"Therapeutic Action" in Lacan's Psychoanalysis and Criticisms of the Lacanian Clinic

For Jacques Lacan, therapeutic action is fundamentally different from what is commonly understood in other forms of therapy, such as cognitive-behavioral therapy or traditional Freudian analysis. Rather than aiming for symptom relief, behavioral adjustment, or even the resolution of inner conflict, Lacan’s approach focuses on transforming the patient’s relationship with their unconscious, their desire, and the symbolic structures that shape their subjectivity.

Here’s an outline of what therapeutic action entails in Lacanian psychoanalysis:

1. Traversing the Fantasy

At the heart of Lacan’s therapeutic process is the idea of traversing the fantasy. The fantasy is a core structure through which the subject organizes their desire and relates to the lack at the center of their being. It acts as a protective screen, offering the illusion that the subject’s desires are coherent and attainable. However, the fantasy also traps the subject in repetitive and often unfulfilling cycles of behavior.

Therapeutic Goal: The goal is not to eliminate fantasy but to help the patient see through it—to understand how their fantasy structures their experience of reality and how it relates to their unconscious desires.
Outcome: By traversing the fantasy, the patient can confront the inherent lack (manque-à-être) in their subjectivity without being overwhelmed by it, leading to a more flexible and less symptomatic relationship with desire.

2. The Role of the Symptom

Lacan views the symptom not as something to be eradicated but as a message from the unconscious—a way for the subject to navigate their unconscious conflicts and the gaps in their symbolic structure. Symptoms are deeply tied to the subject's jouissance (a paradoxical mix of pleasure and pain).

Therapeutic Action: The analyst helps the patient "enjoy their symptom" in a new way, reinterpreting it as a creative expression of their unconscious rather than merely a problem to solve.
Outcome: The symptom is not necessarily cured in the traditional sense but transformed, allowing the subject to relate to it differently and derive new meaning from it.

3. The Role of the Analyst

Lacan emphasized that the analyst should not position themselves as a "master" who provides answers or guidance. Instead, the analyst serves as a function within the analysis, occupying the place of the objet petit a (the object-cause of desire) to provoke the subject's encounter with their own lack.

Avoiding Suggestion: Lacan was critical of approaches where the therapist imposes their own meaning or values on the patient. Instead, the analyst uses techniques like silence, interpretation, and even strategic interventions to disrupt the patient’s existing frameworks and open space for new insights.
The Analyst as "Dead": The analyst must maintain a position of neutrality, refraining from offering direct solutions or emotional engagement, to avoid becoming a substitute for the patient’s own subjective work.

4. Reconfiguring the Subject's Relationship to the Symbolic

Lacan’s focus is on the subject’s position within the symbolic order, the structure of language and societal norms that shapes identity and desire. Many symptoms arise because of misalignments or conflicts within this structure.

Therapeutic Action: Through interpretation and analysis, the patient is guided to recognize how their unconscious formations—dreams, slips, symptoms—are tied to their place in the symbolic order.
Outcome: The subject achieves greater freedom by renegotiating their relationship with the symbolic, allowing for new ways of being and relating.

5. Encounters with the Real

The Real in Lacan’s theory refers to what is outside language and representation—a traumatic kernel of experience that resists symbolization. While the Real cannot be fully integrated, therapeutic action involves helping the subject confront and work through these encounters without being overwhelmed.

Therapeutic Action: The analyst helps the patient approach the Real indirectly, often through the gaps and inconsistencies in their symbolic narrative.
Outcome: The patient learns to live with the impossibility of fully symbolizing the Real, gaining a sense of agency in the face of life’s uncertainties.

6. Subjective Responsibility

For Lacan, true therapeutic action involves the patient taking responsibility for their desire. This does not mean "choosing" or "controlling" desires in a conventional sense but rather acknowledging and embracing the unique ways in which their unconscious structures their subjectivity.

Therapeutic Goal: The goal is to move the patient from a position of alienation (where they see their desires as imposed by external forces) to one of subjective responsibility, where they recognize their role in shaping and sustaining their psychic reality.

Summary of Lacanian Therapeutic Action

Lacan’s therapeutic action focuses on helping the patient:

Traverse their fantasy and confront the structural lack at the core of their being.
Transform their relationship to their symptoms, enjoying them in new ways.
Reconfigure their place within the symbolic order.
Acknowledge and work through encounters with the Real.
Take subjective responsibility for their desire.

