The dialectic of presence and absence impasses and the retrieval of meaning states

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Abstract
Every analysis involves oscillations in the ability to generate new meaning, depending on the nature of the anxieties present and containable by the patient, the analyst, or both. Breakdown in this creative process can result in treatment impasses when primitive anxieties are uncontained and projective identifications abound. In this article, I situate clinical impasses within the dialectic of presence and absence. That dialectic requires that the tension be sustained between both terms in such a way that neither is fully negated and a space can exist between the terms, a space in which meaning can flourish and the recognition of freedom can be embraced. I view impasses as psychic and philosophical breakdowns in which presence and absence are polarized and the ability to constitute presence out of absence is lost. I examine this collapsed space as one in which goodness has become perverted in the mind of the patient. I then offer clinical examples in which the analyst discovers how attention to her own subjective experiences helps to decipher the meaning of unconscious communications. These subjective experiences include the emergence of an internal supervisor, subliminal thought and images, and dreams about the patient. These communications can then serve as tools to release the analytic couple from the bonds of presymbolic treatment impasses.

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