Commentary by a Member of Severnside Intitute for Psychotherapy

My clinical practice is informed by the work of Jacques Lacan and as such my approach to the work has some fundamental differences from the clinical presentation of Mr B. There are some similarities in relation to issues of importance in the patient's speech, but radical differences in the way these issues are taken up in the therapy as a consequence of the differences in the position of the therapist. Rather than giving meaning and explanation to the patient's speech, I would take the effects of the unconscious as the ‘Royal Road’ to psychic truth. Effects that interrupt Mr B's speech such as slips of the tongue, bungled acts or bungled speech, dreams and so on as identified by Freud.

I want to start by taking up the question of diagnosis. Lacanian psychoanalysis puts special emphasis on the question of diagnosis. This does not mean pigeonholing the patient, but elaborating a framework which will help with the listening process and with attending to the particularity of each individual patient. There are markers first described by Freud, which distinguish the clinical structure, three in number, neurosis, psychosis and perversion. In practice, it isn't easy to make a differential diagnosis and the approach to each particular case, in the sense that each case is singular, demands a rigorous deciphering which may take some time. Work with a psychotic