While this approach can be intellectually demanding and emotionally challenging, it offers a radical rethinking of what it means to heal, emphasizing transformation over adaptation and insight over symptom relief.

Critics of Lacan's Clinical Practice

Lacan's clinical practice and theoretical innovations have attracted significant criticism, particularly regarding his methods, style, and the institutional structure of his École Freudienne de Paris (EFP). Here are some prominent critics and post-Lacanian theorists worth considering:

Jean LaplancheWhile Laplanche moved away from Lacan’s teachings, his critiques focus less on Lacan’s clinical practice and more on theoretical divergences, particularly the centrality of the concept of the other and the primal seduction theory. Laplanche's General Theory of Seduction is considered an alternative psychoanalytic paradigm.
François RoustangAs you mention, The Lacanian Delusion (1990) is a significant critique, where Roustang accuses Lacan of promoting obscurantism and creating a cult-like atmosphere around his work. Roustang also critiques Lacan's clinical practice as neglecting patient care in favor of theoretical dogmatism.
Jacques-Alain MillerAlthough Miller was one of Lacan’s closest disciples and a major interpreter of Lacanian thought, his stewardship of Lacanian psychoanalysis has been controversial within psychoanalytic circles. Some critics argue that Miller’s institutionalization of Lacan’s work has led to rigidity and orthodoxy, effectively replicating some of the issues critics ascribe to Lacan himself.
Mikkel Borch-JacobsenIn The Freudian Subject and other works, Borch-Jacobsen critiques Lacanian psychoanalysis as overly speculative and disconnected from empirical clinical practice. He challenges Lacan’s reworking of Freud and questions the therapeutic value of Lacanian methods.
Elisabeth RoudinescoRoudinesco, despite being a historian and sometimes defender of Lacanian psychoanalysis, has critiqued the authoritarian aspects of Lacan’s École and its lack of concern for democratic structures within psychoanalysis.
Darian Leader and Andrew SamuelsBoth are psychoanalytic practitioners who have expressed concerns about Lacanian theory's abstraction and lack of clinical applicability, emphasizing its divergence from Freud’s more pragmatic methods.

Prominent Post-Lacanian French Psychoanalytic Theorists

After Lacan, several French theorists have significantly shaped psychoanalytic discourse, either by extending his ideas or challenging them in productive ways:

Jean LaplancheLaplanche remains one of the most prominent figures. His General Theory of Seduction reframes psychoanalysis with a focus on how enigmatic messages from the caregiver implant unconscious material in the subject, diverging significantly from Lacanian emphasis on language and the symbolic order.
André GreenGreen is known for his work on the dead mother complex and the development of concepts like the work of the negative. While he draws on some Lacanian ideas, his focus on affect, psychosis, and the role of the object in psychic life places him in contrast to Lacan’s emphasis on language and structure.
Piera AulagnierAulagnier was a former student of Lacan who developed her own theories of psychic development and psychosis. Her book The Violence of Interpretation critiques aspects of Lacanian thought, especially the neglect of the preverbal and the maternal.
Serge LeclaireAn early follower of Lacan, Leclaire focused on the role of the unconscious in language and its relation to desire. His clinical approach is less rigid than Lacan’s, and his writings on desire, particularly Psychoanalyzing, remain influential.
Julia KristevaKristeva is not a clinical psychoanalyst in the strictest sense but is profoundly influential in integrating psychoanalysis with semiotics, feminism, and literary theory. Her concept of the semiotic challenges the Lacanian symbolic order by emphasizing prelinguistic drives and maternal influence.
Didier AnzieuBest known for his work on the Skin Ego, Anzieu moved away from Lacan to explore how early bodily experiences form the foundation of ego development. His work emphasizes the importance of tactile and sensory experiences, often overlooked in Lacanian frameworks.
René MajorMajor critiques Lacan's institutional legacy while integrating deconstruction into psychoanalytic thought. He aligns with Derridean critiques of Lacanian structuralism.

Broader Post-Lacanian Legacy

While Lacan's work remains a touchstone for many psychoanalysts, his critics and post-Lacanian thinkers highlight the diversity and evolution of psychoanalytic theory in France. Laplanche and Green are particularly prominent, but figures like Kristeva and Aulagnier show how Lacanian thought has influenced fields far beyond clinical psychoanalysis.