysis, which provokes resistance by its very existence as the bearer of truths no one wants to know anything about. Before Lacan, Freud was forced to take up this issue many times. Most painful is his account of his splits with Adler and Jung in “On the History of the Psychoanalytic Movement” (1914/1999). Referring to the latter, he writes, “It may lastly be said that by his ‘modification’ of psychoanalysis, Jung has given us a counterpart to the famous Lichtenberg knife” (Freud, 1914/1999, p.66). And what is this no longer famous knife? The invention of Georg Christoph Lichteberg, an 18th-century satirist, aphorist, and physicist (who was one of Freud’s favorite sources for witticisms and paradoxes), it makes its “appearance” in the humorous “Miroir d l’ame: a consolation for the unfortunates born on 29 February,” which consists of “an inventory of objects which Lichtenberg claims to have found by chance in the library of an eccentric English collector” (Riolo, 2007, p.4). Included in this text is a blank page that, Lichtenberg explains, depicts “a bladeless knife with no handle.” Freud first mentions this paradoxical implement in his book on the witz, to illustrate a particular form of logical violation that seeks to “maintain a connection which seems to be excluded by the special conditions implied in its content” (Freud, 1905/1999, pp.60–61n1).4 Thus, when he invokes “Lichtenberg’s knife” to describe Jung’s work, it is to tell us that Jung has departed absolutely “from all the points which I should regard as the essence of psychoanalysis” and yet is “unwilling to give up [his] connection with psycho-analysis” (Freud, 1905/1999, p.60). Without question, Miller makes the case that reading Lacan has been influential to his clinical work and incited him to pay careful attention to his patient’s speech. This can be heard as welcome news in a field increasingly dominated by the deafening call for so-called empirically based treatments. Nevertheless, by naming his work and his book“Lacanian psychotherapy,” is he not left clutching Lichtenberg’s phantom instrument, unable to make a cut and accept the loss that this ethically implies?


Freud, S. (1905/1999). Jokes and their relation to the unconscious. Standard Edition, 8.

Freud, S.. (1914/1999). On the history of the psychoanalytic movement. Standard Edition, 14.

Lacan, J. (1991/2007). The other side of psychoanalysis: The seminar of Jacques Lacan, Book XVII. (R. Grigg, Trans.). New York, NY: W. W. Norton.

Riolo, F. (2007). Freud and Lichtenberg’s knife. Italian Psychoanalytic Annual, 1, 59–60.

Roudinesco, E. (1997). Jacques Lacan. (B. Bray, Trans.). New York, NY: Columbia University Press.

About the Author

Ona Nierenberg, PhD, is a psychoanalyst practicing in New York and aclinical psychologist working at Bellevue Hospital Center. She has published articles on psychoanalysis, sexuality, and the discourse of science, as well as on licensing and the question of lay analysis. She is a member of Apres Coup Psychoanalytic Association.

1. In America, the transference to the text and desire to read that leads to study in the humanities often allows for a more open engagement with Lacan’s texts than does the furor sanandi and scientism that more typically lead to graduate studies in the psy- disciplines. That is why, in my opinion, efforts to provide wider exposure to Lacan’s thought within the psy- discplines may be a false solution to a mistakenly diagnosed problem (an issue leading directly to the broader question of lay analysis).
2. Given that Lacan’s work continued until his death in 1981, with substantive shifts in emphasis and elaboration, an explanation of this self-imposed limit by the author would have been most helpful.
3. As Freud writes, “I am of course perfectly ready to allow that everyone has a right to think and write what he pleases; but he has no right to put it forward as something other than what it really is” (Freud, 1914, p.60).
4. Freud provides another joke to amplify: “Is this the place where the Duke of Wellington spoke those words?”— “Yes, it is the place, but he never spoke those words.”


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