In this paper I describe my work with Mr. S. to illustrate a way to conceptualize and work therapeutically with an individual whose early traumatic environment was characterized by non-responsiveness and the external ‘absence’ of the other. The external absence of the other came to be represented in my patient's psyche as an internal absence or, in Winnicott's (1974) terms, a ‘nameless dread’ that introduced a variety of challenges for patient and analyst. Winnicott identified the phenomenon as a “clinical fear of breakdown” (p. 103). He suggested that a patient wishes to ‘return to scene of the dread’ in an effort to integrate the experience, not to master it (see e.g., Tyson, 1996; Tolpin, 2002).

Specifically, I suggest that the analyst's capacity to surrender to the patient's experience of absence is necessary to work effectively with absence in the therapeutic encounter. Ghent (1990) describes surrender as conveying a quality of liberation and expansion of the self as a corollary to letting down defensive barriers. In the therapeutic encounter, the analyst's capacity to surrender to the patient's experience of absence allows the patient to live it out and integrate these aspects of their mind within the analytic relationship. In essence, the analyst's surrendering to the patient's experience as they live it out (through action and enactments) allows the analyst to touch them non-symbolically first and to embed herself in the experience without making meaning of it first initially. This takes place in the transference/countertransference matrix.