A Particular Perspective on Impasses in the Clinical Situation: Further Reflections on Psychoanalytic Listening Presenter: Evelyne Albrecht Schwaber, M.D.

Evelyne Schwaber described an impasse historically as a manifest, puzzling event apparent to analyst and patient alike. In its more current context, she notes,

an impasse may be disguised and can occur quietly, unrelentingly, perceived by either analyst or patient, but not necessarily recognized simultaneously by both. How we understand and listen to the nuances of a patient's communication, according to Schwaber, enables us to remove the impediments that block analytic work.

In looking for the seeds of development of an impasse, Schwaber directed our attention to what she calls “soft signs” in the patient's response—a hesitation or elusive quality, a shift in tone or demeanor, a fleeting, penetrating glance, or an inconsistency between content and affect. Analogously, she pondered the exploration of vital feeling states and pivotal conflictual characterological issues in the analyst, and wondered how they can remain outside clinical focus.

Four cases illustrating clinical impasses were offered, with Schwaber unabashedly citing her own unconscious contributions: In the case of Mr. K, a young man seeking therapy for intense loneliness and a lifelong learning disability, she found herself conducting the treatment according to her own psychic reality and middle-class values, rather than incorporating the patient's reality or inner experience. In hindsight, Schwaber recalled bypassing her patient's expression of doubt and the blandness of his “maybe,” thus ignoring a central aspect of his response. Later, she realized the noxious way he was experiencing her was not just a part of the dilemma but a cause of it as well.

For Mrs. T, a woman with difficulties maintaining a fluid associative stream, a request for a phone session led to an essential piece of data that had been outside of analytic scrutiny. Schwaber questioned with candor how she had missed the poignancy of her patient's affectional longing. In looking back, she found it was her own self-consciousness at “being