dictionary's setdefault is a good way to update an existing dict entry if it's there, or create a new one if it's not all in one go:
Looping style:
# This is our sample data
data = [("Milter", "Miller", 4), ("Milter", "Miler", 4), ("Milter", "Malter", 2)]
# dictionary we want for the result
dictionary = {}
# loop that makes it work
for realName, falseName, position in data:
dictionary.setdefault(realName, {})[falseName] = position
dictionary now equals:
{'Milter': {'Malter': 2, 'Miler': 4, 'Miller': 4}}